AmerisourceBergen Corporation (ABC), one of the nation’s largest wholesale drug companies, and some of its subsidiaries entered into a settlement with the United States in which it agreed to pay $625 million to resolve civil liability under the False Claims Act. The claims against ABC arise from its repackaging and distributing of Pre-Filled Syringes (PFS) that were not approved for sale or use by the U.S. Food and Drug Administration (FDA).
The term "overfill" is a frequently used term in the pharmaceutical industry generally meaning the amount of extra drug above and beyond the labeled dose that is contained in an FDA-approved vial of drug. The overfill is not listed on the FDA-approved drug label. The reason manufacturers put overfill in each vial of drug is to ensure that the health care provider administering the drug will be able to extract the full labeled dose from the vial to give to the patient.
ABC admitted its subsidiaries operated a program that created, packed and shipped millions of PFS to oncology practices after the drug product was removed from the original glass vials and multiple vials of the product were pooled in untested plastic containers. Then the drug, including the overfill, was extracted and repackaged into syringes.
By harvesting the overfill, ABC was able to create more doses than it bought from the original vial manufacturers and avoid opening some of the vials. ABC retained the unopened vials and sold them to other customers and to its subsidiary for resale. These syringes were sold throughout the United States.The profit from the PFS Program was between $2.3 and $14.4 million annually for a total profit of at least $99.6 million.
ABC’s scheme enabled it to bill multiple health care providers for the same vial of drug, causing some of those providers to bill the Federal Health Care Programs for the same vial more than once. The scheme also enabled ABC to increase its market share by offering various product discounts, which it leveraged to obtain new customers and to keep existing customers who purchased its entire portfolio of oncology drugs.
This civil settlement brings to $885 million the total penalties that ABC has paid to resolve liability resulting from the PFS Program.
The settlement also resolves allegations that ABC gave kickbacks to physicians to induce them to purchase drugs through the PFS program. The alleged kickbacks were in the form of general pharmacy credits provided to the customer.
AmerisourceBergen said in a statement that the settlement reflects its acknowledgment that some practices at the now-closed Medical Initiatives unit "were not consistent with AmerisourceBergen’s approach to corporate compliance."
Four whistleblowers including Michael Mullen, the former chief operating officer of a subsidiary of AmerisourceBergen Corporation, played an instrumental role in the civil settlement. His amended qui tam complaint filed in the United States District Court for the Eastern District of New York, details AmerisourceBergen's overfill laundering scheme and the executives who knew about the oncology business model and regulatory issues, including the former and current AmerisourceBergen CEOs.
The whistleblowers will share $99 million from the settlement ...
The term "overfill" is a frequently used term in the pharmaceutical industry generally meaning the amount of extra drug above and beyond the labeled dose that is contained in an FDA-approved vial of drug. The overfill is not listed on the FDA-approved drug label. The reason manufacturers put overfill in each vial of drug is to ensure that the health care provider administering the drug will be able to extract the full labeled dose from the vial to give to the patient.
ABC admitted its subsidiaries operated a program that created, packed and shipped millions of PFS to oncology practices after the drug product was removed from the original glass vials and multiple vials of the product were pooled in untested plastic containers. Then the drug, including the overfill, was extracted and repackaged into syringes.
By harvesting the overfill, ABC was able to create more doses than it bought from the original vial manufacturers and avoid opening some of the vials. ABC retained the unopened vials and sold them to other customers and to its subsidiary for resale. These syringes were sold throughout the United States.The profit from the PFS Program was between $2.3 and $14.4 million annually for a total profit of at least $99.6 million.
ABC’s scheme enabled it to bill multiple health care providers for the same vial of drug, causing some of those providers to bill the Federal Health Care Programs for the same vial more than once. The scheme also enabled ABC to increase its market share by offering various product discounts, which it leveraged to obtain new customers and to keep existing customers who purchased its entire portfolio of oncology drugs.
This civil settlement brings to $885 million the total penalties that ABC has paid to resolve liability resulting from the PFS Program.
The settlement also resolves allegations that ABC gave kickbacks to physicians to induce them to purchase drugs through the PFS program. The alleged kickbacks were in the form of general pharmacy credits provided to the customer.
AmerisourceBergen said in a statement that the settlement reflects its acknowledgment that some practices at the now-closed Medical Initiatives unit "were not consistent with AmerisourceBergen’s approach to corporate compliance."
Four whistleblowers including Michael Mullen, the former chief operating officer of a subsidiary of AmerisourceBergen Corporation, played an instrumental role in the civil settlement. His amended qui tam complaint filed in the United States District Court for the Eastern District of New York, details AmerisourceBergen's overfill laundering scheme and the executives who knew about the oncology business model and regulatory issues, including the former and current AmerisourceBergen CEOs.
The whistleblowers will share $99 million from the settlement ...
On June 23, 2014, an inspector from Division of Occupational Safety and Health (DOSH) conducted an inspection of a job site in Oakland at which Raam Construction, Inc. served as general building contractor. Following this inspection, DOSH cited Raam as a "controlling employer" for a safety violation.
Raam thereafter contested this citation before an administrative law judge (ALJ) of the Appeals Board. (§ 6319.)
After the ALJ issued a decision upholding the citation, Raam filed a timely petition for reconsideration with the Appeals Board. On March 4, 2016, the Appeals Board issued a decision denying Raam’s petition for reconsideration. On the same day (March 4), the Appeals Board filed this decision and served a copy on Raam via first class mail.
On April 8, 2016, 35 days after the Appeals Board’s denial was issued, filed and served, Raam filed a petition for writ of mandate with the Alameda County Superior Court. Both the Appeals Board and DOSH, as real party in interest, challenged Raam’s petition for writ of mandate on untimeliness grounds, the former by motion to dismiss and the latter by demurrer. After a contested hearing presided over by Commissioner Thomas Rasch, the demurrer was sustained and the motion to dismiss granted, without leave to amend. The Court of Appeal affirmed the dismissal in the unpublished case of Raam Construction v. Occupational Safety and Health Appeals Board.
Section 6627 states in relevant part: "Any person affected by an order or decision of the appeals board may, within the time limit specified in this section, apply to the superior court of the county in which he resides, for a writ of mandate, for the purpose of inquiring into and determining the lawfulness of the original order or decision or of the order or decision following reconsideration. The application for writ of mandate must be made within 30 days after a petition for reconsideration is denied, or, if a petition is granted or reconsideration is had on the appeals board’s own motion, within 30 days after the filing of the order or decision following reconsideration." (Italics added.)
"The California Supreme Court has interpreted another Labor Code provision that is in all significant respects identical to section 6627. In Camper v. Workers’ Comp. Appeals Bd. (1992) 3 Cal.4th 679 (Camper), the high court was asked to interpret section 5950, the statute governing the time limits for an aggrieved party to file a petition for review of a Workers’ Compensation Appeals Board decision before the Supreme Court or an appellate court. It concluding section 5950 is clear on its face that the filing of the Appeals Board’s decision is what triggers the running of the limitations period: "The 45-day time period specified in section 5950 runs from the time ‘a petition for review is denied’ or from the ‘filing of [a]n order, decision, or award following reconsideration.’ (Lab. Code, § 5950, italics added.) There is no reference in this statute to service. The operative trigger of the time period set forth in section 5950 is the filing of the order ...
Raam thereafter contested this citation before an administrative law judge (ALJ) of the Appeals Board. (§ 6319.)
After the ALJ issued a decision upholding the citation, Raam filed a timely petition for reconsideration with the Appeals Board. On March 4, 2016, the Appeals Board issued a decision denying Raam’s petition for reconsideration. On the same day (March 4), the Appeals Board filed this decision and served a copy on Raam via first class mail.
On April 8, 2016, 35 days after the Appeals Board’s denial was issued, filed and served, Raam filed a petition for writ of mandate with the Alameda County Superior Court. Both the Appeals Board and DOSH, as real party in interest, challenged Raam’s petition for writ of mandate on untimeliness grounds, the former by motion to dismiss and the latter by demurrer. After a contested hearing presided over by Commissioner Thomas Rasch, the demurrer was sustained and the motion to dismiss granted, without leave to amend. The Court of Appeal affirmed the dismissal in the unpublished case of Raam Construction v. Occupational Safety and Health Appeals Board.
Section 6627 states in relevant part: "Any person affected by an order or decision of the appeals board may, within the time limit specified in this section, apply to the superior court of the county in which he resides, for a writ of mandate, for the purpose of inquiring into and determining the lawfulness of the original order or decision or of the order or decision following reconsideration. The application for writ of mandate must be made within 30 days after a petition for reconsideration is denied, or, if a petition is granted or reconsideration is had on the appeals board’s own motion, within 30 days after the filing of the order or decision following reconsideration." (Italics added.)
"The California Supreme Court has interpreted another Labor Code provision that is in all significant respects identical to section 6627. In Camper v. Workers’ Comp. Appeals Bd. (1992) 3 Cal.4th 679 (Camper), the high court was asked to interpret section 5950, the statute governing the time limits for an aggrieved party to file a petition for review of a Workers’ Compensation Appeals Board decision before the Supreme Court or an appellate court. It concluding section 5950 is clear on its face that the filing of the Appeals Board’s decision is what triggers the running of the limitations period: "The 45-day time period specified in section 5950 runs from the time ‘a petition for review is denied’ or from the ‘filing of [a]n order, decision, or award following reconsideration.’ (Lab. Code, § 5950, italics added.) There is no reference in this statute to service. The operative trigger of the time period set forth in section 5950 is the filing of the order ...
Orange County District Attorney Tony Rackauckas recently formed the Sober Living-home Investigation and Prosecution (SLIP) task force to stop large scale insurance fraud and to address citizen and community complaints and concerns about criminal activities occurring within the addiction treatment industry. Rackauckas said Orange County has become known as "Rehab Riviera," with many addicts coming to the region from out of state, and that sober living homes, which have quickly proliferated.
And his efforts seem to be paying off. SLIP just netted 11 defendants in a multi-million dollar, large scale insurance fraud scheme. Five doctors, two administrators, and four body brokers were charged with participating in this scheme.
The physicians charged in the case are:
-- Dr. David Michael Scarpino, 53, of Huntington Beach, who faces one count of conspiring in aiding and abetting the unauthorized practice of medicine and 19 counts of insurance fraud, with sentencing enhancement allegations of aggravated white collar crime exceeding $100,000
-- Dr. Gary Lamont Baker, 54, of Tustin, who is charged with one count of conspiring in the unauthorized practice of medicine, five counts of insurance fraud and one count of assault with force likely to produce great bodily injury
-- Dr. Fritz John Baumgartner, 61, of Rancho Palos Verdes, who is charged with two counts of conspiring in the unauthorized practice of medicine, four counts of rebates for referral, three counts of conspiracy to commit medical insurance fraud, five counts of insurance fraud and one count of assault with force likely to produce great bodily injury, with a sentencing enhancement for aggravated white collar crime exceeding $500,000
-- Dr. Michael Henry Wong, 53, of Irvine, and Dr. Nabil Charle Morcos, 66, of Irvine, who are both charged with one count of conspiring in the unauthorized practice of medicine and 22 counts of insurance fraud, with a sentencing enhancement for aggravated white collar crime exceeding $100,000.
