Arizona’s attorney general sued Insys Therapeutics Inc this week, accusing the drugmaker of engaging in a fraudulent marketing scheme aimed at increasing sales of a fentanyl-based cancer pain medicine.
According to the report in Reuters Health, the lawsuit by Arizona Attorney General Mark Brnovich in Maricopa County Superior Court in Phoenix comes during a series of federal and state investigations centered on Insys’ Subsys opioid drug.
The lawsuit, filed in Maricopa County Superior Court in Phoenix, accused Insys of paying doctors sham speaker fees in exchange for writing prescriptions of Subsys without regard for the health of patients.
The lawsuit also named three Arizona doctors as defendants who it said collected speaker fees from Insys while writing prescriptions that generated more than $33 million in sales of Subsys, or 64 percent of all sales of the drug in the state.
"We need to put a stop to the unethical and greedy behavior in the pharmaceutical industry that is fueling the opioid crisis in our state," Brnovich said in a statement.
Insys did not immediately respond to a request for comment. Lawyers for the three doctors - Steve Fanto, Nikesh Seth and Sheldon Gingerich - could not be immediately identified.
The case is the latest to center on Subsys, an under-the-tongue spray intended for cancer patients that contains fentanyl, a highly addictive and regulated synthetic opioid.
In December, federal prosecutors in Boston charged six former Insys executives and managers, including ex-Chief Executive Michael Babich, with engaging in a scheme to bribe doctors to prescribe Subsys.
Federal charges have also been filed in several other states against other ex-Insys employees and medical practitioners who prescribed Subsys.
Two former Insys Therapeutics Inc sales representatives including the wife of its ex-chief executive pleaded guilty in July 2017 to engaging in schemes to pay kickbacks to medical practitioners to prescribe a drug containing the opioid fentanyl.
Natalie Levine, who worked at the Arizona-based drugmaker from 2013 to 2014, plead guilty in federal court in Hartford, Connecticut, to conspiring to violate a federal anti-kickback statute, prosecutors said.
Karen Hill, a sales representative who became the company’s district manager for the Miami region, pleaded guilty in federal court in Mobile, Alabama to conspiring to violate the same anti-kickback law, court records show.
Insys has said it is in talks with the U.S. Justice Department to resolve the federal probe.
The Arizona-based drugmaker previously agreed to pay a combined $8.95 million to resolve investigations by attorneys general in Oregon, New Hampshire and Illinois ...
According to the report in Reuters Health, the lawsuit by Arizona Attorney General Mark Brnovich in Maricopa County Superior Court in Phoenix comes during a series of federal and state investigations centered on Insys’ Subsys opioid drug.
The lawsuit, filed in Maricopa County Superior Court in Phoenix, accused Insys of paying doctors sham speaker fees in exchange for writing prescriptions of Subsys without regard for the health of patients.
The lawsuit also named three Arizona doctors as defendants who it said collected speaker fees from Insys while writing prescriptions that generated more than $33 million in sales of Subsys, or 64 percent of all sales of the drug in the state.
"We need to put a stop to the unethical and greedy behavior in the pharmaceutical industry that is fueling the opioid crisis in our state," Brnovich said in a statement.
Insys did not immediately respond to a request for comment. Lawyers for the three doctors - Steve Fanto, Nikesh Seth and Sheldon Gingerich - could not be immediately identified.
The case is the latest to center on Subsys, an under-the-tongue spray intended for cancer patients that contains fentanyl, a highly addictive and regulated synthetic opioid.
In December, federal prosecutors in Boston charged six former Insys executives and managers, including ex-Chief Executive Michael Babich, with engaging in a scheme to bribe doctors to prescribe Subsys.
Federal charges have also been filed in several other states against other ex-Insys employees and medical practitioners who prescribed Subsys.
Two former Insys Therapeutics Inc sales representatives including the wife of its ex-chief executive pleaded guilty in July 2017 to engaging in schemes to pay kickbacks to medical practitioners to prescribe a drug containing the opioid fentanyl.
Natalie Levine, who worked at the Arizona-based drugmaker from 2013 to 2014, plead guilty in federal court in Hartford, Connecticut, to conspiring to violate a federal anti-kickback statute, prosecutors said.
Karen Hill, a sales representative who became the company’s district manager for the Miami region, pleaded guilty in federal court in Mobile, Alabama to conspiring to violate the same anti-kickback law, court records show.
Insys has said it is in talks with the U.S. Justice Department to resolve the federal probe.
The Arizona-based drugmaker previously agreed to pay a combined $8.95 million to resolve investigations by attorneys general in Oregon, New Hampshire and Illinois ...
A new California Workers’ Compensation Institute (CWCI) study tracks changes in the prevalence, volume and strength of opioid prescriptions in California work injury lost-time claims that involve a mental health component, and compares those results to other indemnity claims that have no mental health component.
Using data from 368,538 lost-time claims for work injuries that occurred during the 10-year span ending in December 2016, the study’s authors calculated the percentage of claims with and without mental health disorders in which opioids were dispensed, with results broken out by accident year at 6 different development periods (3, 12, 24, 36, 48 and 60 months post injury).
Among the findings:
- Between one quarter and one third of California workers’ comp indemnity claims (with or without a mental health disorder) had opioids dispensed within three months of the injury, with opioids slightly less prevalent among the claims with mental health disorders during this acute injury phase.
- By 12 months post injury, opioids were more prevalent in the claims with mental health disorders than in those without a mental health component for all accident years except 2015 and 2016; and at 24, 36, 48 and 60 months post injury, opioids were more prevalent among mental health claims from all 10 years.
- The average number of opioid prescriptions per claim was higher for injured workers with mental health disorders at all stages of claim development in all 10 accident years, and widened as the claim aged, though looking at the average number of prescriptions at the same development periods across different accident years shows the volume of opioid prescriptions has diminished in recent accident years.
- Claims with mental health disorders were more likely to have opioids introduced later in the claim, so at 5 years post injury, 60.7 percent of the claims with mental health disorders had involved opioids compared to less than half of the claims without mental health disorders.
- The average potency of the opioids dispensed was significantly higher for injured workers with mental health disorders than for those without mental health disorders. For example, for AY 2011 injuries, the average morphine milligram equivalent (MME) per opioid prescription was 51.4 percent higher for claims with mental health disorders.
CWCI has published its study as a Spotlight Report, "Differential Use of Opioids in California Workers’ Compensation Claims with Mental Health Disorders." The public can access the report at its website ...
Using data from 368,538 lost-time claims for work injuries that occurred during the 10-year span ending in December 2016, the study’s authors calculated the percentage of claims with and without mental health disorders in which opioids were dispensed, with results broken out by accident year at 6 different development periods (3, 12, 24, 36, 48 and 60 months post injury).
Among the findings:
- Between one quarter and one third of California workers’ comp indemnity claims (with or without a mental health disorder) had opioids dispensed within three months of the injury, with opioids slightly less prevalent among the claims with mental health disorders during this acute injury phase.
- By 12 months post injury, opioids were more prevalent in the claims with mental health disorders than in those without a mental health component for all accident years except 2015 and 2016; and at 24, 36, 48 and 60 months post injury, opioids were more prevalent among mental health claims from all 10 years.
- The average number of opioid prescriptions per claim was higher for injured workers with mental health disorders at all stages of claim development in all 10 accident years, and widened as the claim aged, though looking at the average number of prescriptions at the same development periods across different accident years shows the volume of opioid prescriptions has diminished in recent accident years.
- Claims with mental health disorders were more likely to have opioids introduced later in the claim, so at 5 years post injury, 60.7 percent of the claims with mental health disorders had involved opioids compared to less than half of the claims without mental health disorders.
- The average potency of the opioids dispensed was significantly higher for injured workers with mental health disorders than for those without mental health disorders. For example, for AY 2011 injuries, the average morphine milligram equivalent (MME) per opioid prescription was 51.4 percent higher for claims with mental health disorders.
CWCI has published its study as a Spotlight Report, "Differential Use of Opioids in California Workers’ Compensation Claims with Mental Health Disorders." The public can access the report at its website ...
Most of the events that led to sustained prescription opioid use were not hospital events and associated procedures, but diagnoses that were either nonspecific or associated with spinal or other conditions for which opioid administration is not considered standard of care, according to a study published by JAMA Surgery.
The initial event associated with exposure to prescription opioids has not been widely explored, but is often maintained to stem from an injury or surgical procedure.
Andrew J. Schoenfeld, M.D., M.Sc., of Brigham and Women's Hospital, Harvard Medical School, Boston, and colleagues evaluated the medical diagnoses linked with an opioid prescription that resulted in sustained opioid use in Americans insured through TRICARE, the insurance plan of the U.S. Department of Defense that provides health care coverage for over 9 million beneficiaries. This population may be comparable to the proportion of the general public at greatest risk of sustained opioid use.
The researchers identified 117,118 patients (opioid naïve, i.e., no use of prescription opioids for six months before receipt of a new prescription) who met the criteria for sustained prescription opioid use. Only 800 individuals (0.7 percent) received their initial opioid prescription following an inpatient encounter, with 0.4 percent having undergone an inpatient procedure.
The most common diagnosis associated with the initial opioid prescription for the entire group was other ill-defined conditions (30.6 percent). The most frequent diagnosis among patients treated in military facilities was lumbago. Spinal conditions were among the most frequent diagnoses in both civilian and military settings.
Among specific categories of conditions associated with the initial opioid prescription, spine and orthopedic disorders were the most prominent.
Limitations of the study include its retrospective design and reliance on insurance claims.
"Improved adherence to best practices in opioid prescribing and requirements for better documentation of the rationale for such prescriptions may reduce the risk of sustained use," the authors write.
This suggestion seems like good advice for claims administrators as they review any Request for Authorization for an opioid medication ...
The initial event associated with exposure to prescription opioids has not been widely explored, but is often maintained to stem from an injury or surgical procedure.
