Machine learning offers more efficient tools to smoke out fraudsters, as students from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) learned during the recent ComputeFest 2018 Student Data Challenge, organized by Institute for Applied Computational Science (IACS).
During the nine-hour hackathon, student teams put their computational skills to the test in a race against the clock, using machine learning techniques to detect fraudulent insurance claims. Presented with data from more than 18,000 health care providers, the open-ended problem challenged students to devise, test, and then refine the best algorithmic technique to identify fraud.
The winning team, consisting of Xuefeng Peng, M.E., a computational science and engineering student, and T.H. Chan School of Public Health master’s students Yi Ding and Linying Zhang, who were able to find fraud with 95.7 percent accuracy. They used an autoencoder, a type of neural network, which learned common patterns in the dataset to decode genuine data points. Since the autoencoder was unable to decode anomalies, it was sensitive to fraudulent claims, Peng explained.
Teammates Amil Merchant, A.B., an applied math concentrator, and Kate Zhou, a first-year mechanical engineering Ph.D. candidate, scoured the web for examples of medical fraud, such as overbilling or prescribing too many drugs.
Another team, comprised of visiting graduate student Christoph Kurz, and Chan School graduate students Hannah James and Anna Zink, tried two approaches in parallel - a linear regression model and a random forest algorithm - to study patterns and distinguish outliers. The students were surprised to find that the simplest technique, linear regression modeling, yielded the best results.
The massive data set included 86 features, such as percentage of a provider’s patients who suffer from depression or diabetes. Representing those features in a model through linear and nonlinear combinations was a challenge, said Alexander Munoz, A.B., an applied math concentrator.
Each team was able to submit an answer three times per hour, but only received feedback on how accurate their results were collectively. Using their most recent feedback, Munoz and teammates Eshan Tewari, A.B., and statistics Ph.D. candidate Niloy Biswas considered which features to include in the next iteration of their model.
The challenge was designed to teach students some fundamental machine learning techniques, while emphasizing their practical applications, said competition architect Marouan Belhaj, an IACS Fellow.
Many students had never encountered an unsupervised problem before, but those are the types of situations fraud detection agents often face, where billions of dollars and millions of lives are at stake. With so many ways to trick the system, machine learning is an ideal method to detect fraud quickly and precisely, while there is still time to intervene, he said.
"In real-world fraud detection, you rarely get feedback from inside the company about how your model is performing," he said. "To improve the model is very difficult. You really need to think like a hacker or someone trying to defraud the system to understand which techniques you might use to trick the system and then try, through the modeling, to see if your results actually confirm your ideas."
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During the nine-hour hackathon, student teams put their computational skills to the test in a race against the clock, using machine learning techniques to detect fraudulent insurance claims. Presented with data from more than 18,000 health care providers, the open-ended problem challenged students to devise, test, and then refine the best algorithmic technique to identify fraud.
The winning team, consisting of Xuefeng Peng, M.E., a computational science and engineering student, and T.H. Chan School of Public Health master’s students Yi Ding and Linying Zhang, who were able to find fraud with 95.7 percent accuracy. They used an autoencoder, a type of neural network, which learned common patterns in the dataset to decode genuine data points. Since the autoencoder was unable to decode anomalies, it was sensitive to fraudulent claims, Peng explained.
Teammates Amil Merchant, A.B., an applied math concentrator, and Kate Zhou, a first-year mechanical engineering Ph.D. candidate, scoured the web for examples of medical fraud, such as overbilling or prescribing too many drugs.
Another team, comprised of visiting graduate student Christoph Kurz, and Chan School graduate students Hannah James and Anna Zink, tried two approaches in parallel - a linear regression model and a random forest algorithm - to study patterns and distinguish outliers. The students were surprised to find that the simplest technique, linear regression modeling, yielded the best results.
The massive data set included 86 features, such as percentage of a provider’s patients who suffer from depression or diabetes. Representing those features in a model through linear and nonlinear combinations was a challenge, said Alexander Munoz, A.B., an applied math concentrator.
Each team was able to submit an answer three times per hour, but only received feedback on how accurate their results were collectively. Using their most recent feedback, Munoz and teammates Eshan Tewari, A.B., and statistics Ph.D. candidate Niloy Biswas considered which features to include in the next iteration of their model.
The challenge was designed to teach students some fundamental machine learning techniques, while emphasizing their practical applications, said competition architect Marouan Belhaj, an IACS Fellow.
Many students had never encountered an unsupervised problem before, but those are the types of situations fraud detection agents often face, where billions of dollars and millions of lives are at stake. With so many ways to trick the system, machine learning is an ideal method to detect fraud quickly and precisely, while there is still time to intervene, he said.
"In real-world fraud detection, you rarely get feedback from inside the company about how your model is performing," he said. "To improve the model is very difficult. You really need to think like a hacker or someone trying to defraud the system to understand which techniques you might use to trick the system and then try, through the modeling, to see if your results actually confirm your ideas."
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The Division of Workers’ Compensation has suspended 11 more medical providers from participating in California’s workers’ compensation system, bringing the total number of providers suspended to 177. The providers were suspended for fraud or other criminal actions, or the loss of their license.
The most notorious on the list are Edward Aslanyan, Armen Shagoyen and Carolyn Vasquez, who were convicted in federal court for conspiracy to defraud Medicare through their medical clinics and durable medical equipment companies in Los Angeles County.
Their case dates back to 2008 when Federal and state Medicare Fraud Strike Force (MFSF) agents arrested 18 people in the greater Los Angeles area. Agents targeted durable medical equipment (DME) company owners, medical professionals and medical clinic owners who were alleged to have engaged in various schemes to defraud Medicare of $33,264,133 in fraudulent billing.
The eight indictments in which the defendants were initially charged outline various types of fraud including schemes involving the fraudulent ordering of power wheelchairs, orthotics, hospital beds, enteral nutrition and feeding supplies. Enteral nutrition is sustenance ingested by patients through a feeding apparatus. In addition, federal agents began executing search warrants at six locations throughout Los Angeles County.
The first indictment charged Armen Shagoyan, Edward Aslanyan, Carolyn A. Vasquez, and Zurama C. Espana, with conspiring to submit more than $16.3 million in Medicare claims for medically unnecessary power wheelchairs between April 2007 and June 2008 from medical clinics they owned in Los Angeles and Van Nuys.
In addition to the clinics, Aslanyan and Shagoyan were charged with owning multiple DME companies that allegedly billed Medicare for unnecessary items. Shagoyan, Aslanyan, Vasquez and Espana were charged with one count of conspiracy to commit health care fraud. Shagoyan, Aslanyan and Vasquez were also charged with six counts of submitting false claims to the Medicare program. Espana was additionally charged with four counts of submitting false claims to the Medicare program.
Aslanyan was sentenced to federal prison for 77 months and ordered to pay more than $10 million in restitution. Shagoyen was sentenced to federal prison for 12 months and 1 day. Vasquez was sentenced to federal prison for 60 months and ordered to pay more than $6 million in restitution.
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The most notorious on the list are Edward Aslanyan, Armen Shagoyen and Carolyn Vasquez, who were convicted in federal court for conspiracy to defraud Medicare through their medical clinics and durable medical equipment companies in Los Angeles County.
Their case dates back to 2008 when Federal and state Medicare Fraud Strike Force (MFSF) agents arrested 18 people in the greater Los Angeles area. Agents targeted durable medical equipment (DME) company owners, medical professionals and medical clinic owners who were alleged to have engaged in various schemes to defraud Medicare of $33,264,133 in fraudulent billing.
The eight indictments in which the defendants were initially charged outline various types of fraud including schemes involving the fraudulent ordering of power wheelchairs, orthotics, hospital beds, enteral nutrition and feeding supplies. Enteral nutrition is sustenance ingested by patients through a feeding apparatus. In addition, federal agents began executing search warrants at six locations throughout Los Angeles County.
The first indictment charged Armen Shagoyan, Edward Aslanyan, Carolyn A. Vasquez, and Zurama C. Espana, with conspiring to submit more than $16.3 million in Medicare claims for medically unnecessary power wheelchairs between April 2007 and June 2008 from medical clinics they owned in Los Angeles and Van Nuys.
In addition to the clinics, Aslanyan and Shagoyan were charged with owning multiple DME companies that allegedly billed Medicare for unnecessary items. Shagoyan, Aslanyan, Vasquez and Espana were charged with one count of conspiracy to commit health care fraud. Shagoyan, Aslanyan and Vasquez were also charged with six counts of submitting false claims to the Medicare program. Espana was additionally charged with four counts of submitting false claims to the Medicare program.
Aslanyan was sentenced to federal prison for 77 months and ordered to pay more than $10 million in restitution. Shagoyen was sentenced to federal prison for 12 months and 1 day. Vasquez was sentenced to federal prison for 60 months and ordered to pay more than $6 million in restitution.
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After years of lobbying in Washington, U.S. telehealth providers have the first hints that the dam could break on public funding for an industry they say could save taxpayers billions.
Reuters reports that four bills that could be signed into law over the next year carry the solutions to barriers that have prevented the United States’ huge over-65 health program Medicare from reimbursing doctors’ and medical visits, which often start over the phone.
The bills come at a time when the industry’s claims of cost savings - powered by apps and mass smartphone usage - have begun to gain traction with private insurers striving to save on healthcare costs.
One issue for public spending on telehealth has been the inability to charge across state lines. Another is that Medicare does not recognize medical consultations that do not happen in person as the equivalent of a visit to the doctor.
The fate of legislative amendments that unlock these barriers is far from clear in a fractured U.S. Congress, but investors and some of the world’s big healthcare providers are already circling firms like the U.S. sector’s dominant player Teladoc Inc.
Analysts say Teladoc racked up 75 percent of reported video or phone visits, according to 2016 estimates, but European insurance company Allianz Group earlier this month committed $59 million to American Well, one of a handful of smaller privately-run operations expanding in the sector.
Apple Inc’s Heart Study app, which flags irregular heart rhythms in users wearing Apple Watches, allows them to instantly connect with a doctor using American Well’s technology.