Also charged are Thuy Rucks, 78, of Mission Viejo, the owner of SoberLife USA at 10900 Warner Ave. in Fountain Valley. He faces one count of unauthorized practice of medicine, four counts of unlawful offer or receipt of consideration by claims handler for referral, four counts of conspiracy to commit medical insurance fraud and three counts of insurance fraud, with a sentencing enhancement for aggravated white collar crime exceeding $100,000.
Christianne Tiemann, an administrator for SoberLife USA, is accused of hiring "body brokers" who recruited prospective patients who were paid $1,000 to receive a surgical implant of Naltrexone, an opioid blocker. The 66-year-old Trabuco Canyon resident is charged with one count of unauthorized practice of medicine, four counts of unlawful offer or receipt of consideration by claims handler for referral, four counts of conspiracy to commit medical insurance fraud and three counts of insurance fraud.
The defendants accused of recruiting patients are:
-- Dylan James Walker, 27, of Huntington Beach, who is charged with 62 felony counts of false and fraudulent claims
-- Harrison Anthony Romanowski, 27, of Huntington Beach, who is charged with 35 felony counts of false and fraudulent claims
-- John T. Kahal, 67, of Dana Point, who is charged with 16 felony counts of false and fraudulent claims
-- Jordan Tyler Hendrickson, 25, of Studio City, who is charged with 14 felony counts of false and fraudulent claims.
The recruiters allegedly mined for patients at sober living homes and AA meetings, among other venues, Rackauckas said.
The defendants are accused of participating in a scheme that subjected patients to a procedure that was experimental, not FDA approved, and dangerous and billing insurance companies such as Anthem Blue Cross, United Health Care and Centene (Healthnet) on average $40,000 per surgery. Some who received surgeries were addicted to methamphetamine and not opiates ...
And his efforts seem to be paying off. SLIP just netted 11 defendants in a multi-million dollar, large scale insurance fraud scheme. Five doctors, two administrators, and four body brokers were charged with participating in this scheme.
The physicians charged in the case are:
-- Dr. David Michael Scarpino, 53, of Huntington Beach, who faces one count of conspiring in aiding and abetting the unauthorized practice of medicine and 19 counts of insurance fraud, with sentencing enhancement allegations of aggravated white collar crime exceeding $100,000
-- Dr. Gary Lamont Baker, 54, of Tustin, who is charged with one count of conspiring in the unauthorized practice of medicine, five counts of insurance fraud and one count of assault with force likely to produce great bodily injury
-- Dr. Fritz John Baumgartner, 61, of Rancho Palos Verdes, who is charged with two counts of conspiring in the unauthorized practice of medicine, four counts of rebates for referral, three counts of conspiracy to commit medical insurance fraud, five counts of insurance fraud and one count of assault with force likely to produce great bodily injury, with a sentencing enhancement for aggravated white collar crime exceeding $500,000
-- Dr. Michael Henry Wong, 53, of Irvine, and Dr. Nabil Charle Morcos, 66, of Irvine, who are both charged with one count of conspiring in the unauthorized practice of medicine and 22 counts of insurance fraud, with a sentencing enhancement for aggravated white collar crime exceeding $100,000.
Also charged are Thuy Rucks, 78, of Mission Viejo, the owner of SoberLife USA at 10900 Warner Ave. in Fountain Valley. He faces one count of unauthorized practice of medicine, four counts of unlawful offer or receipt of consideration by claims handler for referral, four counts of conspiracy to commit medical insurance fraud and three counts of insurance fraud, with a sentencing enhancement for aggravated white collar crime exceeding $100,000.
Christianne Tiemann, an administrator for SoberLife USA, is accused of hiring "body brokers" who recruited prospective patients who were paid $1,000 to receive a surgical implant of Naltrexone, an opioid blocker. The 66-year-old Trabuco Canyon resident is charged with one count of unauthorized practice of medicine, four counts of unlawful offer or receipt of consideration by claims handler for referral, four counts of conspiracy to commit medical insurance fraud and three counts of insurance fraud.
The defendants accused of recruiting patients are:
-- Dylan James Walker, 27, of Huntington Beach, who is charged with 62 felony counts of false and fraudulent claims
-- Harrison Anthony Romanowski, 27, of Huntington Beach, who is charged with 35 felony counts of false and fraudulent claims
-- John T. Kahal, 67, of Dana Point, who is charged with 16 felony counts of false and fraudulent claims
-- Jordan Tyler Hendrickson, 25, of Studio City, who is charged with 14 felony counts of false and fraudulent claims.
The recruiters allegedly mined for patients at sober living homes and AA meetings, among other venues, Rackauckas said.
The defendants are accused of participating in a scheme that subjected patients to a procedure that was experimental, not FDA approved, and dangerous and billing insurance companies such as Anthem Blue Cross, United Health Care and Centene (Healthnet) on average $40,000 per surgery. Some who received surgeries were addicted to methamphetamine and not opiates ...
The DWC has posted proposed amendments to the Pharmaceutical Fee Schedule to its online forum where members of the public may review and comment on the proposal.
Under the California Labor Code, the fee schedule for pharmaceuticals is based primarily upon the Medi-Cal pharmacy payment system. Medi-Cal is now implementing a revised payment methodology approved by the Centers for Medicare and Medicaid Services (CMS). Background information on the Medi-Cal changes can be reviewed on the Department of Health Care Services (DHCS) Pharmacy Reimbursement Project web page.
Due to requirements of federal law, the DHCS will implement Medi-Cal pharmacy fee schedule changes retroactively to April 1, 2017. For workers’ compensation, fee schedule changes will not be retroactive; the draft regulations propose that the new methodology become effective for pharmaceuticals dispensed on or after January 1, 2019.
The following regulation changes are proposed to implement Labor Code section 5307.1 and to align the fee schedule with the new Medi-Cal system:
Adoption of the revised two-tier Medi-Cal dispensing fee structure for pharmacies (which increases the dispensing fee from the current $7.25 to $10.05, or to $13.20 for those pharmacies listed by Medi-Cal as eligible for the higher fee); Rules addressing fees for compounded drugs and repackaged drugs
The forum can be found on the DWC forums web page under "current forums." Comments will be accepted on the forum until Monday, October 8 ...
Under the California Labor Code, the fee schedule for pharmaceuticals is based primarily upon the Medi-Cal pharmacy payment system. Medi-Cal is now implementing a revised payment methodology approved by the Centers for Medicare and Medicaid Services (CMS). Background information on the Medi-Cal changes can be reviewed on the Department of Health Care Services (DHCS) Pharmacy Reimbursement Project web page.
Due to requirements of federal law, the DHCS will implement Medi-Cal pharmacy fee schedule changes retroactively to April 1, 2017. For workers’ compensation, fee schedule changes will not be retroactive; the draft regulations propose that the new methodology become effective for pharmaceuticals dispensed on or after January 1, 2019.
The following regulation changes are proposed to implement Labor Code section 5307.1 and to align the fee schedule with the new Medi-Cal system:
- Elimination of the Average Wholesale Price (AWP) minus 17 percent as a benchmark for the drug ingredient;
- Revised methodology for payment of the drug ingredient, which sets the maximum at the lower of the following:
- National Drug Acquisition Cost (NADAC) or Wholesale Acquisition Cost (WAC) for drugs lacking a NADAC price;
- Federal Upper Limit;
- Maximum Allowable Ingredient Cost (MAIC);
- Usual and Customary Charge;
The forum can be found on the DWC forums web page under "current forums." Comments will be accepted on the forum until Monday, October 8 ...
The Division of Workers’ Compensation has adopted amendments to the Official Medical Fee Schedule (OMFS) for Physician and Non-Physician Practitioner Services (California Code of Regulations, title 8, section 9789.12.1 through 9789.19.1) to replace the average statewide geographic adjustment factor with local geographic adjustment factors as of January 1.
The locality-specific geographic adjustment factors, known as the Geographic Practice Cost Index (GPCI), was implemented by Medicare in January 2017 as part of its Metropolitan Statistical Area (MSA) program. Geographic Practice Cost Index is used along with Relative Value Units by Medicare to determine allowable payment amounts for medical procedures.
Fee-for-service Medicare payments to physicians and certain other licensed clinical practitioners (including nurse practitioners, physician assistants, clinical nurse specialists, and occupational and physical therapists) are adjusted for geographic differences in market conditions and business costs. These geographic adjustments are intended to ensure that payment to providers reflects the local costs of providing care, so that the Medicare program does not overpay in certain areas and underpay in others.
Each of the three components of the Medicare Physician Fee Schedule (PFS) - physician work, practice expense (PE), and malpractice (MP) insurance - is adjusted for differences across geographic areas in the input prices related to each component. When they are combined, these three components are known as the geographic adjustment factor (GAF).1
The GPCI payment adjustments are made for 89 different geographic areas in the United States, also known as payment areas (or localities). Some are defined according to metropolitan areas, but there are 34 statewide payment areas that include both metropolitan and nonmetropolitan areas.
By federal statute, any changes to the GPCIs that do not explicitly receive additional funding must be budget neutral. In practice, budget neutrality requires that the total amount of payment be unaffected by new adjustments, so that any adjustment upward for one payment area must be paid for by a downward adjustment for other areas. This requirement creates significant tensions among providers in high-versus low-cost areas.
Another major source of disagreement is whether the geographic adjusters should be used as policy levers to help influence provider supply, particularly in nonmetropolitan areas. Some rural health policy experts and practitioners argue that because earning potential influences physicians' decisions on where to practice, and because many private payers use Medicare prices as a basis for setting their own rates, the geographic adjustments should be used as policy tools to encourage physicians to practice in nonmetropolitan areas.
The DWC says that adoption of the Medicare MSA-based locality GPCIs will improve payment allowance accuracy by reflecting the resources required to provide a service according to specific regions.
The amendments also make minor clarifying revisions to the regulations.
DWC submitted a request to the California Office of Administrative Law to file the amended regulations with the Secretary of State and have them published in the California Code of Regulations. The regulations can be found on the DWC website ...
The locality-specific geographic adjustment factors, known as the Geographic Practice Cost Index (GPCI), was implemented by Medicare in January 2017 as part of its Metropolitan Statistical Area (MSA) program. Geographic Practice Cost Index is used along with Relative Value Units by Medicare to determine allowable payment amounts for medical procedures.
Fee-for-service Medicare payments to physicians and certain other licensed clinical practitioners (including nurse practitioners, physician assistants, clinical nurse specialists, and occupational and physical therapists) are adjusted for geographic differences in market conditions and business costs. These geographic adjustments are intended to ensure that payment to providers reflects the local costs of providing care, so that the Medicare program does not overpay in certain areas and underpay in others.
