Former QMEs Dr. Timothy C. Howard, Dr. Meera Jani and Dr. Benjamin Simon have filed a lawsuit in the Los Angeles Superior Court against the California Department of Industrial Relations, its Director Christine Baker and other officials seeking a writ of mandate ordering their reinstatement and reappointment as a QME.
Howard has been licensed as an orthopedist since 1971, and has performed 400 to 500 total knee and hip surgeries, and 200 to 300 spinal surgeries. He was first appointed as a QME in 2005, and has prepared approximately 1,500 QME reports. Jani has been licensed as a chiropractor since 2000, and was first appointed as a QME in 2001. Simon has practiced medicine as a cardiologist for 30 years during which time he has performed thousands of interventional procedures. He has been a QME since 2015 and has prepared approximately 150 QME reports.
Prior to the DWC's actions described below, none of them claim to have received any billing or other complaints from the DWC.
They allege that in addition to these three plaintiffs, so far approximately 400 QMEs have now "unlawfully" been denied reappointment out of a total DWC panel of only 3,000 QMEs, or approximately 1 3 .3% of all QMEs in California.
The 134 page complaint cites a variety of reasons for issuance of the relief they request. They assert that the DWC has "engaged in a scorched earth policy to deny reappointment licenses to qualified medical evaluators without due process of law - including without a hearing to challenge Respondents' mere accusations - through Respondents' imposition of new and different criteria governing such reappointments and the medical-legal fee schedule applicable to QMEs in California."
The "new policy" they claim is the product of "underground regulations." They allege that the DIR has "without notice, intentionally adopted underground regulations regarding the medical-legal fee schedule used as prima facie evidence of the reasonable fees paid for QME medical-legal evaluations of injured workers under California's workers' compensation system. These underground regulations are being utilized by Respondents to impose new and different criteria that effectively eliminate hourly billing code 104, a goal sought by the workers' compensation insurers and other payors of the workers' compensation benefits, which is contrary to the interests of the injured workers that workers' compensation laws, for over 100 years, are designed to protect."
Plaintiffs further say that respondents "are required by California law to provide QMEs with a hearing that protects QME rights to due process of law and procedural safeguards, before suspending, terminating or otherwise disciplining a QME for crimes, fraud, and all other violations of law, save for a few specifically enumerated circumstances that are irrelevant herein. However, through its use of underground regulations, Respondents have improperly extended the "no due process hearing" exception to apply specifically to the reappointment process for QMEs, thereby illegally denying reappointment based solely on mere accusations, and thus achieving an end-run around the QMEs' rights to a due process hearing."
The three allege they have requested hearings to contest the denial of their reappointment, and that the DIR refuses to allow them any type of hearing to present their case.
Petitioners allege that "a disproportionate number of QMES who have been denied reappointment without a due process hearing based on Respondents' mere accusations of violations of the medical-legal fee schedule, reside in Los Angeles County." ...
Howard has been licensed as an orthopedist since 1971, and has performed 400 to 500 total knee and hip surgeries, and 200 to 300 spinal surgeries. He was first appointed as a QME in 2005, and has prepared approximately 1,500 QME reports. Jani has been licensed as a chiropractor since 2000, and was first appointed as a QME in 2001. Simon has practiced medicine as a cardiologist for 30 years during which time he has performed thousands of interventional procedures. He has been a QME since 2015 and has prepared approximately 150 QME reports.
Prior to the DWC's actions described below, none of them claim to have received any billing or other complaints from the DWC.
They allege that in addition to these three plaintiffs, so far approximately 400 QMEs have now "unlawfully" been denied reappointment out of a total DWC panel of only 3,000 QMEs, or approximately 1 3 .3% of all QMEs in California.
The 134 page complaint cites a variety of reasons for issuance of the relief they request. They assert that the DWC has "engaged in a scorched earth policy to deny reappointment licenses to qualified medical evaluators without due process of law - including without a hearing to challenge Respondents' mere accusations - through Respondents' imposition of new and different criteria governing such reappointments and the medical-legal fee schedule applicable to QMEs in California."
The "new policy" they claim is the product of "underground regulations." They allege that the DIR has "without notice, intentionally adopted underground regulations regarding the medical-legal fee schedule used as prima facie evidence of the reasonable fees paid for QME medical-legal evaluations of injured workers under California's workers' compensation system. These underground regulations are being utilized by Respondents to impose new and different criteria that effectively eliminate hourly billing code 104, a goal sought by the workers' compensation insurers and other payors of the workers' compensation benefits, which is contrary to the interests of the injured workers that workers' compensation laws, for over 100 years, are designed to protect."
Plaintiffs further say that respondents "are required by California law to provide QMEs with a hearing that protects QME rights to due process of law and procedural safeguards, before suspending, terminating or otherwise disciplining a QME for crimes, fraud, and all other violations of law, save for a few specifically enumerated circumstances that are irrelevant herein. However, through its use of underground regulations, Respondents have improperly extended the "no due process hearing" exception to apply specifically to the reappointment process for QMEs, thereby illegally denying reappointment based solely on mere accusations, and thus achieving an end-run around the QMEs' rights to a due process hearing."
The three allege they have requested hearings to contest the denial of their reappointment, and that the DIR refuses to allow them any type of hearing to present their case.
Petitioners allege that "a disproportionate number of QMES who have been denied reappointment without a due process hearing based on Respondents' mere accusations of violations of the medical-legal fee schedule, reside in Los Angeles County." ...
The Food and Drug Administration Commissioner said on Thursday that makers of fast-acting opioids will have to fund voluntary training for healthcare professionals who prescribe the drugs, including education on safe prescribing practices and non-opioid alternatives.
FDA Commissioner Scott Gottlieb announced that "This week, we issued letters notifying 74 manufacturers of IR opioid analgesics intended for use in the outpatient setting that their drugs will now be subject to a more stringent set of requirements under a Risk Evaluation and Mitigation Strategy (REMS). The REMS requires that training be made available to health care providers who prescribe IR opioids, including training on safe prescribing practices and consideration of non-opioid alternatives."
The medications, which include Vicodin and Percocet, often combine oxycodone or hydrocodone with less powerful painkillers like acetaminophen. They account for 90 percent of all opioid painkillers prescribed.
Manufacturers of long-acting opioids such as OxyContin, which release their doses over 12 hours or more, have been subject to the requirements since 2012.
Gottlieb called the immediate-release versions a "potential gateway to addiction" in a blog post Thursday.
Dr. Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing and an advocate for opioid reform, said the details of the trainings will be important in determining whether they have the potential to make a difference, but said Gottlieb's choice of words is significant.
"To have the head of the FDA talk about addiction caused by medical treatment really suggests a change in what we hear about opioids," Kolodny said.
The prescriber training, which could take a year to organize and implement, must include consideration of non-opioid alternatives.
Gottlieb wrote in the blog post that the agency's new opioid policy steering committee is considering "whether there are circumstances when FDA should require some form of mandatory education for health care professionals, and how the agency would pursue such a goal." ...
FDA Commissioner Scott Gottlieb announced that "This week, we issued letters notifying 74 manufacturers of IR opioid analgesics intended for use in the outpatient setting that their drugs will now be subject to a more stringent set of requirements under a Risk Evaluation and Mitigation Strategy (REMS). The REMS requires that training be made available to health care providers who prescribe IR opioids, including training on safe prescribing practices and consideration of non-opioid alternatives."
The medications, which include Vicodin and Percocet, often combine oxycodone or hydrocodone with less powerful painkillers like acetaminophen. They account for 90 percent of all opioid painkillers prescribed.
Manufacturers of long-acting opioids such as OxyContin, which release their doses over 12 hours or more, have been subject to the requirements since 2012.
Gottlieb called the immediate-release versions a "potential gateway to addiction" in a blog post Thursday.
Dr. Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing and an advocate for opioid reform, said the details of the trainings will be important in determining whether they have the potential to make a difference, but said Gottlieb's choice of words is significant.
"To have the head of the FDA talk about addiction caused by medical treatment really suggests a change in what we hear about opioids," Kolodny said.
The prescriber training, which could take a year to organize and implement, must include consideration of non-opioid alternatives.
Gottlieb wrote in the blog post that the agency's new opioid policy steering committee is considering "whether there are circumstances when FDA should require some form of mandatory education for health care professionals, and how the agency would pursue such a goal." ...
According to an indictment made public on Wednesday, the U.S. Justice Department has brought new charges over a scheme that it says enabled Tenet Healthcare Corp to fraudulently bill state Medicaid for $400 million.
William Moore, the ex-chief executive of Atlanta Medical Center Inc, which had been operated by Tenet; and Edmundo Cota, the ex-head of a clinic operator that provided prenatal care to Hispanic women, were charged in an indictment filed in Atlanta federal court. They were added as defendants in a case the Justice Department brought in February against John Holland, a former Tenet senior vice president. The trio faces multiple charges including conspiracy and wire fraud, according to the indictment.
The charges came after Dallas-based Tenet and two of its Atlanta-area units in October 2016 reached a deal with the Justice Department and agreed to pay more than $513 million to resolve criminal charges and civil claims in a related case.
Brian McEvoy, a lawyer for Moore at the law firm Polsinelli PC, said in a statement he was "extremely disappointed" with the agency’s action. "Mr. Moore is not guilty and we look forward to presenting this case to a jury at trial," McEvoy said.
A lawyer for Cota, the former CEO of medical clinic operator Clinica de la Mama, could not be immediately identified. A Justice Department spokesman declined to comment.
The indictment said that from 2000 to 2013, Holland, Moore Cota engaged in a scheme to cause Tenet to pay over $12 million in bribes and other illegal inducements to Clinica, which operated clinics in Georgia and South Carolina. In exchange, the owners and operators of Clinica referred patients to Tenet hospitals and arrange for medical services for Clinica patients related to child birth at the hospitals.
To justify the $12 million, Holland, Moore, Cota and others created pre-textual contracts between Tenet’s hospitals and Clinica, which provided services mostly to undocumented Hispanic women, the indictment said.
In order to steer patients to Tenet hospitals in Georgia and South Carolina, Cota and others blocked doctors from seeing patients at Clinica unless the physicians agreed to deliver their babies at Tenet hospitals, the indictment said.
Prosecutors said the scheme enabled Tenet hospitals to fraudulently bill the Georgia and South Carolina Medicaid programs for over $400 million, and allowed Tenet to receive at least $127 million on those claims.
The case is U.S. v. Holland, et al, U.S. District Court, Northern District of Atlanta, No. 17-cr-234 ...
William Moore, the ex-chief executive of Atlanta Medical Center Inc, which had been operated by Tenet; and Edmundo Cota, the ex-head of a clinic operator that provided prenatal care to Hispanic women, were charged in an indictment filed in Atlanta federal court. They were added as defendants in a case the Justice Department brought in February against John Holland, a former Tenet senior vice president. The trio faces multiple charges including conspiracy and wire fraud, according to the indictment.
The charges came after Dallas-based Tenet and two of its Atlanta-area units in October 2016 reached a deal with the Justice Department and agreed to pay more than $513 million to resolve criminal charges and civil claims in a related case.