American Well Chief Executive Roy Schoenberg says that while revenue is steadily rising in the industry, it could grow 10-fold if payment parity, state-line and location-based constraints were lifted.
"There is a big black line between the availability of telehealth services to Americans under the age of 65 and Americans that are above the age of 65," Schoenberg said.
"This (legislation) would be an earthquake." ...
Reuters reports that four bills that could be signed into law over the next year carry the solutions to barriers that have prevented the United States’ huge over-65 health program Medicare from reimbursing doctors’ and medical visits, which often start over the phone.
The bills come at a time when the industry’s claims of cost savings - powered by apps and mass smartphone usage - have begun to gain traction with private insurers striving to save on healthcare costs.
One issue for public spending on telehealth has been the inability to charge across state lines. Another is that Medicare does not recognize medical consultations that do not happen in person as the equivalent of a visit to the doctor.
The fate of legislative amendments that unlock these barriers is far from clear in a fractured U.S. Congress, but investors and some of the world’s big healthcare providers are already circling firms like the U.S. sector’s dominant player Teladoc Inc.
Analysts say Teladoc racked up 75 percent of reported video or phone visits, according to 2016 estimates, but European insurance company Allianz Group earlier this month committed $59 million to American Well, one of a handful of smaller privately-run operations expanding in the sector.
Apple Inc’s Heart Study app, which flags irregular heart rhythms in users wearing Apple Watches, allows them to instantly connect with a doctor using American Well’s technology.
American Well Chief Executive Roy Schoenberg says that while revenue is steadily rising in the industry, it could grow 10-fold if payment parity, state-line and location-based constraints were lifted.
"There is a big black line between the availability of telehealth services to Americans under the age of 65 and Americans that are above the age of 65," Schoenberg said.
"This (legislation) would be an earthquake." ...
Amazon, Berkshire Hathaway and JPMorgan Chase announced today that they are partnering on ways to address healthcare for their U.S. employees, with the aim of improving employee satisfaction and reducing costs.
News Tuesday that the three companies plan to join forces to change how health care is provided to their combined 1 million U.S. employees sent shock waves through the health-care industry. The plan, while focused solely on the three giants’ staff for now, seems almost certain to set its sights on disrupting the broader industry.
Amazon, Berkshire and JPMorgan are among the largest private employers in the U.S. And they’re among the most valuable, with a combined market capitalization of $1.6 trillion, according to data compiled by Bloomberg.
It’s the first big move by Amazon in the sector after months of speculation that the internet behemoth might make an entry. The Amazon-Berkshire-JPMorgan collaboration will likely pressure profits for middlemen in the health-care supply chain.
The announcement was enough to sink health-care stocks. Express Scripts Holding Co. and CVS Health Corp., which manage pharmacy benefits, slumped 6.9 percent and 4.9 percent, respectively. Health insurers such as Cigna Corp. and Anthem Inc. and biotechnology companies also dropped.
The three companies, which bring their scale and complementary expertise to this long-term effort, will pursue this objective through an independent company that is free from profit-making incentives and constraints.
The initial focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality and transparent healthcare at a reasonable cost.
The group plans to hire a CEO and start partnering with other organizations, according to a person familiar with the matter. The effort would be focused internally first, and the companies would bring their data and bargaining power to bear on lowering health-care costs, the person said. Potential ways to bring down costs include providing more transparency over the prices for doctor visits and lab tests, as well as by enabling direct purchasing of some medical items, the person said.
The the company jointly will be spearheaded by Todd Combs, an investment officer of Berkshire Hathaway; Marvelle Sullivan Berchtold, a Managing Director of JPMorgan Chase; and Beth Galetti, a Senior Vice President at Amazon.
The longer-term management team, headquarters location and key operational details will be communicated in due course.
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News Tuesday that the three companies plan to join forces to change how health care is provided to their combined 1 million U.S. employees sent shock waves through the health-care industry. The plan, while focused solely on the three giants’ staff for now, seems almost certain to set its sights on disrupting the broader industry.
Amazon, Berkshire and JPMorgan are among the largest private employers in the U.S. And they’re among the most valuable, with a combined market capitalization of $1.6 trillion, according to data compiled by Bloomberg.
It’s the first big move by Amazon in the sector after months of speculation that the internet behemoth might make an entry. The Amazon-Berkshire-JPMorgan collaboration will likely pressure profits for middlemen in the health-care supply chain.
The announcement was enough to sink health-care stocks. Express Scripts Holding Co. and CVS Health Corp., which manage pharmacy benefits, slumped 6.9 percent and 4.9 percent, respectively. Health insurers such as Cigna Corp. and Anthem Inc. and biotechnology companies also dropped.
The three companies, which bring their scale and complementary expertise to this long-term effort, will pursue this objective through an independent company that is free from profit-making incentives and constraints.
The initial focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality and transparent healthcare at a reasonable cost.
The group plans to hire a CEO and start partnering with other organizations, according to a person familiar with the matter. The effort would be focused internally first, and the companies would bring their data and bargaining power to bear on lowering health-care costs, the person said. Potential ways to bring down costs include providing more transparency over the prices for doctor visits and lab tests, as well as by enabling direct purchasing of some medical items, the person said.
The the company jointly will be spearheaded by Todd Combs, an investment officer of Berkshire Hathaway; Marvelle Sullivan Berchtold, a Managing Director of JPMorgan Chase; and Beth Galetti, a Senior Vice President at Amazon.
The longer-term management team, headquarters location and key operational details will be communicated in due course.
...
The California Self-Insurers’ Security Fund is a nonprofit organization charged by the state Legislature with continuing payment of workers’ compensation claims when a self-insured entity is unable to do so. When the Fund steps in to provide such payments, it is required by law to seek reimbursement from the employer. The law permits groups of employers to band together into self-insurance groups, and the Fund is also responsible for paying workers’ compensation claims when such groups cannot.
The Healthcare Industry Self-Insurance Program is one such group. In 2013, the California Department of Industrial Relations ordered the Fund to assume the Program’s workers’ compensation claims.
The Fund hired the law firm of Nixon Peabody to represent it in order to seek reimbursement from the employer group. In November 2013, the Fund filed a lawsuit naming 304 members of the Program as defendants, approximately 170 of which have since settled.
Attorney Andrew Selesnick served as Chair of the Health Care Department at Michelman & Robinson, LLP (M&R), overseeing and managing a team of attorneys who represented clients in the healthcare industry. Since 2014, M&R served as attorneys for employer defendants in this collection case. The representation of those parties was handled primarily by four attorneys at M&R, including Selesnick. Selesnick was actively involved in the case, including participation in a confidential discussion pertaining to moving parties’ liability and damages.
In February 2017, Selesnick left M&R and joined the Nixon Peabody law firm. Nixon Peabody was promptly advised of the potential conflict issue by M&R. On or about March 8, Selesnick "parted ways" with Nixon Peabody.
On March 15, moving parties filed a motion to disqualify Nixon Peabody. They argued that Selesnick had done prior work for the moving parties in the same action, and as a result, Nixon Peabody and all its attorneys had a conflict of interest as a matter of law. M&R claimed that Selesnick had not shared confidential information with them, and the firm had put an "ethical wall" in place. The trial court granted the motion and M&R appealed. The Court of Appeal reversed in the published case of California Self-Insurers Security Fund v Superior Court, concluding that "automatic disqualification was not required under the facts."
There "is no question that if Selesnick were seeking to represent the Fund, he could not do so. There is also no question that if Selesnick continued to work at Nixon Peabody, the entire firm would be disqualified. The question that is left is whether Nixon Peabody and all its attorneys are also prohibited from representing the Fund given all the relevant facts, including that Selesnick no longer works at Nixon Peabody, and was only there for a very brief period."
"We conclude the trial court must perform an analysis regarding whether confidential information was, indeed, transmitted from Selesnick to the attorneys working on the matter at Nixon Peabody." The question, then, is whether Selesnick’s tenure at the firm endangers the duty of confidentiality he owes to real parties; if it does, disqualification is required. If it does not, then the court must exercise its discretion to determine whether other reasons compel disqualification ...
The Healthcare Industry Self-Insurance Program is one such group. In 2013, the California Department of Industrial Relations ordered the Fund to assume the Program’s workers’ compensation claims.
The Fund hired the law firm of Nixon Peabody to represent it in order to seek reimbursement from the employer group. In November 2013, the Fund filed a lawsuit naming 304 members of the Program as defendants, approximately 170 of which have since settled.
Attorney Andrew Selesnick served as Chair of the Health Care Department at Michelman & Robinson, LLP (M&R), overseeing and managing a team of attorneys who represented clients in the healthcare industry. Since 2014, M&R served as attorneys for employer defendants in this collection case. The representation of those parties was handled primarily by four attorneys at M&R, including Selesnick. Selesnick was actively involved in the case, including participation in a confidential discussion pertaining to moving parties’ liability and damages.
In February 2017, Selesnick left M&R and joined the Nixon Peabody law firm. Nixon Peabody was promptly advised of the potential conflict issue by M&R. On or about March 8, Selesnick "parted ways" with Nixon Peabody.
On March 15, moving parties filed a motion to disqualify Nixon Peabody. They argued that Selesnick had done prior work for the moving parties in the same action, and as a result, Nixon Peabody and all its attorneys had a conflict of interest as a matter of law. M&R claimed that Selesnick had not shared confidential information with them, and the firm had put an "ethical wall" in place. The trial court granted the motion and M&R appealed. The Court of Appeal reversed in the published case of California Self-Insurers Security Fund v Superior Court, concluding that "automatic disqualification was not required under the facts."
There "is no question that if Selesnick were seeking to represent the Fund, he could not do so. There is also no question that if Selesnick continued to work at Nixon Peabody, the entire firm would be disqualified. The question that is left is whether Nixon Peabody and all its attorneys are also prohibited from representing the Fund given all the relevant facts, including that Selesnick no longer works at Nixon Peabody, and was only there for a very brief period."