Each of the three components of the Medicare Physician Fee Schedule (PFS) - physician work, practice expense (PE), and malpractice (MP) insurance - is adjusted for differences across geographic areas in the input prices related to each component. When they are combined, these three components are known as the geographic adjustment factor (GAF).1
The GPCI payment adjustments are made for 89 different geographic areas in the United States, also known as payment areas (or localities). Some are defined according to metropolitan areas, but there are 34 statewide payment areas that include both metropolitan and nonmetropolitan areas.
By federal statute, any changes to the GPCIs that do not explicitly receive additional funding must be budget neutral. In practice, budget neutrality requires that the total amount of payment be unaffected by new adjustments, so that any adjustment upward for one payment area must be paid for by a downward adjustment for other areas. This requirement creates significant tensions among providers in high-versus low-cost areas.
Another major source of disagreement is whether the geographic adjusters should be used as policy levers to help influence provider supply, particularly in nonmetropolitan areas. Some rural health policy experts and practitioners argue that because earning potential influences physicians' decisions on where to practice, and because many private payers use Medicare prices as a basis for setting their own rates, the geographic adjustments should be used as policy tools to encourage physicians to practice in nonmetropolitan areas.
The DWC says that adoption of the Medicare MSA-based locality GPCIs will improve payment allowance accuracy by reflecting the resources required to provide a service according to specific regions.
The amendments also make minor clarifying revisions to the regulations.
DWC submitted a request to the California Office of Administrative Law to file the amended regulations with the Secretary of State and have them published in the California Code of Regulations. The regulations can be found on the DWC website ...
43-year-old Rashimir Salazar, of Woodland, was sentenced by Judge David Rosenberg for committing workers’ compensation insurance fraud.
Judge Rosenberg sentenced Salazar to 30 days county jail, two years felony probation and 40 hours of community service. Salazar had pled no contest On August 23, 2018, to one count of felony workers’ compensation insurance fraud. Salazar was also ordered to pay restitution in the amount of $9,820.86.
While working for Woodland Residential Services in February 2014, Salazar was injured while working. She received $13,567.92 in temporary total disability (TTD) payments in lost wages due to the injury.
It was discovered that Salazar was also working separately for a private customer while she was receiving TTD payments.
Salazar intentionally withheld this information from the workers’ compensation insurance company in order to continue to receive TTD payments. This fraudulent conduct went unnoticed until the Special Investigations Unit (SIU) for CompWest Insurance started investigating the facts surrounding Salazar’s claim.
This case was investigated by the Yolo County District Attorney’s Workers’ Compensation Insurance Fraud Investigator and prosecuted by the Yolo County District Attorney Office.
The Workers’ Compensation Insurance Fraud unit works to prevent and investigate claimant fraud, medical provider fraud, premium fraud, and uninsured employers throughout Colusa, Sutter, Yuba, and Yolo Counties.
The most common type of workers’ compensation insurance fraud is claimant fraud, for which Salazar was convicted. Claimant fraud occurs when an employee lies or omits a material fact in order to obtain benefits that they would not have otherwise been entitled to. Examples would be to lie about how an injury occurred, the extent of their injury, or not to report outside employment and income.
While government resources are dedicated to determining fraudulent action, the public’s attention to this workers’ compensation fraud is important. To report workers’ compensation insurance fraud, call the DA’s hotline at 530-406-4524. Additional resources can be found at www.yoloda.org ...
Judge Rosenberg sentenced Salazar to 30 days county jail, two years felony probation and 40 hours of community service. Salazar had pled no contest On August 23, 2018, to one count of felony workers’ compensation insurance fraud. Salazar was also ordered to pay restitution in the amount of $9,820.86.
While working for Woodland Residential Services in February 2014, Salazar was injured while working. She received $13,567.92 in temporary total disability (TTD) payments in lost wages due to the injury.
It was discovered that Salazar was also working separately for a private customer while she was receiving TTD payments.
Salazar intentionally withheld this information from the workers’ compensation insurance company in order to continue to receive TTD payments. This fraudulent conduct went unnoticed until the Special Investigations Unit (SIU) for CompWest Insurance started investigating the facts surrounding Salazar’s claim.
This case was investigated by the Yolo County District Attorney’s Workers’ Compensation Insurance Fraud Investigator and prosecuted by the Yolo County District Attorney Office.
The Workers’ Compensation Insurance Fraud unit works to prevent and investigate claimant fraud, medical provider fraud, premium fraud, and uninsured employers throughout Colusa, Sutter, Yuba, and Yolo Counties.
The most common type of workers’ compensation insurance fraud is claimant fraud, for which Salazar was convicted. Claimant fraud occurs when an employee lies or omits a material fact in order to obtain benefits that they would not have otherwise been entitled to. Examples would be to lie about how an injury occurred, the extent of their injury, or not to report outside employment and income.
While government resources are dedicated to determining fraudulent action, the public’s attention to this workers’ compensation fraud is important. To report workers’ compensation insurance fraud, call the DA’s hotline at 530-406-4524. Additional resources can be found at www.yoloda.org ...
Insurance Commissioner Dave Jones has approved a Universal Claims Certification (UCC) program from Claims and Litigation Management Alliance (CLM) designed to streamline the licensing process for independent insurance adjusters.
The UCC makes the process of licensing independent insurance adjusters who wish to acquire and manage their independent insurance adjuster licenses in multiple states more efficient. The UCC does not replace an independent insurance adjuster license, but makes the process of securing a license more efficient. Both licensed and unlicensed individuals can acquire a UCC. However, unlicensed individuals must first go through an intensive training by completing a 40-hour online pre-certification education program and successfully pass an examination to earn the UCC.
Insurance Commissioner Dave Jones said "The Universal Claims Certification process is designed to streamline the independent insurance adjuster licensing process and reduce costs. Also, the UCC program sets requirements for licensees that exceed the requirements under current California law, meaning it requires licensees to complete more continuing education, which greatly benefits the independent insurance adjusters and consumers."
Currently, independent insurance adjuster applicants are not required to complete any prelicensing education. California's applicants are only required to take and pass the independent insurance adjuster license examination and meet the license requirements to receive an independent insurance adjuster license.
For a licensee to maintain the UCC, the independent insurance adjusters must complete 24 hours of continuing education every two years including five hours of insurance law and ethics. The UCC program's insurance law and ethics requirement exceeds California's required three hours of law and ethics that is a part of and not in addition to the 24-hour continuing education requirement.
Once independent insurance adjusters acquire the UCC, they will be able to more quickly obtain a license in the states where the UCC is currently approved, including Alabama, Florida, Georgia, Mississippi, Texas, and now California. This will allow out-of-state adjusters to be more readily available when a natural disaster occurs.
"For years, the CLM membership has complained of the tedious state-by-state adjuster licensing process. We first worked to tackle the process of managing multiple licenses with our Tracker product, then we started to work with various states to actually change the licensing process," says CLM Founder and former CEO Adam Potter. "It's exciting to see this work come to life as we launch the UCC."
CLM is an insurance industry association with more than 45,000 members that focuses on education and resources. CLM offers over 300 live courses, events and conferences annually ...
The UCC makes the process of licensing independent insurance adjusters who wish to acquire and manage their independent insurance adjuster licenses in multiple states more efficient. The UCC does not replace an independent insurance adjuster license, but makes the process of securing a license more efficient. Both licensed and unlicensed individuals can acquire a UCC. However, unlicensed individuals must first go through an intensive training by completing a 40-hour online pre-certification education program and successfully pass an examination to earn the UCC.
Insurance Commissioner Dave Jones said "The Universal Claims Certification process is designed to streamline the independent insurance adjuster licensing process and reduce costs. Also, the UCC program sets requirements for licensees that exceed the requirements under current California law, meaning it requires licensees to complete more continuing education, which greatly benefits the independent insurance adjusters and consumers."
Currently, independent insurance adjuster applicants are not required to complete any prelicensing education. California's applicants are only required to take and pass the independent insurance adjuster license examination and meet the license requirements to receive an independent insurance adjuster license.
For a licensee to maintain the UCC, the independent insurance adjusters must complete 24 hours of continuing education every two years including five hours of insurance law and ethics. The UCC program's insurance law and ethics requirement exceeds California's required three hours of law and ethics that is a part of and not in addition to the 24-hour continuing education requirement.
Once independent insurance adjusters acquire the UCC, they will be able to more quickly obtain a license in the states where the UCC is currently approved, including Alabama, Florida, Georgia, Mississippi, Texas, and now California. This will allow out-of-state adjusters to be more readily available when a natural disaster occurs.
"For years, the CLM membership has complained of the tedious state-by-state adjuster licensing process. We first worked to tackle the process of managing multiple licenses with our Tracker product, then we started to work with various states to actually change the licensing process," says CLM Founder and former CEO Adam Potter. "It's exciting to see this work come to life as we launch the UCC."
CLM is an insurance industry association with more than 45,000 members that focuses on education and resources. CLM offers over 300 live courses, events and conferences annually ...
Health Management Associates, LLC (HMA) will pay over $260 million to resolve criminal charges and civil claims relating to a scheme to defraud the United States. The government alleged that HMA knowingly billed government health care programs for inpatient services that should have been billed as outpatient or observation services, paid remuneration to physicians in return for patient referrals, and submitted inflated claims for emergency department facility fees.
HMA was acquired by Community Health Systems Inc. (CHS), a major U.S. hospital chain, in January 2014, after the alleged conduct at HMA occurred. ;Since July 2014, HMA has been operating under a Corporate Integrity Agreement (CIA) between CHS and the HHS-OIG.
In addition, an HMA subsidiary, Carlisle HMA, LLC, formerly doing business as Carlisle Regional Medical Center, has agreed to plead guilty to one count of conspiracy to commit health care fraud.
HMA admitted in settlement agreements that it instituted a formal and aggressive plan to improperly increase overall emergency department inpatient admissions at all HMA hospitals. As part of the plan, HMA set mandatory company-wide admission rate benchmarks for patients presenting to HMA hospital emergency departments - a range of 15 to 20 percent for all patients presenting to the emergency department, depending on the HMA hospital, and 50 percent for patients 65 and older (i.e. Medicare beneficiaries) - solely to increase HMA revenue.
HMA executives and HMA hospital administrators executed the scheme by pressuring, coercing and inducing physicians and medical directors to meet the mandatory admission rate benchmarks and admit patients who did not need impatient admission through a variety of means, including by threatening to fire physicians and medical directors if they did not increase the number of patients admitted.
The civil settlement also resolves allegations that two HMA hospitals billed federal health care programs for services referred by physicians to whom HMA provided remuneration in return for patient referrals or kickbacks. HMA agreed to pay $93.5 million to resolve these civil allegations, with the United States receiving $87.96 million, and the State of Florida receiving $5.54 million.
The government further alleged that certain HMA hospitals submitted claims to Medicare and Medicaid seeking reimbursement for falsely inflated emergency department facility charges. HMA agreed to pay $12 million to resolve these civil allegations ...
HMA was acquired by Community Health Systems Inc. (CHS), a major U.S. hospital chain, in January 2014, after the alleged conduct at HMA occurred. ;Since July 2014, HMA has been operating under a Corporate Integrity Agreement (CIA) between CHS and the HHS-OIG.