Andrew J. Schoenfeld, M.D., M.Sc., of Brigham and Women's Hospital, Harvard Medical School, Boston, and colleagues evaluated the medical diagnoses linked with an opioid prescription that resulted in sustained opioid use in Americans insured through TRICARE, the insurance plan of the U.S. Department of Defense that provides health care coverage for over 9 million beneficiaries. This population may be comparable to the proportion of the general public at greatest risk of sustained opioid use.
The researchers identified 117,118 patients (opioid naïve, i.e., no use of prescription opioids for six months before receipt of a new prescription) who met the criteria for sustained prescription opioid use. Only 800 individuals (0.7 percent) received their initial opioid prescription following an inpatient encounter, with 0.4 percent having undergone an inpatient procedure.
The most common diagnosis associated with the initial opioid prescription for the entire group was other ill-defined conditions (30.6 percent). The most frequent diagnosis among patients treated in military facilities was lumbago. Spinal conditions were among the most frequent diagnoses in both civilian and military settings.
Among specific categories of conditions associated with the initial opioid prescription, spine and orthopedic disorders were the most prominent.
Limitations of the study include its retrospective design and reliance on insurance claims.
"Improved adherence to best practices in opioid prescribing and requirements for better documentation of the rationale for such prescriptions may reduce the risk of sustained use," the authors write.
This suggestion seems like good advice for claims administrators as they review any Request for Authorization for an opioid medication ...
The Division of Workers’ Compensation (DWC) has posted a searchable database of liens dismissed by operation of law per Labor Code §4903.05(c)(2).
Or you may download the entire data set (15.3 MB): in Microsoft Excel format.
As detailed in Newsline 2017-75, which announced the dismissal of 292,000 unresolved liens, Senate Bill 1160 amended Labor Code section 4903.05(c) to require lien claimants to file a declaration verifying the legitimacy of liens for medical treatment or medical-legal expenses. Claimants who had filed liens between January 1, 2013 and December 31, 2016, were required to file the declarations by July 1, 2017, to avoid having those liens dismissed.
The information available on this page is based on case records in EAMS and is current as of August 15. For the latest available information, please check the Public Information Case Search Function.
The initial set of dismissals entered on August 15, 2017, covered liens filed between January 1, 2013, and December 31, 2016, for which a filing fee had been paid but for which the declaration required by Labor Code § 4903.05(c) was not filed by the July 1, 2017 deadline.
The companion cases associated with these liens may not yet have been identified and added to the data base ...
Or you may download the entire data set (15.3 MB): in Microsoft Excel format.
As detailed in Newsline 2017-75, which announced the dismissal of 292,000 unresolved liens, Senate Bill 1160 amended Labor Code section 4903.05(c) to require lien claimants to file a declaration verifying the legitimacy of liens for medical treatment or medical-legal expenses. Claimants who had filed liens between January 1, 2013 and December 31, 2016, were required to file the declarations by July 1, 2017, to avoid having those liens dismissed.
The information available on this page is based on case records in EAMS and is current as of August 15. For the latest available information, please check the Public Information Case Search Function.
The initial set of dismissals entered on August 15, 2017, covered liens filed between January 1, 2013, and December 31, 2016, for which a filing fee had been paid but for which the declaration required by Labor Code § 4903.05(c) was not filed by the July 1, 2017 deadline.
The companion cases associated with these liens may not yet have been identified and added to the data base ...
Keenan HealthCare and actuarial consultant Milliman released the 2017 results of their California Hospital Workers’ Compensation and Payroll Benchmarking Survey.
The survey from 18 hospital systems and more than 44 individual facilities within California shows average losses paid per indemnity claim rose 2.9 percent annually over the past 10 years. Data for the survey was collected in the 2nd half of 2016 and early part of 2017 from past participants and entities that expressed an interest in participating.
The survey provides data on more than 4,300 annual claims. The survey analysis also relied on payroll and medical utilization information obtained from the California Office of Statewide Health Planning and Development website.
While the landscape of providing healthcare in the United States is seemingly in flux, "the workers' compensation environment in California has been surprisingly stable over the last several years." Despite this stability, workers' compensation remains one of the most complex exposures for employers who must continue to look for ways to protect employees from injury and improve loss prevention programs.
The survey identified the following workers’ comp trends in the hospital sector:
- Projected loss cost for accidents occurring during 2016 and 2017 were at $2.10 per $100 of payroll. The decrease as compared to prior projections is largely driven by less than expected development in claim severity, while overall claim frequency has largely remained stable.
- Average losses paid per indemnity claim rose 2.9 percent annually over the past 10 years.
- Medical loss trends abated in recent years. Indemnity loss trends are less than long-term averages. Combined, these have resulted in a lower annual rate of severity increase as compared to prior versions of this study.
- However, annual allocated loss adjustment expenses increased significantly during this time period, representing an increasing share of the total cost of claims.
"Looking forward, we expect longer term trend rates closer to 5 percent or 6 percent to prevail, with stronger medical and indemnity loss trends than the recent past, and ALAE trends remaining high," Bill Poland, marketing director of property/casualty for Keenan, said in a statement. "We believe these key indicators will be valuable in developing plans to modify or adjust programs where necessary with the goal of improving results." ...
The survey from 18 hospital systems and more than 44 individual facilities within California shows average losses paid per indemnity claim rose 2.9 percent annually over the past 10 years. Data for the survey was collected in the 2nd half of 2016 and early part of 2017 from past participants and entities that expressed an interest in participating.
The survey provides data on more than 4,300 annual claims. The survey analysis also relied on payroll and medical utilization information obtained from the California Office of Statewide Health Planning and Development website.
While the landscape of providing healthcare in the United States is seemingly in flux, "the workers' compensation environment in California has been surprisingly stable over the last several years." Despite this stability, workers' compensation remains one of the most complex exposures for employers who must continue to look for ways to protect employees from injury and improve loss prevention programs.
The survey identified the following workers’ comp trends in the hospital sector:
- Projected loss cost for accidents occurring during 2016 and 2017 were at $2.10 per $100 of payroll. The decrease as compared to prior projections is largely driven by less than expected development in claim severity, while overall claim frequency has largely remained stable.
- Average losses paid per indemnity claim rose 2.9 percent annually over the past 10 years.
- Medical loss trends abated in recent years. Indemnity loss trends are less than long-term averages. Combined, these have resulted in a lower annual rate of severity increase as compared to prior versions of this study.
- However, annual allocated loss adjustment expenses increased significantly during this time period, representing an increasing share of the total cost of claims.
"Looking forward, we expect longer term trend rates closer to 5 percent or 6 percent to prevail, with stronger medical and indemnity loss trends than the recent past, and ALAE trends remaining high," Bill Poland, marketing director of property/casualty for Keenan, said in a statement. "We believe these key indicators will be valuable in developing plans to modify or adjust programs where necessary with the goal of improving results." ...
Governor Jerry Brown has designated Katherine Zalewski, of Richmond, as the Chair on the California Workers’ Compensation Appeals Board. Zalewski served on the board since her appointment by Governor Brown on April 30, 2014.
Prior to her appointment, she joined the Department of Industrial Relations (DIR) as a workers’ compensation administrative law judge and advisor to the Division of Workers’ Compensation from 2009 to 2011, and served as DIR chief counsel from 2012 to 2014.
Prior to state service, she was senior associate at Schmit Law Office from 2000 to 2009, manager and attorney at Pacific Coast Services from 1998 to 2000, and worked at Express Network and Direct Legal Support Services from 1993 to 1998.
She was an attorney at Kinder and Wuerfel from 1990 to 1993 at Finnegan and Marks from 1988 to 1990 and at Foreman and Brasso from 1986 to 1988.
Zalewski earned a Juris Doctor degree from the University of California Hastings College of the Law.
This position requires Senate confirmation and the compensation is $131,952.
She was selected from a list of current WCAB commissioners including Frank M. Brass, Deidra E. Lowe, José H. Razo and Marguerite Sweeney ...
Prior to her appointment, she joined the Department of Industrial Relations (DIR) as a workers’ compensation administrative law judge and advisor to the Division of Workers’ Compensation from 2009 to 2011, and served as DIR chief counsel from 2012 to 2014.
Prior to state service, she was senior associate at Schmit Law Office from 2000 to 2009, manager and attorney at Pacific Coast Services from 1998 to 2000, and worked at Express Network and Direct Legal Support Services from 1993 to 1998.
She was an attorney at Kinder and Wuerfel from 1990 to 1993 at Finnegan and Marks from 1988 to 1990 and at Foreman and Brasso from 1986 to 1988.
Zalewski earned a Juris Doctor degree from the University of California Hastings College of the Law.
This position requires Senate confirmation and the compensation is $131,952.
She was selected from a list of current WCAB commissioners including Frank M. Brass, Deidra E. Lowe, José H. Razo and Marguerite Sweeney ...
Ravinderjit Singh was employed as a physician with the California Department of Corrections and Rehabilitation (CDCR) at North Kern State Prison in Delano, California, when she claimed to have suffered a January 8, 2013, industrial injury to her psyche following a fire marshal order to close examination room doors while examining inmates.
Qualified Medical Evaluator (QME) John M. Stalberg, M.D., issued five medical reports regarding Dr. Sing. Following a workers’ compensation hearing a WCJ found, that the injury did not cause permanent disability and that based on Dr. Stalberg’s reporting, Singh "failed to meet the burden of showing entitlement to any period of temporary total disability.
Singh petitioned the WCAB for reconsideration, contending primarily that she was entitled to temporary disability. The WCAB issued its own decision finding Dr. Stalberg’s medical reporting lacking and that Singh "failed to follow-up with Dr. Stalberg and provide the requisite information for him to determine the period she was temporarily totally disabled." The WCAB accordingly agreed with the WCJ and denied reconsideration.
Singh petitioned the court of appeal for a writ of review, and presented her case for entitlement to temporary disability payments. Singh notes that Dr. Stalberg opined she could return to work inside the prison with the reasonable accommodation of either leaving the examination room open or having a chaperone during examinations, but that the prison refused to accommodate her work restriction.