"We conclude the trial court must perform an analysis regarding whether confidential information was, indeed, transmitted from Selesnick to the attorneys working on the matter at Nixon Peabody." The question, then, is whether Selesnick’s tenure at the firm endangers the duty of confidentiality he owes to real parties; if it does, disqualification is required. If it does not, then the court must exercise its discretion to determine whether other reasons compel disqualification ...
A Utah pharmacy and the husband-and-wife owners of a Tennessee medical practice have been indicted on allegations that they used Marines and sailors in San Diego County as pawns in a nearly $66 million medical insurance scheme, according to an indictment unsealed Friday.
The San Diego Tribune reports that Jimmy and Ashley Collins, who own Choice MD in Cleveland, Tenn., made their first court appearance Friday in Chattanooga, a precursor to an upcoming San Diego hearing.
The charges accuse the couple, as well as CFK Inc., owners of a pharmacy in Bountiful, Utah, of defrauding the military’s health insurance system TRICARE.
At the center of the alleged scheme are compound medications - drugs that are custom-made by pharmacists to tailor to a patient’s unique needs and are significantly more expensive than typical prescription drugs. The ingredients are not FDA approved.
Military members in San Diego would be paid to recruit other service members to participate in a fake medical study, according to the allegations. The participants were paid $100 to $300 to speak with a doctor in a telemedicine session and would be prescribed compound medication - some in cream form, according to details in a search warrant affidavit obtained last year by the Union-Tribune.
Many of the compound drugs came from the pharmacy in Utah, which was then known as The Medicine Shoppe but has since changed its name to Bountiful Drug under new ownership, according to the indictment.
The number of compound medications to TRICARE patients from the pharmacy skyrocketed, from 218 such medications in all of 2013 to 4,637 in the first four months of 2015, records say. The batch in 2015 elicited $67.3 million in reimbursement claims, according to court records.
Many of the prescriptions were authorized by physicians working for Choice MD.
Investigators tracked millions of dollars flowing among the office, the pharmacy and alleged recruiters. The Collinses were paid $45 million in kickbacks, according to the indictment. They bought up property around Tennessee, a yacht and luxury cars, including two Aston-Martins, prosecutors said.
The compound prescriptions stopped after a government audit in May 2015 looked into the sudden rise in claims and payment was denied ...
The San Diego Tribune reports that Jimmy and Ashley Collins, who own Choice MD in Cleveland, Tenn., made their first court appearance Friday in Chattanooga, a precursor to an upcoming San Diego hearing.
The charges accuse the couple, as well as CFK Inc., owners of a pharmacy in Bountiful, Utah, of defrauding the military’s health insurance system TRICARE.
At the center of the alleged scheme are compound medications - drugs that are custom-made by pharmacists to tailor to a patient’s unique needs and are significantly more expensive than typical prescription drugs. The ingredients are not FDA approved.
Military members in San Diego would be paid to recruit other service members to participate in a fake medical study, according to the allegations. The participants were paid $100 to $300 to speak with a doctor in a telemedicine session and would be prescribed compound medication - some in cream form, according to details in a search warrant affidavit obtained last year by the Union-Tribune.
Many of the compound drugs came from the pharmacy in Utah, which was then known as The Medicine Shoppe but has since changed its name to Bountiful Drug under new ownership, according to the indictment.
The number of compound medications to TRICARE patients from the pharmacy skyrocketed, from 218 such medications in all of 2013 to 4,637 in the first four months of 2015, records say. The batch in 2015 elicited $67.3 million in reimbursement claims, according to court records.
Many of the prescriptions were authorized by physicians working for Choice MD.
Investigators tracked millions of dollars flowing among the office, the pharmacy and alleged recruiters. The Collinses were paid $45 million in kickbacks, according to the indictment. They bought up property around Tennessee, a yacht and luxury cars, including two Aston-Martins, prosecutors said.
The compound prescriptions stopped after a government audit in May 2015 looked into the sudden rise in claims and payment was denied ...
A former National Football League player accused of participating in a $1.5 million scheme to defraud a Sacramento business that managed workers’ compensation claims has been sentenced to 24 months in federal prison.
Marcus Buckley, 46, of Weatherford, Texas, was sentenced Thursday in U.S. District Court in Sacramento. Judge Troy L. Nunley also ordered Buckley to pay more than $1.58 million in restitution, according to a U.S. Attorney’s Office news release.The Court recommended that he be incarcerated at FCI Seagoville or FCI Texarkana, Texas.
Nunley's sentence was nine months less than what prosecutors had asked for, and that Buckley had apparently agreed to, after his guilty plea on a single count of money laundering.
Buckley played professional football for seven seasons, from 1993 to 2000, with the New York Giants. During that time, the Giants had workers’ compensation insurance coverage through Pennsylvania Manufacturer’s Association Insurance Group, or PMA.
In 2006, Buckley filed a workers’ compensation claim against the Giants for cumulative stress injuries sustained while playing football, part of that time in California. During the first week of November 2010, Buckley, the Giants and PMA settled Buckley’s claim for $300,000 as part of a "compromise and release" agreement, according to the news release.
After Buckley’s claim was settled, between late 2010 and June 2011, Buckley prepared and filed numerous requests for additional reimbursement under his claim. He prepared false invoices and statements from medial providers for medical service purportedly provided. He also prepared false credit collection notices from collection agencies purportedly seeking payment from Buckley from various medical providers for past-due medical bills, the news release said.
Buckley sent the false invoices, statements and credit collection letters to his co-defendant, Kimberly Jones, who was a claims adjuster with Gallagher Bassett Services at its Sacramento office. The firm was a third-party administrator that managed workers’ compensation claims in California on behalf of PMA.
Jones was aware that Buckley was not entitled to additional reimbursement under his disability claim, and that the documentation and requests he submitted were false, the news release said. Jones nevertheless caused Gallagher Bassett to issue checks payable to Buckley, and he ultimately received more than $1.58 million to which he was not entitled.
Jones pleaded guilty to wire fraud in October 2015, is to be sentenced Feb. 8 by Judge Nunley at 09:30 AM in Courtroom 2 ...
Marcus Buckley, 46, of Weatherford, Texas, was sentenced Thursday in U.S. District Court in Sacramento. Judge Troy L. Nunley also ordered Buckley to pay more than $1.58 million in restitution, according to a U.S. Attorney’s Office news release.The Court recommended that he be incarcerated at FCI Seagoville or FCI Texarkana, Texas.
Nunley's sentence was nine months less than what prosecutors had asked for, and that Buckley had apparently agreed to, after his guilty plea on a single count of money laundering.
Buckley played professional football for seven seasons, from 1993 to 2000, with the New York Giants. During that time, the Giants had workers’ compensation insurance coverage through Pennsylvania Manufacturer’s Association Insurance Group, or PMA.
In 2006, Buckley filed a workers’ compensation claim against the Giants for cumulative stress injuries sustained while playing football, part of that time in California. During the first week of November 2010, Buckley, the Giants and PMA settled Buckley’s claim for $300,000 as part of a "compromise and release" agreement, according to the news release.
After Buckley’s claim was settled, between late 2010 and June 2011, Buckley prepared and filed numerous requests for additional reimbursement under his claim. He prepared false invoices and statements from medial providers for medical service purportedly provided. He also prepared false credit collection notices from collection agencies purportedly seeking payment from Buckley from various medical providers for past-due medical bills, the news release said.
Buckley sent the false invoices, statements and credit collection letters to his co-defendant, Kimberly Jones, who was a claims adjuster with Gallagher Bassett Services at its Sacramento office. The firm was a third-party administrator that managed workers’ compensation claims in California on behalf of PMA.
Jones was aware that Buckley was not entitled to additional reimbursement under his disability claim, and that the documentation and requests he submitted were false, the news release said. Jones nevertheless caused Gallagher Bassett to issue checks payable to Buckley, and he ultimately received more than $1.58 million to which he was not entitled.
Jones pleaded guilty to wire fraud in October 2015, is to be sentenced Feb. 8 by Judge Nunley at 09:30 AM in Courtroom 2 ...
The U.S. Department of Veterans Affairs (VA) and Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) announced a partnership to share data, data analytics tools and best practices for identifying and preventing fraud, waste and abuse.
This newest partnership enhances ongoing efforts between the country’s two largest public-private health-care payment organizations to help America’s Veterans by leveraging the gains made by CMS.
"The VA-HHS alliance represents the latest example of VA’s commitment to find partners to assist with identifying new and innovative ways to seek out fraud, waste and abuse and ensure every tax dollar given to VA supports Veterans," said VA Secretary Dr. David J. Shulkin. "This effort marks another step toward achieving President Trump’s 10-point plan to reform the VA by collaborating with our federal partners to improve VA’s ability to investigate fraud and wrongdoing in VA programs."
CMS continues to focus on reducing and eliminating fraud, waste and abuse in Medicare, and in 2010, it established the Center for Program Integrity to help with this work. CMS estimates that its program integrity activities saved Medicare operations $17 billion in fiscal 2015. Other HHS combined efforts - including law enforcement - contributed to greater program savings.
VA plans to capitalize on the advancements in analytics CMS has made by concentrating on its use of advanced technology, statistics and data analytics to improve fraud detection and prevention efforts. Additionally, in November 2017, VA invited industry experts to provide information on the latest commercial sector tools and techniques to enhance VA’s fraud detection capabilities. In April, VA will invite these industry experts to demonstrate their capabilities for detecting and preventing fraud, waste and abuse and recovering improper payments.
"We have a special obligation to keep America’s promise to those who have served our country and ensure that Veterans receive high-quality and accessible health care," said CMS Administrator Seema Verma. "CMS is sharing lessons learned and expertise to support VA to identify waste and fraud and eliminate these abuses of the public trust. Using state-of-the-art data analytics, CMS is partnering with VA to better detect and prevent wrongdoing in its programs."
By using CMS’ successes in its program integrity protocols, VA will be able to close existing gaps in its own claims payment process ...
This newest partnership enhances ongoing efforts between the country’s two largest public-private health-care payment organizations to help America’s Veterans by leveraging the gains made by CMS.