Brian McEvoy, a lawyer for Moore at the law firm Polsinelli PC, said in a statement he was "extremely disappointed" with the agency’s action. "Mr. Moore is not guilty and we look forward to presenting this case to a jury at trial," McEvoy said.
A lawyer for Cota, the former CEO of medical clinic operator Clinica de la Mama, could not be immediately identified. A Justice Department spokesman declined to comment.
The indictment said that from 2000 to 2013, Holland, Moore Cota engaged in a scheme to cause Tenet to pay over $12 million in bribes and other illegal inducements to Clinica, which operated clinics in Georgia and South Carolina. In exchange, the owners and operators of Clinica referred patients to Tenet hospitals and arrange for medical services for Clinica patients related to child birth at the hospitals.
To justify the $12 million, Holland, Moore, Cota and others created pre-textual contracts between Tenet’s hospitals and Clinica, which provided services mostly to undocumented Hispanic women, the indictment said.
In order to steer patients to Tenet hospitals in Georgia and South Carolina, Cota and others blocked doctors from seeing patients at Clinica unless the physicians agreed to deliver their babies at Tenet hospitals, the indictment said.
Prosecutors said the scheme enabled Tenet hospitals to fraudulently bill the Georgia and South Carolina Medicaid programs for over $400 million, and allowed Tenet to receive at least $127 million on those claims.
The case is U.S. v. Holland, et al, U.S. District Court, Northern District of Atlanta, No. 17-cr-234 ...
The Division of Workers’ Compensation (DWC) has posted an order adjusting the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) section of the Official Medical Fee Schedule to conform to the fourth quarter 2017 changes in the Medicare payment system as required by Labor Code section 5307.1.
The order effective for services rendered on or after October 1, 2017 adopts the Medicare DMEPOS Quarter 4, 2017, DME17-D ZIP file.
The 2017 Parenteral and Enteral Nutrition Fee Schedule File from DME17-A (Updated 01/06/17) ZIP file was not updated for the fourth quarter, and remains in effect for services on or after October 1, 2017.
The order adopting the adjustment can be found on the DWC website ...
The order effective for services rendered on or after October 1, 2017 adopts the Medicare DMEPOS Quarter 4, 2017, DME17-D ZIP file.
The 2017 Parenteral and Enteral Nutrition Fee Schedule File from DME17-A (Updated 01/06/17) ZIP file was not updated for the fourth quarter, and remains in effect for services on or after October 1, 2017.
The order adopting the adjustment can be found on the DWC website ...
Governor Brown signed AB 1422 into law on Tuesday. According to the Governor's signing memo he said "I am signing AB 1422 which is clean-up legislation to last year's workers' compensation anti-fraud bills, AB 1244 and SB 1160. Those measures established new requirements and authority to help prevent and reduce fraud in the workers' compensation system. Specifically, they require the suspension of medical providers who have been convicted of crimes involving fraud or abuse. They also require placing a stay on any liens filed by providers charged with such crimes (pending disposition of the charges)."
"AB 1422 confirms that the Workers' Compensation Appeals Board retains jurisdiction to resolve disputes about the applicability of the automatic stay provision to specific liens. This bill is declaratory of existing law which provides for the resolution of these disputes through the Board's current practices and procedures. Nothing in last year's legislation creating the stay was intended, or operated, to divest the Board from jurisdiction over these issues."
The Administrative Director of the Workers’ Compensation System would be authorized to adopt regulations to implement these provisions.
The original fraud law was ambiguous in terms of the status of liens filed by companies who were not themselves part of a criminal prosecution. Under the revised law, the stay provisions will apply not only to a person who is being prosecuted, but to a "controlled entity" as well. An entity is controlled by an individual if the individual is an officer or a director of the entity, or a shareholder with a 10 percent or greater interest in the entity.
In addition, the amendments address some other complications that have arisen. For example, in criminal law, a conviction is not entered until judgment is imposed, which usually means at the time of sentencing. With respect to addressing liens, that time frame does not work in cases where a provider pleads guilty, agrees to cooperate with prosecutors, and delays sentencing for an extended period. Other clarifications, such as the right to refuse to pay a bill of a convicted provider, simply fill in some gaps in the drafting of last year's bills.
In some respects, the amendments are intended to be more explicit about what the Legislature intended the language in last year's enactments to mean - and these are designated as declaratory of existing law because it is clear that the new language is precisely what was intended by the Legislature in this bill and SB 1160.
The new law deletes language that terminates the stay on lien proceedings at the end of the criminal proceedings, and specifies that the stay remains in effect until the completion of the special administrative proceedings that apply to liens filed by providers convicted of workers’ compensation fraud.
With respect to the constitutional issue of "due process" over the automatic stay provisions, the new law added the following language to LC 4615 "(e) The automatic stay required by this section shall not preclude the appeals board from inquiring into and determining within a workers’ compensation proceeding whether a lien is stayed pursuant to subdivision (a) or whether a lien claimant is controlled by a physician, practitioner, or provider."
The next hearing on the motion for preliminary injunction pending in federal court based upon this constitutional issue filed Dr. Eduardo Anguizola, who is facing multiple counts of insurance fraud filed by Orange County prosecutors, is set on this Thursday, September 28, 2017 at 8:30 am in courtroom 9D in downtown Los Angeles. AB 1422 should provide federal Judge Wu with ample authority to deny the request for an injunction now that there is clear language affording stayed lien claimants with "due process" of law ...
"AB 1422 confirms that the Workers' Compensation Appeals Board retains jurisdiction to resolve disputes about the applicability of the automatic stay provision to specific liens. This bill is declaratory of existing law which provides for the resolution of these disputes through the Board's current practices and procedures. Nothing in last year's legislation creating the stay was intended, or operated, to divest the Board from jurisdiction over these issues."
The Administrative Director of the Workers’ Compensation System would be authorized to adopt regulations to implement these provisions.
The original fraud law was ambiguous in terms of the status of liens filed by companies who were not themselves part of a criminal prosecution. Under the revised law, the stay provisions will apply not only to a person who is being prosecuted, but to a "controlled entity" as well. An entity is controlled by an individual if the individual is an officer or a director of the entity, or a shareholder with a 10 percent or greater interest in the entity.
In addition, the amendments address some other complications that have arisen. For example, in criminal law, a conviction is not entered until judgment is imposed, which usually means at the time of sentencing. With respect to addressing liens, that time frame does not work in cases where a provider pleads guilty, agrees to cooperate with prosecutors, and delays sentencing for an extended period. Other clarifications, such as the right to refuse to pay a bill of a convicted provider, simply fill in some gaps in the drafting of last year's bills.
In some respects, the amendments are intended to be more explicit about what the Legislature intended the language in last year's enactments to mean - and these are designated as declaratory of existing law because it is clear that the new language is precisely what was intended by the Legislature in this bill and SB 1160.
The new law deletes language that terminates the stay on lien proceedings at the end of the criminal proceedings, and specifies that the stay remains in effect until the completion of the special administrative proceedings that apply to liens filed by providers convicted of workers’ compensation fraud.
With respect to the constitutional issue of "due process" over the automatic stay provisions, the new law added the following language to LC 4615 "(e) The automatic stay required by this section shall not preclude the appeals board from inquiring into and determining within a workers’ compensation proceeding whether a lien is stayed pursuant to subdivision (a) or whether a lien claimant is controlled by a physician, practitioner, or provider."
The next hearing on the motion for preliminary injunction pending in federal court based upon this constitutional issue filed Dr. Eduardo Anguizola, who is facing multiple counts of insurance fraud filed by Orange County prosecutors, is set on this Thursday, September 28, 2017 at 8:30 am in courtroom 9D in downtown Los Angeles. AB 1422 should provide federal Judge Wu with ample authority to deny the request for an injunction now that there is clear language affording stayed lien claimants with "due process" of law ...
In 2012, Mr. Ong’s vehicle collided with a vehicle driven by Louis Deandre Gonzalez, Jr. A passenger in the Gonzalez vehicle, Marisol Morales, was killed in the collision.
Ong told the officer who investigated the accident that he was driving to his employer, Genentech in South San Francisco on his night off to collect resumes for "some upcoming interviews he had." Ong said that he worked the night shift at Genentech. A few hours before the accident, Ong told his friend Dan Alvarez that he was going to Genentech to do something important for work.
Ong resided in Hayward, California and commuted to Genentech in his own vehicle. Genentech never owned, leased, or possessed Ong’s 1999 Range Rover or Land Rover, the vehicle he was driving at the time of the accident. Genentech did not require Ong to drive or own a vehicle, and did not compensate Ong for travel time or expenses.
During his deposition, Ong gave various reasons for his trip to Genentech that morning. Ong testified that he intended to stop at Genentech to retrieve old resumes he had left in his mailbox and some personal belongings from his locker on his way to visit his grandmother in hospice care in South San Francisco. He also said one purpose of the trip to Genentech was to pick up the resume of his unemployed friend, Dan Alvarez, who had asked Ong if he could recommend Alvarez for a job. Ong’s testimony with respect to Alvarez’s resume was impeached; Alvarez stated he does not have a resume and never gave one to Ong.
Plaintiffs filed a civil complaint in 2013 alleging Ong and Genentech were both liable for the accident that caused Marisol Morales’ death, asserting causes of action for motor vehicle negligence and general negligence, together with a survivorship action. Plaintiffs’ claim against Genentech was based on the doctrine of respondeat superior.
Genentech moved for summary judgment. The trial court entered judgment in favor of Genentech, dismissing it from the case and leaving Ong as the sole defendant. The court of appeal affirmed in the unpublished case of Morales-Simental v. Genentech.
Under the doctrine of respondeat superior, an employer is vicariously liable for the tortious conduct of its employees within the scope of their employment. The scope of employment has been interpreted broadly under the respondeat superior doctrine in California. Nevertheless, there are exceptions to the respondeat superior doctrine. Pursuant to the going and coming rule the employment relationship is ‘suspended’ from the time the employee leaves until he returns or that in commuting he is not rendering service to his employer.
An employee’s decision to take work home or to drive to work at an unusual time does not bring the trip within the scope of employment. Even accepting as true plaintiffs’ assertion that Ong took it upon himself to drive to Genentech on his day off to respond to a hiring crisis, an employee’s unilateral decision to commute to work after hours does not bring the trip within the special errand rule.
The court concluded by stating "we decline plaintiffs’ invitation to expand the special errand exception in the manner they suggest. What they propose is an invitation to self-serving pretense by anyone with a plausible claim to supervisorial authority." ...
Ong told the officer who investigated the accident that he was driving to his employer, Genentech in South San Francisco on his night off to collect resumes for "some upcoming interviews he had." Ong said that he worked the night shift at Genentech. A few hours before the accident, Ong told his friend Dan Alvarez that he was going to Genentech to do something important for work.
Ong resided in Hayward, California and commuted to Genentech in his own vehicle. Genentech never owned, leased, or possessed Ong’s 1999 Range Rover or Land Rover, the vehicle he was driving at the time of the accident. Genentech did not require Ong to drive or own a vehicle, and did not compensate Ong for travel time or expenses.