The WCAB filed a letter brief with the court of appeal stating that it "would admit error in this case and request that the Opinion and Order Denying Petition for Reconsideration issued on March 6, 2017, be annulled and that this matter be returned to the Board for further proceedings."
The WCAB explains that while it focused its analysis on whether Singh proved temporary disability, she correctly pointed out in her petition for writ of review that "where an employer fails to provide modified work to an injured employee, temporary partial disability is deemed total. (Huston v. Workers’ Comp. Appeals Bd. (1979) 95 Cal.App.3d 856, 868.)" The WCAB explained that the record appeared incomplete, that it may have improperly analyzed Singh’s claim of temporary total disability, and expressed its desire to return the matter to the WCJ for further proceedings.
In response to this court’s inquiry as to whether this court should grant peremptory relief in light of the WCAB’s letter brief, the CDCR contends the matter should not be remanded because "[i]t is well established that an appellant cannot complain about an error that he or she created." The CDCR asserts any lack of an adequate record is invited error of Singh’s own making by not further developing the record. (Mesecher v. County of San Diego (1992) 9 Cal.App.4th 1677, 1685.)
The court granted the WCAB request in the unpublished case of Sing v WCAB, and the California Department of Corrections and Rehabilitation, "Given the WCAB’s admission it did not consider all available legal theories that might have entitled Singh to benefits, we conclude the WCAB’s decision fails to "state the evidence relied upon and specify in detail the reasons for the decision" as required under section 5908.5. The WCAB’s failure to set forth its reasoning in adequate detail constitutes a sufficient basis to annul the decision and remand for a statement of reasons." ...
Qualified Medical Evaluator (QME) John M. Stalberg, M.D., issued five medical reports regarding Dr. Sing. Following a workers’ compensation hearing a WCJ found, that the injury did not cause permanent disability and that based on Dr. Stalberg’s reporting, Singh "failed to meet the burden of showing entitlement to any period of temporary total disability.
Singh petitioned the WCAB for reconsideration, contending primarily that she was entitled to temporary disability. The WCAB issued its own decision finding Dr. Stalberg’s medical reporting lacking and that Singh "failed to follow-up with Dr. Stalberg and provide the requisite information for him to determine the period she was temporarily totally disabled." The WCAB accordingly agreed with the WCJ and denied reconsideration.
Singh petitioned the court of appeal for a writ of review, and presented her case for entitlement to temporary disability payments. Singh notes that Dr. Stalberg opined she could return to work inside the prison with the reasonable accommodation of either leaving the examination room open or having a chaperone during examinations, but that the prison refused to accommodate her work restriction.
The WCAB filed a letter brief with the court of appeal stating that it "would admit error in this case and request that the Opinion and Order Denying Petition for Reconsideration issued on March 6, 2017, be annulled and that this matter be returned to the Board for further proceedings."
The WCAB explains that while it focused its analysis on whether Singh proved temporary disability, she correctly pointed out in her petition for writ of review that "where an employer fails to provide modified work to an injured employee, temporary partial disability is deemed total. (Huston v. Workers’ Comp. Appeals Bd. (1979) 95 Cal.App.3d 856, 868.)" The WCAB explained that the record appeared incomplete, that it may have improperly analyzed Singh’s claim of temporary total disability, and expressed its desire to return the matter to the WCJ for further proceedings.
In response to this court’s inquiry as to whether this court should grant peremptory relief in light of the WCAB’s letter brief, the CDCR contends the matter should not be remanded because "[i]t is well established that an appellant cannot complain about an error that he or she created." The CDCR asserts any lack of an adequate record is invited error of Singh’s own making by not further developing the record. (Mesecher v. County of San Diego (1992) 9 Cal.App.4th 1677, 1685.)
The court granted the WCAB request in the unpublished case of Sing v WCAB, and the California Department of Corrections and Rehabilitation, "Given the WCAB’s admission it did not consider all available legal theories that might have entitled Singh to benefits, we conclude the WCAB’s decision fails to "state the evidence relied upon and specify in detail the reasons for the decision" as required under section 5908.5. The WCAB’s failure to set forth its reasoning in adequate detail constitutes a sufficient basis to annul the decision and remand for a statement of reasons." ...
The growing trend of states working to legalize medical marijuana has created challenges in the workplace. However, there are opportunities to implement best practices to manage the use of medical marijuana in workers’ compensation, according to Kevin Glennon, RN, vice president of Clinical Education and Quality Assurance Programs at One Call Care Management.
The Claims Journal reported that Glennon spoke on the panel, "Legalized Marijuana: Its Impact on the Workplace," for the 2015 Risk Management Society Conference held in New Orleans last week.
Among the challenges are the conflicts between state and federal laws, lack of evidence for the efficacy of medical marijuana, and risks posed to employee safety.medical marijuana
"In workers’ compensation, medical marijuana is predominantly requested to manage pain," noted Glennon. "However, payers rely on evidence-based guidelines when making coverage decisions. Without FDA approval or a large-scale randomized, controlled human trial to demonstrate medical value, many payers are choosing to categorically deny coverage of medical marijuana. It’s a catch-22: lack of evidence continues to hamper adoption, and yet clinical trials are not permitted under current federal law."
At the federal level, marijuana is categorized as an illegal substance, and it is not FDA approved to treat any medical condition. Despite these restrictions, in the 23 states and the District of Columbia where medical marijuana is now legal, it is recommended for many medical purposes.
In certain cases, court rulings could force carriers to cover medical marijuana for treatment. Glennon pointed to a New Mexico case, in which a court ruled that a workers’ compensation carrier must reimburse a 55-year-old former mechanic for medical marijuana used to alleviate pain from a work-related back injury. The ruling circumvented the carrier from directly paying for an illegal drug.
Glennon delivered an overview of state legalization trends and the issues related to the use of medical marijuana in the treatment of injured workers. Colorado state risk manager Markie Davis also participated, sharing Colorado’s experience with legalized marijuana for both medical and recreational use and insights into the potential impact to the workplace.
Glennon identified potential risks for payers that do cover the use of medical marijuana for workers’ compensation cases. Although effects differ by individual and are dependent on use and dosage, they may include mental health issues, delays in return to work, diminished levels of productivity, and safety hazards, especially if users operate heavy machinery or drive vehicles.
The conflict between state and federal law will eventually need to be resolved, particularly for drug-free workplace and employment policies. In the meantime, organizations should stay abreast of new cases, judgments, and verdicts that could forecast further impact on policies ...
The Claims Journal reported that Glennon spoke on the panel, "Legalized Marijuana: Its Impact on the Workplace," for the 2015 Risk Management Society Conference held in New Orleans last week.
Among the challenges are the conflicts between state and federal laws, lack of evidence for the efficacy of medical marijuana, and risks posed to employee safety.medical marijuana
"In workers’ compensation, medical marijuana is predominantly requested to manage pain," noted Glennon. "However, payers rely on evidence-based guidelines when making coverage decisions. Without FDA approval or a large-scale randomized, controlled human trial to demonstrate medical value, many payers are choosing to categorically deny coverage of medical marijuana. It’s a catch-22: lack of evidence continues to hamper adoption, and yet clinical trials are not permitted under current federal law."
At the federal level, marijuana is categorized as an illegal substance, and it is not FDA approved to treat any medical condition. Despite these restrictions, in the 23 states and the District of Columbia where medical marijuana is now legal, it is recommended for many medical purposes.
In certain cases, court rulings could force carriers to cover medical marijuana for treatment. Glennon pointed to a New Mexico case, in which a court ruled that a workers’ compensation carrier must reimburse a 55-year-old former mechanic for medical marijuana used to alleviate pain from a work-related back injury. The ruling circumvented the carrier from directly paying for an illegal drug.
Glennon delivered an overview of state legalization trends and the issues related to the use of medical marijuana in the treatment of injured workers. Colorado state risk manager Markie Davis also participated, sharing Colorado’s experience with legalized marijuana for both medical and recreational use and insights into the potential impact to the workplace.
Glennon identified potential risks for payers that do cover the use of medical marijuana for workers’ compensation cases. Although effects differ by individual and are dependent on use and dosage, they may include mental health issues, delays in return to work, diminished levels of productivity, and safety hazards, especially if users operate heavy machinery or drive vehicles.
The conflict between state and federal law will eventually need to be resolved, particularly for drug-free workplace and employment policies. In the meantime, organizations should stay abreast of new cases, judgments, and verdicts that could forecast further impact on policies ...
Scientists in the UK and Sweden previously developed a new surgical technique to reconnect sensory neurons to the spinal cord after traumatic spinal injuries. Now, they have gained new insight into how the technique works at a cellular level by recreating it in rats with implications for designing new therapies for injuries where the spinal cord itself is severed.
The brain and the neurons (nerve cells) in the rest of our body are connected in the spine. Here, motor neurons, which control muscle movement, and sensory neurons, which relay sensory information such as pain, temperature and touch, connect with the spinal cord.
Where the neurons connect with the cord, motor neurons bundle together to form a structure called the motor root, while sensory neurons form a sensory root. In patients with traumatic injuries, these roots can be torn, causing areas of the body to lose neural control.
Surgeons can implant motor roots at the area from which they are torn, and they will usually successfully reconnect, as motor neurons can regrow out of the spinal cord and into the motor root. However, this does not apply to the more troublesome sensory root, which surgeons couldn’t reconnect properly until recently. "Doctors previously considered this type of spinal cord injury impossible to repair," says Nicholas James, a researcher at King’s College London. "These torn root injuries can cause serious disability and excruciating pain."
Happily, Thomas Carlstedt, also at King’s College London, recently helped to develop a new surgical technique to reconnect the sensory root. It involves cutting the original sensory nerve cells out of the root and implanting the remaining root directly into a deeper structure in the spinal cord. This area is called the dorsal horn, and it contains secondary sensory neurons that don’t normally directly connect to sensory roots. When the team tried the technique in patients, certain spinal reflexes returned, indicating that the implanted neuron had integrated with the spine to form a functional neural circuit.
In a new study recently published in Frontiers in Neurology, James, Carlstedt and other collaborators set out to understand how the implanted sensory root was connecting with the spinal cord in the dorsal horn. By understanding the mechanism, they hope to develop new treatments for patients with other types of spinal injuries.