"The VA-HHS alliance represents the latest example of VA’s commitment to find partners to assist with identifying new and innovative ways to seek out fraud, waste and abuse and ensure every tax dollar given to VA supports Veterans," said VA Secretary Dr. David J. Shulkin. "This effort marks another step toward achieving President Trump’s 10-point plan to reform the VA by collaborating with our federal partners to improve VA’s ability to investigate fraud and wrongdoing in VA programs."
CMS continues to focus on reducing and eliminating fraud, waste and abuse in Medicare, and in 2010, it established the Center for Program Integrity to help with this work. CMS estimates that its program integrity activities saved Medicare operations $17 billion in fiscal 2015. Other HHS combined efforts - including law enforcement - contributed to greater program savings.
VA plans to capitalize on the advancements in analytics CMS has made by concentrating on its use of advanced technology, statistics and data analytics to improve fraud detection and prevention efforts. Additionally, in November 2017, VA invited industry experts to provide information on the latest commercial sector tools and techniques to enhance VA’s fraud detection capabilities. In April, VA will invite these industry experts to demonstrate their capabilities for detecting and preventing fraud, waste and abuse and recovering improper payments.
"We have a special obligation to keep America’s promise to those who have served our country and ensure that Veterans receive high-quality and accessible health care," said CMS Administrator Seema Verma. "CMS is sharing lessons learned and expertise to support VA to identify waste and fraud and eliminate these abuses of the public trust. Using state-of-the-art data analytics, CMS is partnering with VA to better detect and prevent wrongdoing in its programs."
By using CMS’ successes in its program integrity protocols, VA will be able to close existing gaps in its own claims payment process ...
Last May, congressional staffers started with a very simple question: Exactly how easy is it for the average person to order some of the deadliest drugs on the planet over the internet and have them delivered to their home from the other side of the globe?
The answer, they revealed this week, is: shockingly easy.
At a briefing on Wednesday several Senate investigators working for Sens. Rob Portman (R-OH) and Tom Carper (D-DE) detailed to reporters exactly how simple it is to order fentanyl, a synthetic opioid that has overtaken heroin and prescription painkillers to become the biggest killer of Americans, online.
The staff started, quite literally, by Googling "fentanyl for sale," they said. They found pages and pages of advertisements. Posing as first-time buyers, they made contact with six responsive sellers. These sounded like sophisticated operations, offering discounts on bulk purchases and even trying to upsell the investigators to carfentanil, an even more powerful opioid.
The sellers preferred Bitcoin, the investigators said, but they also accepted Western Union transfers, PayPal, and prepaid credit cards. They wanted to ship the packages through the international arm of the US Postal Service, rather than a private carrier like FedEx or UPS. They told the investigators that there was less of a chance the package would end up detained.
At one point, when China cracked down on a specific strand of fentanyl, the sellers advertised "a hot sale" on the top of the email, which the staff included in their report, literally said: "JUNE SPECIAL OFFER" - to try to empty their reserves before the ban went into effect.
Using payment and shipment information that the sellers themselves provided, the Senate investigators identified 500 transactions in 43 states adding up to $766 million worth of fentanyl, going by its street value, just from these six sellers. They found people who were purchasing for personal use - including seven who overdosed and died - as well as the people buying to set up their own distribution network in America.
It became clear how adaptable the fentanyl sellers were. Now that shipments from China have come under suspicion, the sellers told the investigators that they preferred to ship through Europe. Even as the US worked with China to crack down on one fentanyl compound, the sellers simply tweaked their formula and offered to sell a new version in another email included in the report.
The underlying message of the report was that the US Postal Service should do more to crack down on these illicit shipments. Right now, private carriers are required to collect advanced electronic data, a bar code with information about the sender, the recipient, and what is in the package. But the Postal Service and its foreign counterparts do not. That’s precisely why sellers prefer the US Postal Service over FedEx or UPS ...
The answer, they revealed this week, is: shockingly easy.
At a briefing on Wednesday several Senate investigators working for Sens. Rob Portman (R-OH) and Tom Carper (D-DE) detailed to reporters exactly how simple it is to order fentanyl, a synthetic opioid that has overtaken heroin and prescription painkillers to become the biggest killer of Americans, online.
The staff started, quite literally, by Googling "fentanyl for sale," they said. They found pages and pages of advertisements. Posing as first-time buyers, they made contact with six responsive sellers. These sounded like sophisticated operations, offering discounts on bulk purchases and even trying to upsell the investigators to carfentanil, an even more powerful opioid.
The sellers preferred Bitcoin, the investigators said, but they also accepted Western Union transfers, PayPal, and prepaid credit cards. They wanted to ship the packages through the international arm of the US Postal Service, rather than a private carrier like FedEx or UPS. They told the investigators that there was less of a chance the package would end up detained.
At one point, when China cracked down on a specific strand of fentanyl, the sellers advertised "a hot sale" on the top of the email, which the staff included in their report, literally said: "JUNE SPECIAL OFFER" - to try to empty their reserves before the ban went into effect.
Using payment and shipment information that the sellers themselves provided, the Senate investigators identified 500 transactions in 43 states adding up to $766 million worth of fentanyl, going by its street value, just from these six sellers. They found people who were purchasing for personal use - including seven who overdosed and died - as well as the people buying to set up their own distribution network in America.
It became clear how adaptable the fentanyl sellers were. Now that shipments from China have come under suspicion, the sellers told the investigators that they preferred to ship through Europe. Even as the US worked with China to crack down on one fentanyl compound, the sellers simply tweaked their formula and offered to sell a new version in another email included in the report.
The underlying message of the report was that the US Postal Service should do more to crack down on these illicit shipments. Right now, private carriers are required to collect advanced electronic data, a bar code with information about the sender, the recipient, and what is in the package. But the Postal Service and its foreign counterparts do not. That’s precisely why sellers prefer the US Postal Service over FedEx or UPS ...
Property Casualty 360 just published its 10 workers' compensation trends to watch in 2018." Healthcare consolidation, new drug treatment guidelines, and judicial challenges are a few of the issues impacting workers' compensation specialists this year.
Thirty-four of the 50 state governors are currently Republicans. This, combined with the fact that insurance rates are down in most of the U.S., means we have not seen a significant push for workers' compensation reforms the last few years.
But, in California, it is Governor Brown's last year. Thus expect "yet another push by the legislature to undermine prior workers’ compensation reforms. Universal healthcare will likely be an issue in the 2018 governor's race and the outcome of this election could have a significant impact on workers’ compensation in 2019."
Concerns about the new Governor were also the topic of the presentation this month at the Employer's Fraud Task Force meeting. Jerry Azevedo, from the Workers Comp Action Network expressed similar concerns.
And California seems to be ahead of the trend on drug formularies. In 2018, California, New York and Arkansas will all be implementing new treatment guidelines or drug formularies. Montana is also implementing a drug formulary but the timeline for this is not set yet.Georgia, Pennsylvania, North Carolina and Louisiana all considered either treatment guidelines or drug formularies in 2017 and they will revisit this again in 2018.
And California is also ahead of the trend to challenge the constitutionality of aspects of workers' compensation law. Last year, Pennsylvania joined the list of states to have a portion of their workers' compensation statutes found unconstitutional by the state supreme court. There is a case on appeal in Kansas right now challenging the constitutionality of a portion of their statute as well. It is worth noting that the basis for these constitutional challenges exists in many other states.
Last year, a judge in Alabama declared the state's entire workers' compensation statutes unconstitutional. This was appealed, and the case settled on appeal, so that decision ultimately was rendered moot. However, the issues raised in that court case regarding benefit adequacy are something we could see again anywhere.
Multiple brokers have indicated that the workers' compensation rate outlook for 2018 is relatively flat. But with workers' compensation being such a long-tail business, premiums collected today must cover losses 30 years into the future. As losses continue to climb, it is inevitable that insurance rates will need to increase in the future to offset those losses ...
Thirty-four of the 50 state governors are currently Republicans. This, combined with the fact that insurance rates are down in most of the U.S., means we have not seen a significant push for workers' compensation reforms the last few years.
But, in California, it is Governor Brown's last year. Thus expect "yet another push by the legislature to undermine prior workers’ compensation reforms. Universal healthcare will likely be an issue in the 2018 governor's race and the outcome of this election could have a significant impact on workers’ compensation in 2019."
Concerns about the new Governor were also the topic of the presentation this month at the Employer's Fraud Task Force meeting. Jerry Azevedo, from the Workers Comp Action Network expressed similar concerns.
And California seems to be ahead of the trend on drug formularies. In 2018, California, New York and Arkansas will all be implementing new treatment guidelines or drug formularies. Montana is also implementing a drug formulary but the timeline for this is not set yet.Georgia, Pennsylvania, North Carolina and Louisiana all considered either treatment guidelines or drug formularies in 2017 and they will revisit this again in 2018.
And California is also ahead of the trend to challenge the constitutionality of aspects of workers' compensation law. Last year, Pennsylvania joined the list of states to have a portion of their workers' compensation statutes found unconstitutional by the state supreme court. There is a case on appeal in Kansas right now challenging the constitutionality of a portion of their statute as well. It is worth noting that the basis for these constitutional challenges exists in many other states.
Last year, a judge in Alabama declared the state's entire workers' compensation statutes unconstitutional. This was appealed, and the case settled on appeal, so that decision ultimately was rendered moot. However, the issues raised in that court case regarding benefit adequacy are something we could see again anywhere.
Multiple brokers have indicated that the workers' compensation rate outlook for 2018 is relatively flat. But with workers' compensation being such a long-tail business, premiums collected today must cover losses 30 years into the future. As losses continue to climb, it is inevitable that insurance rates will need to increase in the future to offset those losses ...
The U.S. Food and Drug Administration and the Federal Trade Commission today posted joint warning letters to the marketers and distributors of 12 opioid cessation products, for illegally marketing unapproved products with claims about their ability to help in the treatment of opioid addiction and withdrawal.