During his deposition, Ong gave various reasons for his trip to Genentech that morning. Ong testified that he intended to stop at Genentech to retrieve old resumes he had left in his mailbox and some personal belongings from his locker on his way to visit his grandmother in hospice care in South San Francisco. He also said one purpose of the trip to Genentech was to pick up the resume of his unemployed friend, Dan Alvarez, who had asked Ong if he could recommend Alvarez for a job. Ong’s testimony with respect to Alvarez’s resume was impeached; Alvarez stated he does not have a resume and never gave one to Ong.
Plaintiffs filed a civil complaint in 2013 alleging Ong and Genentech were both liable for the accident that caused Marisol Morales’ death, asserting causes of action for motor vehicle negligence and general negligence, together with a survivorship action. Plaintiffs’ claim against Genentech was based on the doctrine of respondeat superior.
Genentech moved for summary judgment. The trial court entered judgment in favor of Genentech, dismissing it from the case and leaving Ong as the sole defendant. The court of appeal affirmed in the unpublished case of Morales-Simental v. Genentech.
Under the doctrine of respondeat superior, an employer is vicariously liable for the tortious conduct of its employees within the scope of their employment. The scope of employment has been interpreted broadly under the respondeat superior doctrine in California. Nevertheless, there are exceptions to the respondeat superior doctrine. Pursuant to the going and coming rule the employment relationship is ‘suspended’ from the time the employee leaves until he returns or that in commuting he is not rendering service to his employer.
An employee’s decision to take work home or to drive to work at an unusual time does not bring the trip within the scope of employment. Even accepting as true plaintiffs’ assertion that Ong took it upon himself to drive to Genentech on his day off to respond to a hiring crisis, an employee’s unilateral decision to commute to work after hours does not bring the trip within the special errand rule.
The court concluded by stating "we decline plaintiffs’ invitation to expand the special errand exception in the manner they suggest. What they propose is an invitation to self-serving pretense by anyone with a plausible claim to supervisorial authority." ...
The U.S. attorney general isn’t letting up on efforts to go after doctors and other medical professionals who overprescribe opioids.
Attorney General Jeff Sessions reiterated in speeches in West Virginia on Thursday and Pennsylvania on Friday that he is expanding efforts of the Opioid Fraud and Abuse Detection Unit, which was unveiled last month and is designed to combat the overprescribing of opioid painkillers that have contributed to the country’s opioid epidemic.
"I have assigned 12 experienced prosecutors to focus solely on investigating and prosecuting opioid-related healthcare fraud cases in a dozen 'hot-spot' locations around the country, places where they are especially needed," he said. The locations include both southern West Virginia and western Pennsylvania.
The other states include Ohio, Florida, Michigan, Alabama, Tennessee, Nevada, Kentucky, Maryland, North Carolina and California.
Sessions said the prosecutors will be working with the FBI, the Drug Enforcement Agency and the Department of Health and Human Services to target and prosecute doctors, pharmacies and medical providers who have profited from the epidemic.
The Detection Unit is using data to track anomalies in the disbursement of prescription opioids to find those who are fueling the epidemic, he said.
"The data analytics team will help us to find the telltale signs of opioid-related healthcare fraud by identifying statistical outliers," Sessions said. "They can tell us which physicians are writing opioid prescriptions at a rate that far exceeds their peers, how many of a doctor’s patients died within 60 days of an opioid prescription, the average age of the patients receiving these prescriptions that pharmacies are dispensing, and which pharmacies are dispensing a disproportionate amount of opioids in regional hot-spots for opioid issues."
"Fraudsters might lie but the numbers don’t," he said. "They give a clear indication of who we need to examine."
In addition, Sessions announced that the Justice Department will award nearly $20 million in federal grants to help law enforcement and public health agencies address prescription drug and opioid abuse. That's part of $58.8 million in funding announced Friday by the Department of Justice that will also strengthen drug court programs.
Those efforts build on earlier attempts to reverse the opioid epidemic. Sessions spoke about the action two months ago when the DOJ coordinated the largest healthcare fraud takedown in American history, with the arrest of more than 400 defendants. More than 100 defendants have been charged with opioid-related crimes, including many doctors, he said.
...
Attorney General Jeff Sessions reiterated in speeches in West Virginia on Thursday and Pennsylvania on Friday that he is expanding efforts of the Opioid Fraud and Abuse Detection Unit, which was unveiled last month and is designed to combat the overprescribing of opioid painkillers that have contributed to the country’s opioid epidemic.
"I have assigned 12 experienced prosecutors to focus solely on investigating and prosecuting opioid-related healthcare fraud cases in a dozen 'hot-spot' locations around the country, places where they are especially needed," he said. The locations include both southern West Virginia and western Pennsylvania.
The other states include Ohio, Florida, Michigan, Alabama, Tennessee, Nevada, Kentucky, Maryland, North Carolina and California.
Sessions said the prosecutors will be working with the FBI, the Drug Enforcement Agency and the Department of Health and Human Services to target and prosecute doctors, pharmacies and medical providers who have profited from the epidemic.
The Detection Unit is using data to track anomalies in the disbursement of prescription opioids to find those who are fueling the epidemic, he said.
"The data analytics team will help us to find the telltale signs of opioid-related healthcare fraud by identifying statistical outliers," Sessions said. "They can tell us which physicians are writing opioid prescriptions at a rate that far exceeds their peers, how many of a doctor’s patients died within 60 days of an opioid prescription, the average age of the patients receiving these prescriptions that pharmacies are dispensing, and which pharmacies are dispensing a disproportionate amount of opioids in regional hot-spots for opioid issues."
"Fraudsters might lie but the numbers don’t," he said. "They give a clear indication of who we need to examine."
In addition, Sessions announced that the Justice Department will award nearly $20 million in federal grants to help law enforcement and public health agencies address prescription drug and opioid abuse. That's part of $58.8 million in funding announced Friday by the Department of Justice that will also strengthen drug court programs.
Those efforts build on earlier attempts to reverse the opioid epidemic. Sessions spoke about the action two months ago when the DOJ coordinated the largest healthcare fraud takedown in American history, with the arrest of more than 400 defendants. More than 100 defendants have been charged with opioid-related crimes, including many doctors, he said.
...
With growing pressure on physicians to replace opioid medications for pain relief, scientists are focusing attention on non opioid pain relief strategies. A new study reviewed in Medical News Today illustrates some of the new findings.
Inadequate postoperative pain management has profound effects. Long-term influences of poor pain management include transition to chronic pain and prolonged narcotic consumption, which can result in opioid dependence, an epidemic in the United States. There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty (TKA; knee replacement). Yet, little consensus supports the effectiveness of these interventions.
An analysis of drug-free interventions to reduce pain or opioid use after total knee replacement found modest but clinically significant evidence that acupuncture and electrotherapy can potentially reduce and delay opioid use; evidence for other interventions, such as cryotherapy and preoperative exercise, had less support, according to a study published by JAMA Surgery..
Tina Hernandez-Boussard, Ph.D., of Stanford University, Stanford, Calif., and colleagues conducted a review and meta-analysis to evaluate the effectiveness of commonly used drug-free interventions for pain management after TKA. The researchers identified 39 randomized clinical trials (2,391 patients) that met criteria for inclusion in the analysis.
The most commonly performed interventions included continuous passive motion (CPM), preoperative exercise, cryotherapy, electrotherapy, and acupuncture. The researchers found moderate evidence that acupuncture and electrotherapy improved postoperative pain management and reduced opioid consumption. There was very low-certainty evidence that cryotherapy reduced opioid consumption, but no evidence that it improves perceived pain. The findings suggested that CPM and preoperative exercise do not help alleviate pain or reduce opioid consumption.
Several limitations of the study are noted in the article.
"As prescription opioid use is under national scrutiny and because surgery has been identified as an avenue for addiction, it is important to recognize effective alternatives to standard pharmacological therapy, which remains the first option for treatment," the authors write.
Article: Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty A Systematic Review and Meta-analysis, Tina Hernandez-Boussard, PhD et al., JAMA, doi: 10.1001/jamasurg.2017.2872, published online 16 August 2017 ...
Inadequate postoperative pain management has profound effects. Long-term influences of poor pain management include transition to chronic pain and prolonged narcotic consumption, which can result in opioid dependence, an epidemic in the United States. There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty (TKA; knee replacement). Yet, little consensus supports the effectiveness of these interventions.
An analysis of drug-free interventions to reduce pain or opioid use after total knee replacement found modest but clinically significant evidence that acupuncture and electrotherapy can potentially reduce and delay opioid use; evidence for other interventions, such as cryotherapy and preoperative exercise, had less support, according to a study published by JAMA Surgery..
Tina Hernandez-Boussard, Ph.D., of Stanford University, Stanford, Calif., and colleagues conducted a review and meta-analysis to evaluate the effectiveness of commonly used drug-free interventions for pain management after TKA. The researchers identified 39 randomized clinical trials (2,391 patients) that met criteria for inclusion in the analysis.
The most commonly performed interventions included continuous passive motion (CPM), preoperative exercise, cryotherapy, electrotherapy, and acupuncture. The researchers found moderate evidence that acupuncture and electrotherapy improved postoperative pain management and reduced opioid consumption. There was very low-certainty evidence that cryotherapy reduced opioid consumption, but no evidence that it improves perceived pain. The findings suggested that CPM and preoperative exercise do not help alleviate pain or reduce opioid consumption.
Several limitations of the study are noted in the article.
"As prescription opioid use is under national scrutiny and because surgery has been identified as an avenue for addiction, it is important to recognize effective alternatives to standard pharmacological therapy, which remains the first option for treatment," the authors write.
Article: Drug-Free Interventions to Reduce Pain or Opioid Consumption After Total Knee Arthroplasty A Systematic Review and Meta-analysis, Tina Hernandez-Boussard, PhD et al., JAMA, doi: 10.1001/jamasurg.2017.2872, published online 16 August 2017 ...
Dr. Eduardo Anguizola, who is facing multiple counts of insurance fraud filed by Orange County prosecutors, is the lead plaintiff who claims Labor Code 4615 - the automatic lien stay law - violates the procedural component of the due process clause because it immediately stays all liens without notice or a hearing.
The federal case was filed this May, and there have been several hearings in federal court on his request for a preliminary injunction halting the implementation of the new lien automatic stay law.
The final brief by the California Attorney General on behalf of DIR Director Christine Baker asserts that the lien claimants have not made their case. The AG says that despite "submitting 10 declarations and 53 exhibits, Plaintiffs have still failed to establish that due process is being denied to the parties in this case or to lien claimants more broadly."
"Plaintiffs continue to confuse (1) whether existing procedures permit a lien claimant to challenge whether its liens fall within the parameters of Section 4615 and are thus subject to the stay (existing procedures do) with (2) whether a workers’ compensation administrative law judge ("WCALJ") has the discretion to determine that the stay should not apply to a particular lien notwithstanding the provisions of the statute (no, the stay is automatic for liens within the statute’s parameters)."