The scientists used a rat model of spinal injury to study the process at a cellular level. During surgery, they produced a similar spinal injury in the rats and then reattached the sensory root using the new technique. At 12-16 weeks after surgery, the researchers assessed the spinal repair by passing electricity along the neurons to see if they formed a complete neural circuit. They then analyzed the neural tissue under a microscope.
The electrical tests showed that the neural circuit was complete, and that the root had successfully integrated with the spinal cord. When they examined the tissue, they found that small neural offshoots had grown from structures called dendrites (branched projections at the end of neurons) in the dorsal horn. These thin offshoots had extended all the way into the implanted sensory root to create a functional neural circuit.
So, what does this teach us about spinal cord repair? The researchers hope that this type of neural growth could also be used to repair other types of spinal cord injury. "The strategy of encouraging new growth from spinal neurons could potentially be of use in other injuries of the nervous system," says Carlstedt. For example, scientists could capitalize on this mechanism when designing new therapies for injuries where the spinal cord itself is severed, by implanting grafts that encourage or facilitate this type of nerve growth ...
The brain and the neurons (nerve cells) in the rest of our body are connected in the spine. Here, motor neurons, which control muscle movement, and sensory neurons, which relay sensory information such as pain, temperature and touch, connect with the spinal cord.
Where the neurons connect with the cord, motor neurons bundle together to form a structure called the motor root, while sensory neurons form a sensory root. In patients with traumatic injuries, these roots can be torn, causing areas of the body to lose neural control.
Surgeons can implant motor roots at the area from which they are torn, and they will usually successfully reconnect, as motor neurons can regrow out of the spinal cord and into the motor root. However, this does not apply to the more troublesome sensory root, which surgeons couldn’t reconnect properly until recently. "Doctors previously considered this type of spinal cord injury impossible to repair," says Nicholas James, a researcher at King’s College London. "These torn root injuries can cause serious disability and excruciating pain."
Happily, Thomas Carlstedt, also at King’s College London, recently helped to develop a new surgical technique to reconnect the sensory root. It involves cutting the original sensory nerve cells out of the root and implanting the remaining root directly into a deeper structure in the spinal cord. This area is called the dorsal horn, and it contains secondary sensory neurons that don’t normally directly connect to sensory roots. When the team tried the technique in patients, certain spinal reflexes returned, indicating that the implanted neuron had integrated with the spine to form a functional neural circuit.
In a new study recently published in Frontiers in Neurology, James, Carlstedt and other collaborators set out to understand how the implanted sensory root was connecting with the spinal cord in the dorsal horn. By understanding the mechanism, they hope to develop new treatments for patients with other types of spinal injuries.
The scientists used a rat model of spinal injury to study the process at a cellular level. During surgery, they produced a similar spinal injury in the rats and then reattached the sensory root using the new technique. At 12-16 weeks after surgery, the researchers assessed the spinal repair by passing electricity along the neurons to see if they formed a complete neural circuit. They then analyzed the neural tissue under a microscope.
The electrical tests showed that the neural circuit was complete, and that the root had successfully integrated with the spinal cord. When they examined the tissue, they found that small neural offshoots had grown from structures called dendrites (branched projections at the end of neurons) in the dorsal horn. These thin offshoots had extended all the way into the implanted sensory root to create a functional neural circuit.
So, what does this teach us about spinal cord repair? The researchers hope that this type of neural growth could also be used to repair other types of spinal cord injury. "The strategy of encouraging new growth from spinal neurons could potentially be of use in other injuries of the nervous system," says Carlstedt. For example, scientists could capitalize on this mechanism when designing new therapies for injuries where the spinal cord itself is severed, by implanting grafts that encourage or facilitate this type of nerve growth ...
The Labor Commissioner’s Office cited a Chula Vista restaurant more than $274,000 in back wages and penalties for multiple wage theft and labor law violations.
Dorantes Inc., doing business as La Querencia, was ordered to pay $164,688 to six workers who worked an average of nine hours per day, five days a week without breaks, and were paid on average less than $6 per hour.
La Querencia was also fined $110,150 in civil penalties, workers’ compensation penalties and wage statement penalties.
The Labor Commissioner’s Office launched a complaint-based investigation at the Mexican restaurant in January and found that the owner was under-reporting the number of workers employed there. The owner claimed only five employees, but investigators found 14 workers employed. Investigators in February cited La Querencia $21,000 for failing to carry adequate workers’ compensation insurance coverage. An audit of the restaurant revealed that La Querencia management denied six workers meal or rest breaks, and paid them a straight rate of $50 per day regardless of hours worked, for a period spanning June 2014 through February 2017.
The Labor Commissioner’s Office last month cited La Querencia $72,290 for minimum wage violations and penalties, $83,131 for liquidated damages, $1,735 for unpaid overtime wages, $3,077 for meal period violations, $3,234 for rest period violations, and $1,221 for waiting time penalties, all payable to the six affected workers. Additionally, the Labor Commissioner’s Office fined La Querencia $54,500 for wage statement violations and $34,650 in civil penalties for minimum and overtime wage violations.
When workers are paid less than minimum wage, they are entitled to liquidated damages that equal the amount of underpaid wages plus interest. Waiting time penalties are imposed when the employer fails to provide workers their final paycheck after separation. This penalty is calculated by taking the employee’s daily rate of pay and multiplying it by the number of days the employee was not paid, up to a maximum of 30 days. The civil penalties collected will be transferred to the State’s General Fund as required by law.
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.
"Honest business owners in California should not have to compete with businesses that skirt the law and deprive their workers of their hard-earned pay," said Labor Commissioner Julie A. Su.
...
Dorantes Inc., doing business as La Querencia, was ordered to pay $164,688 to six workers who worked an average of nine hours per day, five days a week without breaks, and were paid on average less than $6 per hour.
La Querencia was also fined $110,150 in civil penalties, workers’ compensation penalties and wage statement penalties.
The Labor Commissioner’s Office launched a complaint-based investigation at the Mexican restaurant in January and found that the owner was under-reporting the number of workers employed there. The owner claimed only five employees, but investigators found 14 workers employed. Investigators in February cited La Querencia $21,000 for failing to carry adequate workers’ compensation insurance coverage. An audit of the restaurant revealed that La Querencia management denied six workers meal or rest breaks, and paid them a straight rate of $50 per day regardless of hours worked, for a period spanning June 2014 through February 2017.
The Labor Commissioner’s Office last month cited La Querencia $72,290 for minimum wage violations and penalties, $83,131 for liquidated damages, $1,735 for unpaid overtime wages, $3,077 for meal period violations, $3,234 for rest period violations, and $1,221 for waiting time penalties, all payable to the six affected workers. Additionally, the Labor Commissioner’s Office fined La Querencia $54,500 for wage statement violations and $34,650 in civil penalties for minimum and overtime wage violations.
When workers are paid less than minimum wage, they are entitled to liquidated damages that equal the amount of underpaid wages plus interest. Waiting time penalties are imposed when the employer fails to provide workers their final paycheck after separation. This penalty is calculated by taking the employee’s daily rate of pay and multiplying it by the number of days the employee was not paid, up to a maximum of 30 days. The civil penalties collected will be transferred to the State’s General Fund as required by law.
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.
"Honest business owners in California should not have to compete with businesses that skirt the law and deprive their workers of their hard-earned pay," said Labor Commissioner Julie A. Su.
...
Reuters reports that specialty pharmacy firm US Bioservices Corp has agreed to pay $13.4 million to settle U.S. government claims that it pushed patients to refill prescriptions of Novartis AG's iron overload drug Exjade in exchange for referrals from the Swiss drugmaker.
US Bioservices, a unit of drug wholesaler AmerisourceBergen, agreed to pay $10.6 million to the federal government and $2.8 million to states, according to a filing on Tuesday in Manhattan federal court by Acting U.S. Attorney Joon Kim.
The deal, which must be approved by the court, would resolve a civil lawsuit filed by Kim earlier on Tuesday claiming that U.S. federal and state insurance programs were illegally billed for Exjade prescriptions that stemmed from kickbacks.
AmerisourceBergen said in a previous filing with U.S. securities regulators that it was not admitting wrongdoing as part of the settlement.
According to the lawsuit, from August 2010 to March 2012, US Bioservices encouraged patients to refill Exjade prescriptions by having its nurses call them with "one-sided advice," emphasizing the dangers of not treating iron overload and downplaying the drug's side effects.
Exjade had been linked to severe side effects including kidney and liver failure and gastrointestinal bleeding, which have resulted in deaths, according to the lawsuit.
US Bioservices also assigned a group of employees known as patient care coordinators to call patients and urge them to refill their prescriptions, the lawsuit said.
US Bioservices competed with two other pharmacy companies that distributed the drug - BioScrip Inc and Express Scripts unit Accredo Health Group Inc - for patient referrals from Novartis. Novartis would dole out the referrals according to how many refills each pharmacy achieved, according to the lawsuit.
As a result of the scheme, the government-run Medicare and Medicaid programs were billed for prescriptions "tainted" by kickbacks, violating federal law, according to the lawsuit.
Novartispreviously settled claims that it paid kickbacks to promote Exjade and other drugs for $390 million in 2015. BioScrip and Accredo also previously settled claims, collectively paying $75 million.
The case is United States v. US Bioservices Corp, U.S. District Court, Southern District of New York, No. 17-cv-06353 ...
US Bioservices, a unit of drug wholesaler AmerisourceBergen, agreed to pay $10.6 million to the federal government and $2.8 million to states, according to a filing on Tuesday in Manhattan federal court by Acting U.S. Attorney Joon Kim.
The deal, which must be approved by the court, would resolve a civil lawsuit filed by Kim earlier on Tuesday claiming that U.S. federal and state insurance programs were illegally billed for Exjade prescriptions that stemmed from kickbacks.
AmerisourceBergen said in a previous filing with U.S. securities regulators that it was not admitting wrongdoing as part of the settlement.