In addition, an HMA subsidiary, Carlisle HMA, LLC, formerly doing business as Carlisle Regional Medical Center, has agreed to plead guilty to one count of conspiracy to commit health care fraud.
HMA admitted in settlement agreements that it instituted a formal and aggressive plan to improperly increase overall emergency department inpatient admissions at all HMA hospitals. As part of the plan, HMA set mandatory company-wide admission rate benchmarks for patients presenting to HMA hospital emergency departments - a range of 15 to 20 percent for all patients presenting to the emergency department, depending on the HMA hospital, and 50 percent for patients 65 and older (i.e. Medicare beneficiaries) - solely to increase HMA revenue.
HMA executives and HMA hospital administrators executed the scheme by pressuring, coercing and inducing physicians and medical directors to meet the mandatory admission rate benchmarks and admit patients who did not need impatient admission through a variety of means, including by threatening to fire physicians and medical directors if they did not increase the number of patients admitted.
The civil settlement also resolves allegations that two HMA hospitals billed federal health care programs for services referred by physicians to whom HMA provided remuneration in return for patient referrals or kickbacks. HMA agreed to pay $93.5 million to resolve these civil allegations, with the United States receiving $87.96 million, and the State of Florida receiving $5.54 million.
The government further alleged that certain HMA hospitals submitted claims to Medicare and Medicaid seeking reimbursement for falsely inflated emergency department facility charges. HMA agreed to pay $12 million to resolve these civil allegations ...
A WCJ found Dean Fitzpatrick "100 percent permanently totally disabled" as a result of injury to his heart and psyche sustained during the course of his employment as a correctional officer. The award was based on the reports of two doctors regarding Fitzpatrick’s injury -- Peter Chang-Sing for his heart and Richard Lieberman for his psyche.
Chang-Sing rated Fitzpatrick’s WPI for his heart at 75 percent and his resulting permanent disability at 97 percent. Lieberman rated Fitzpatrick’s GAF score at 45, resulting in 40 percent WPI, and permanent disability of 71 percent for his psyche. It is undisputed that, combining the 97 percent and 71 percent ratings under the Combined Values Chart Fitzpatrick’s permanent disability scheduled rating is 99 percent -- permanent partial disability.
Thus Fitzpatrick’s permanent disability scheduled rating is 99 percent -- permanent partial disability.
In the July 16, 2015 report, Dr. Lieberman felt that applicant was"on strict psychiatric grounds totally and permanently disabled" . . . Dr. Lieberman elaborated further: "I am dubious that this patient will return to work in any capacity."
The ALJ concluded: "Based upon [Fitzpatrick’s] credible testimony, the medical reports of Dr. Chang-Sing and Dr. Lieberman, and in accordance with the facts (see Labor Code §4662(b)), it is found that applicant is permanently totally disabled." The administrative law judge did not mention or discuss the combined rating under the 2005 Schedule. No vocational expert presented evidence in the case.
The Board affirmed the Decision in its opinion and order denying the petition for reconsideration. However, the Court of Appeal reversed in the published case of Department of Corrections v WCAB (Dean Fitzpatrick).
The question presented on appeal is whether the Board correctly interpreted and applied sections 4660 and 4662, subdivision (b).
"We easily harmonize sections 4660 and 4662, subdivision (b). Section 4662, subdivision (b), provides that, in nonconclusively presumed permanent total disability cases (i.e., those cases not enumerated in section 4662, subdivision (a)), permanent total disability may be found 'in accordance with the fact.' This section does not, however, address how such a determination shall be made; read plainly, it merely provides that a determination of permanent total disability shall be made on the facts of the case."
Section 4660 addresses how the determination on the facts shall be made in each case for injuries occurring before January 1, 2013. Indeed, section 4660 expressly applies to the determination of "the percentages of permanent disability." A "final permanent disability rating" is obtained by going through the steps outlined in the 2005 Schedule.
"Our interpretation of sections 4660 and 4662, subdivision (b), is squarely at odds with the Board panel’s interpretation of those statutes in Jaramillo (on which the administrative law judge and the Board relied in this case)." [Coca-Cola Enterprises, Inc. v. Workers’ Comp. Appeals Bd. (Jaramillo) (2012) 77 Cal.Comp.Cases 445 [writ. den.].
"We thus disapprove of Jaramillo with respect to its analysis on this issue, and annul the Board’s Opinion for the same reason." ...
Chang-Sing rated Fitzpatrick’s WPI for his heart at 75 percent and his resulting permanent disability at 97 percent. Lieberman rated Fitzpatrick’s GAF score at 45, resulting in 40 percent WPI, and permanent disability of 71 percent for his psyche. It is undisputed that, combining the 97 percent and 71 percent ratings under the Combined Values Chart Fitzpatrick’s permanent disability scheduled rating is 99 percent -- permanent partial disability.
Thus Fitzpatrick’s permanent disability scheduled rating is 99 percent -- permanent partial disability.
In the July 16, 2015 report, Dr. Lieberman felt that applicant was"on strict psychiatric grounds totally and permanently disabled" . . . Dr. Lieberman elaborated further: "I am dubious that this patient will return to work in any capacity."
The ALJ concluded: "Based upon [Fitzpatrick’s] credible testimony, the medical reports of Dr. Chang-Sing and Dr. Lieberman, and in accordance with the facts (see Labor Code §4662(b)), it is found that applicant is permanently totally disabled." The administrative law judge did not mention or discuss the combined rating under the 2005 Schedule. No vocational expert presented evidence in the case.
The Board affirmed the Decision in its opinion and order denying the petition for reconsideration. However, the Court of Appeal reversed in the published case of Department of Corrections v WCAB (Dean Fitzpatrick).
The question presented on appeal is whether the Board correctly interpreted and applied sections 4660 and 4662, subdivision (b).
"We easily harmonize sections 4660 and 4662, subdivision (b). Section 4662, subdivision (b), provides that, in nonconclusively presumed permanent total disability cases (i.e., those cases not enumerated in section 4662, subdivision (a)), permanent total disability may be found 'in accordance with the fact.' This section does not, however, address how such a determination shall be made; read plainly, it merely provides that a determination of permanent total disability shall be made on the facts of the case."
Section 4660 addresses how the determination on the facts shall be made in each case for injuries occurring before January 1, 2013. Indeed, section 4660 expressly applies to the determination of "the percentages of permanent disability." A "final permanent disability rating" is obtained by going through the steps outlined in the 2005 Schedule.
"Our interpretation of sections 4660 and 4662, subdivision (b), is squarely at odds with the Board panel’s interpretation of those statutes in Jaramillo (on which the administrative law judge and the Board relied in this case)." [Coca-Cola Enterprises, Inc. v. Workers’ Comp. Appeals Bd. (Jaramillo) (2012) 77 Cal.Comp.Cases 445 [writ. den.].
"We thus disapprove of Jaramillo with respect to its analysis on this issue, and annul the Board’s Opinion for the same reason." ...
The Division of Workers’ Compensation (DWC) will hold a public meeting on Wednesday, October 17 to discuss the structure of a new medical-legal fee schedule for the workers’ compensation system. This fee schedule is used to compensate physicians for examinations and reports that decide issues of compensability for work-related injuries.
DWC posted a notice of pre-rulemaking proposed amendments to the current medical-legal fee schedule in an open forum on May 3 and says it received an overwhelming response by the workers’ compensation community, with most respondents requesting an overhaul of the entire medical-legal fee schedule.
There were no changes to the amount of fee schedule payments in the May proposed amendments to section 9794 and 9795 of the regulations. It did clarify the use of the complexity factors relating to causation, medical research, record review and apportionment. The factors that indicate the presence of extraordinary circumstances in a medical -legal evaluation were more clearly defined. The language required in a report to define extraordinary circumstances is explained. Realistic limits on certain areas of billing are implemented.
The characterization of the responses as "overwhelming" is an understatement. The file containing the written responses is 520 pages. For the most part, physicians claim they are not paid enough for QME medical legal work.
The October meeting is intended to respond to this input and develop next steps for revising the fee schedule. DWC seeks input from stakeholders who will be affected by the final version of the medical-legal fee schedule. The Division is particularly interested in:
- Determining the best format for the new fee schedule to offer optimum benefit for QMEs, AMEs, Injured Workers, Employers, Medical Management Organizations and Carriers;
- Identifying any possible obstacles to that process; and
- Identifying representatives to participate in small pre-rulemaking meetings to further develop the best format for the new medical-legal fee schedule.
The public meeting is scheduled for Wednesday, October 17 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland.
Meeting attendees will be allowed up to three minutes to express their ideas on changes to the fee schedule. Written comments can also be submitted at the public meeting, emailed to DWCRules@dir.ca.gov, or mailed to: Division of Workers’ Compensation, P.O. Box 420603, San Francisco, CA 94142 - Attn: Medical-Legal Fee Schedule Forum ...
DWC posted a notice of pre-rulemaking proposed amendments to the current medical-legal fee schedule in an open forum on May 3 and says it received an overwhelming response by the workers’ compensation community, with most respondents requesting an overhaul of the entire medical-legal fee schedule.
There were no changes to the amount of fee schedule payments in the May proposed amendments to section 9794 and 9795 of the regulations. It did clarify the use of the complexity factors relating to causation, medical research, record review and apportionment. The factors that indicate the presence of extraordinary circumstances in a medical -legal evaluation were more clearly defined. The language required in a report to define extraordinary circumstances is explained. Realistic limits on certain areas of billing are implemented.
The characterization of the responses as "overwhelming" is an understatement. The file containing the written responses is 520 pages. For the most part, physicians claim they are not paid enough for QME medical legal work.
The October meeting is intended to respond to this input and develop next steps for revising the fee schedule. DWC seeks input from stakeholders who will be affected by the final version of the medical-legal fee schedule. The Division is particularly interested in:
- Determining the best format for the new fee schedule to offer optimum benefit for QMEs, AMEs, Injured Workers, Employers, Medical Management Organizations and Carriers;
- Identifying any possible obstacles to that process; and
- Identifying representatives to participate in small pre-rulemaking meetings to further develop the best format for the new medical-legal fee schedule.
The public meeting is scheduled for Wednesday, October 17 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland.
Meeting attendees will be allowed up to three minutes to express their ideas on changes to the fee schedule. Written comments can also be submitted at the public meeting, emailed to DWCRules@dir.ca.gov, or mailed to: Division of Workers’ Compensation, P.O. Box 420603, San Francisco, CA 94142 - Attn: Medical-Legal Fee Schedule Forum ...
Governor Brown has signed new provisions that apply to California Workers' Compensation Benefits. Here are highlights of new law that will take effect next January.
AB 1749 Workers’ compensation: off-duty peace officers. This new law was created as a result of the October 1, 2017, mass shooting in Las Vegas, Nevada. The new law provides that an employer, at its discretion or in accordance with specified policies, is not precluded from accepting liability for compensation for an injury sustained by a peace officer by reason of engaging in the apprehension or attempted apprehension of law violators or suspected law violators, or protection or preservation of life or property, or the preservation of the peace, outside the state of California.