The FDA and FTC issued joint warning letters to 11 companies for their products: Opiate Freedom Center ("Opiate Freedom 5-Pack"), U4Life, LLC ("Mitadone"), CalmSupport, LLC ("CalmSupport"), TaperAid ("TaperAid" & "TaperAid Complete"), Medicus Holistic Alternatives LLC ("Natracet"), NutraCore Health Products, LLC ("Opiate Detox Pro"), Healthy Healing, LLC ("Withdrawal Support"), Soothedrawal, Inc. ("Soothedrawal"), Choice Detox Center, Inc. ("Nofeel"), GUNA, Inc. ("GUNA-ADDICT 1"), and King Bio, Inc. ("AddictaPlex").
The FTC sent four additional warning letters to other marketers of opioid cessation products.
All of the companies use online platforms to make illegal claims about their products' ability to cure, treat, or prevent a disease. Examples of claims made include:
- "#1 Selling Opiate Withdrawal Brand"
- "Imagine a life without the irritability, cravings, restlessness, excitability, exhaustion and discomfort associated with the nightmare of addiction and withdrawal symptoms"
- "Safe and effective natural supplements that work to ease many physical symptoms of opiate withdrawal"
- "Break the pain killer habit"
- "Relieve Your Symptoms - addiction, withdrawal, cravings."
The FDA and FTC have requested responses from each of the companies within 15 working days. The companies are directed to inform each agency of the specific actions taken to address each agency’s concerns. The warning letters also state that failure to correct violations may result in law enforcement action such as seizure or injunction.
Also today, the FTC, in coordination with SAMHSA of the U.S. Department of Health and Human Services (HHS), issued a fact sheet to help consumers get real help for opioid addiction or withdrawal, while avoiding products that promise but do not deliver help. The fact sheet has tips that consumers and health practitioners alike can share with those considering help for opioid addiction or withdrawal.
Health care professionals and consumers are encouraged to report any adverse events related to these products to the FDA’s MedWatch Adverse Event Reporting program. To file a report, use the MedWatch Online Voluntary Reporting Form. The completed form can be submitted online or via fax to 800-FDA-0178 ...
The FDA and FTC issued joint warning letters to 11 companies for their products: Opiate Freedom Center ("Opiate Freedom 5-Pack"), U4Life, LLC ("Mitadone"), CalmSupport, LLC ("CalmSupport"), TaperAid ("TaperAid" & "TaperAid Complete"), Medicus Holistic Alternatives LLC ("Natracet"), NutraCore Health Products, LLC ("Opiate Detox Pro"), Healthy Healing, LLC ("Withdrawal Support"), Soothedrawal, Inc. ("Soothedrawal"), Choice Detox Center, Inc. ("Nofeel"), GUNA, Inc. ("GUNA-ADDICT 1"), and King Bio, Inc. ("AddictaPlex").
The FTC sent four additional warning letters to other marketers of opioid cessation products.
All of the companies use online platforms to make illegal claims about their products' ability to cure, treat, or prevent a disease. Examples of claims made include:
- "#1 Selling Opiate Withdrawal Brand"
- "Imagine a life without the irritability, cravings, restlessness, excitability, exhaustion and discomfort associated with the nightmare of addiction and withdrawal symptoms"
- "Safe and effective natural supplements that work to ease many physical symptoms of opiate withdrawal"
- "Break the pain killer habit"
- "Relieve Your Symptoms - addiction, withdrawal, cravings."
The FDA and FTC have requested responses from each of the companies within 15 working days. The companies are directed to inform each agency of the specific actions taken to address each agency’s concerns. The warning letters also state that failure to correct violations may result in law enforcement action such as seizure or injunction.
Also today, the FTC, in coordination with SAMHSA of the U.S. Department of Health and Human Services (HHS), issued a fact sheet to help consumers get real help for opioid addiction or withdrawal, while avoiding products that promise but do not deliver help. The fact sheet has tips that consumers and health practitioners alike can share with those considering help for opioid addiction or withdrawal.
Health care professionals and consumers are encouraged to report any adverse events related to these products to the FDA’s MedWatch Adverse Event Reporting program. To file a report, use the MedWatch Online Voluntary Reporting Form. The completed form can be submitted online or via fax to 800-FDA-0178 ...
The MEMIC Group has been ranked the top workers' compensation company in the U.S. by ACORD.
The MEMIC Group includes MEMIC Indemnity Company, MEMIC Casualty Company, and parent company Maine Employers' Mutual Insurance Company (MEMIC), a workers’ compensation specialty insurer that opened for business in January 1993. MEMIC was, and remains, the keystone to the landmark 1992 reforms of Maine workers' compensation law passed by the Maine Legislature and signed by then Gov. John R. McKernan.
ACORD (Association for Cooperative Operations Research and Development) is the global standards-setting body for the insurance industry. ACORD maintains offices in New York and London.
In a first of its kind study of the $48 billion U.S. workers' compensation insurance market, Maine-based MEMIC came out on top based on strong financial performance as well as measurable, superior capabilities in customer experience, employee satisfaction, and brand reputation.
The Workers' Compensation Study examined the top 50 workers' compensation writers in the U.S. These top 50 account for 85% of U.S. workers' compensation premiums and the insurers generate annual premiums ranging from $200 million to $4 billion.
The results showed that top performing workers' compensation carriers simultaneously pursued four key strategies - operational efficiency, customer experience, product differentiation and innovation. More results of the Workers' Compensation Study, including additional analysis, will be released in a paper published later this year.
"Congratulations to MEMIC for distinguishing itself as the top workers' compensation company in the U.S.," said Bill Pieroni, President and CEO of ACORD. "Given MEMIC's significant contribution to workers' compensation in Maine and their strong reputation in the insurance industry, it's admirable that they not only grew faster than the market but also had materially better financial performance. This is a first and we applaud everyone at their organization for their respective contributions."
"As we celebrate our 25th anniversary year, we are thrilled with this recognition," said MEMIC President and CEO Michael P. Bourque. "It is a reflection wonderful of everyone at our growing organization who has worked incredibly hard, year after year, to better serve our customers. - especially have to point out that this award is shared with our recently retired CEO John Leonard who led us since the beginning and during the 5 years ACORD evaluated. He set the vision of safer workplaces and the compassionate treatment of all workers that will continue to be the key to our success."
With 8 offices across the Eastern Seaboard, The MEMIC Group holds licenses to write workers’ compensation across the country and is rated "A" (Excellent) by A.M. Best. MEMIC insures more than 20,000 employers and their estimated 300,000 employees, and holds more than $1.3 billion in assets.
...
The MEMIC Group includes MEMIC Indemnity Company, MEMIC Casualty Company, and parent company Maine Employers' Mutual Insurance Company (MEMIC), a workers’ compensation specialty insurer that opened for business in January 1993. MEMIC was, and remains, the keystone to the landmark 1992 reforms of Maine workers' compensation law passed by the Maine Legislature and signed by then Gov. John R. McKernan.
ACORD (Association for Cooperative Operations Research and Development) is the global standards-setting body for the insurance industry. ACORD maintains offices in New York and London.
In a first of its kind study of the $48 billion U.S. workers' compensation insurance market, Maine-based MEMIC came out on top based on strong financial performance as well as measurable, superior capabilities in customer experience, employee satisfaction, and brand reputation.
The Workers' Compensation Study examined the top 50 workers' compensation writers in the U.S. These top 50 account for 85% of U.S. workers' compensation premiums and the insurers generate annual premiums ranging from $200 million to $4 billion.
The results showed that top performing workers' compensation carriers simultaneously pursued four key strategies - operational efficiency, customer experience, product differentiation and innovation. More results of the Workers' Compensation Study, including additional analysis, will be released in a paper published later this year.
"Congratulations to MEMIC for distinguishing itself as the top workers' compensation company in the U.S.," said Bill Pieroni, President and CEO of ACORD. "Given MEMIC's significant contribution to workers' compensation in Maine and their strong reputation in the insurance industry, it's admirable that they not only grew faster than the market but also had materially better financial performance. This is a first and we applaud everyone at their organization for their respective contributions."
"As we celebrate our 25th anniversary year, we are thrilled with this recognition," said MEMIC President and CEO Michael P. Bourque. "It is a reflection wonderful of everyone at our growing organization who has worked incredibly hard, year after year, to better serve our customers. - especially have to point out that this award is shared with our recently retired CEO John Leonard who led us since the beginning and during the 5 years ACORD evaluated. He set the vision of safer workplaces and the compassionate treatment of all workers that will continue to be the key to our success."
With 8 offices across the Eastern Seaboard, The MEMIC Group holds licenses to write workers’ compensation across the country and is rated "A" (Excellent) by A.M. Best. MEMIC insures more than 20,000 employers and their estimated 300,000 employees, and holds more than $1.3 billion in assets.
...
The U.S. Drug Enforcement Administration said on Tuesday it had changed a regulation to allow more healthcare professionals to prescribe a medication used to treat opioid addiction, opening up access in rural America where there are few doctors.
Prior to 2000, only physicians could treat those with opioid addiction and had to register with the DEA as both physicians and operators of narcotic treatment programs. The latest change is part of a 2016 law that added categories of practitioners who may prescribe the narcotic drug buprenorphine for maintenance or detoxification treatment, the DEA said in a statement.
Buprenorphine, sold under the brand name Subutex, among others, is an opioid used to treat opioid addiction, acute pain, and chronic pain. It can be used under the tongue, by injection, as a skin patch, or as an implant. When used for opioid addiction it is recommended that a health care provider observe the person while they take the medication. For longer term treatment of addiction a combination formulation of buprenorphine/naloxone is usually recommended. Maximum pain relief is generally within an hour with effects up to 24 hours.
Buprenorphine was approved for medical use in the United States in 1981.In 2012, 9.3 million prescription for the medication were written in the United States. Buprenorphine may also be used recreationally by injection or in the nose for the high it produces. Some use it as a substitute for heroin. In the United States it is a Schedule III controlled substance.