According to the lawsuit, from August 2010 to March 2012, US Bioservices encouraged patients to refill Exjade prescriptions by having its nurses call them with "one-sided advice," emphasizing the dangers of not treating iron overload and downplaying the drug's side effects.
Exjade had been linked to severe side effects including kidney and liver failure and gastrointestinal bleeding, which have resulted in deaths, according to the lawsuit.
US Bioservices also assigned a group of employees known as patient care coordinators to call patients and urge them to refill their prescriptions, the lawsuit said.
US Bioservices competed with two other pharmacy companies that distributed the drug - BioScrip Inc and Express Scripts unit Accredo Health Group Inc - for patient referrals from Novartis. Novartis would dole out the referrals according to how many refills each pharmacy achieved, according to the lawsuit.
As a result of the scheme, the government-run Medicare and Medicaid programs were billed for prescriptions "tainted" by kickbacks, violating federal law, according to the lawsuit.
Novartispreviously settled claims that it paid kickbacks to promote Exjade and other drugs for $390 million in 2015. BioScrip and Accredo also previously settled claims, collectively paying $75 million.
The case is United States v. US Bioservices Corp, U.S. District Court, Southern District of New York, No. 17-cv-06353 ...
Weak patient admissions that plagued U.S. hospital operators in the June quarter are likely to persist through 2018, as patients fret about soaring out-of-pocket costs and the future of Obamacare remains uncertain. Companies including HCA Healthcare Inc, the largest for-profit hospital operator, and Tenet Healthcare Corp have reported dismal quarterly results and cut their forecasts for the year.
According to the report in Reuters Health, high-deductible health plans - which shift initial medical costs to patients, but have lower monthly premiums - are becoming popular, resulting in patients pushing back non-emergency surgeries.
Tenet saw weakness in elective procedures including orthopedics, Eric Evans, the company's president of hospital operations, said earlier this month. "That does play into the story of deductibles rising and changing behaviors."
Also, HCA, Tenet, and rivals such as Community Health Systems Inc enjoyed a surge in admissions in 2014 and 2015, thanks to the Affordable Care Act, popularly known as Obamacare. But with big insurers reducing exposure to the program since last year, results for hospital operators are suffering in comparison, analysts said.
HCA is expected to grow at a compound annual rate (CAGR) of 4.8 percent through this year and the next, down from 6.7 percent growth over the last three years. Tenet's CAGR is expected to plunge to 0.2 percent from 21 percent.
"I think the seasonality is changing, somewhat, where the fourth quarter is really shaping up to be the biggest quarter because of all the people deferring things until their co-pays are deductible," said J.P. Morgan analyst Gary Taylor.
High-deductible plans have been around for over a decade but have become more popular as wage rises fail to keep up with rising medical costs, said Bret Schroeder, healthcare expert at PA Consulting Group. Participation in high-deductible plans in the five years through January 2016 has risen about 76 percent, according to lobby group America's Health Insurance Plans.
While this has been a problem for all hospital operators, HCA, with its well-capitalized balance sheet and strong cash flow, is best positioned to weather the storm, analysts said. But for Tenet and Community Health, these problems add to piles of debt, which they have been trying to repay by selling assets ...
According to the report in Reuters Health, high-deductible health plans - which shift initial medical costs to patients, but have lower monthly premiums - are becoming popular, resulting in patients pushing back non-emergency surgeries.
Tenet saw weakness in elective procedures including orthopedics, Eric Evans, the company's president of hospital operations, said earlier this month. "That does play into the story of deductibles rising and changing behaviors."
Also, HCA, Tenet, and rivals such as Community Health Systems Inc enjoyed a surge in admissions in 2014 and 2015, thanks to the Affordable Care Act, popularly known as Obamacare. But with big insurers reducing exposure to the program since last year, results for hospital operators are suffering in comparison, analysts said.
HCA is expected to grow at a compound annual rate (CAGR) of 4.8 percent through this year and the next, down from 6.7 percent growth over the last three years. Tenet's CAGR is expected to plunge to 0.2 percent from 21 percent.
"I think the seasonality is changing, somewhat, where the fourth quarter is really shaping up to be the biggest quarter because of all the people deferring things until their co-pays are deductible," said J.P. Morgan analyst Gary Taylor.
High-deductible plans have been around for over a decade but have become more popular as wage rises fail to keep up with rising medical costs, said Bret Schroeder, healthcare expert at PA Consulting Group. Participation in high-deductible plans in the five years through January 2016 has risen about 76 percent, according to lobby group America's Health Insurance Plans.
While this has been a problem for all hospital operators, HCA, with its well-capitalized balance sheet and strong cash flow, is best positioned to weather the storm, analysts said. But for Tenet and Community Health, these problems add to piles of debt, which they have been trying to repay by selling assets ...
August is the final month of the California legislative session for the year. Over the last several years several bills passed during the final months, and some even arrived, sometimes by surprise, during this last month. Indeed, SB 863 and its sweeping changes was introduced, passed and signed by the Governor all in the last week of the 2012 legislative session.
This year, AB 570 seems to be the only substantial workers' compensation related proposed law on the horizon, at least as known to the industry pundits at this time.
AB 570 in the broad analysis is an attempted rollback of permanent disability apportionment rules. The purpose of the bill is to eliminate elements of what the author believes is gender bias in the workers' compensation system. According to the author, women can receive disproportionately low compensation amounts for work-related permanent disability because of the gender-specific conditions of pregnancy and childbirth. The author points to specific examples where the evaluating physician has pointed to pre-existing conditions that have involved pregnancy or childbirth in apportioning the causation of subsequent industrial injuries, and argues that this constitutes an inappropriate discrimination, since male injured workers can never have their disability apportioned in this manner.
This bill would prohibit apportionment in the case of a physical injury occurring on or after January 1, 2018, based on pregnancy, childbirth, or other medical conditions related to pregnancy or childbirth. It is similar to AB 1643 (Gonzalez) of 2016 which would have prohibited apportionment in cases of physical injury based on pregnancy, menopause, osteoporosis, and carpal tunnel syndrome. AB 1643 passed the legislature last year but was vetoed by the Governor.
According to the legislative analysis "This issue has been presented to, and debated in, the Legislature in one form or another for at least eight years, and there is a paucity of concrete evidence, either academic or anecdotal, to show that there is pervasive discrimination based on gender, or other protected classes. Proponents cite several examples of cases where women are alleged to have suffered unfair treatment by the system. In these examples it is claimed that the evaluating physician has pointed to the offending apportionment factor. Despite requests for any information indicating that workers' compensation judges have accepted these apportionment factors, proponents have been unable to do so."
Unlike previous bills on this subject, AB 570 expressly adds language that brings in other medical conditions that are related to the gender-based condition. Thus, the bill appears to expressly prohibit apportionment not merely to pregnancy or childbirth, but to any other medical condition that pre-dates the industrial injury if that prior condition can be shown to have been related to a pregnancy or child birth. For example, if a pregnancy causes back problems, and those back problems persist as a chronic problem, the bill appears to preclude using that pre-existing condition as a basis to apportion a subsequent industrial back injury. Opponents are concerned about the scope of this provision, and the amount of litigation it would create. They also note the underlying principle that employers should pay for what the job caused, but not pre-existing conditions.
It is likely that if this bill is passed by the legislature, it will be vetoed by the Governor as he has done in the past. Thus, the concept as a bill is alive in it's eighth year, but certainly not well ...
This year, AB 570 seems to be the only substantial workers' compensation related proposed law on the horizon, at least as known to the industry pundits at this time.
AB 570 in the broad analysis is an attempted rollback of permanent disability apportionment rules. The purpose of the bill is to eliminate elements of what the author believes is gender bias in the workers' compensation system. According to the author, women can receive disproportionately low compensation amounts for work-related permanent disability because of the gender-specific conditions of pregnancy and childbirth. The author points to specific examples where the evaluating physician has pointed to pre-existing conditions that have involved pregnancy or childbirth in apportioning the causation of subsequent industrial injuries, and argues that this constitutes an inappropriate discrimination, since male injured workers can never have their disability apportioned in this manner.
This bill would prohibit apportionment in the case of a physical injury occurring on or after January 1, 2018, based on pregnancy, childbirth, or other medical conditions related to pregnancy or childbirth. It is similar to AB 1643 (Gonzalez) of 2016 which would have prohibited apportionment in cases of physical injury based on pregnancy, menopause, osteoporosis, and carpal tunnel syndrome. AB 1643 passed the legislature last year but was vetoed by the Governor.
According to the legislative analysis "This issue has been presented to, and debated in, the Legislature in one form or another for at least eight years, and there is a paucity of concrete evidence, either academic or anecdotal, to show that there is pervasive discrimination based on gender, or other protected classes. Proponents cite several examples of cases where women are alleged to have suffered unfair treatment by the system. In these examples it is claimed that the evaluating physician has pointed to the offending apportionment factor. Despite requests for any information indicating that workers' compensation judges have accepted these apportionment factors, proponents have been unable to do so."
Unlike previous bills on this subject, AB 570 expressly adds language that brings in other medical conditions that are related to the gender-based condition. Thus, the bill appears to expressly prohibit apportionment not merely to pregnancy or childbirth, but to any other medical condition that pre-dates the industrial injury if that prior condition can be shown to have been related to a pregnancy or child birth. For example, if a pregnancy causes back problems, and those back problems persist as a chronic problem, the bill appears to preclude using that pre-existing condition as a basis to apportion a subsequent industrial back injury. Opponents are concerned about the scope of this provision, and the amount of litigation it would create. They also note the underlying principle that employers should pay for what the job caused, but not pre-existing conditions.
It is likely that if this bill is passed by the legislature, it will be vetoed by the Governor as he has done in the past. Thus, the concept as a bill is alive in it's eighth year, but certainly not well ...
Thomas S. Powers M.D. - a physician at Open Care Medical Clinic in Santa Ana, who claimed to specialize in anti-aging and preventive medicine, cosmetic medicine, stress management, pain management, addiction recovery, weight management and regenerative medicine - was accused of poor record keeping by the medical board eight years ago.