The Attorney General further said that "Not one declaration demonstrates that a lien claimant followed proper procedures for requesting adjudication of an issue of law or fact by a workers’ compensation judge, and was wrongly denied that adjudication.1 Further, not one declaration demonstrates that any party claiming that a workers’ compensation judge wrongly refused to hear a Section 4615 lien issue followed proper procedures and filed either a petition for reconsideration or a petition for removal to the workers’ compensation appeals board (“WCAB”) to challenge the judge’s action or lack thereof."
"Even after this latest of three rounds of briefing, Plaintiffs have failed to demonstrate that they are entitled to the preliminary injunctive relief that they seek. Their motion should be denied."
"Missing from the declarations are any examples of lien claimants who attempted to raise Section 4615 issues using the proper procedures provided in the regulations and described in Judge Levy’s declaration, and who have had those efforts rejected."
"These conclusory allegations are insufficient to establish the violation of lien claimants’ due process rights by operation of Section 4615 and cannot support a preliminary injunction invalidating the statute on its face. They also fail to establish a likelihood of irreparable harm. To the extent Plaintiffs’ allege irreparable harm stemming solely from the deprivation of Plaintiffs’ due process rights, their failure to offer sufficient evidence to support their procedural due process claims also dooms their claim of irreparable harm."
The next and perhaps final hearing on the preliminary injunction is set on this Thursday, September 28, 2017 at 8:30 am in courtroom 9D in downtown Los Angeles ...
The federal case was filed this May, and there have been several hearings in federal court on his request for a preliminary injunction halting the implementation of the new lien automatic stay law.
The final brief by the California Attorney General on behalf of DIR Director Christine Baker asserts that the lien claimants have not made their case. The AG says that despite "submitting 10 declarations and 53 exhibits, Plaintiffs have still failed to establish that due process is being denied to the parties in this case or to lien claimants more broadly."
"Plaintiffs continue to confuse (1) whether existing procedures permit a lien claimant to challenge whether its liens fall within the parameters of Section 4615 and are thus subject to the stay (existing procedures do) with (2) whether a workers’ compensation administrative law judge ("WCALJ") has the discretion to determine that the stay should not apply to a particular lien notwithstanding the provisions of the statute (no, the stay is automatic for liens within the statute’s parameters)."
The Attorney General further said that "Not one declaration demonstrates that a lien claimant followed proper procedures for requesting adjudication of an issue of law or fact by a workers’ compensation judge, and was wrongly denied that adjudication.1 Further, not one declaration demonstrates that any party claiming that a workers’ compensation judge wrongly refused to hear a Section 4615 lien issue followed proper procedures and filed either a petition for reconsideration or a petition for removal to the workers’ compensation appeals board (“WCAB”) to challenge the judge’s action or lack thereof."
"Even after this latest of three rounds of briefing, Plaintiffs have failed to demonstrate that they are entitled to the preliminary injunctive relief that they seek. Their motion should be denied."
"Missing from the declarations are any examples of lien claimants who attempted to raise Section 4615 issues using the proper procedures provided in the regulations and described in Judge Levy’s declaration, and who have had those efforts rejected."
"These conclusory allegations are insufficient to establish the violation of lien claimants’ due process rights by operation of Section 4615 and cannot support a preliminary injunction invalidating the statute on its face. They also fail to establish a likelihood of irreparable harm. To the extent Plaintiffs’ allege irreparable harm stemming solely from the deprivation of Plaintiffs’ due process rights, their failure to offer sufficient evidence to support their procedural due process claims also dooms their claim of irreparable harm."
The next and perhaps final hearing on the preliminary injunction is set on this Thursday, September 28, 2017 at 8:30 am in courtroom 9D in downtown Los Angeles ...
Aegerion Pharmaceuticals Inc will plead guilty to two misdemeanors and pay $40.1 million to resolve investigations into its marketing and sales of an expensive cholesterol drug, U.S. authorities said on Friday.
Reuters Health reports that the settlements will resolve long-running investigations into Aegerion, a subsidiary of Canada’s Novelion Therapeutics Inc, by the U.S. Justice Department and the U.S. Securities and Exchange Commission related to its drug Juxtapid.
Under the agreements, Aegerion will plead guilty to two misdemeanor drug misbranding violations of the Food, Drug and Cosmetic Act, pay $36 million to resolve cases by the Justice Department and pay $4.1 million to settle the SEC’s lawsuit. It also entered into a deferred prosecution agreement to resolve a charge that it conspired to violate the Health Insurance Portability and Accountability Act.
The settlements finalized agreements Aegerion disclosed in May 2016. The Cambridge, Massachusetts-based company in November merged with QLT Inc and became a subsidiary of the newly named Novelion. "We are eager to get the problems that occurred with Aegerion under prior leadership behind us, and we believe these agreements are in the best interest of shareholders," Aegerion said in a statement.
Prosecutors said after the U.S. Food and Drug Administration in 2012 approved Juxtapid for treating a rare genetic condition that causes high cholesterol, Aegerion promoted it for patients who had not been diagnosed with the condition. Juxtapid, which cost $250,000 to $300,000 annually per patient, featured a black box warning on its label that it could cause serious liver and stomach problems, prosecutors said.
Sales representatives also were trained to tell doctors and patients that Juxtapid would "take patients out of harm’s way" and prevent "impending" heart attacks and strokes, despite the lack of data supporting those claims, prosecutors alleged.
Numerous patients discontinued using Juxtapid after suffering conditions including liver toxicity and gastrointestinal distress, prosecutors said.
The Justice Department said Aegerion’s promotion of Juxtapid for patients without the genetic condition also led to false claims for payment to be submitted to government health care programs including Medicare.
The SEC alleged Aegerion also misled investors by exaggerating how many new patients filled prescriptions for Juxtapid.
The Justice Department said three ex-Aegerion employees who brought a whistleblower lawsuit against the company will receive $4.7 million as part of its civil settlement ...
Reuters Health reports that the settlements will resolve long-running investigations into Aegerion, a subsidiary of Canada’s Novelion Therapeutics Inc, by the U.S. Justice Department and the U.S. Securities and Exchange Commission related to its drug Juxtapid.
Under the agreements, Aegerion will plead guilty to two misdemeanor drug misbranding violations of the Food, Drug and Cosmetic Act, pay $36 million to resolve cases by the Justice Department and pay $4.1 million to settle the SEC’s lawsuit. It also entered into a deferred prosecution agreement to resolve a charge that it conspired to violate the Health Insurance Portability and Accountability Act.
The settlements finalized agreements Aegerion disclosed in May 2016. The Cambridge, Massachusetts-based company in November merged with QLT Inc and became a subsidiary of the newly named Novelion. "We are eager to get the problems that occurred with Aegerion under prior leadership behind us, and we believe these agreements are in the best interest of shareholders," Aegerion said in a statement.
Prosecutors said after the U.S. Food and Drug Administration in 2012 approved Juxtapid for treating a rare genetic condition that causes high cholesterol, Aegerion promoted it for patients who had not been diagnosed with the condition. Juxtapid, which cost $250,000 to $300,000 annually per patient, featured a black box warning on its label that it could cause serious liver and stomach problems, prosecutors said.
Sales representatives also were trained to tell doctors and patients that Juxtapid would "take patients out of harm’s way" and prevent "impending" heart attacks and strokes, despite the lack of data supporting those claims, prosecutors alleged.
Numerous patients discontinued using Juxtapid after suffering conditions including liver toxicity and gastrointestinal distress, prosecutors said.
The Justice Department said Aegerion’s promotion of Juxtapid for patients without the genetic condition also led to false claims for payment to be submitted to government health care programs including Medicare.
The SEC alleged Aegerion also misled investors by exaggerating how many new patients filled prescriptions for Juxtapid.
The Justice Department said three ex-Aegerion employees who brought a whistleblower lawsuit against the company will receive $4.7 million as part of its civil settlement ...
A 2013 start-up, Zenefits is a San Francisco based company whose business model was to provide online HR services to businesses and then encourage those same businesses to use Zenefits as an insurance broker selling lines of insurance needed by HR departments.
The company was started by funding from well known gurus such as David Sacks who made his first fortune as an early executive at PayPal, then a second as the co-founder of Yammer, a social network for businesses, which he sold to Microsoft in 2012 for $1.2 billion. He then became an early investor in Uber and SpaceX.
Zenefits launched in April 2013 through startup incubator Y Combinator. Within eight months it was on track to make about $1 million in recurring annual revenue. It moved into a highrise in San Francisco’s SoMa district and expanded from fewer than 20 people to roughly 500, many on the sales side. By the end of 2014, Zenefits hit it’s $20 million recurring revenue goal and was making good on its promises to shake up the insurance brokerage business.
Soon, Zenefits ran into snags. The Utah Insurance Department banned it from operating in the state because the agency considered the free HR software to be in violation of a law against offering rebates to customers. Still, Zenefits kept growing. By the middle of 2015 it was serving 14,000 businesses and in the process of hiring more than 1,000 additional employees.
But in Novermber 2016 the California Department of Insurance announced that the enforcement action taken against Zenefits for multiple insurance broker license violations resulted in a $7 million penalty.
Zenefits was charged with allowing unlicensed employees to transact insurance and circumventing insurance agent education requirements. This was the largest penalty assessed by any commissioner against Zenefits and one of the largest penalties for licensing violations ever assessed in the California department's history.
Shortly after the California investigation into Zenefits’ business practices and compliance began, the company announced publicly that they were not complying with insurance laws and regulations, which was followed by the resignation of Zenefits’ CEO, Parker Conrad.
The 2016 settlement agreement obtained by the California insurance commissioner included a $3 million penalty for licensing violations, including allowing unlicensed employees to transact insurance, a $4 million penalty for subverting the pre-licensing education and study-hour requirements for agent and broker licensing, and a $160,000 payment to reimburse the Department of Insurance for investigation and examination expenses.
Zenefits has been investigated and fined in other states for similar compliance issues, including Texas, Massachusetts, Tennessee and Washington. In July 2016 Zenefits reached a settlement with the Tennessee Department of Insurance and Commerce, agreeing to pay a fine of $62,500. And the Texas insurance regulators have fined Zenefits, $550,000 for its past use of unlicensed health insurance brokers. BuzzFeed published a series of articles about Zenefits’ use of unlicensed brokers. And details of how the company devised schemes to circumvent broker licensing laws have been reported by Bloomberg Businessweek.
Jay Fulcher the former CEO of Ooyala and Agile Software was ultimately appointed its new CEO, Since then, Fulcher has been trying to re-orient Zenefits into something that’s seen as compliant and business-friendly - and away from the chaotic culture that it had under the prior CEO Parker Conrad who was shown the door.
Fulcher and the company have come out this week with two big announcements: first, the name isn’t going anywhere while the brand gets a makeover; and second, that it’s getting out of the insurance brokerage business and leaving that up to new partners. By doing that, Zenefits hopes to become an all-in-one HR tool for small businesses while leaving insurance brokerage deals to partners.
Initially, Zenefits will partner with OneDigital, an employee benefits company, as it starts to expand to partner with more regional and local brokers that have the expertise for various companies’ needs ...