AB 2046 Workers’ compensation insurance fraud reporting. Requires data sharing between governmental agencies involved in combating workers' compensation fraud, and grants the Fraud Assessment Commission (FAC) discretion to augment an assessment with unused funds from a prior year's assessment.
SB 880 Workers’ compensation prepaid cards. This bill would authorize an employer, with the written consent of the employee, to deposit disability indemnity payments for the employee in a prepaid card account. The bill would require the Commission on Health and Safety and Workers’ Compensation to issue a report to the Legislature regarding payments made to those prepaid card accounts.
SB 1086 Workers’ compensation: firefighters and peace officers. Section 5406.7 of the Labor Code currently sets extended time limits for death claims for firefighters and peace officers. By its terms, this provision was to expire on January 1, 2019. The new law deletes the January 1, 2019, date of repeal of Section 5406.7 so that the time limits will now apply to death cases after January 2019.
Governor Brown has vetoed several bills passed by the legislature that pertain to California Workers' Compensation Benefits. Here are highlights of what he chose not to sign into law.
AB 479 Workers’ compensation: permanent disability apportionment. This proposed law would have set limits to apportionment of permanent disability in cases involving breast cancer. The veto message notes that is similar to three previous measures that he has vetoed, Assembly Bill 570 in 2017, Assembly Bill 1643 in 2016 and Assembly 305 in 2015. He said that this bill and its predecessors have repeatedly singled out specific conditions and proposed a special set of rules that apply to them. This would result in an even more complex workers' compensation system that would essentially be "disease by statute," which would ultimately burden injured workers seeking quick resolution to their claims.
AB 553 Workers’ compensation: return-to-work program. This bill would have required the Department of Industrial Relations to completely disburse $120 million annually from the Workers' Compensation Return to Work Fund to eligible injured workers. The veto message noted that the Return-to-Work Program began in 2015 and is relatively new. He was concerned this measure proposes sweeping revisions to the Return-to-Work program that are premature.
AB 1697 Workers’ compensation fraud unit. This would have required the DIR to establish an anti-fraud unit within the DWC. The veto message notes that the work required by this measure is already underway.
AB 2496 Janitorial employees.The proposed law was a codification of the California Supreme Court new ABC test for an employment relationship in Dynamex Operations West, Inc. v. Superior Court (2018) 4 Cal.5th 903. The bill was vetoed because the Administration and the Legislature are still reviewing this decision and any statutory changes to such tests would be premature.
SB 899 Workers’ compensation permanent disability apportionment. This measure seeks to preclude a physician from using race, gender, or national origin as a basis for apportionment. The Governor vetoed this bill for many of the same reasons that he returned a similar measure in 2011 - Assembly Bill 1155. This bill is unnecessary as it would not change existing law and may disturb settled court decisions, which already provide protection from the inappropriate application of the apportionment statutes ...
AB 1749 Workers’ compensation: off-duty peace officers. This new law was created as a result of the October 1, 2017, mass shooting in Las Vegas, Nevada. The new law provides that an employer, at its discretion or in accordance with specified policies, is not precluded from accepting liability for compensation for an injury sustained by a peace officer by reason of engaging in the apprehension or attempted apprehension of law violators or suspected law violators, or protection or preservation of life or property, or the preservation of the peace, outside the state of California.
AB 2046 Workers’ compensation insurance fraud reporting. Requires data sharing between governmental agencies involved in combating workers' compensation fraud, and grants the Fraud Assessment Commission (FAC) discretion to augment an assessment with unused funds from a prior year's assessment.
SB 880 Workers’ compensation prepaid cards. This bill would authorize an employer, with the written consent of the employee, to deposit disability indemnity payments for the employee in a prepaid card account. The bill would require the Commission on Health and Safety and Workers’ Compensation to issue a report to the Legislature regarding payments made to those prepaid card accounts.
SB 1086 Workers’ compensation: firefighters and peace officers. Section 5406.7 of the Labor Code currently sets extended time limits for death claims for firefighters and peace officers. By its terms, this provision was to expire on January 1, 2019. The new law deletes the January 1, 2019, date of repeal of Section 5406.7 so that the time limits will now apply to death cases after January 2019.
Governor Brown has vetoed several bills passed by the legislature that pertain to California Workers' Compensation Benefits. Here are highlights of what he chose not to sign into law.
AB 479 Workers’ compensation: permanent disability apportionment. This proposed law would have set limits to apportionment of permanent disability in cases involving breast cancer. The veto message notes that is similar to three previous measures that he has vetoed, Assembly Bill 570 in 2017, Assembly Bill 1643 in 2016 and Assembly 305 in 2015. He said that this bill and its predecessors have repeatedly singled out specific conditions and proposed a special set of rules that apply to them. This would result in an even more complex workers' compensation system that would essentially be "disease by statute," which would ultimately burden injured workers seeking quick resolution to their claims.
AB 553 Workers’ compensation: return-to-work program. This bill would have required the Department of Industrial Relations to completely disburse $120 million annually from the Workers' Compensation Return to Work Fund to eligible injured workers. The veto message noted that the Return-to-Work Program began in 2015 and is relatively new. He was concerned this measure proposes sweeping revisions to the Return-to-Work program that are premature.
AB 1697 Workers’ compensation fraud unit. This would have required the DIR to establish an anti-fraud unit within the DWC. The veto message notes that the work required by this measure is already underway.
AB 2496 Janitorial employees.The proposed law was a codification of the California Supreme Court new ABC test for an employment relationship in Dynamex Operations West, Inc. v. Superior Court (2018) 4 Cal.5th 903. The bill was vetoed because the Administration and the Legislature are still reviewing this decision and any statutory changes to such tests would be premature.
SB 899 Workers’ compensation permanent disability apportionment. This measure seeks to preclude a physician from using race, gender, or national origin as a basis for apportionment. The Governor vetoed this bill for many of the same reasons that he returned a similar measure in 2011 - Assembly Bill 1155. This bill is unnecessary as it would not change existing law and may disturb settled court decisions, which already provide protection from the inappropriate application of the apportionment statutes ...
Five years after he was paralyzed in a snowmobile accident, a man has learned to walk again aided by an electrical implant, in a potential breakthrough for spinal injury sufferers. A team of doctors at the Mayo Clinic in Minnesota say the man, using a front-wheeled walker, was able to cover the equivalent of the length of a football pitch, issuing commands from his brain to transfer weight and maintain balance -- all previously thought impossible for paralyzed patients.
The man, now 29, severed his spinal cord in the middle of his back when he crashed his snowmobile in 2013. He is completely paralyzed from the waist down, and cannot move or feel anything below the middle of his torso.
In the study, the results of which were published on Monday in the journal Nature Medicine, doctors in 2016 implanted a small electronic device in the man's spine. The wirelessly operated implant, about the size of a AA battery, generates electrical pulses to stimulate nerves that -- due to the injury -- had been permanently disconnected from the brain.
Within weeks of the device being switched on, the man began to take his first steps since the accident -- but was still suspended in a harness. Astonishingly, after several more sessions of rehab and physiotherapy, he was able to support most of his own body weight and take steps on a treadmill.
Although the device was able to help generate power and control in the patient's lower body, it did nothing to restore sensation in his legs. This initially proved challenging. Without the physical feeling of walking registering in his brain, it was hard for him to make the instantaneous balance adjustments most of us make without thinking.
The team overcame the problem by installing mirrors at knee height so the patient could see what position his legs were in while walking. Eventually the man was able to walk on the treadmill with only periodic glances down at his legs. While the device's effect is remarkable, the man is still paralysed once it is turned off.
In 2011, electrodes implanted on the lower spine of a paraplegic man allowed him to stand and regain some movement in his legs, but the team believes this is the first instance an implant has been used to get a paralyzed person to walk.
The study was conducted in conjunction with the University of California Los Angeles and was partly funded by the Christopher and Dana Reeve Foundation. Christopher Reeve, best known for starring role in the "Superman" film, was left paraplegic after a horse-riding accident in 1995 ...
The man, now 29, severed his spinal cord in the middle of his back when he crashed his snowmobile in 2013. He is completely paralyzed from the waist down, and cannot move or feel anything below the middle of his torso.
In the study, the results of which were published on Monday in the journal Nature Medicine, doctors in 2016 implanted a small electronic device in the man's spine. The wirelessly operated implant, about the size of a AA battery, generates electrical pulses to stimulate nerves that -- due to the injury -- had been permanently disconnected from the brain.
Within weeks of the device being switched on, the man began to take his first steps since the accident -- but was still suspended in a harness. Astonishingly, after several more sessions of rehab and physiotherapy, he was able to support most of his own body weight and take steps on a treadmill.
Although the device was able to help generate power and control in the patient's lower body, it did nothing to restore sensation in his legs. This initially proved challenging. Without the physical feeling of walking registering in his brain, it was hard for him to make the instantaneous balance adjustments most of us make without thinking.
The team overcame the problem by installing mirrors at knee height so the patient could see what position his legs were in while walking. Eventually the man was able to walk on the treadmill with only periodic glances down at his legs. While the device's effect is remarkable, the man is still paralysed once it is turned off.
In 2011, electrodes implanted on the lower spine of a paraplegic man allowed him to stand and regain some movement in his legs, but the team believes this is the first instance an implant has been used to get a paralyzed person to walk.
The study was conducted in conjunction with the University of California Los Angeles and was partly funded by the Christopher and Dana Reeve Foundation. Christopher Reeve, best known for starring role in the "Superman" film, was left paraplegic after a horse-riding accident in 1995 ...
Barrett Business Services Inc. (BBSI) has agreed to pay a $1.5 million civil penalty to resolve accounting fraud allegations by the U.S. Securities and Exchange Commission.
BBSI, a publicly traded company, provides human resources and other business management services. It reported $920 million in revenue last year and profits of $25.2 million.Clients hire BBSI to process payroll and payroll taxes, to provide workers’ compensation coverage, and to perform other business administration and consulting services. It has over 50 offices in 12 states and lists 24 offices in Northern and Southern California.
According to the SEC settlement, BBSI's former chief financial officer, James Douglas Miller hid negative trends in BBSI's financials by concealing the company's workers' compensation expense and liabilities. The SEC said former controller Mark Cannon approved improper journal entries created by Miller to manipulate BBSI's tax expenses.
Separately, Cannon agreed to pay a $20,000 penalty, the agency said.
Concurrently, federal prosecutors announced they have obtained a criminal indictment against Miller, who's been accused of falsifying financial reports. Miller served as the CFO of BBSI from 2008 to 2016. He was fired in 2016 when he disclosed to the company that he had falsified entries in the company’s books to improperly report workers’ compensation expenses as payroll taxes and fees.
As a result of Miller's accounting improprieties, BBSI under reported approximately $12 million in workman’s compensation expenses in 2013. At the same time as he falsified BBSI’s books and falsely certified the periodic reports filed with the U.S. Securities and Exchange Commission,
Miler allegedly profited on BBSI stock, by exercising stock options worth 35,300 shares for $467,261 and selling it for more than $2.4 million.