In a newer case filed last October, the board accused Powers of prescribing himself pain medication and more sloppy record keeping that led to him overprescribing medications to four patients, including the one who passed away.
By April 5 2017, Powers and his attorney John D. Martin signed off on the medical board's license probation order due to what they acknowledged was "gross negligence" and "repeated negligence" in the treatment of four patients, overprescribing them powerful medications, failing to keep adequate records of the prescriptions he wrote them and prescribing himself the muscle relaxer carisoprodol and suboxone, a highly addictive substance that is nonetheless used to treat substance abuse addiction. One of those patients died.
During the 2017 probation imposed for the new offense, the Medical Board records said that Powers "shall not order, prescribe, dispense, administer, furnish, or possess any controlled substances listed in Schedules II and III, except anabolic steroids; and is prohibited from supervising physician assistants and advanced practice nurses," the Medical Board added that failure to adhere by those conditions could lead to license revocation proceedings.
Powers did not last long on his newly imposed probation.
Kimberly Kirchmeyer, the Medical Board’s executive director, reported his probation violations in the new August 18, 2017 Cease Practice Order saying that "The Respondent has failed to comply with Condition No. 3, Controlled Substances - Abstain From Use, by testing positive for marijuana on July 30, 2017, and Aug. 6, 2017, and failing to check in daily for 10 days,
Accordingly Powers is now prohibited from engaging in the practice of medicine. It will be up to the board to decide if and when Powers can resume a medical practice in California.
United States Attorney General Jeff Sessions announced in July that Powers was among 13 others in Southern California and more than 400 defendants nationwide charged in federal court in Los Angeles with being part of the largest health-care fraud operation ever undertaken, with false billings totaling about $1.3 billion.
Federal prosecutors specifically alleged that Powers authorized prescriptions for patients he never examined, receiving payments from another defendant, Newport Beach resident Anthony Paduano, who allegedly got about $1.2 million for referring the prescriptions to a local pharmacy that billed more than $4.8 million to TRICARE, the healthcare system for military personnel and other Department of Defense employees ...
In a newer case filed last October, the board accused Powers of prescribing himself pain medication and more sloppy record keeping that led to him overprescribing medications to four patients, including the one who passed away.
By April 5 2017, Powers and his attorney John D. Martin signed off on the medical board's license probation order due to what they acknowledged was "gross negligence" and "repeated negligence" in the treatment of four patients, overprescribing them powerful medications, failing to keep adequate records of the prescriptions he wrote them and prescribing himself the muscle relaxer carisoprodol and suboxone, a highly addictive substance that is nonetheless used to treat substance abuse addiction. One of those patients died.
During the 2017 probation imposed for the new offense, the Medical Board records said that Powers "shall not order, prescribe, dispense, administer, furnish, or possess any controlled substances listed in Schedules II and III, except anabolic steroids; and is prohibited from supervising physician assistants and advanced practice nurses," the Medical Board added that failure to adhere by those conditions could lead to license revocation proceedings.
Powers did not last long on his newly imposed probation.
Kimberly Kirchmeyer, the Medical Board’s executive director, reported his probation violations in the new August 18, 2017 Cease Practice Order saying that "The Respondent has failed to comply with Condition No. 3, Controlled Substances - Abstain From Use, by testing positive for marijuana on July 30, 2017, and Aug. 6, 2017, and failing to check in daily for 10 days,
Accordingly Powers is now prohibited from engaging in the practice of medicine. It will be up to the board to decide if and when Powers can resume a medical practice in California.
United States Attorney General Jeff Sessions announced in July that Powers was among 13 others in Southern California and more than 400 defendants nationwide charged in federal court in Los Angeles with being part of the largest health-care fraud operation ever undertaken, with false billings totaling about $1.3 billion.
Federal prosecutors specifically alleged that Powers authorized prescriptions for patients he never examined, receiving payments from another defendant, Newport Beach resident Anthony Paduano, who allegedly got about $1.2 million for referring the prescriptions to a local pharmacy that billed more than $4.8 million to TRICARE, the healthcare system for military personnel and other Department of Defense employees ...
A Fresno County Superior Court judge has dismissed a wrongful death lawsuit filed by the family of a Fresno paramedic who was killed in an air ambulance helicopter crash in December 2015. The ruling was based upon the application of the exclusive remedy provisions of the workers' compensation law.
Brooke Juarez, and her children sued Rogers Helicopters and American Airborne, claiming they were negligent in the maintenance and operation of the Bell 407 aircraft that crashed in a field nine miles east of McFarland in Kern County resulting in the death of her husband, paramedic Kyle Juarez. At the time, the SkyLife Air Ambulance Bell 407 helicopter was carrying a patient from Porterville to Bakersfield on a routine transportation mission.
Kyle Juarez was a flight and ground paramedic and nine-year veteran of American Ambulance. He spent the last three years on the Skylife team.
Defendants Rogers Helicopters, lnc. , ROAM, and American Airborne, EMS moved for summary judgment on the ground that workers compensation exclusivity precludes plaintiffs' actions against them, as decedent Kyle Juarez's joint employers.
The decision recited the history of the joint employers. In 1991 American Airborne entered into a general partnership with defendant Rogers to form ROAM dba SkyLife ("ROAM/SkyLife"). The helicopters used in this partnership were jointly owned by and registered to Rogers and American Airborne. Rogers provided aircraft operations, and American Airborne/Ambulance provided medical support services.
The ROAM/SkyLife Standard Operating Procedures manual includes many provisions indicating a level of control by the partnership over workers such as Mr. Juarez. This includes requirements relating to clothing/uniforms on the job, grooming, weight limits, where and when employees will work, scheduling, and required certification.
Juarez attended monthly safety meetings and mandatory quarterly staff meetings, along with pre-flight briefings and post-flight de-briefings. Juarez wore a ROAM/SkyLife uniform and participated in decisions whether to undertake each flight, and in the cleaning of the aircraft.
Juarez was not paid directly by ROAM/SkyLife, but ROAM/SkyLife indirectly paid his wages and benefits when invoiced by American Ambulance. He; was a skilled worker with substantial control over the details of his work, though he was supervised by American Ambulance personnel, effectively a ROAM/SkyLife partner, with regards to the provision of medical care.
An employee may have more than one employer for purposes of Workers compensation, and, in situations of dual employers, the second or "special" employer may enjoy the same immunity from a common law negligence action on account of an industrial injury as does the first or "general" employer. (Santa Cruz Poultry, Inc. v. Superior Court (1987) 194 Cal.App.3d 575, 578.)
Joint employment occurs when two or more persons engage the services of an employee in an enterprise In which the employee is subject to the control of both. (In-Home Supportive Services v. Workers' Comp. Appeals Bd. (1984) i52 Cal. App. 3d 720, 732.) Once a special employment relationship is identified, the special employer' is liable for workers compensation coverage, and that employer Is immune from a common law tort action.
The court found that the undisputed facts demonstrate that American Ambulance was the general employer of Juarez, and that ROAM/SkyLife Was his special employer. Because Juarez’s death occurred during the course and scope of his employment, the court ruled that his family’s legal remedy is through the workers’ compensation system, which, by law, precludes them from suing the defendants.
Also killed in the Dec. 10 2014 crash was pilot Thomas Hampl, 49, of Bend, Ore., an employee of Rogers Helicopters; critical care nurse Marco Lopez, 42, of Hanford, a three-year SkyLife veteran; and the patient, Kathryn Ann Brown, 40, of Springville, who was employed as a substitute school teacher.
The cause of the crash is being investigated by the National Transportation Safety Board. The NTSB has not yet issue a report of its findings ...
Brooke Juarez, and her children sued Rogers Helicopters and American Airborne, claiming they were negligent in the maintenance and operation of the Bell 407 aircraft that crashed in a field nine miles east of McFarland in Kern County resulting in the death of her husband, paramedic Kyle Juarez. At the time, the SkyLife Air Ambulance Bell 407 helicopter was carrying a patient from Porterville to Bakersfield on a routine transportation mission.
Kyle Juarez was a flight and ground paramedic and nine-year veteran of American Ambulance. He spent the last three years on the Skylife team.
Defendants Rogers Helicopters, lnc. , ROAM, and American Airborne, EMS moved for summary judgment on the ground that workers compensation exclusivity precludes plaintiffs' actions against them, as decedent Kyle Juarez's joint employers.
The decision recited the history of the joint employers. In 1991 American Airborne entered into a general partnership with defendant Rogers to form ROAM dba SkyLife ("ROAM/SkyLife"). The helicopters used in this partnership were jointly owned by and registered to Rogers and American Airborne. Rogers provided aircraft operations, and American Airborne/Ambulance provided medical support services.
The ROAM/SkyLife Standard Operating Procedures manual includes many provisions indicating a level of control by the partnership over workers such as Mr. Juarez. This includes requirements relating to clothing/uniforms on the job, grooming, weight limits, where and when employees will work, scheduling, and required certification.
Juarez attended monthly safety meetings and mandatory quarterly staff meetings, along with pre-flight briefings and post-flight de-briefings. Juarez wore a ROAM/SkyLife uniform and participated in decisions whether to undertake each flight, and in the cleaning of the aircraft.
Juarez was not paid directly by ROAM/SkyLife, but ROAM/SkyLife indirectly paid his wages and benefits when invoiced by American Ambulance. He; was a skilled worker with substantial control over the details of his work, though he was supervised by American Ambulance personnel, effectively a ROAM/SkyLife partner, with regards to the provision of medical care.
An employee may have more than one employer for purposes of Workers compensation, and, in situations of dual employers, the second or "special" employer may enjoy the same immunity from a common law negligence action on account of an industrial injury as does the first or "general" employer. (Santa Cruz Poultry, Inc. v. Superior Court (1987) 194 Cal.App.3d 575, 578.)
Joint employment occurs when two or more persons engage the services of an employee in an enterprise In which the employee is subject to the control of both. (In-Home Supportive Services v. Workers' Comp. Appeals Bd. (1984) i52 Cal. App. 3d 720, 732.) Once a special employment relationship is identified, the special employer' is liable for workers compensation coverage, and that employer Is immune from a common law tort action.