The company was started by funding from well known gurus such as David Sacks who made his first fortune as an early executive at PayPal, then a second as the co-founder of Yammer, a social network for businesses, which he sold to Microsoft in 2012 for $1.2 billion. He then became an early investor in Uber and SpaceX.
Zenefits launched in April 2013 through startup incubator Y Combinator. Within eight months it was on track to make about $1 million in recurring annual revenue. It moved into a highrise in San Francisco’s SoMa district and expanded from fewer than 20 people to roughly 500, many on the sales side. By the end of 2014, Zenefits hit it’s $20 million recurring revenue goal and was making good on its promises to shake up the insurance brokerage business.
Soon, Zenefits ran into snags. The Utah Insurance Department banned it from operating in the state because the agency considered the free HR software to be in violation of a law against offering rebates to customers. Still, Zenefits kept growing. By the middle of 2015 it was serving 14,000 businesses and in the process of hiring more than 1,000 additional employees.
But in Novermber 2016 the California Department of Insurance announced that the enforcement action taken against Zenefits for multiple insurance broker license violations resulted in a $7 million penalty.
Zenefits was charged with allowing unlicensed employees to transact insurance and circumventing insurance agent education requirements. This was the largest penalty assessed by any commissioner against Zenefits and one of the largest penalties for licensing violations ever assessed in the California department's history.
Shortly after the California investigation into Zenefits’ business practices and compliance began, the company announced publicly that they were not complying with insurance laws and regulations, which was followed by the resignation of Zenefits’ CEO, Parker Conrad.
The 2016 settlement agreement obtained by the California insurance commissioner included a $3 million penalty for licensing violations, including allowing unlicensed employees to transact insurance, a $4 million penalty for subverting the pre-licensing education and study-hour requirements for agent and broker licensing, and a $160,000 payment to reimburse the Department of Insurance for investigation and examination expenses.
Zenefits has been investigated and fined in other states for similar compliance issues, including Texas, Massachusetts, Tennessee and Washington. In July 2016 Zenefits reached a settlement with the Tennessee Department of Insurance and Commerce, agreeing to pay a fine of $62,500. And the Texas insurance regulators have fined Zenefits, $550,000 for its past use of unlicensed health insurance brokers. BuzzFeed published a series of articles about Zenefits’ use of unlicensed brokers. And details of how the company devised schemes to circumvent broker licensing laws have been reported by Bloomberg Businessweek.
Jay Fulcher the former CEO of Ooyala and Agile Software was ultimately appointed its new CEO, Since then, Fulcher has been trying to re-orient Zenefits into something that’s seen as compliant and business-friendly - and away from the chaotic culture that it had under the prior CEO Parker Conrad who was shown the door.
Fulcher and the company have come out this week with two big announcements: first, the name isn’t going anywhere while the brand gets a makeover; and second, that it’s getting out of the insurance brokerage business and leaving that up to new partners. By doing that, Zenefits hopes to become an all-in-one HR tool for small businesses while leaving insurance brokerage deals to partners.
Initially, Zenefits will partner with OneDigital, an employee benefits company, as it starts to expand to partner with more regional and local brokers that have the expertise for various companies’ needs ...
The Division of Workers’ Compensation has suspended six more medical providers from participating in California’s workers’ compensation system, bringing the total number of suspended providers to 38.
DWC Acting Administrative Director George Parisotto issued Orders of Suspension against the following providers:
- Jeffrey Campau and Landen Mirallegro of Yorba Linda, co-founders of the medical equipment company Aspen Medical Resources, MRI diagnostic facility Elite Mgmt. LLC dba Elite Diagnostics, and an MRI services company, Regional Medical Services LLC. Campau and Mirallegro pled guilty in Orange County Superior Court on May 5, 2017 to medical insurance fraud for their involvement in an overbilling scheme in which they defrauded insurance companies of more than $70 million. Along with their co-defendant, Campau and Mirallegro agreed to pay over $8 million in restitution to several insurers and self-insured employers, and to voluntarily dismiss liens of nearly $140 million, in the case involving Aspen Medical Resources.
- Simon Hong of Brea, a medical clinic operator who on October 19, 2016 was found guilty by a federal jury in Orange County of 19 counts of health care fraud, illegal kickbacks, and identity theft involving the Medicare program.
- Chi Hong Yang of San Gabriel, who pled guilty in Kern County Superior Court on August 2, 2013 to conspiracy to commit insurance fraud, involving among other things billing and obtaining payment for services not provided. Yang surrendered his physician’s and surgeon’s certificate earlier this year.
- Rafael U. Chavez of Rancho Cucamonga, due to revocation of his certification as a Physician Assistant by the Physician Assistant Board of California on June 19, 2014.
- Wendell Wenneker of Napa, whose physician’s and surgeon’s certificate was revoked on June 2, 2017 by the Medical Board of California.
The Department of Industrial Relation’s fraud prevention efforts are posted online, including frequently updated lists for physicians, practitioners, and providers who have been issued notices of suspension, and those who have been suspended pursuant to Labor Code §139.21(a)(1).
The department recently added a new web page with information on lien consolidations and the Special Adjudication Unit ...
DWC Acting Administrative Director George Parisotto issued Orders of Suspension against the following providers:
- Jeffrey Campau and Landen Mirallegro of Yorba Linda, co-founders of the medical equipment company Aspen Medical Resources, MRI diagnostic facility Elite Mgmt. LLC dba Elite Diagnostics, and an MRI services company, Regional Medical Services LLC. Campau and Mirallegro pled guilty in Orange County Superior Court on May 5, 2017 to medical insurance fraud for their involvement in an overbilling scheme in which they defrauded insurance companies of more than $70 million. Along with their co-defendant, Campau and Mirallegro agreed to pay over $8 million in restitution to several insurers and self-insured employers, and to voluntarily dismiss liens of nearly $140 million, in the case involving Aspen Medical Resources.
- Simon Hong of Brea, a medical clinic operator who on October 19, 2016 was found guilty by a federal jury in Orange County of 19 counts of health care fraud, illegal kickbacks, and identity theft involving the Medicare program.
- Chi Hong Yang of San Gabriel, who pled guilty in Kern County Superior Court on August 2, 2013 to conspiracy to commit insurance fraud, involving among other things billing and obtaining payment for services not provided. Yang surrendered his physician’s and surgeon’s certificate earlier this year.
- Rafael U. Chavez of Rancho Cucamonga, due to revocation of his certification as a Physician Assistant by the Physician Assistant Board of California on June 19, 2014.
- Wendell Wenneker of Napa, whose physician’s and surgeon’s certificate was revoked on June 2, 2017 by the Medical Board of California.
The Department of Industrial Relation’s fraud prevention efforts are posted online, including frequently updated lists for physicians, practitioners, and providers who have been issued notices of suspension, and those who have been suspended pursuant to Labor Code §139.21(a)(1).
The department recently added a new web page with information on lien consolidations and the Special Adjudication Unit ...
Three Laotian correctional officers, Va Ly, Travis Herr and Pao Yang, were allegedly subjected to racial and national origin discrimination, harassment and retaliation by their employer, the County of Fresno, and its employees. The three filed suit against the County pursuant to the Fair Employment and Housing Act (FEHA), Government Code section 12900 et seq., while simultaneously pursuing their workers’ compensation remedies.
Prior to commencing the FEHA action, each plaintiff filed a workers’ compensation claim with the Department of Industrial Relations, Workers’ Compensation Appeals Board, for psychiatric injuries arising from the discrimination, harassment and retaliation.
Ly testified in the workers' compensation case that he was subjected to racial discrimination and harassment when his requests to swap shifts with other officers were denied; he was moved out of his regular assignment and repeatedly reassigned to the main jail; and his sergeant, referred to him as "the Swap King," which led to teasing by other officers. WCJ Geoffrey H. Sims found the denial of Ly’s swap request "as not a discriminatory action and was made as a good faith personnel action,"and the reassignments were due to business necessity and were not discriminatory actions and ordered that Ly take nothing by way of his application.
In Herr's case, WCJ Thomas J. Heslin issued his decision, in which he found Herr did not sustain industrial injury to his psyche and ordered that he take nothing as a result of his claim. In response to a petition for reconsideration, the WCAB found that the actions of Herr’s supervisors "were good faith personnel actions" that "were taken in order to provide for the best and most effective staffing at the jail."
In the Yang case, WCJ Dominic E. Marcelli issued his decision, in which he found Yang did not sustain "a compensable industrial injury to his psyche" and ordered he take nothing by way of his application. Marcelli determined the County’s actions were "lawful, non-discriminatory and done in good faith." Yang filed a petition for reconsideration, which the WCAB dismissed as untimely.
The County moved for summary judgment of the new civil FEHA case based on the doctrines of res judicata and collateral estoppel, arguing the workers’ compensation decisions barred plaintiffs’ FEHA claims. The trial court granted summary judgment. The court of appeal affirmed in the unpublished case of Va Li et.al.v County of Fresno.
An employee who claims to have been discriminated against or harassed in the workplace has a choice of remedies: a claim may be made under the FEHA or under workers’ compensation. Here, plaintiffs elected to pursue both remedies. The workers’ compensation claims were resolved first, in the County’s favor.
The case is analogous to Busick v. Workmen’s Comp. Appeals Bd. (1972) 7 Cal.3d 967, 973-974. There, the petitioner was shot by her former employer when she was picking up her final paycheck. She filed both a workers’ compensation claim on the theory that her injury arose out of and in the course of her employment, and a superior court action for assault and battery. (Id. at p. 971.) The superior court action was resolved before the workers’ compensation case was final, with the court finding in her favor and awarding her damages.
The subsequent workers’ compensation decision which denied her compensation because the injury did not arise out of the course and scope of her employment. The Supreme Court concluded res judicata barred the workers’ compensation action. The Court concluded the workers’ compensation proceeding was brought on the same cause of action as in the superior court case, since in the latter, petitioner sought "redress for injuries suffered from one tortious act, the shooting incident. . . . Violation of one primary right in the [workers’ compensation] case constitutes a single cause of action even though two mutually exclusive remedies are available." (Busick, supra, 7 Cal.3d at p. 975.)
In sum, plaintiffs had one primary right: their right to recover for an injury caused by discrimination, harassment and retaliation in the workplace. Two alternate forums were available to them to redress the injury. Plaintiffs proceeded first with their workers’ compensation remedy, even though the standard for recovery under FEHA may be broader. The workers’ compensation decisions are now final and binding. When two tribunals have jurisdiction and neither party objects to the jurisdiction of one or the other, then the first final judgment from one of the tribunals becomes conclusive and renders the same issue res judicata in the other court. (Busick, supra, 7 Cal.3d at p. 977.) ...
Prior to commencing the FEHA action, each plaintiff filed a workers’ compensation claim with the Department of Industrial Relations, Workers’ Compensation Appeals Board, for psychiatric injuries arising from the discrimination, harassment and retaliation.
Ly testified in the workers' compensation case that he was subjected to racial discrimination and harassment when his requests to swap shifts with other officers were denied; he was moved out of his regular assignment and repeatedly reassigned to the main jail; and his sergeant, referred to him as "the Swap King," which led to teasing by other officers. WCJ Geoffrey H. Sims found the denial of Ly’s swap request "as not a discriminatory action and was made as a good faith personnel action,"and the reassignments were due to business necessity and were not discriminatory actions and ordered that Ly take nothing by way of his application.