According to records filed in the case, on four different occasions in 2013 and 2014, Miller falsely certified periodic reports filed with the SEC. His certifications contained a number of false statements including statements that BBSI’s periodic reports fairly presented, in all material respects, the results of BBSI’s operations.
Contrary to his representations, Miller allegedly knew that during each calendar quarter of 2013, he had circumvented BBSI’s internal controls and created a number of accounting entries that improperly classified workers’ compensation expenses as payroll and payroll tax expenses in violation of generally accepted accounting procedures.
"Mr. Miller will be pleading not guilty to the charge and defending the matter vigorously," said his lawyer, Portland attorney Janet Hoffman. Willful certification of a false periodic report is punishable by up to 20 years in prison and a fine of up to $5,000,000 ...
BBSI, a publicly traded company, provides human resources and other business management services. It reported $920 million in revenue last year and profits of $25.2 million.Clients hire BBSI to process payroll and payroll taxes, to provide workers’ compensation coverage, and to perform other business administration and consulting services. It has over 50 offices in 12 states and lists 24 offices in Northern and Southern California.
According to the SEC settlement, BBSI's former chief financial officer, James Douglas Miller hid negative trends in BBSI's financials by concealing the company's workers' compensation expense and liabilities. The SEC said former controller Mark Cannon approved improper journal entries created by Miller to manipulate BBSI's tax expenses.
Separately, Cannon agreed to pay a $20,000 penalty, the agency said.
Concurrently, federal prosecutors announced they have obtained a criminal indictment against Miller, who's been accused of falsifying financial reports. Miller served as the CFO of BBSI from 2008 to 2016. He was fired in 2016 when he disclosed to the company that he had falsified entries in the company’s books to improperly report workers’ compensation expenses as payroll taxes and fees.
As a result of Miller's accounting improprieties, BBSI under reported approximately $12 million in workman’s compensation expenses in 2013. At the same time as he falsified BBSI’s books and falsely certified the periodic reports filed with the U.S. Securities and Exchange Commission,
Miler allegedly profited on BBSI stock, by exercising stock options worth 35,300 shares for $467,261 and selling it for more than $2.4 million.
According to records filed in the case, on four different occasions in 2013 and 2014, Miller falsely certified periodic reports filed with the SEC. His certifications contained a number of false statements including statements that BBSI’s periodic reports fairly presented, in all material respects, the results of BBSI’s operations.
Contrary to his representations, Miller allegedly knew that during each calendar quarter of 2013, he had circumvented BBSI’s internal controls and created a number of accounting entries that improperly classified workers’ compensation expenses as payroll and payroll tax expenses in violation of generally accepted accounting procedures.
"Mr. Miller will be pleading not guilty to the charge and defending the matter vigorously," said his lawyer, Portland attorney Janet Hoffman. Willful certification of a false periodic report is punishable by up to 20 years in prison and a fine of up to $5,000,000 ...
"Incidence rates for deaths directly attributable to medical care gone awry haven’t been recognized in any standardized method for collecting national statistics," says Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and an authority on health reform.
"The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used." In 1949, Makary says, the U.S. adopted an international form that used International Classification of Diseases (ICD) billing codes to tally causes of death.
"At that time, it was under-recognized that diagnostic errors, medical mistakes and the absence of safety nets could result in someone’s death, and because of that, medical errors were unintentionally excluded from national health statistics," says Makary.
The researchers say that since that time, national mortality statistics have been tabulated using billing codes, which don’t have a built-in way to recognize incidence rates of mortality due to medical care gone wrong.
In their study, the researchers examined four separate studies that analyzed medical death rate data from 2000 to 2008, including one by the U.S. Department of Health and Human Services’ Office of the Inspector General and the Agency for Healthcare Research and Quality.
Then, using hospital admission rates from 2013, they extrapolated that based on a total of 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error, which the researchers say now translates to 9.5 percent of all deaths each year in the U.S.
According to the CDC, in 2013, 611,105 people died of heart disease, 584,881 died of cancer and 149,205 died of chronic respiratory disease - the top three causes of death in the U.S. The newly calculated figure for medical errors puts this cause of death behind cancer but ahead of respiratory disease.
"Top-ranked causes of death as reported by the CDC inform our country’s research funding and public health priorities," says Makary. "Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves."
The researchers caution that most of medical errors aren’t due to inherently bad doctors, and that reporting these errors shouldn’t be addressed by punishment or legal action.
Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability ...
"The medical coding system was designed to maximize billing for physician services, not to collect national health statistics, as it is currently being used." In 1949, Makary says, the U.S. adopted an international form that used International Classification of Diseases (ICD) billing codes to tally causes of death.
"At that time, it was under-recognized that diagnostic errors, medical mistakes and the absence of safety nets could result in someone’s death, and because of that, medical errors were unintentionally excluded from national health statistics," says Makary.
The researchers say that since that time, national mortality statistics have been tabulated using billing codes, which don’t have a built-in way to recognize incidence rates of mortality due to medical care gone wrong.
In their study, the researchers examined four separate studies that analyzed medical death rate data from 2000 to 2008, including one by the U.S. Department of Health and Human Services’ Office of the Inspector General and the Agency for Healthcare Research and Quality.
Then, using hospital admission rates from 2013, they extrapolated that based on a total of 35,416,020 hospitalizations, 251,454 deaths stemmed from a medical error, which the researchers say now translates to 9.5 percent of all deaths each year in the U.S.
According to the CDC, in 2013, 611,105 people died of heart disease, 584,881 died of cancer and 149,205 died of chronic respiratory disease - the top three causes of death in the U.S. The newly calculated figure for medical errors puts this cause of death behind cancer but ahead of respiratory disease.
"Top-ranked causes of death as reported by the CDC inform our country’s research funding and public health priorities," says Makary. "Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves."
The researchers caution that most of medical errors aren’t due to inherently bad doctors, and that reporting these errors shouldn’t be addressed by punishment or legal action.
Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability ...
Governor Brown has signed AB 2334 into law. The new law requires that, as part of occupational injury and illness reporting, employers additionally file specified injury and illness forms electronically with Cal/OSHA no later than February 1 of each year.
And requires Cal/OSHA to develop a searchable database for one of those forms relating to summary information on its web site by a date specified and further requires Cal/OSHA to post those forms on the database within 90 days of receipt. "While posting of injury information at each worksite is important, specific workplace injury and illness information is not accessible to the public and prospective employees in an easily accessible database on the Internet."
The new law seems to have been triggered by federal initiatives to reduce employer reporting requirements.
The federal Occupational Safety and Health Administration (OSHA) adopted the Improve Tracking of Workplace Injuries and Illnesses rule in 2016. This rule requires electronic submission of certain occupational injury and illness reports by covered employers with at least 250 employees and by smaller employers in high-risk industries. In the fall of 2017,
However, OSHA issued a Notice of Proposed Rulemaking to potentially relax these workplace injury and illness reporting requirements.
In response to the federal initiative to reduce employer reporting requirements, California decided to pass a new law that went the other way - Increase employer reporting requirements.
Along the way, the bill was amended in the senate to authorize the director of the DIR to publish information regarding the costs of administration, workers' compensation benefit expenditures, and solvency and performance of public self-insured employers' workers' compensation programs.
As expected, support and opposition of AB 2334 polarized around the allegiance of advocacy groups. Labor Unions and employee groups were in favor, while employer groups were opposed.
In support, a coalition of labor organizations, including UNITE-HERE, AFL-CIO, states that "by making these annual summaries text-searchable, AB 2334 will simply improve public access to these important reports. We believe that spreading awareness can in turn only foster safer workplaces."
The bill’s sponsor, California Professional Firefighters, contends that "firefighters and all workers in California will benefit from public access to workplace injury and illness data in a searchable database."
It further claims that the "current system of posting Form 300A [the annual summary of injuries and illnesses] at the workplace benefits workers at the site or facility but does not provide an opportunity for review by the public. Reporting to Cal/OSHA will strengthen California’s access to data regarding workplace injuries, will help further drive data supported solutions to improve workplace safety and ensure California required reporting is in place if the U.S. Department of Labor relaxes federal reporting rules."
In opposition, a group of employer organizations, including the California Chamber of Commerce, argues that the bill ‘seeks to publicly shame employers by disclosing for public review on a searchable website, each employer’s injury and illness records, that can be misconstrued and distorted in a manner that does not reflect employers’ commitment to the safety of their employees while providing no advancement of worker safety." ...
And requires Cal/OSHA to develop a searchable database for one of those forms relating to summary information on its web site by a date specified and further requires Cal/OSHA to post those forms on the database within 90 days of receipt. "While posting of injury information at each worksite is important, specific workplace injury and illness information is not accessible to the public and prospective employees in an easily accessible database on the Internet."
The new law seems to have been triggered by federal initiatives to reduce employer reporting requirements.
The federal Occupational Safety and Health Administration (OSHA) adopted the Improve Tracking of Workplace Injuries and Illnesses rule in 2016. This rule requires electronic submission of certain occupational injury and illness reports by covered employers with at least 250 employees and by smaller employers in high-risk industries. In the fall of 2017,
However, OSHA issued a Notice of Proposed Rulemaking to potentially relax these workplace injury and illness reporting requirements.
In response to the federal initiative to reduce employer reporting requirements, California decided to pass a new law that went the other way - Increase employer reporting requirements.
Along the way, the bill was amended in the senate to authorize the director of the DIR to publish information regarding the costs of administration, workers' compensation benefit expenditures, and solvency and performance of public self-insured employers' workers' compensation programs.
As expected, support and opposition of AB 2334 polarized around the allegiance of advocacy groups. Labor Unions and employee groups were in favor, while employer groups were opposed.
In support, a coalition of labor organizations, including UNITE-HERE, AFL-CIO, states that "by making these annual summaries text-searchable, AB 2334 will simply improve public access to these important reports. We believe that spreading awareness can in turn only foster safer workplaces."
The bill’s sponsor, California Professional Firefighters, contends that "firefighters and all workers in California will benefit from public access to workplace injury and illness data in a searchable database."
It further claims that the "current system of posting Form 300A [the annual summary of injuries and illnesses] at the workplace benefits workers at the site or facility but does not provide an opportunity for review by the public. Reporting to Cal/OSHA will strengthen California’s access to data regarding workplace injuries, will help further drive data supported solutions to improve workplace safety and ensure California required reporting is in place if the U.S. Department of Labor relaxes federal reporting rules."
In opposition, a group of employer organizations, including the California Chamber of Commerce, argues that the bill ‘seeks to publicly shame employers by disclosing for public review on a searchable website, each employer’s injury and illness records, that can be misconstrued and distorted in a manner that does not reflect employers’ commitment to the safety of their employees while providing no advancement of worker safety." ...
Cal/OSHA has issued citations to GreenWaste Recovery Inc. after a waste collection worker was fatally run over by his own truck in San Jose. An investigation found that the employer failed to ensure the truck’s safety restraint was in working order and did not ensure it was being used by workers driving from the right-hand side of the truck.
On March 2, a GreenWaste Recovery worker was driving a waste collection truck to gather recyclables in San Jose. The worker was making a turn while operating the truck from the right-hand side when he fell out and was run over. Cal/OSHA’s inspection determined that the waste collection truck had a safety chain for the truck cab opening that could not be used because a part was missing.