The court found that the undisputed facts demonstrate that American Ambulance was the general employer of Juarez, and that ROAM/SkyLife Was his special employer. Because Juarez’s death occurred during the course and scope of his employment, the court ruled that his family’s legal remedy is through the workers’ compensation system, which, by law, precludes them from suing the defendants.
Also killed in the Dec. 10 2014 crash was pilot Thomas Hampl, 49, of Bend, Ore., an employee of Rogers Helicopters; critical care nurse Marco Lopez, 42, of Hanford, a three-year SkyLife veteran; and the patient, Kathryn Ann Brown, 40, of Springville, who was employed as a substitute school teacher.
The cause of the crash is being investigated by the National Transportation Safety Board. The NTSB has not yet issue a report of its findings ...
According to court records filed in San Diego by federal authorities, a small pharmacy in Utah and a doctor’s office in Tennessee have been implicated in an alleged kickback scheme that used San Diego County Marines to defraud the military’s health insurance provider out of at least $67 million.
The story published in the San Diego Tribune claims the allegations add to a growing number of investigations into fraudulent prescriptions of compound medications - high-priced drugs custom-made by pharmacists to tailor to a patient’s specific needs. The investigations have led to arrests in similar cases across the country and a change in how TRICARE - which serves 9.4 million active, retired and reserve military and their families - pays for such drugs.
In just the first four months of 2015, the costs of claims to TRICARE for compounded drugs surged to more than $1 billion, according to the insurer. Federal investigators say in court documents that a chunk of those claims came from a pharmacy in Bountiful, Utah, that was issuing prescriptions to patients in Southern California.
No arrests have been made in the San Diego-based investigation, which is ongoing. But federal authorities described their investigation in a sealed search warrant affidavit filed in March that was obtained by The San Diego Union-Tribune and a complaint filed publicly by the U.S. Attorney’s Office as part of a civil asset forfeiture case against a Tennessee couple.
The pharmacy at the center of the probe was formerly known as The Medicine Shoppe, a franchise opened by noted compound pharmacist Kort Delost in 1993. The former president of the Utah Pharmacist Association and Young Pharmacist of the Year for Utah sold the business in 2014 to two people, who are identified in court documents only by the initials T.S. and W.W.
The pharmacy, in the town just north of Salt Lake City, had a license to ship medications to California, according to the complaint.
The vast majority of the prescriptions were authorized by emergency room physicians who served as medical directors for Choice MD, a medical practice in Cleveland, Tenn., owned by Jimmy and Ashley Collins, the court documents allege. The practice offers everything from primary care to therapeutic massage to Botox, according to its website. The physicians are not named and only referred to by their initials, S.V. and C.L. One of the doctors also signed off on prescriptions written by a nurse practitioner, the complaint states.
Authorities say The Medicine Shoppe billed TRICARE for 2,721 compound prescriptions authorized by S.V. from December 2014 to May 9, 2015, resulting in more than $47 million in reimbursements. During the same period, the doctor wrote three non-compounded prescriptions for TRICARE patients.
Investigators say the specialized drugs went to a network of Southern California Marines who were recruited by fellow Marines to participate in a medical study. The Marines were paid $100 to $300 a month to talk to the doctors over the phone in a telemedicine exam, the affidavit states. TRICARE allows telemedicine consultations, but they must be held in places such as a doctor’s office, not at home.
Investigators tracked some $45 million linked to The Medicine Shoppe that moved around in bank accounts owned by the Collinses and several entities in their control, including $4.4 million allegedly paid to unnamed recruiters during the first half of 2015, the affidavit states.
Prosecutors allege the Collinses laundered the illegal proceeds by buying four properties in Tennessee, including a farm and a shopping center called Colony Square, for a total of nearly $5.7 million.
In a motion asking a San Diego judge to dismiss the forfeiture, lawyers for the Collinses complained that the details of the allegations were sealed, making it difficult for them to respond to the claims of wrongdoing. The judge ordered the government to file the allegations publicly, which prosecutors did last week.
In the motion to dismiss, the lawyers also denied their clients were involved in any kind of healthcare fraud.
In mid-2015, The Medicine Shoppe changed its name to Prescriptions Plus Pharmacy. A photo on the pharmacy’s Facebook page shows workers changing out the sign on the building front, with the announcement: "New name, same great people! Beginning a new chapter."
The pharmacy changed hands again in October 2016 and has been renamed Bountiful Drug, recapturing the pharmacy’s original name when it opened in 1910.
The new owner, pharmacist Mary Rogers, said Friday the business is "not associated" with the old owners and that she was not permitted to discuss the investigation.
...
The story published in the San Diego Tribune claims the allegations add to a growing number of investigations into fraudulent prescriptions of compound medications - high-priced drugs custom-made by pharmacists to tailor to a patient’s specific needs. The investigations have led to arrests in similar cases across the country and a change in how TRICARE - which serves 9.4 million active, retired and reserve military and their families - pays for such drugs.
In just the first four months of 2015, the costs of claims to TRICARE for compounded drugs surged to more than $1 billion, according to the insurer. Federal investigators say in court documents that a chunk of those claims came from a pharmacy in Bountiful, Utah, that was issuing prescriptions to patients in Southern California.
No arrests have been made in the San Diego-based investigation, which is ongoing. But federal authorities described their investigation in a sealed search warrant affidavit filed in March that was obtained by The San Diego Union-Tribune and a complaint filed publicly by the U.S. Attorney’s Office as part of a civil asset forfeiture case against a Tennessee couple.
The pharmacy at the center of the probe was formerly known as The Medicine Shoppe, a franchise opened by noted compound pharmacist Kort Delost in 1993. The former president of the Utah Pharmacist Association and Young Pharmacist of the Year for Utah sold the business in 2014 to two people, who are identified in court documents only by the initials T.S. and W.W.
The pharmacy, in the town just north of Salt Lake City, had a license to ship medications to California, according to the complaint.
The vast majority of the prescriptions were authorized by emergency room physicians who served as medical directors for Choice MD, a medical practice in Cleveland, Tenn., owned by Jimmy and Ashley Collins, the court documents allege. The practice offers everything from primary care to therapeutic massage to Botox, according to its website. The physicians are not named and only referred to by their initials, S.V. and C.L. One of the doctors also signed off on prescriptions written by a nurse practitioner, the complaint states.
Authorities say The Medicine Shoppe billed TRICARE for 2,721 compound prescriptions authorized by S.V. from December 2014 to May 9, 2015, resulting in more than $47 million in reimbursements. During the same period, the doctor wrote three non-compounded prescriptions for TRICARE patients.
Investigators say the specialized drugs went to a network of Southern California Marines who were recruited by fellow Marines to participate in a medical study. The Marines were paid $100 to $300 a month to talk to the doctors over the phone in a telemedicine exam, the affidavit states. TRICARE allows telemedicine consultations, but they must be held in places such as a doctor’s office, not at home.
Investigators tracked some $45 million linked to The Medicine Shoppe that moved around in bank accounts owned by the Collinses and several entities in their control, including $4.4 million allegedly paid to unnamed recruiters during the first half of 2015, the affidavit states.
Prosecutors allege the Collinses laundered the illegal proceeds by buying four properties in Tennessee, including a farm and a shopping center called Colony Square, for a total of nearly $5.7 million.
In a motion asking a San Diego judge to dismiss the forfeiture, lawyers for the Collinses complained that the details of the allegations were sealed, making it difficult for them to respond to the claims of wrongdoing. The judge ordered the government to file the allegations publicly, which prosecutors did last week.
In the motion to dismiss, the lawyers also denied their clients were involved in any kind of healthcare fraud.
In mid-2015, The Medicine Shoppe changed its name to Prescriptions Plus Pharmacy. A photo on the pharmacy’s Facebook page shows workers changing out the sign on the building front, with the announcement: "New name, same great people! Beginning a new chapter."
The pharmacy changed hands again in October 2016 and has been renamed Bountiful Drug, recapturing the pharmacy’s original name when it opened in 1910.
The new owner, pharmacist Mary Rogers, said Friday the business is "not associated" with the old owners and that she was not permitted to discuss the investigation.
...
South Carolina sued Purdue Pharma becoming the latest state or local government to accuse the OxyContin maker of deceptive marketing practices that have contributed to a national opioid addiction epidemic.
According to CNBC News, the lawsuit by South Carolina Attorney General Alan Wilson, filed in Richland County Court of Common Pleas in Columbia, accuses the company of the unfair and deceptive marketing of opioid painkillers.
Wilson claimed Purdue has told doctors that patients who receive prescriptions for opioids generally will not become addicted and those who appeared to be were only "pseudoaddicted" and needed more of the drugs.
Since a 2007 settlement with South Carolina, Purdue has continued to downplay the addictiveness of its opioid products and overstated the benefits compared to other pain management treatments, according to the lawsuit.
Stamford, Connecticut-based Purdue has denied similar allegations and said it shares the concerns of public officials about the opioid crisis, and is committed to finding solutions.
Purdue and other drugmakers have been sued over opioid products by Oklahoma, Mississippi, Ohio, Missouri and New Hampshire as well as cities and counties in California, Illinois, Ohio, Oregon, Tennessee and New York.
A group of state attorneys general in June announced an investigation into the role played by pharmaceutical manufacturers in the opioid epidemic.
Purdue and three executives pleaded guilty in 2007 to federal charges related to the misbranding of OxyContin, which is used to relieve pain, and agreed to pay a total of $634.5 million to resolve a U.S. Justice Department probe.
That year, the privately held company also reached a $19.5 million settlement with 26 states including South Carolina as well as the District of Columbia. It agreed in 2015 to pay $24 million to resolve a lawsuit by Kentucky.
In Tuesday's lawsuit, South Carolina claimed that since the 2007 settlement, Purdue has continued to engage in misleading opioid marketing practices rather than reforming them to conform with the law ...