A 2017 study published by the National Rural Health Association found that 53 percent of rural counties had no physician able to prescribe medication to those addicted to opioids, the DEA said. About 90 percent of physicians allowed to prescribe such medication live in urban counties, and 30 million people live in areas where treatment is unavailable.
About 5,000 mid-level practitioners can now prescribe the medication, and nearly 43,000 practitioners may qualify to do so, the DEA said.
Rural America has more drug overdose deaths than urban areas, a 2017 study by the Centers for Disease Control and Prevention showed. Prescription drug abuse is a leading cause of death, with opioids killing more than 42,000 people in 2016, the highest U.S. death toll of any year on record, CDC said.
"This action reflects this work and the ongoing need to further expand access to the most effective treatment for opioid use disorder," said David Fiellin, professor of medicine, emergency medicine and public health at Yale School of Medicine, in an email to Reuters, who published the story ...
Prior to 2000, only physicians could treat those with opioid addiction and had to register with the DEA as both physicians and operators of narcotic treatment programs. The latest change is part of a 2016 law that added categories of practitioners who may prescribe the narcotic drug buprenorphine for maintenance or detoxification treatment, the DEA said in a statement.
Buprenorphine, sold under the brand name Subutex, among others, is an opioid used to treat opioid addiction, acute pain, and chronic pain. It can be used under the tongue, by injection, as a skin patch, or as an implant. When used for opioid addiction it is recommended that a health care provider observe the person while they take the medication. For longer term treatment of addiction a combination formulation of buprenorphine/naloxone is usually recommended. Maximum pain relief is generally within an hour with effects up to 24 hours.
Buprenorphine was approved for medical use in the United States in 1981.In 2012, 9.3 million prescription for the medication were written in the United States. Buprenorphine may also be used recreationally by injection or in the nose for the high it produces. Some use it as a substitute for heroin. In the United States it is a Schedule III controlled substance.
A 2017 study published by the National Rural Health Association found that 53 percent of rural counties had no physician able to prescribe medication to those addicted to opioids, the DEA said. About 90 percent of physicians allowed to prescribe such medication live in urban counties, and 30 million people live in areas where treatment is unavailable.
About 5,000 mid-level practitioners can now prescribe the medication, and nearly 43,000 practitioners may qualify to do so, the DEA said.
Rural America has more drug overdose deaths than urban areas, a 2017 study by the Centers for Disease Control and Prevention showed. Prescription drug abuse is a leading cause of death, with opioids killing more than 42,000 people in 2016, the highest U.S. death toll of any year on record, CDC said.
"This action reflects this work and the ongoing need to further expand access to the most effective treatment for opioid use disorder," said David Fiellin, professor of medicine, emergency medicine and public health at Yale School of Medicine, in an email to Reuters, who published the story ...
A nine-year veteran of the Los Angeles Police Department, whose last assignment was with the Valley Traffic Division, was arrested last week on suspicion of workers’ compensation fraud.
Jason Gordon, 48, of Los Angeles County was arrested on Jan. 17 on a felony arrest warrant related to workers’ compensation fraud and attempted perjury, the Los Angeles Police Department said.
Pully, 51, was an 18-year city employee who filed a medical compensation claim in 2016.
The LAPD’s Special Operations Division Workers’ Compensation Fraud Unit conducted an investigation that began when Gordon filed a medical claim in 2015, authorities said.
Investigators worked with the L.A. County District Attorney’s Healthcare Fraud Division and the L.A. City Attorney’s Office to established probable cause to believe Gordon “knowingly engaged” in physical workout activities.
Authorities said Gordon performed activities inconsistent with his claimed injury while on temporary totally disabled status.
"Thus he received benefits to which he was not entitled," authorities said.
Gordon was booked and released after posting $40,000 bail.
Authorities said the the Workers Compensation Fraud Unit was expanded in late 2008 to investigate fraud and other allegations involving abuse of benefits by city employees.
Gordon is the second LAPD employee to be arrested on suspicion of committing workers comp fraud in the last few weeks.
Gerald Pully, who was last assigned to the LAPD’s Records and Identification Division, was arrested on Jan. 11, on suspicion of exaggerating the extent of his injuries while receiving benefits from the police department on Jan. 11 ...
Jason Gordon, 48, of Los Angeles County was arrested on Jan. 17 on a felony arrest warrant related to workers’ compensation fraud and attempted perjury, the Los Angeles Police Department said.
Pully, 51, was an 18-year city employee who filed a medical compensation claim in 2016.
The LAPD’s Special Operations Division Workers’ Compensation Fraud Unit conducted an investigation that began when Gordon filed a medical claim in 2015, authorities said.
Investigators worked with the L.A. County District Attorney’s Healthcare Fraud Division and the L.A. City Attorney’s Office to established probable cause to believe Gordon “knowingly engaged” in physical workout activities.
Authorities said Gordon performed activities inconsistent with his claimed injury while on temporary totally disabled status.
"Thus he received benefits to which he was not entitled," authorities said.
Gordon was booked and released after posting $40,000 bail.
Authorities said the the Workers Compensation Fraud Unit was expanded in late 2008 to investigate fraud and other allegations involving abuse of benefits by city employees.
Gordon is the second LAPD employee to be arrested on suspicion of committing workers comp fraud in the last few weeks.
Gerald Pully, who was last assigned to the LAPD’s Records and Identification Division, was arrested on Jan. 11, on suspicion of exaggerating the extent of his injuries while receiving benefits from the police department on Jan. 11 ...
In 2001, Alexander Zaks M.D. formed several businesses in California’s Central Valley that focused on providing medical treatment to the region’s agricultural workers. Zaks, along with David Holmes D.C. and Daniel Reyes D.C., formed Accident Help Line Medical Group (AHL) at that time. The entities focused on patients with chronic work-related injuries. Zaks also established Millcreek Surgery Center and Alta Surgery Center. Zaks and a partner also owned Reliable Medical Supply, which provided medical equipment. In 2003 Zaks and partners also created Valley Interpreting, a translation service for patients who spoke limited or no English.
Dr. Khan and Dr. Zaks engaged in some cross marketing of their respective services to attorneys representing clients with workers’ compensation issues.
Bruce Roth, then a senior attorney with State Fund, was assigned to defend State Fund against the Zaks Entities’ WCAB liens. Suspecting possible fraud, Roth led an investigation of the Zaks Entities. In January 2006, Roth filed a petition with the WCAB to consolidate the Khan Entities’ and Zaks Entities’ 1,200+ liens against State Fund.
In October 2009, after losing on several issues before the WCAB, Roth settled the consolidated case with the Zaks Defendants without first gaining the approval of his manager at State Fund or State Fund’s claims department. Once Roth’s superiors learned of the settlement they removed Roth from the case, contacted the Zaks Entities, and disavowed the settlement on the basis that Roth lacked authority to enter into it. They forced Roth to resign and referred the case to other attorneys.
State Fund then entered into superseding settlement agreements with the Zaks Entities for substantially the same amount of money as provided for in the 2009 Settlement Memorandum negotiated by Roth. State Fund asserts that it did so in large part out of concern that the WCAB might have enforced the original 2009 Settlement Memorandum between Roth and the Zaks Entities based on Roth’s ostensible authority to bind State Fund. The newer 2010 Settlement Agreement between State Fund and the Zaks Entities released both State Fund and the Zaks Entities from all claims they had against each other up until the time of that agreement.
The State Fund then filed a federal suit for violation of the federal Racketeering and Corrupt Organizations Act (RICO) statute against defendants Alexander Zaks, M.D., Sana Khan, M.D., David Holmes, D.C., and Daniel Reyes, D.C.; their various companies and State Fund’s own former employee, attorney Bruce Roth.
After three years of litigation and extensive discovery, the Zaks Defendants, the Khan Defendants, and Roth filed three separate motions for summary judgment which were granted in March 2016. SCIF appealed the summary judgment to the 9th Circuit Court of Appeal which just affirmed the trial court in the unpublished case of SCIF v Kahn, Zaks et.al.
State Fund’s claims against these Defendants-Appellees were precluded by the broad liability releases contained in the 2010 Settlement Agreements. The district court correctly determined that the releases protected all of these Defendants-Appellees because even State Fund’s claims against the Individual Zaks Defendants were premised on acts within the scope of their agency relationships with lien claimants, such that liability was precluded by the releases’ plain terms.
The court also correctly held that there were no grounds for rescinding the 2010 Settlement Agreements. For fraud to justify rescission, however, it must be extrinsic. Here, there was no extrinsic fraud to justify rescission ...
Dr. Khan and Dr. Zaks engaged in some cross marketing of their respective services to attorneys representing clients with workers’ compensation issues.
Bruce Roth, then a senior attorney with State Fund, was assigned to defend State Fund against the Zaks Entities’ WCAB liens. Suspecting possible fraud, Roth led an investigation of the Zaks Entities. In January 2006, Roth filed a petition with the WCAB to consolidate the Khan Entities’ and Zaks Entities’ 1,200+ liens against State Fund.
In October 2009, after losing on several issues before the WCAB, Roth settled the consolidated case with the Zaks Defendants without first gaining the approval of his manager at State Fund or State Fund’s claims department. Once Roth’s superiors learned of the settlement they removed Roth from the case, contacted the Zaks Entities, and disavowed the settlement on the basis that Roth lacked authority to enter into it. They forced Roth to resign and referred the case to other attorneys.
State Fund then entered into superseding settlement agreements with the Zaks Entities for substantially the same amount of money as provided for in the 2009 Settlement Memorandum negotiated by Roth. State Fund asserts that it did so in large part out of concern that the WCAB might have enforced the original 2009 Settlement Memorandum between Roth and the Zaks Entities based on Roth’s ostensible authority to bind State Fund. The newer 2010 Settlement Agreement between State Fund and the Zaks Entities released both State Fund and the Zaks Entities from all claims they had against each other up until the time of that agreement.
The State Fund then filed a federal suit for violation of the federal Racketeering and Corrupt Organizations Act (RICO) statute against defendants Alexander Zaks, M.D., Sana Khan, M.D., David Holmes, D.C., and Daniel Reyes, D.C.; their various companies and State Fund’s own former employee, attorney Bruce Roth.