"Collection vehicles with the option to operate the truck from the right-hand side must be equipped with an occupant restraint system such as a door, locking or latching bar, safety chain or strap," said Cal/OSHA Chief Juliann Sum. "To prevent serious and fatal injuries, employers must maintain occupant restraints in working order and ensure the restraints are used by workers."
Cal/OSHA issued two general and two serious accident-related citations totaling $46,270 in proposed penalties to GreenWaste Recovery. The serious accident-related citations were issued for the employer’s failure to ensure that occupant restraints were being used by workers driving from the right-hand side of the truck and failure to identify and evaluate the unsafe work practice of workers not using occupant restraints. In addition, the employer received two general citations for not maintaining vehicle safety equipment.
Cal/OSHA conducted inspections of GreenWaste Recovery involving three separate worker injuries in 2016 and 2017. Over the last three years, Cal/OSHA has opened at least 186 inspections with solid waste collection and material recovery employers. Those inspections include a fatal incident last year in La Jolla when a waste collection worker was crushed by his unsecured truck that rolled forward and pinned him against a wall. Department of Industrial Relations Release No.18-77 Page 2
A citation is classified as serious when there is a realistic possibility that death or serious harm could result from the actual hazard created by the violation. Citations are classified as accident-related when the injury, illness or fatality is caused by the violation ...
On March 2, a GreenWaste Recovery worker was driving a waste collection truck to gather recyclables in San Jose. The worker was making a turn while operating the truck from the right-hand side when he fell out and was run over. Cal/OSHA’s inspection determined that the waste collection truck had a safety chain for the truck cab opening that could not be used because a part was missing.
"Collection vehicles with the option to operate the truck from the right-hand side must be equipped with an occupant restraint system such as a door, locking or latching bar, safety chain or strap," said Cal/OSHA Chief Juliann Sum. "To prevent serious and fatal injuries, employers must maintain occupant restraints in working order and ensure the restraints are used by workers."
Cal/OSHA issued two general and two serious accident-related citations totaling $46,270 in proposed penalties to GreenWaste Recovery. The serious accident-related citations were issued for the employer’s failure to ensure that occupant restraints were being used by workers driving from the right-hand side of the truck and failure to identify and evaluate the unsafe work practice of workers not using occupant restraints. In addition, the employer received two general citations for not maintaining vehicle safety equipment.
Cal/OSHA conducted inspections of GreenWaste Recovery involving three separate worker injuries in 2016 and 2017. Over the last three years, Cal/OSHA has opened at least 186 inspections with solid waste collection and material recovery employers. Those inspections include a fatal incident last year in La Jolla when a waste collection worker was crushed by his unsecured truck that rolled forward and pinned him against a wall. Department of Industrial Relations Release No.18-77 Page 2
A citation is classified as serious when there is a realistic possibility that death or serious harm could result from the actual hazard created by the violation. Citations are classified as accident-related when the injury, illness or fatality is caused by the violation ...
The National Football League, which entered a concussion-related settlement that has been valued at approximately $1 billion, is far from the only organization affected by the emergence of civil and workers' compensation claims alleging long-term injuries from repeated blows to the head.
Sports organizations at all levels, from youth clubs to colleges to professional leagues, as well as coaches and other individuals, have faced lawsuits claiming that athletes suffered from such progressive injuries, including an alleged brain disease known as chronic traumatic encephalopathy ("CTE").
Not all of these claims succeed. U.S. District Judge Vanessa Bryant in Hartford, Connecticut, ruled on Monday that claims filed on behalf of 53 wrestlers like Joseph "Road Warrior Animal" Laurinaitis and Jimmy "Superfly" Snuka were brought too late and some were frivolous.
Bryant also found no basis to suggest the defendants, including WWE Chief Executive Officer Vince McMahon, knew of any link between wrestling and CTE before 2007, which was after most of the plaintiffs had retired.
"The court is also unwilling to find that the diagnosis of one wrestler with CTE is sufficient to imbue WWE with actual awareness of a probable link between wrestling and CTE," Bryant added.
CTE is a neurodegenerative disease often caused by repeated trauma to the head, and cannot be diagnosed before death.
A large part of Bryant’s 40-page decision focused on the plaintiffs’ lawyer Konstantine Kyros, who the judge said "persistently" ignored her orders and caused a "considerable waste" of time and resources over 3-1/2 years of litigation.
"The opinions expressed about my strong advocacy are inaccurate, bizarre and unworthy of the court," Kyros said in an email to Reuters on Tuesday, adding that Bryant should have let the case go to a jury. "We trust the wrestlers’ claims will be better received in the appeals courts," he added.
Jerry McDevitt, a partner at K&L Gates representing Stamford, Connecticut-based WWE, welcomed the ruling according to the Reuters report.
"It was a thoughtful decision," he said in an interview. "The WWE did not engage in misconduct, and had educated wrestlers about the risks."
Laurinaitis has experienced memory loss, dizzy spells and sleep apnea, according to an amended complaint filed last November, while Snuka had CTE, dementia and Alzheimer’s disease when he died in January 2017 at age 73 ...
Sports organizations at all levels, from youth clubs to colleges to professional leagues, as well as coaches and other individuals, have faced lawsuits claiming that athletes suffered from such progressive injuries, including an alleged brain disease known as chronic traumatic encephalopathy ("CTE").
Not all of these claims succeed. U.S. District Judge Vanessa Bryant in Hartford, Connecticut, ruled on Monday that claims filed on behalf of 53 wrestlers like Joseph "Road Warrior Animal" Laurinaitis and Jimmy "Superfly" Snuka were brought too late and some were frivolous.
Bryant also found no basis to suggest the defendants, including WWE Chief Executive Officer Vince McMahon, knew of any link between wrestling and CTE before 2007, which was after most of the plaintiffs had retired.
"The court is also unwilling to find that the diagnosis of one wrestler with CTE is sufficient to imbue WWE with actual awareness of a probable link between wrestling and CTE," Bryant added.
CTE is a neurodegenerative disease often caused by repeated trauma to the head, and cannot be diagnosed before death.
A large part of Bryant’s 40-page decision focused on the plaintiffs’ lawyer Konstantine Kyros, who the judge said "persistently" ignored her orders and caused a "considerable waste" of time and resources over 3-1/2 years of litigation.
"The opinions expressed about my strong advocacy are inaccurate, bizarre and unworthy of the court," Kyros said in an email to Reuters on Tuesday, adding that Bryant should have let the case go to a jury. "We trust the wrestlers’ claims will be better received in the appeals courts," he added.
Jerry McDevitt, a partner at K&L Gates representing Stamford, Connecticut-based WWE, welcomed the ruling according to the Reuters report.
"It was a thoughtful decision," he said in an interview. "The WWE did not engage in misconduct, and had educated wrestlers about the risks."
Laurinaitis has experienced memory loss, dizzy spells and sleep apnea, according to an amended complaint filed last November, while Snuka had CTE, dementia and Alzheimer’s disease when he died in January 2017 at age 73 ...
Christopher Owens, a former UCSF surgeon, was sentenced to 41 months in prison for unlawfully prescribing oxycodone hydrochloride without a medical purpose. He worked at the university-affiliated Veterans Affairs Medical Center in San Francisco.
Owens was arrested in Indiana on July 11th, 2017, as part of the largest health care fraud enforcement action in the Department of Justice's history. The former San Francisco vascular surgeon initially entered a not guilty plea on the drug charges, 36 counts of distributing oxycodone.
Owens’ profile on the university website said he is a 1998 graduate of Indiana University’s school of medicine and listed nine research grants and 70 published studies under his name. Another site listed him as a specialist in vascular surgery, aneurysms, deep vein thrombosis and diseases of the carotid artery.
One of his alleged victims, 35 year old Danielle Pattillo, was found dead in her apartment under what investigators called suspicious circumstances. Pattillo worked at the Veteran's Affairs Medical Center with Owens. She mysteriously died in what investigators initially thought was a mere drug overdose.
But Paul Pattillo, who was in the midst of a divorce with Danielle, said she had become involved with Owens. She was found deceased and he was the last person who was with her.
Owens was immediately placed on investigatory leave by the University, UCSF fired him five months later after he was booked on local drug charges. But those charges with the San Francisco District Attorney's office never stuck.
DEA agents also arrested Owens as part of the nationwide crackdown on fraudulent opioid prescriptions spearheaded by Attorney General Jeff Sessions.
The federal indictment alleged that between September of 2012 and June of 2015, Owens, who had moved to Indiana, intended to act outside the course of usual professional practice and without a legitimate medical purpose when he prescribed oxycodone on numerous occasions. In sum, Owens is charged with 36 counts of illegally distributing oxycodone.
His California Physicians and Surgeons certificate was revoked by the Board of Medicine in June, 2017.
Owens pleaded guilty to Count 36 of the indictment on March 20, 2018. According to his open plea application filed with the court, Owens acknowledged he prescribed the drugs without a legitimate medical need and outside of the course of medical practice.
In sentencing Owens, Judge Alsup stated, "[Owens] was not running a pill mill, . . . but he was doing something just as bad . . .. He used that prescription pad to feed a habit."
In addition to the prison term, Judge Alsup ordered Owens to serve three years of supervised release to begin after his prison term is completed and a $7,500 fine. Judge Alsup ordered Owens to surrender and begin serving his sentence on December 3, 2018 ...
Owens was arrested in Indiana on July 11th, 2017, as part of the largest health care fraud enforcement action in the Department of Justice's history. The former San Francisco vascular surgeon initially entered a not guilty plea on the drug charges, 36 counts of distributing oxycodone.
Owens’ profile on the university website said he is a 1998 graduate of Indiana University’s school of medicine and listed nine research grants and 70 published studies under his name. Another site listed him as a specialist in vascular surgery, aneurysms, deep vein thrombosis and diseases of the carotid artery.
One of his alleged victims, 35 year old Danielle Pattillo, was found dead in her apartment under what investigators called suspicious circumstances. Pattillo worked at the Veteran's Affairs Medical Center with Owens. She mysteriously died in what investigators initially thought was a mere drug overdose.
But Paul Pattillo, who was in the midst of a divorce with Danielle, said she had become involved with Owens. She was found deceased and he was the last person who was with her.
Owens was immediately placed on investigatory leave by the University, UCSF fired him five months later after he was booked on local drug charges. But those charges with the San Francisco District Attorney's office never stuck.
DEA agents also arrested Owens as part of the nationwide crackdown on fraudulent opioid prescriptions spearheaded by Attorney General Jeff Sessions.
The federal indictment alleged that between September of 2012 and June of 2015, Owens, who had moved to Indiana, intended to act outside the course of usual professional practice and without a legitimate medical purpose when he prescribed oxycodone on numerous occasions. In sum, Owens is charged with 36 counts of illegally distributing oxycodone.
His California Physicians and Surgeons certificate was revoked by the Board of Medicine in June, 2017.