In Herr's case, WCJ Thomas J. Heslin issued his decision, in which he found Herr did not sustain industrial injury to his psyche and ordered that he take nothing as a result of his claim. In response to a petition for reconsideration, the WCAB found that the actions of Herr’s supervisors "were good faith personnel actions" that "were taken in order to provide for the best and most effective staffing at the jail."
In the Yang case, WCJ Dominic E. Marcelli issued his decision, in which he found Yang did not sustain "a compensable industrial injury to his psyche" and ordered he take nothing by way of his application. Marcelli determined the County’s actions were "lawful, non-discriminatory and done in good faith." Yang filed a petition for reconsideration, which the WCAB dismissed as untimely.
The County moved for summary judgment of the new civil FEHA case based on the doctrines of res judicata and collateral estoppel, arguing the workers’ compensation decisions barred plaintiffs’ FEHA claims. The trial court granted summary judgment. The court of appeal affirmed in the unpublished case of Va Li et.al.v County of Fresno.
An employee who claims to have been discriminated against or harassed in the workplace has a choice of remedies: a claim may be made under the FEHA or under workers’ compensation. Here, plaintiffs elected to pursue both remedies. The workers’ compensation claims were resolved first, in the County’s favor.
The case is analogous to Busick v. Workmen’s Comp. Appeals Bd. (1972) 7 Cal.3d 967, 973-974. There, the petitioner was shot by her former employer when she was picking up her final paycheck. She filed both a workers’ compensation claim on the theory that her injury arose out of and in the course of her employment, and a superior court action for assault and battery. (Id. at p. 971.) The superior court action was resolved before the workers’ compensation case was final, with the court finding in her favor and awarding her damages.
The subsequent workers’ compensation decision which denied her compensation because the injury did not arise out of the course and scope of her employment. The Supreme Court concluded res judicata barred the workers’ compensation action. The Court concluded the workers’ compensation proceeding was brought on the same cause of action as in the superior court case, since in the latter, petitioner sought "redress for injuries suffered from one tortious act, the shooting incident. . . . Violation of one primary right in the [workers’ compensation] case constitutes a single cause of action even though two mutually exclusive remedies are available." (Busick, supra, 7 Cal.3d at p. 975.)
In sum, plaintiffs had one primary right: their right to recover for an injury caused by discrimination, harassment and retaliation in the workplace. Two alternate forums were available to them to redress the injury. Plaintiffs proceeded first with their workers’ compensation remedy, even though the standard for recovery under FEHA may be broader. The workers’ compensation decisions are now final and binding. When two tribunals have jurisdiction and neither party objects to the jurisdiction of one or the other, then the first final judgment from one of the tribunals becomes conclusive and renders the same issue res judicata in the other court. (Busick, supra, 7 Cal.3d at p. 977.) ...
The Division of Workers’ Compensation (DWC) has posted an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.
The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update Order adopts the following Medicare changes:
- The Centers for Medicare & Medicaid Services (CMS) Medicare Hospital Outpatient Prospective Payment System (HOPPS) October 1, 2017 Addendum A [Zip] quarterly update
- The Centers for Medicare & Medicaid Services (CMS) Medicare Hospital Outpatient Prospective Payment System (HOPPS) October 1, 2017 Addendum B [Zip] quarterly update
- The Centers for Medicare & Medicaid Services (CMS) Ambulatory Surgical Center Payment System, October 2017 ASC Approved HCPCS Code and Payment Rates [zip], Column A entitled "HCPCS Code" of "Oct 2017 ASC AA" and Column A entitled "HCPCS Code" of "Oct 2017 ASC EE"
The order adopting the OMFS adjustments is effective for services rendered on or after October 1, 2017 and is posted on the DWC website ...
The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update Order adopts the following Medicare changes:
- The Centers for Medicare & Medicaid Services (CMS) Medicare Hospital Outpatient Prospective Payment System (HOPPS) October 1, 2017 Addendum A [Zip] quarterly update
- The Centers for Medicare & Medicaid Services (CMS) Medicare Hospital Outpatient Prospective Payment System (HOPPS) October 1, 2017 Addendum B [Zip] quarterly update
- The Centers for Medicare & Medicaid Services (CMS) Ambulatory Surgical Center Payment System, October 2017 ASC Approved HCPCS Code and Payment Rates [zip], Column A entitled "HCPCS Code" of "Oct 2017 ASC AA" and Column A entitled "HCPCS Code" of "Oct 2017 ASC EE"
The order adopting the OMFS adjustments is effective for services rendered on or after October 1, 2017 and is posted on the DWC website ...
A California federal judge dismissed a fraud claim in a medical malpractice suit accusing a QME orthopedic surgeon of botching a man’s knee replacement surgery and fraudulently concealing an infection, saying there is no evidence that the doctor knew about the infection.
Before commencement of a jury trial, Law360 reports that U.S. Magistrate Judge Jacqueline Scott Corley granted partial summary judgment in favor of QME Dr. David Jupina and his practice group, Tri Valley Orthopedics & Sports Medicine Group Inc., in a suit brought by William Denis McCann accusing the health care providers of botching his total knee replacement surgery which purportedly resulted in a bacterial infection that ultimately required corrective surgery and replacement of the artificial joint.
The judge said McCann’s fraudulent concealment claim fails since the patient didn’t prove that Jupina knew that McCann had a deep tissue infection, only that he had a superficial infection that was treated with antibiotics.
"Based on the record before the court, no reasonable trier of fact could find that Dr. Jupina knew plaintiff had a deep tissue infection," Judge Corley wrote in a six-page order. "No test result told Dr. Jupina that plaintiff had a deep tissue infection; - No expert has opined that based on what Dr. Jupina observed he had to know that plaintiff had an infection despite not having any test results."
A fraudulent concealment claim requires that the doctor has a duty to disclose certain facts, and the judge said the claim fails without evidence the doctor had knowledge of those facts.
"A duty cannot arise when the fact is not actually known to the defendant," she said.
Judge Corley said the fact that Jupina referred McCann to another doctor for a second opinion and informed the patient he didn’t know what was wrong with his knee undermines McCann’s argument that the doctor knew he had a deep tissue infection and wanted to hide that fact from the patient.
The suit was filed in June 2016 and seeks more than $500,000 in damages. A jury trial is set for November on the remaining claims, according to court records. The case is William Denis McCann v. David Jupina et al., case number 3:16-cv-03244, in the U.S. District Court for the Northern District of California.
Dr. Jupina joined the Tri-Valley Orthopedic group in 1998. He is currently team physician for local Foothill High School athletes, and Orthopedic Surgery Consultant to the Federal Correctional Institution in Dublin, CA. He performs surgery at ValleyCare Hospital, San Ramon Regional Medical Center, Hacienda Surgery Center and Pleasanton Surgery Center.
The DWC lists him as a QME with offices in ten locations in Northern California ...
Before commencement of a jury trial, Law360 reports that U.S. Magistrate Judge Jacqueline Scott Corley granted partial summary judgment in favor of QME Dr. David Jupina and his practice group, Tri Valley Orthopedics & Sports Medicine Group Inc., in a suit brought by William Denis McCann accusing the health care providers of botching his total knee replacement surgery which purportedly resulted in a bacterial infection that ultimately required corrective surgery and replacement of the artificial joint.
The judge said McCann’s fraudulent concealment claim fails since the patient didn’t prove that Jupina knew that McCann had a deep tissue infection, only that he had a superficial infection that was treated with antibiotics.
"Based on the record before the court, no reasonable trier of fact could find that Dr. Jupina knew plaintiff had a deep tissue infection," Judge Corley wrote in a six-page order. "No test result told Dr. Jupina that plaintiff had a deep tissue infection; - No expert has opined that based on what Dr. Jupina observed he had to know that plaintiff had an infection despite not having any test results."
A fraudulent concealment claim requires that the doctor has a duty to disclose certain facts, and the judge said the claim fails without evidence the doctor had knowledge of those facts.
"A duty cannot arise when the fact is not actually known to the defendant," she said.
Judge Corley said the fact that Jupina referred McCann to another doctor for a second opinion and informed the patient he didn’t know what was wrong with his knee undermines McCann’s argument that the doctor knew he had a deep tissue infection and wanted to hide that fact from the patient.
The suit was filed in June 2016 and seeks more than $500,000 in damages. A jury trial is set for November on the remaining claims, according to court records. The case is William Denis McCann v. David Jupina et al., case number 3:16-cv-03244, in the U.S. District Court for the Northern District of California.
Dr. Jupina joined the Tri-Valley Orthopedic group in 1998. He is currently team physician for local Foothill High School athletes, and Orthopedic Surgery Consultant to the Federal Correctional Institution in Dublin, CA. He performs surgery at ValleyCare Hospital, San Ramon Regional Medical Center, Hacienda Surgery Center and Pleasanton Surgery Center.
The DWC lists him as a QME with offices in ten locations in Northern California ...
A federal jury has convicted a physician assistant who worked at a Fountain Valley medical clinic on federal drug trafficking charges for writing prescriptions for dangerous and addictive narcotics without a medical purpose.
Kaitlyn Phuong Nguyen, 32, of San Jose, California, was found guilty yesterday of 10 counts related to the illegal distribution of oxycodone, methadone and alprazolam. The trial jury heard evidence that four “patients” died of drug overdoses after obtaining prescriptions from Nguyen.
On the eve of Nguyen’s trial last week, the doctor who oversaw the clinic was sentenced to 70 months in prison after pleading guilty to two counts of illegal distribution of a controlled substance by a practitioner.
When he pleaded guilty earlier this year, Dr. Victor Boon Huat Siew admitted illegally prescribing oxycodone, methadone and alprazolam from his clinic from the beginning of 2009 through early 2015.
Siew, 66, of Laguna Beach, was sentenced by United States District Judge James V. Selna, who presided over Nguyen’s trial.
According to court documents and evidence presented during Nguyen’s trial, Siew and Nguyen issued prescriptions without a medical purpose in exchange for cash and insurance payments. "Many of the patients.... had ‘red flags’ in their patient files, indicating that they were abusing their pain medication and should not have been given prescriptions," according to a brief filed in relation to Nguyen’s trial.
Nguyen, who worked at the clinic in 2012, performed only cursory examinations on most "patients" prior to prescribing them narcotics. "Despite having a license to write prescriptions herself, defendant [Nguyen] usually used a prescription pad pre-signed by Siew (which was not a lawful practice) to prescribe addictive substances such as oxycodone, methadone and alprazolam," according to the trial brief.
The most common drugs prescribed by Siew and his employees were oxycodone (best known under the brand name OxyContin), methadone (a synthetic opioid often used as a treatment for addiction to opioids such as heroin), and alprazolam (sold primarily under the brand name Xanax).
The jury found Nguyen guilty of conspiring to distribute controlled substances and nine counts of distribution of controlled substances. As a result of yesterday’s convictions, Nguyen will face a statutory maximum penalty of 140 years in federal prison when she is sentenced by Judge Selna on January 22.