After three years of litigation and extensive discovery, the Zaks Defendants, the Khan Defendants, and Roth filed three separate motions for summary judgment which were granted in March 2016. SCIF appealed the summary judgment to the 9th Circuit Court of Appeal which just affirmed the trial court in the unpublished case of SCIF v Kahn, Zaks et.al.
State Fund’s claims against these Defendants-Appellees were precluded by the broad liability releases contained in the 2010 Settlement Agreements. The district court correctly determined that the releases protected all of these Defendants-Appellees because even State Fund’s claims against the Individual Zaks Defendants were premised on acts within the scope of their agency relationships with lien claimants, such that liability was precluded by the releases’ plain terms.
The court also correctly held that there were no grounds for rescinding the 2010 Settlement Agreements. For fraud to justify rescission, however, it must be extrinsic. Here, there was no extrinsic fraud to justify rescission ...
One of the largest entitlement programs in the country is incentivizing prescription drug trafficking and exacerbating the national opioid epidemic, according to a new Senate report published last week.
The Senate Committee on Homeland Security and Governmental Affairs released a Major Staff report, which details how Medicaid policies governing prescription drug prices, expanded at the state level through the Affordable Care Act (ACA) in 2014, "perversely" incentivize opioid abuse and illicit sales, as well as larger scale trafficking operations involving both criminal drug lords and respected doctors.
The Majority Staff Report presents evidence that financial incentives provided through Medicaid are negatively contributing to the ongoing addiction crisis, contradicting the common media narrative that Medicaid expansion under the ACA is essential to combating the epidemic because of its funding for addiction treatment programs.
It offers Clay County, Kentucky, as an example, where the number of residents on Medicaid rose from 35 percent to 60 percent in the three years following Medicaid expansion under the ACA. Over that same time period, opioid abuse increased, as did wait lists for inpatient drug treatment centers.
The report notes that roughly 70 million people are covered under Medicaid, "more than one fifth of the U.S. population," which has created, "a series of incentives for potential abuse of opioids, which are rooted in federal law itself." It points out Medicaid patients usually do not not pay for "covered medical expenses," and that federal law mandates additional costs such as co-payments be kept small for lower income groups.
The incentives were made worse, according to the report, through an Obama administration rule mandating that states could charge no more than $4 to Medicaid patients for certain groups of prescription drugs, including opioid painkillers. In some states patients on Medicaid pay as little as a $1 co-payment for up to 240 prescription pills that carry a street value of roughly $4,000.
While evidence of fraud concerning opioids exists in many other federal programs, the authors of the Majority Staff Report argue, that Medicaid is the federal program most prone to abuse, and the primary government funding source for the epidemic.- More than 80 percent of the cases presented in the report are from states participating in ACA Medicaid expansion ...
The Senate Committee on Homeland Security and Governmental Affairs released a Major Staff report, which details how Medicaid policies governing prescription drug prices, expanded at the state level through the Affordable Care Act (ACA) in 2014, "perversely" incentivize opioid abuse and illicit sales, as well as larger scale trafficking operations involving both criminal drug lords and respected doctors.
The Majority Staff Report presents evidence that financial incentives provided through Medicaid are negatively contributing to the ongoing addiction crisis, contradicting the common media narrative that Medicaid expansion under the ACA is essential to combating the epidemic because of its funding for addiction treatment programs.
It offers Clay County, Kentucky, as an example, where the number of residents on Medicaid rose from 35 percent to 60 percent in the three years following Medicaid expansion under the ACA. Over that same time period, opioid abuse increased, as did wait lists for inpatient drug treatment centers.
The report notes that roughly 70 million people are covered under Medicaid, "more than one fifth of the U.S. population," which has created, "a series of incentives for potential abuse of opioids, which are rooted in federal law itself." It points out Medicaid patients usually do not not pay for "covered medical expenses," and that federal law mandates additional costs such as co-payments be kept small for lower income groups.
The incentives were made worse, according to the report, through an Obama administration rule mandating that states could charge no more than $4 to Medicaid patients for certain groups of prescription drugs, including opioid painkillers. In some states patients on Medicaid pay as little as a $1 co-payment for up to 240 prescription pills that carry a street value of roughly $4,000.
While evidence of fraud concerning opioids exists in many other federal programs, the authors of the Majority Staff Report argue, that Medicaid is the federal program most prone to abuse, and the primary government funding source for the epidemic.- More than 80 percent of the cases presented in the report are from states participating in ACA Medicaid expansion ...
For years, hospital executives have expressed frustration when essential drugs like heart medicines have become scarce, or when prices have skyrocketed because investors manipulated the market.
Now, some of the country’s largest hospital systems are taking an aggressive step to combat the problem: They plan to go into the drug business themselves, in a move that appears to be the first on this scale.
Intermountain Healthcare is a not-for-profit health system based in Salt Lake City, Utah, with 22 hospitals, a broad range of clinics and services, about 1,400 employed primary care and secondary care physicians at more than 185 clinics in the Intermountain Medical Group, and health insurance plans from SelectHealth.
The organization just announced a bold initiative to establish a not-for-profit generic drug company aimed at ending shortages and reducing prices. Intermountain Healthcare is leading a collaboration with Ascension, SSM Health, and Trinity Health, in consultation with the U.S. Department of Veterans Affairs, to form the company. The five organizations represent more than 450 hospitals around the U.S. The press release made clear price and availability are the key issues.
The story on Forbes says the new company intends to be an FDA approved manufacturer and will either directly manufacture generic drugs or sub-contract manufacturing to reputable contract manufacturing organizations, providing patients an affordable alternative to products from generic drug companies whose capricious and unfair pricing practices are damaging the generic drug market and hurting consumers.
The company will also seek to stabilize the supply of essential generic medications administered in hospitals, many of which have fallen into chronic shortage. The new initiative will result in lower costs and more predictable supplies of essential generic medicines, helping ensure that patients and their needs come first in the generic drug marketplace.
Several major hospital systems, including Ascension, a Catholic system that is the nation’s largest nonprofit hospital group, plan to participate the new nonprofit company, that will provide a number of generic drugs to the hospitals. The Department of Veterans Affairs is also expressing interest in participating. Other hospitals are expected to join.
"This is a shot across the bow of the bad guys," said Dr. Marc Harrison, the chief executive of Intermountain Healthcare, the nonprofit that is spearheading the effort. "We are not going to lay down. We are going to go ahead and try and fix it."
Dr. Carolyn Clancy, the executive in charge of the Veterans Health Administration, said its pharmacy experts have consulted with the other systems about the project and is now working out the details of its possible involvement. "Our strong interest here is minimizing the impact of any shortages of generic drugs," she said. While she said the agency is able to negotiate good prices for veterans, "we don’t necessarily control supply" and have experienced many of the same shortages, including the recent lack of saline fluids, as the other health groups.
Dr. Kevin A. Schulman, a professor of medicine at the Duke University School of Medicine who has studied the generic drug market and is advising the effort, said: "If they all agree to buy enough to sustain this effort, you will have a huge threat to people that are trying to manipulate the generic drug market. They will want to think twice." ...
Now, some of the country’s largest hospital systems are taking an aggressive step to combat the problem: They plan to go into the drug business themselves, in a move that appears to be the first on this scale.
Intermountain Healthcare is a not-for-profit health system based in Salt Lake City, Utah, with 22 hospitals, a broad range of clinics and services, about 1,400 employed primary care and secondary care physicians at more than 185 clinics in the Intermountain Medical Group, and health insurance plans from SelectHealth.
The organization just announced a bold initiative to establish a not-for-profit generic drug company aimed at ending shortages and reducing prices. Intermountain Healthcare is leading a collaboration with Ascension, SSM Health, and Trinity Health, in consultation with the U.S. Department of Veterans Affairs, to form the company. The five organizations represent more than 450 hospitals around the U.S. The press release made clear price and availability are the key issues.
The story on Forbes says the new company intends to be an FDA approved manufacturer and will either directly manufacture generic drugs or sub-contract manufacturing to reputable contract manufacturing organizations, providing patients an affordable alternative to products from generic drug companies whose capricious and unfair pricing practices are damaging the generic drug market and hurting consumers.
The company will also seek to stabilize the supply of essential generic medications administered in hospitals, many of which have fallen into chronic shortage. The new initiative will result in lower costs and more predictable supplies of essential generic medicines, helping ensure that patients and their needs come first in the generic drug marketplace.
Several major hospital systems, including Ascension, a Catholic system that is the nation’s largest nonprofit hospital group, plan to participate the new nonprofit company, that will provide a number of generic drugs to the hospitals. The Department of Veterans Affairs is also expressing interest in participating. Other hospitals are expected to join.
"This is a shot across the bow of the bad guys," said Dr. Marc Harrison, the chief executive of Intermountain Healthcare, the nonprofit that is spearheading the effort. "We are not going to lay down. We are going to go ahead and try and fix it."
Dr. Carolyn Clancy, the executive in charge of the Veterans Health Administration, said its pharmacy experts have consulted with the other systems about the project and is now working out the details of its possible involvement. "Our strong interest here is minimizing the impact of any shortages of generic drugs," she said. While she said the agency is able to negotiate good prices for veterans, "we don’t necessarily control supply" and have experienced many of the same shortages, including the recent lack of saline fluids, as the other health groups.
Dr. Kevin A. Schulman, a professor of medicine at the Duke University School of Medicine who has studied the generic drug market and is advising the effort, said: "If they all agree to buy enough to sustain this effort, you will have a huge threat to people that are trying to manipulate the generic drug market. They will want to think twice." ...
The head of the U.S. Food and Drug Administration on Thursday said it is preparing a new, more restrictive policy targeting what drugs compounding pharmacies can produce that do not go through the agency’s approval process.
FDA Commissioner Scott Gottlieb said the agency in March will issue draft guidance with new criteria for determining what substances can be used to produce drugs in bulk for hospitals and doctors’ offices without individual patient prescriptions.