According to CNBC News, the lawsuit by South Carolina Attorney General Alan Wilson, filed in Richland County Court of Common Pleas in Columbia, accuses the company of the unfair and deceptive marketing of opioid painkillers.
Wilson claimed Purdue has told doctors that patients who receive prescriptions for opioids generally will not become addicted and those who appeared to be were only "pseudoaddicted" and needed more of the drugs.
Since a 2007 settlement with South Carolina, Purdue has continued to downplay the addictiveness of its opioid products and overstated the benefits compared to other pain management treatments, according to the lawsuit.
Stamford, Connecticut-based Purdue has denied similar allegations and said it shares the concerns of public officials about the opioid crisis, and is committed to finding solutions.
Purdue and other drugmakers have been sued over opioid products by Oklahoma, Mississippi, Ohio, Missouri and New Hampshire as well as cities and counties in California, Illinois, Ohio, Oregon, Tennessee and New York.
A group of state attorneys general in June announced an investigation into the role played by pharmaceutical manufacturers in the opioid epidemic.
Purdue and three executives pleaded guilty in 2007 to federal charges related to the misbranding of OxyContin, which is used to relieve pain, and agreed to pay a total of $634.5 million to resolve a U.S. Justice Department probe.
That year, the privately held company also reached a $19.5 million settlement with 26 states including South Carolina as well as the District of Columbia. It agreed in 2015 to pay $24 million to resolve a lawsuit by Kentucky.
In Tuesday's lawsuit, South Carolina claimed that since the 2007 settlement, Purdue has continued to engage in misleading opioid marketing practices rather than reforming them to conform with the law ...
Mylan has finalized a $465 million settlement with the U.S. Justice Department, resolving claims it overcharged the government for its EpiPen emergency allergy treatment, which became the center of a firestorm over price increases.
Reuters reports that the U.S. Attorney's Office in Massachusetts revealed the accord 10 months after Mylan said it reached a deal resolving claims it misclassified the EpiPen as a generic rather than a branded product, underpaying rebates to state Medicaid programs as a result.
The investigation followed a whistleblower lawsuit filed under the False Claims Act that rival drugmaker Sanofi filed in 2016, two years after it first raised the matter with investigators.
As a result of the settlement, Sanofi will receive $38.7 million as a reward, authorities said.
"Bringing closure to this matter is the right course of action for Mylan and our stakeholders to allow us to move forward," Mylan Chief Executive Heather Bresch said in a statement.
Mylan shares gained 1 percent to $30.76 on the Nasdaq.
Sanofi did not immediately respond to a request for comment.
The EpiPen, which Mylan acquired in 2007, is a handheld device that treats life-threatening allergic reactions by automatically injecting a dose of epinephrine.
Mylan came under fire last year after raising the price of a pair of EpiPens to $600, from $100 in 2008, and listing it with Medicaid as a generic product even though it is listed with the U.S. Food and Drug Administration as a branded one.
The price increase enraged consumers and put the drugmaker at the center of the ongoing debate over the high cost of prescription medicines in the United States.
Mylan has since offered its own generic version for about $300 in response to the furor.
The Justice Department settlement centered on claims that Mylan misclassified the EpiPen as a generic product, which under Medicaid does not require the same level of rebates as brand-name products.
The $465-million settlement has previously come under attack by members of Congress in both parties who have called it too small.
An analysis by the U.S. Department of Health and Human Services' Office of Inspector General released in May found the U.S. government may have overpaid for EpiPens by as much as $1.27 billion between 2006 and 2016 ...
Reuters reports that the U.S. Attorney's Office in Massachusetts revealed the accord 10 months after Mylan said it reached a deal resolving claims it misclassified the EpiPen as a generic rather than a branded product, underpaying rebates to state Medicaid programs as a result.
The investigation followed a whistleblower lawsuit filed under the False Claims Act that rival drugmaker Sanofi filed in 2016, two years after it first raised the matter with investigators.
As a result of the settlement, Sanofi will receive $38.7 million as a reward, authorities said.
"Bringing closure to this matter is the right course of action for Mylan and our stakeholders to allow us to move forward," Mylan Chief Executive Heather Bresch said in a statement.
Mylan shares gained 1 percent to $30.76 on the Nasdaq.
Sanofi did not immediately respond to a request for comment.
The EpiPen, which Mylan acquired in 2007, is a handheld device that treats life-threatening allergic reactions by automatically injecting a dose of epinephrine.
Mylan came under fire last year after raising the price of a pair of EpiPens to $600, from $100 in 2008, and listing it with Medicaid as a generic product even though it is listed with the U.S. Food and Drug Administration as a branded one.
The price increase enraged consumers and put the drugmaker at the center of the ongoing debate over the high cost of prescription medicines in the United States.
Mylan has since offered its own generic version for about $300 in response to the furor.
The Justice Department settlement centered on claims that Mylan misclassified the EpiPen as a generic product, which under Medicaid does not require the same level of rebates as brand-name products.
The $465-million settlement has previously come under attack by members of Congress in both parties who have called it too small.
An analysis by the U.S. Department of Health and Human Services' Office of Inspector General released in May found the U.S. government may have overpaid for EpiPens by as much as $1.27 billion between 2006 and 2016 ...
One of our own, John "Jack" Maher Esq.,passed away on July 20th, 2017.
Jack was born on April 17th, 1951 in Mukwonago, Wisconsin to his mother Mildred, and father John "Jack" Maher Sr.
Along with being a successful attorney for decades within the California’s workers compensation community, he enjoyed hunting and was an avid and very competitive golfer.
Jack is survived by his loving wife Jennifer, children John and Amber, siblings Tim and Mary, and grandchildren Jaxon and Kaylee.
Jack was described by many as a "Wisconsin boy living temporarily in California for 50 years."
His celebration of life will be held at the Tustin Ranch Golf Club on Saturday August 19th, 2017 from Noon - 3:00 p.m..
Jack’s warm and friendly personality, and always present sense of humor will be missed dearly by his work family here at Floyd, Skeren and Kelly LLP. He was a great mentor to many and shared a huge breadth of knowledge and experience.
...
Jack was born on April 17th, 1951 in Mukwonago, Wisconsin to his mother Mildred, and father John "Jack" Maher Sr.
Along with being a successful attorney for decades within the California’s workers compensation community, he enjoyed hunting and was an avid and very competitive golfer.
Jack is survived by his loving wife Jennifer, children John and Amber, siblings Tim and Mary, and grandchildren Jaxon and Kaylee.
Jack was described by many as a "Wisconsin boy living temporarily in California for 50 years."
His celebration of life will be held at the Tustin Ranch Golf Club on Saturday August 19th, 2017 from Noon - 3:00 p.m..
Jack’s warm and friendly personality, and always present sense of humor will be missed dearly by his work family here at Floyd, Skeren and Kelly LLP. He was a great mentor to many and shared a huge breadth of knowledge and experience.
...
The Division of Workers’ Compensation has suspended five more medical providers from participating in California’s workers’ compensation system, bringing the total number of suspended providers to 32.
DWC Acting Administrative Director George Parisotto issued Orders of Suspension against the following providers:
1) Leovigildo Sayat, a physical therapist in Lompoc who in October 2015 pled guilty in US District Court for the Central District of California as a co-conspirator in a $15 million scheme to defraud Medicare by billing for physical therapy services never provided.
2) Alexander Kiev Martinez, a durable medical equipment provider in El Centro, who in April 2016 pled guilty in San Diego Superior Court for referring patients in a bribery scheme involving $25 million in improper claims for medical services and devices billed to California workers’ compensation insurance companies.
3) Robert Gogatz, a chiropractor in Murrieta who last May pled guilty in Riverside Superior Court to 16 counts of insurance fraud.
4) Robert Alva Rose, a physician in Irvine who pled guilty in Orange County Superior Court on September 15, 2015 to two misdemeanors related to his qualifications as a medical provider.
5) Paul Barkal, a physician in San Diego who surrendered his license to the Medical Board of California on October 17, 2005.
AB 1244 (Gray and Daly) requires the DWC Administrative Director to suspend any medical provider, physician or practitioner from participating in the workers’ compensation system in cases in which one or more of the following is true:
- The provider has been convicted of a felony or misdemeanor involving fraud or abuse of the Medi-Cal or Medicare programs or the workers’ compensation system, fraud or abuse of a patient, or related types of misconduct;
- The provider has been suspended due to fraud or abuse from the Medicare or Medicaid (including Medi-Cal) programs; or
- The provider’s license or certificate to provide health care has been surrendered or revoked.
The Department of Industrial Relation’s (DIR’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:
1) Leovigildo Sayat, a physical therapist in Lompoc who in October 2015 pled guilty in US District Court for the Central District of California as a co-conspirator in a $15 million scheme to defraud Medicare by billing for physical therapy services never provided.
2) Alexander Kiev Martinez, a durable medical equipment provider in El Centro, who in April 2016 pled guilty in San Diego Superior Court for referring patients in a bribery scheme involving $25 million in improper claims for medical services and devices billed to California workers’ compensation insurance companies.
3) Robert Gogatz, a chiropractor in Murrieta who last May pled guilty in Riverside Superior Court to 16 counts of insurance fraud.
4) Robert Alva Rose, a physician in Irvine who pled guilty in Orange County Superior Court on September 15, 2015 to two misdemeanors related to his qualifications as a medical provider.
5) Paul Barkal, a physician in San Diego who surrendered his license to the Medical Board of California on October 17, 2005.
AB 1244 (Gray and Daly) requires the DWC Administrative Director to suspend any medical provider, physician or practitioner from participating in the workers’ compensation system in cases in which one or more of the following is true:
- The provider has been convicted of a felony or misdemeanor involving fraud or abuse of the Medi-Cal or Medicare programs or the workers’ compensation system, fraud or abuse of a patient, or related types of misconduct;
- The provider has been suspended due to fraud or abuse from the Medicare or Medicaid (including Medi-Cal) programs; or
- The provider’s license or certificate to provide health care has been surrendered or revoked.
The Department of Industrial Relation’s (DIR’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. ...