A third defendant in the case - physician assistant Thanh Nha T. Pham, 31, of Fountain Valley, pleaded guilty to conspiracy to distribute controlled substances and is scheduled to be sentenced by Judge Selna on January 29.
This case is the result of an investigation by the Drug Enforcement Administration, the Fountain Valley Police Department and the California Department of Justice. The case is being prosecuted by Assistant United States Attorneys Ann Luotto Wolf and Rosalind Wang of the Santa Ana Branch Office ...
Kaitlyn Phuong Nguyen, 32, of San Jose, California, was found guilty yesterday of 10 counts related to the illegal distribution of oxycodone, methadone and alprazolam. The trial jury heard evidence that four “patients” died of drug overdoses after obtaining prescriptions from Nguyen.
On the eve of Nguyen’s trial last week, the doctor who oversaw the clinic was sentenced to 70 months in prison after pleading guilty to two counts of illegal distribution of a controlled substance by a practitioner.
When he pleaded guilty earlier this year, Dr. Victor Boon Huat Siew admitted illegally prescribing oxycodone, methadone and alprazolam from his clinic from the beginning of 2009 through early 2015.
Siew, 66, of Laguna Beach, was sentenced by United States District Judge James V. Selna, who presided over Nguyen’s trial.
According to court documents and evidence presented during Nguyen’s trial, Siew and Nguyen issued prescriptions without a medical purpose in exchange for cash and insurance payments. "Many of the patients.... had ‘red flags’ in their patient files, indicating that they were abusing their pain medication and should not have been given prescriptions," according to a brief filed in relation to Nguyen’s trial.
Nguyen, who worked at the clinic in 2012, performed only cursory examinations on most "patients" prior to prescribing them narcotics. "Despite having a license to write prescriptions herself, defendant [Nguyen] usually used a prescription pad pre-signed by Siew (which was not a lawful practice) to prescribe addictive substances such as oxycodone, methadone and alprazolam," according to the trial brief.
The most common drugs prescribed by Siew and his employees were oxycodone (best known under the brand name OxyContin), methadone (a synthetic opioid often used as a treatment for addiction to opioids such as heroin), and alprazolam (sold primarily under the brand name Xanax).
The jury found Nguyen guilty of conspiring to distribute controlled substances and nine counts of distribution of controlled substances. As a result of yesterday’s convictions, Nguyen will face a statutory maximum penalty of 140 years in federal prison when she is sentenced by Judge Selna on January 22.
A third defendant in the case - physician assistant Thanh Nha T. Pham, 31, of Fountain Valley, pleaded guilty to conspiracy to distribute controlled substances and is scheduled to be sentenced by Judge Selna on January 29.
This case is the result of an investigation by the Drug Enforcement Administration, the Fountain Valley Police Department and the California Department of Justice. The case is being prosecuted by Assistant United States Attorneys Ann Luotto Wolf and Rosalind Wang of the Santa Ana Branch Office ...
Declarations and brief continue to be filed in federal court for and against imposing a preliminary injunction halting the implementation of newly adopted SB 1160. This new law provides for a stay on lien claims filed by indicted medical providers until after their case has been resolved.
Dr. Eduardo Anguizola who is facing multiple counts of insurance fraud filed by Orange County prosecutors is the lead plaintiff who claims Labor Code 4615 violates the procedural component of the due process clause because it immediately stays all liens without notice or a hearing.
The defendants responded that Section 4615 affords sufficient process because Plaintiffs still have the same rights afforded to them by the workers' compensation scheme generally. The Defense filed a 117 page Declaration of Workers' Compensation Chief Judge Paige Levy that articulated how lien claimants subject to 4615 have rights to due process under the new law, and indeed attached several illustrative cases on the stay law that have been decided by either Removal or Reconsideration by the WCAB.
Essentially she pointed out several panel decisions that have held that any lien claimant who asserts they do not fall subject to the stay have the right to have their argument heard and decided upon filing a DOR on the issue. Any WCJ that had refused to do so was overturned. Judge Levy pointed out the statutory and regulatory provisions that allowed lien claimants to challenge the application of the "automatic stay" to their individual cases.
The plaintiffs were given time to rebut Judge Levy, and filed a brief and many declarations accordingly. They claim these documents "address the seriously misleading declaration of Judge Levy."
They argue "Now, faced with the State-submitted declaration of Paige S. Levy, the Chief Judge of the California Division of Workers’ Compensation, the Court gave the Plaintiffs a fair chance to reveal what is occurring in the California workers’ compensation courts and to address the seriously misleading declaration of Judge Levy."
They say "Judge Levy offers only anecdotal references to a handful of cases to support the State’s claim that workers’ compensation judges are providing due process to claimants affected by Section 4615. Judge Levy’s declaration is wholly refuted by the detailed declarations submitted concurrently with this brief and is contravened by the DIR and WCAB’s own publications, guidelines, procedures, manuals, recent public admissions, website, and press releases."
They further argue that "the regulations providing procedures like Petitions for Reconsideration and Petitions for Removal are inapplicable because they arise only after a Court has issued an order. However, Section 4615 stays are imposed not by judicial orders but by clerical actions performed in a backroom and distributed to WCAB judges, typically by "flagging" the liens on the EAMS system, resulting in their dismissal by operation of law, a situation in which the workers’ compensation court does not hear the matter at all."
Plaintiffs attach numerous declarations by lien claimants who portray the situation for lien claimants quite differently from Judge Levy. One of them was from Attorney Marty Renetzky who started and ran Medical Collection Company for 6 years and 6 medical clinics for Dr. Floyd Cord from 1981 through 1983. He also started and ran Vista Bay Medical Group until 1991, started and ran Golden State Auto Appraisal Company for 7 years, and currently runs Crestview Medical Collections.
He says "American Allied Diagnostics Medical Group, Inc., has taken all steps to appropriately document and pursue its liens. This includes filing liens, paying activation fees and appearing at all relevant hearings." Yet he says its liens ended up on the stayed liens list although they have not been charged with any crime. They were never given official notice of this, and he says they have no procedure to contest this status.
He does not say that any petition for reconsideration or removal has been filed or rejected, so he does not specifically show how Judge Levy was wrong or how the procedure outlined in her declaration does not work for this lien claimant.
Another court hearing is set for September 28, 2017 at 8:30 am. Judge Wu may make is ruling on a preliminary injunction at this next hearing ...
Dr. Eduardo Anguizola who is facing multiple counts of insurance fraud filed by Orange County prosecutors is the lead plaintiff who claims Labor Code 4615 violates the procedural component of the due process clause because it immediately stays all liens without notice or a hearing.
The defendants responded that Section 4615 affords sufficient process because Plaintiffs still have the same rights afforded to them by the workers' compensation scheme generally. The Defense filed a 117 page Declaration of Workers' Compensation Chief Judge Paige Levy that articulated how lien claimants subject to 4615 have rights to due process under the new law, and indeed attached several illustrative cases on the stay law that have been decided by either Removal or Reconsideration by the WCAB.
Essentially she pointed out several panel decisions that have held that any lien claimant who asserts they do not fall subject to the stay have the right to have their argument heard and decided upon filing a DOR on the issue. Any WCJ that had refused to do so was overturned. Judge Levy pointed out the statutory and regulatory provisions that allowed lien claimants to challenge the application of the "automatic stay" to their individual cases.
The plaintiffs were given time to rebut Judge Levy, and filed a brief and many declarations accordingly. They claim these documents "address the seriously misleading declaration of Judge Levy."
They argue "Now, faced with the State-submitted declaration of Paige S. Levy, the Chief Judge of the California Division of Workers’ Compensation, the Court gave the Plaintiffs a fair chance to reveal what is occurring in the California workers’ compensation courts and to address the seriously misleading declaration of Judge Levy."
They say "Judge Levy offers only anecdotal references to a handful of cases to support the State’s claim that workers’ compensation judges are providing due process to claimants affected by Section 4615. Judge Levy’s declaration is wholly refuted by the detailed declarations submitted concurrently with this brief and is contravened by the DIR and WCAB’s own publications, guidelines, procedures, manuals, recent public admissions, website, and press releases."
They further argue that "the regulations providing procedures like Petitions for Reconsideration and Petitions for Removal are inapplicable because they arise only after a Court has issued an order. However, Section 4615 stays are imposed not by judicial orders but by clerical actions performed in a backroom and distributed to WCAB judges, typically by "flagging" the liens on the EAMS system, resulting in their dismissal by operation of law, a situation in which the workers’ compensation court does not hear the matter at all."
Plaintiffs attach numerous declarations by lien claimants who portray the situation for lien claimants quite differently from Judge Levy. One of them was from Attorney Marty Renetzky who started and ran Medical Collection Company for 6 years and 6 medical clinics for Dr. Floyd Cord from 1981 through 1983. He also started and ran Vista Bay Medical Group until 1991, started and ran Golden State Auto Appraisal Company for 7 years, and currently runs Crestview Medical Collections.
He says "American Allied Diagnostics Medical Group, Inc., has taken all steps to appropriately document and pursue its liens. This includes filing liens, paying activation fees and appearing at all relevant hearings." Yet he says its liens ended up on the stayed liens list although they have not been charged with any crime. They were never given official notice of this, and he says they have no procedure to contest this status.
He does not say that any petition for reconsideration or removal has been filed or rejected, so he does not specifically show how Judge Levy was wrong or how the procedure outlined in her declaration does not work for this lien claimant.
Another court hearing is set for September 28, 2017 at 8:30 am. Judge Wu may make is ruling on a preliminary injunction at this next hearing ...
Prosecutors say a local San Diego sheriff’s deputy, who claimed he had suffered a back injury but may have been seen working out with heavy weights as a gym, has been charged with committing workers compensation insurance fraud resulting in $57,000 in losses.
According to the story in the San Diego Union Tribune, Matthew Tobolsky, 40, faces 14 counts including insurance fraud, filing a false claim, attempted perjury and failing to disclose information that affects a payment. The charges carry a potential sentence of up to 15 years in custody, which would most likely be served in county jail.
Tobolsky has not yet had an opportunity to enter a plea in the case. He is scheduled to be arraigned in San Diego Superior Court Wednesday afternoon.
According to the District Attorney’s Office, Tobolsky claimed in January that he had injured his back from lifting two five-gallon water bottles. But an investigation, initiated by the Sheriff’s Department, indicated Tobolsky had misrepresented his physical condition and what he could or could not do.
Authorities said Tobolsky told medical professionals that he was suffering from debilitating pain and was unable to do light duty on the job. But the investigation revealed he was able to work out with weights at a gym.
Of the $57,000 in losses, $46,000 was paid directly to the defendant, prosecutors said.
The Sheriff’s Department investigated the case will help from the state Department of Insurance and the District Attorney’s Office’s Insurance Fraud Division ...
According to the story in the San Diego Union Tribune, Matthew Tobolsky, 40, faces 14 counts including insurance fraud, filing a false claim, attempted perjury and failing to disclose information that affects a payment. The charges carry a potential sentence of up to 15 years in custody, which would most likely be served in county jail.