"Ultimately, there’s no question that the framework we will be laying out will place more restrictions on what they can do," Gottlieb told Reuters.
The announcement was one of several by the FDA on Thursday regarding its priorities in 2018 for drug compounding, which involves pharmacists making drugs to meet patients’ specific needs.
Gottlieb said the FDA is also preparing a new policy to give state boards of pharmacy more flexibility to oversee compounding pharmacies that ship drugs interstate and is still working on guidance to encourage more pharmacies to register with the FDA.
According to the American Pharmacists Association, 7,500 pharmacies specialize in compounding medicines, which traditionally involved mixing tailored doses for individual patients in response to a specific prescription.
The story in Reuters claims that by 2012, the practice had mushroomed, with some pharmacies selling thousands of doses of regularly used mixtures without prescriptions for physicians to keep for future use.
A fungal meningitis outbreak that year caused by contaminated steroids produced by a Massachusetts compounding pharmacy, New England Compounding Center, sickened hundreds of patients and killed 76, prosecutors said.
After the outbreak, Congress in 2013 passed the Drug Quality and Security Act to bring more compounding pharmacies, traditionally overseen by states, under FDA oversight.
The law established "outsourcing facilities" that could register with the FDA, allowing them to sell products in bulk without individual prescriptions while following federal manufacturing standards.
The FDA was required to determine that bulk compounding using a drug substance was necessary to satisfy an unmet "clinical need" and include those substances on a list.
But the FDA has not yet developed a final list of those substances, and instead adopted an interim policy allowing bulk compounding using drug substances that compounders could nominate for eventual inclusion on the list.
In October, Endo International Plc subsidiaries filed a lawsuit arguing that under that policy, the FDA had improperly authorized the bulk compounding of hundreds of drugs, including essentially a copy of its blood pressure drug Vasostrict ...
FDA Commissioner Scott Gottlieb said the agency in March will issue draft guidance with new criteria for determining what substances can be used to produce drugs in bulk for hospitals and doctors’ offices without individual patient prescriptions.
"Ultimately, there’s no question that the framework we will be laying out will place more restrictions on what they can do," Gottlieb told Reuters.
The announcement was one of several by the FDA on Thursday regarding its priorities in 2018 for drug compounding, which involves pharmacists making drugs to meet patients’ specific needs.
Gottlieb said the FDA is also preparing a new policy to give state boards of pharmacy more flexibility to oversee compounding pharmacies that ship drugs interstate and is still working on guidance to encourage more pharmacies to register with the FDA.
According to the American Pharmacists Association, 7,500 pharmacies specialize in compounding medicines, which traditionally involved mixing tailored doses for individual patients in response to a specific prescription.
The story in Reuters claims that by 2012, the practice had mushroomed, with some pharmacies selling thousands of doses of regularly used mixtures without prescriptions for physicians to keep for future use.
A fungal meningitis outbreak that year caused by contaminated steroids produced by a Massachusetts compounding pharmacy, New England Compounding Center, sickened hundreds of patients and killed 76, prosecutors said.
After the outbreak, Congress in 2013 passed the Drug Quality and Security Act to bring more compounding pharmacies, traditionally overseen by states, under FDA oversight.
The law established "outsourcing facilities" that could register with the FDA, allowing them to sell products in bulk without individual prescriptions while following federal manufacturing standards.
The FDA was required to determine that bulk compounding using a drug substance was necessary to satisfy an unmet "clinical need" and include those substances on a list.
But the FDA has not yet developed a final list of those substances, and instead adopted an interim policy allowing bulk compounding using drug substances that compounders could nominate for eventual inclusion on the list.
In October, Endo International Plc subsidiaries filed a lawsuit arguing that under that policy, the FDA had improperly authorized the bulk compounding of hundreds of drugs, including essentially a copy of its blood pressure drug Vasostrict ...
According to federal prosecutors, Philip Sobol, an orthopedic surgeon, agreed with Michael Drobot to receive kickbacks in exchange for performing surgeries at Pacific Hospital of Long Beach or referring spinal surgery patients to physicians who would perform the spinal surgeries at Pacific Hospital.
Sobol and Drobot concealed the kickbacks through a series of sham agreements including a management agreement and option agreement. Sobol received approximately $5.2 million dollars in kickbacks.
On November 24, 2015, Sobol entered into an agreement to plead guilty to a two-count information that charged him with Conspiracy in violation of 18 U.S.C. § 371, and Interstate Travel in Aid of a Racketeering Enterprise in violation of 18 U.S.C. § 1952.
Sobol further agreed to forfeit the sum of $5,200,000.00 which he admitted represented proceeds he obtained as a result of the offenses to which he entered the guilty plea.
In furtherance of this stipulation, on January 16, 2018, Federal Judge Josephine L. Stanton ordered a money judgment in the amount of $2,000,000.00 in favor of the United States of America and against Defendant Philip A. Sobol.
She furthered ordered that "This Money Judgment is part of the sentence imposed on Defendant Sobol in this case." He remains to be sentenced in February.
Prosecutors filed a Sentencing Report in his criminal case on December 5. On February 24, 2017, the United States Probation Office reported that his sentencing range was 46-57 months’ imprisonment. The report noted that Sobol had agreed to pay restitution but "did not identify any victims from the harm."
But prosecutors say the Court should apply an additional two level increase because the offense involved more than ten victims.
Prosecutors reported that "it is difficult to determine exactly how many surgeries defendant referred where he received a kickback because the kickbacks were paid through sham management and option agreements that were designed to approximate the number of surgeries referred or performed at Pacific Hospital, Drobot admitted in his plea agreement that he paid between $10,000 and $15,000 per surgery performed."
His Sentencing Hearing is currently set for February 16, 2018 at 8:30 a.m ...
Sobol and Drobot concealed the kickbacks through a series of sham agreements including a management agreement and option agreement. Sobol received approximately $5.2 million dollars in kickbacks.
On November 24, 2015, Sobol entered into an agreement to plead guilty to a two-count information that charged him with Conspiracy in violation of 18 U.S.C. § 371, and Interstate Travel in Aid of a Racketeering Enterprise in violation of 18 U.S.C. § 1952.
Sobol further agreed to forfeit the sum of $5,200,000.00 which he admitted represented proceeds he obtained as a result of the offenses to which he entered the guilty plea.
In furtherance of this stipulation, on January 16, 2018, Federal Judge Josephine L. Stanton ordered a money judgment in the amount of $2,000,000.00 in favor of the United States of America and against Defendant Philip A. Sobol.
She furthered ordered that "This Money Judgment is part of the sentence imposed on Defendant Sobol in this case." He remains to be sentenced in February.
Prosecutors filed a Sentencing Report in his criminal case on December 5. On February 24, 2017, the United States Probation Office reported that his sentencing range was 46-57 months’ imprisonment. The report noted that Sobol had agreed to pay restitution but "did not identify any victims from the harm."
But prosecutors say the Court should apply an additional two level increase because the offense involved more than ten victims.
Prosecutors reported that "it is difficult to determine exactly how many surgeries defendant referred where he received a kickback because the kickbacks were paid through sham management and option agreements that were designed to approximate the number of surgeries referred or performed at Pacific Hospital, Drobot admitted in his plea agreement that he paid between $10,000 and $15,000 per surgery performed."
His Sentencing Hearing is currently set for February 16, 2018 at 8:30 a.m ...
Burbank City Council members unanimously voted to approve an alternative dispute resolution with the Burbank Fire Fighters’ Assn. with the goal of significantly reducing the dispute process.
The Los Angeles Times reports that Betsy McClinton, the city’s management services director, said the agreement will establish a list of 29 independent medical examiners approved by both the city and firefighters’ association that the labor organization will use during a medical dispute when filing a workers’ compensation claim.
An examiner from that list will be required to see that employee within 30 days of a request by city staff. The physician will then be required to prepare their report within 30 days of the appointment, McClinton said.
Under the city’s current workers’ compensation process with other labor groups, it could take up to two to three months for the city and labor group to select an agreed medical examiner or state-qualified medical examiner to resolve a medical dispute.
McClinton added that it could take additional months after finding an examiner to make an appointment and get the results.
"The dispute resolution is greatly delayed, and, therefore, treatment and return for the employee is also delayed, and that could result in a poor medical outcome for the employee," McClinton said.
Workers’ compensation costs make up a large chunk of Burbank’s overall payroll.
For example, workers’ compensation for fire personnel for the current fiscal year is roughly 24% of the total payroll; about 18% of the total payroll goes to workers’ compensation for police personnel; and approximately 13.5% is for public works and parks and recreation field employees, McClinton said.
According to an analysis conducted by Aon, Burbank’s insurance broker, the city could have saved about $3.7 million across the 8,545 workers’ compensation claims filed historically with the city if each claim was reduced by 30 days, McClinton added ...
The Los Angeles Times reports that Betsy McClinton, the city’s management services director, said the agreement will establish a list of 29 independent medical examiners approved by both the city and firefighters’ association that the labor organization will use during a medical dispute when filing a workers’ compensation claim.
An examiner from that list will be required to see that employee within 30 days of a request by city staff. The physician will then be required to prepare their report within 30 days of the appointment, McClinton said.
Under the city’s current workers’ compensation process with other labor groups, it could take up to two to three months for the city and labor group to select an agreed medical examiner or state-qualified medical examiner to resolve a medical dispute.
McClinton added that it could take additional months after finding an examiner to make an appointment and get the results.
"The dispute resolution is greatly delayed, and, therefore, treatment and return for the employee is also delayed, and that could result in a poor medical outcome for the employee," McClinton said.
Workers’ compensation costs make up a large chunk of Burbank’s overall payroll.
For example, workers’ compensation for fire personnel for the current fiscal year is roughly 24% of the total payroll; about 18% of the total payroll goes to workers’ compensation for police personnel; and approximately 13.5% is for public works and parks and recreation field employees, McClinton said.
According to an analysis conducted by Aon, Burbank’s insurance broker, the city could have saved about $3.7 million across the 8,545 workers’ compensation claims filed historically with the city if each claim was reduced by 30 days, McClinton added ...