Tobolsky has not yet had an opportunity to enter a plea in the case. He is scheduled to be arraigned in San Diego Superior Court Wednesday afternoon.
According to the District Attorney’s Office, Tobolsky claimed in January that he had injured his back from lifting two five-gallon water bottles. But an investigation, initiated by the Sheriff’s Department, indicated Tobolsky had misrepresented his physical condition and what he could or could not do.
Authorities said Tobolsky told medical professionals that he was suffering from debilitating pain and was unable to do light duty on the job. But the investigation revealed he was able to work out with weights at a gym.
Of the $57,000 in losses, $46,000 was paid directly to the defendant, prosecutors said.
The Sheriff’s Department investigated the case will help from the state Department of Insurance and the District Attorney’s Office’s Insurance Fraud Division ...
The California Labor Commissioner’s Office cited 14 garment manufacturers and contractors $372,135 for labor law and garment registration violations, following inspections of 18 garment manufacturers last month in the Los Angeles area. The businesses cited employ 170 workers in the Los Angeles garment district.
The penalties included $275,835 in fines and stop orders for seven employers operating without workers’ compensation insurance coverage. Fourteen businesses were cited $34,300 for garment regulation violations, including failure to register as a garment manufacturer, display the garment registration or maintain required records. Investigators also confiscated 5,725 illegally manufactured garments with an estimated street value of $103,000 from six of the businesses.
"Garment manufacturers who thwart the law threaten workers’ rights and undermine honest employers in the industry, making it difficult for legitimate businesses to succeed,” said Labor Commissioner Julie A. Su. “These illegal entities should take note: We will shine a light on the underground economy and those who contract with unregistered contractors will also be held accountable."
The Labor Commissioner’s office is also pursuing wage theft investigations on those employers who failed to pay proper wages under the California Labor Code.
The Garment Manufacturing Act of 1980 requires that all industry employers register with the Labor Commissioner and demonstrate adequate character, competency and responsibility, including workers’ compensation insurance coverage. Garment manufacturers who contract with unregistered entities are automatically deemed joint employers of the workers in the contract facility. Clothing confiscated from illegal operations cannot be sold, and will be donated to a non-profit agency that will provide the items to homeless and domestic violence shelters in the Los Angeles area.
The Labor Commissioner also administers a special wage claim adjudication process for garment workers pursuant to California’s AB 633, passed in 1999. This law provides not only an expedited process for garment workers to file wage claims but also provides a wage guarantee where garment manufacturers are responsible for wage theft at their contractors’ facilities.
The Labor Commissioner’s Office, officially known as the Division of Labor Standards Enforcement, is a division of the Department of Industrial Relations (DIR). Among its wide-ranging enforcement responsibilities, the Labor Commissioner’s Office inspects workplaces for wage and hour violations, adjudicates wage claims, investigates retaliation complaints and educates the public on labor laws.
In 2014, Commissioner Su launched the Wage Theft is a Crime multilingual public awareness campaign. The campaign defines wage theft and informs workers of their rights and the resources available to them to recover unpaid wages or report other labor law violations. Employees with work-related questions or complaints may contact DIR’s Call Center in English or Spanish at 844-LABOR-DIR (844-522-6734) ...
The penalties included $275,835 in fines and stop orders for seven employers operating without workers’ compensation insurance coverage. Fourteen businesses were cited $34,300 for garment regulation violations, including failure to register as a garment manufacturer, display the garment registration or maintain required records. Investigators also confiscated 5,725 illegally manufactured garments with an estimated street value of $103,000 from six of the businesses.
"Garment manufacturers who thwart the law threaten workers’ rights and undermine honest employers in the industry, making it difficult for legitimate businesses to succeed,” said Labor Commissioner Julie A. Su. “These illegal entities should take note: We will shine a light on the underground economy and those who contract with unregistered contractors will also be held accountable."
The Labor Commissioner’s office is also pursuing wage theft investigations on those employers who failed to pay proper wages under the California Labor Code.
The Garment Manufacturing Act of 1980 requires that all industry employers register with the Labor Commissioner and demonstrate adequate character, competency and responsibility, including workers’ compensation insurance coverage. Garment manufacturers who contract with unregistered entities are automatically deemed joint employers of the workers in the contract facility. Clothing confiscated from illegal operations cannot be sold, and will be donated to a non-profit agency that will provide the items to homeless and domestic violence shelters in the Los Angeles area.
The Labor Commissioner also administers a special wage claim adjudication process for garment workers pursuant to California’s AB 633, passed in 1999. This law provides not only an expedited process for garment workers to file wage claims but also provides a wage guarantee where garment manufacturers are responsible for wage theft at their contractors’ facilities.
The Labor Commissioner’s Office, officially known as the Division of Labor Standards Enforcement, is a division of the Department of Industrial Relations (DIR). Among its wide-ranging enforcement responsibilities, the Labor Commissioner’s Office inspects workplaces for wage and hour violations, adjudicates wage claims, investigates retaliation complaints and educates the public on labor laws.
In 2014, Commissioner Su launched the Wage Theft is a Crime multilingual public awareness campaign. The campaign defines wage theft and informs workers of their rights and the resources available to them to recover unpaid wages or report other labor law violations. Employees with work-related questions or complaints may contact DIR’s Call Center in English or Spanish at 844-LABOR-DIR (844-522-6734) ...
The head of the U.S. Food and Drug Administration said on the agency is working on a new policy that would encourage more compounding pharmacies to register under a law enacted in the wake of a deadly 2012 meningitis outbreak linked to one such company.
FDA Commissioner Scott Gottlieb made the comments in an interview with Reuters as federal prosecutors in Boston prepare for the second criminal trial over contaminated steroids manufactured by the now-defunct New England Compounding Center (NECC).
That meningitis outbreak sickened 778 patients nationwide, including 76 who died, after receiving contaminated steroids, prosecutors said.
After the outbreak, Congress in 2013 passed the Drug Quality and Security Act, which aimed to bring more compounding pharmacies, which make custom medications, under the authority of the FDA rather than state pharmacy boards.
The law created a category of "outsourcing facilities" that could register with the FDA, allowing them to sell products in bulk to hospitals and physician practices without prescriptions for individual patients.
In exchange, those compounders would have to follow federal manufacturing standards and subject themselves to routine inspections. Today, around 70 firms have registered as outsourcing facilities.
According to the American Pharmacists Association, there are about 7,500 pharmacies that specialize in compounding services.
Under the 2013 law, compounders that did not register with the FDA would remain under state oversight, and according to the agency, could only compound drugs based on prescriptions for specific patients.
Gottlieb said that in order to encourage more compounders to register, the FDA would release draft guidance in the next two months reflecting its intention to adjust its enforcement priorities based on the size of registered compounders and the riskiness of their products.
"We’re looking at ways we can provide more of a gradation in our regulatory architecture so we don’t have a one-size-fits-all approach," Gottlieb said.
Pharmacists have long mixed tailored medications for patients based on individual prescriptions. By 2013, the practice had mushroomed, with some pharmacies selling thousands of doses of regularly used mixtures for physicians to keep for future use.
Gottlieb’s comments came ahead of next week’s trial in Boston of Glenn Chin, a former supervisory pharmacist at NECC who is accused of second-degree murder and fraud. He has pleaded not guilty.
NECC’s co-founder, Barry Cadden, was sentenced in June to nine years in prison after he was convicted on racketeering and fraud charges. Prosecutors said he directed the production of drugs in unsanitary and dangerous ways to boost profits.
The FDA has been criticized by groups like the American Pharmacists Association, which has said the federal agency has been overstepping its authority to regulate state-licensed pharmacies.
That criticism has focused on the FDA’s position that the 2013 law requires prescriptions for specific patients, restricting pharmacies from distributing drugs to stock doctors’ offices for their uses, even if allowed under state law.
Gottlieb said he stood by the FDA’s interpretation of the law and that he expected no slowdown in terms of its enforcement.
But he said the new guidance would help address concerns from smaller pharmacies that want to do just that but have resisted registering as outsourcing facilities because of the expense of regulatory compliance.
The draft guidance, he said, would allow smaller firms creating low-risk drugs to be subject to less onerous requirements than larger outsourcing facilities.
Doing so, he said, would help ensure more pharmacies are in compliance with manufacturing standards, potentially creating more access to compounded medications.
...
FDA Commissioner Scott Gottlieb made the comments in an interview with Reuters as federal prosecutors in Boston prepare for the second criminal trial over contaminated steroids manufactured by the now-defunct New England Compounding Center (NECC).
That meningitis outbreak sickened 778 patients nationwide, including 76 who died, after receiving contaminated steroids, prosecutors said.
After the outbreak, Congress in 2013 passed the Drug Quality and Security Act, which aimed to bring more compounding pharmacies, which make custom medications, under the authority of the FDA rather than state pharmacy boards.
The law created a category of "outsourcing facilities" that could register with the FDA, allowing them to sell products in bulk to hospitals and physician practices without prescriptions for individual patients.
In exchange, those compounders would have to follow federal manufacturing standards and subject themselves to routine inspections. Today, around 70 firms have registered as outsourcing facilities.
According to the American Pharmacists Association, there are about 7,500 pharmacies that specialize in compounding services.
Under the 2013 law, compounders that did not register with the FDA would remain under state oversight, and according to the agency, could only compound drugs based on prescriptions for specific patients.
Gottlieb said that in order to encourage more compounders to register, the FDA would release draft guidance in the next two months reflecting its intention to adjust its enforcement priorities based on the size of registered compounders and the riskiness of their products.
"We’re looking at ways we can provide more of a gradation in our regulatory architecture so we don’t have a one-size-fits-all approach," Gottlieb said.
Pharmacists have long mixed tailored medications for patients based on individual prescriptions. By 2013, the practice had mushroomed, with some pharmacies selling thousands of doses of regularly used mixtures for physicians to keep for future use.
Gottlieb’s comments came ahead of next week’s trial in Boston of Glenn Chin, a former supervisory pharmacist at NECC who is accused of second-degree murder and fraud. He has pleaded not guilty.
NECC’s co-founder, Barry Cadden, was sentenced in June to nine years in prison after he was convicted on racketeering and fraud charges. Prosecutors said he directed the production of drugs in unsanitary and dangerous ways to boost profits.
The FDA has been criticized by groups like the American Pharmacists Association, which has said the federal agency has been overstepping its authority to regulate state-licensed pharmacies.
That criticism has focused on the FDA’s position that the 2013 law requires prescriptions for specific patients, restricting pharmacies from distributing drugs to stock doctors’ offices for their uses, even if allowed under state law.
Gottlieb said he stood by the FDA’s interpretation of the law and that he expected no slowdown in terms of its enforcement.
But he said the new guidance would help address concerns from smaller pharmacies that want to do just that but have resisted registering as outsourcing facilities because of the expense of regulatory compliance.
The draft guidance, he said, would allow smaller firms creating low-risk drugs to be subject to less onerous requirements than larger outsourcing facilities.
Doing so, he said, would help ensure more pharmacies are in compliance with manufacturing standards, potentially creating more access to compounded medications.
...