Owens pleaded guilty to Count 36 of the indictment on March 20, 2018. According to his open plea application filed with the court, Owens acknowledged he prescribed the drugs without a legitimate medical need and outside of the course of medical practice.
In sentencing Owens, Judge Alsup stated, "[Owens] was not running a pill mill, . . . but he was doing something just as bad . . .. He used that prescription pad to feed a habit."
In addition to the prison term, Judge Alsup ordered Owens to serve three years of supervised release to begin after his prison term is completed and a $7,500 fine. Judge Alsup ordered Owens to surrender and begin serving his sentence on December 3, 2018 ...
Humira is one of the best selling drugs in the world. Televised commercials show that a woman with rheumatoid arthritis can wash her puppy in the bathtub, another with colitis can stroll happily through a fair packed with food vendors, while a third suffering from psoriasis can go to the gym without hiding her neck.
The price of Humira, an anti-inflammatory drug dispensed in an injectable pen, has risen from about $19,000 a year in 2012, to more than $38,000 today, per patient, after rebates. Its maker, AbbVie, which was spun from Abbott Laboratories in 2013, has now been accused of illegal kickbacks in the largest health care fraud case in the California Department of Insurance History. Humira accounted for more than two-thirds of AbbVie's $25.6 billion in revenue in 2016.
The California Insurance Commissioner filed a civil fraud complaint in Alameda County Superior Court on behalf of the State of California against AbbVie alleging the company gave illegal kickbacks to health care providers to prescribe HUMIRA - an expensive and dangerous drug with potentially deadly side effects. The case, which is filed on behalf of the State under the Insurance Frauds Prevention Act, alleges that private insurers have paid out $1.2 billion in HUMIRA-related pharmacy claims, making this the largest health insurance fraud case in department history.
According to the complaint, AbbVie engaged in a far-reaching scheme including both classic kickbacks - cash, meals, drinks, gifts, trips, and patient referrals - and more sophisticated ones - free and valuable professional goods and services to physicians to induce and reward HUMIRA prescriptions. These professional goods and services included free insurance processing and prior authorizations, gifts of medical practice management hardware and software, and even marketing assistance, all of which save physicians valuable staff time and resources.
"AbbVie spent millions convincing patients and health care professionals that AbbVie Ambassadors were patient advocates - in fact, the Ambassadors were HUMIRA advocates hired to do one thing, keep patients on a dangerous drug at any cost," said Insurance Commissioner Dave Jones. "Pharmaceutical companies know financial inducements are illegal, and patients depend on their health care professionals for straight forward honest information about their care and medication risks. In this case, patient care was traded for $1.2 billion in ill-gotten gains."
The key to AbbVie's success in pulling off its scheme, and among the most troubling aspects of it, is the fact that AbbVie inserts its own personnel directly into the homes of patients. When doctors prescribe HUMIRA, AbbVie sends its registered nurses—which AbbVie calls "Ambassadors" nto patients' homes, representing them to be an extension of the doctor's office.
The system AbbVie established takes advantage of the Ambassadors' nursing background and direct access to patients to serve the biopharma giant's financial interest in getting patients to take HUMIRA by downplaying its risks. Ambassadors are trained to send patient complaints directly to AbbVie and not the patients' treating physicians. Ambassadors also provide unbalanced information, as they are trained to tout the drug while at the same time also instructed on methods to avoid directly answering patient questions about risks of the medication, including those pertaining to HUMIRA's serious and important side effects.
At no cost and considerable gain to the physician's office, AbbVie nurses provide pharmacy and insurance authorization assistance, open enrollment resources, paperwork help, advice on insurance products, and other services, all of which provide a substantial value and save physicians' time, money, and resources. The catch is AbbVie only provides the Ambassadors as long as the physicians continue to prescribe AbbVie's drug instead of selecting another course of treatment.
The allegations of AbbVie's misconduct were brought to the attention of the department by a whistleblower. The whistleblower, referred to legally as a relator, is a registered nurse and was employed as an AbbVie Nurse Ambassador in Florida. The relator continues to be a party to this action and is represented by Rachel Geman, Robert Nelson,and Jason Lichtman of the law firm of Lieff Cabraser Heimann & Bernstein, LLP ...
The price of Humira, an anti-inflammatory drug dispensed in an injectable pen, has risen from about $19,000 a year in 2012, to more than $38,000 today, per patient, after rebates. Its maker, AbbVie, which was spun from Abbott Laboratories in 2013, has now been accused of illegal kickbacks in the largest health care fraud case in the California Department of Insurance History. Humira accounted for more than two-thirds of AbbVie's $25.6 billion in revenue in 2016.
The California Insurance Commissioner filed a civil fraud complaint in Alameda County Superior Court on behalf of the State of California against AbbVie alleging the company gave illegal kickbacks to health care providers to prescribe HUMIRA - an expensive and dangerous drug with potentially deadly side effects. The case, which is filed on behalf of the State under the Insurance Frauds Prevention Act, alleges that private insurers have paid out $1.2 billion in HUMIRA-related pharmacy claims, making this the largest health insurance fraud case in department history.
According to the complaint, AbbVie engaged in a far-reaching scheme including both classic kickbacks - cash, meals, drinks, gifts, trips, and patient referrals - and more sophisticated ones - free and valuable professional goods and services to physicians to induce and reward HUMIRA prescriptions. These professional goods and services included free insurance processing and prior authorizations, gifts of medical practice management hardware and software, and even marketing assistance, all of which save physicians valuable staff time and resources.
"AbbVie spent millions convincing patients and health care professionals that AbbVie Ambassadors were patient advocates - in fact, the Ambassadors were HUMIRA advocates hired to do one thing, keep patients on a dangerous drug at any cost," said Insurance Commissioner Dave Jones. "Pharmaceutical companies know financial inducements are illegal, and patients depend on their health care professionals for straight forward honest information about their care and medication risks. In this case, patient care was traded for $1.2 billion in ill-gotten gains."
The key to AbbVie's success in pulling off its scheme, and among the most troubling aspects of it, is the fact that AbbVie inserts its own personnel directly into the homes of patients. When doctors prescribe HUMIRA, AbbVie sends its registered nurses—which AbbVie calls "Ambassadors" nto patients' homes, representing them to be an extension of the doctor's office.
The system AbbVie established takes advantage of the Ambassadors' nursing background and direct access to patients to serve the biopharma giant's financial interest in getting patients to take HUMIRA by downplaying its risks. Ambassadors are trained to send patient complaints directly to AbbVie and not the patients' treating physicians. Ambassadors also provide unbalanced information, as they are trained to tout the drug while at the same time also instructed on methods to avoid directly answering patient questions about risks of the medication, including those pertaining to HUMIRA's serious and important side effects.
At no cost and considerable gain to the physician's office, AbbVie nurses provide pharmacy and insurance authorization assistance, open enrollment resources, paperwork help, advice on insurance products, and other services, all of which provide a substantial value and save physicians' time, money, and resources. The catch is AbbVie only provides the Ambassadors as long as the physicians continue to prescribe AbbVie's drug instead of selecting another course of treatment.
The allegations of AbbVie's misconduct were brought to the attention of the department by a whistleblower. The whistleblower, referred to legally as a relator, is a registered nurse and was employed as an AbbVie Nurse Ambassador in Florida. The relator continues to be a party to this action and is represented by Rachel Geman, Robert Nelson,and Jason Lichtman of the law firm of Lieff Cabraser Heimann & Bernstein, LLP ...
Dr. Grant William Robicheaux billed himself as an elite orthopedic surgeon catering to Newport Beach’s famous and wealthy. It was a lifestyle he pushed not only in his medical work but on realty TV, where he appeared on a Bravo dating show wearing his hospital scrubs and a wide smile.
But now Orange County prosecutors have accused Robicheaux and his girlfriend of drugging and raping two women in separate assaults and said they suspect there are many more alleged victims. The two have been arrested, and their arraignment has been scheduled for Oct. 25, 2018, at 8:30 a.m. in Department H-7, Harbor Justice Center, Newport Beach.
Robicheaux graduated from Louisiana State University School of Medicine in New Orleans and has been licensed since 2009. He reports being certified by the American Board of Orthopedic Surgery. The California medical board has opened an investigation into Robicheaux’s conduct.
Orange County Dist. Atty. Tony Rackauckas said in a news conference that Robicheaux and Cerissa Laura Riley seemed like "clean-cut, good-looking people" but used their charms to prey on women they would meet in local bars and festivals such as Burning Man.
Robicheaux, 38, and Riley, 31, are accused of drugging their victims and bringing them back to his Newport Beach bachelor’s pad, where they would sexually assault and rape them.
The article in the Los Angeles times reports that Robicheaux appeared in 2014 on the Bravo’s show "Online Dating Rituals of the American Male," which followed him as he looked for a girlfriend. He also was named "Orange County’s Most Eligible Bachelor" by Orange Coast Magazine in 2013.
Rackauckas said detectives with search warrants found a video of the sex acts with one of the two identified victims. But he said they also saw what he describes as numerous other videos and photographs on the pair's phones of other potential victims. "There are a substantial number of videos, I cannot tell you if it is 10s or 100s, it is certainly more than 10s," the top prosecutor said in an interview. "It appears they are highly intoxicated beyond the ability to consent or resist, they are barely responsive to the defendants' sexual advances," he said. Rackauckas said his office cannot make those images public, but everything suggests those women were also victims of assault.
Those videos were recovered this year by Newport Beach detectives. Some of the images come from festivals across the western U.S. including Burning Man and the Splash House in Palm Springs, Rackauckas said.
The surgeon and his girlfriend came to the attention of authorities when a young woman screamed for help and the physician’s neighbor called Newport police on Oct. 2, 2016. A 32-year-old woman met the couple in a local restaurant in April 2016 and they invited her to a party, authorities alleged. She told authorities she consumed large amounts of alcohol before they invited her to Robicheaux’s residence for an afterparty. But once inside, prosecutors allege, they plied her with piles of drugs and then raped her.
The woman immediately contacted the police the next morning to report that she been assaulted and a subsequent test of her blood showed multiple controlled substances in her body, Rackauckas said.
Prosecutors alleged Robicheaux and Riley struck again Oct. 2, 2016. They are accused of drinking alcohol with a second woman at a Newport Beach bar until the alleged victim was no longer conscious. They brought her to Robicheaux's apartment and began "sexually assaulting her with the intent to commit rape," officials said.
A subsequent search of Robicheaux’s home on Jan. 9. 2018, turned up large quantities of illegal drugs along with a small arsenal of firearms.Rackauckas said those drugs included GHB, the so-called date rape drug, MDMA and cocaine ...
But now Orange County prosecutors have accused Robicheaux and his girlfriend of drugging and raping two women in separate assaults and said they suspect there are many more alleged victims. The two have been arrested, and their arraignment has been scheduled for Oct. 25, 2018, at 8:30 a.m. in Department H-7, Harbor Justice Center, Newport Beach.
Robicheaux graduated from Louisiana State University School of Medicine in New Orleans and has been licensed since 2009. He reports being certified by the American Board of Orthopedic Surgery. The California medical board has opened an investigation into Robicheaux’s conduct.
Orange County Dist. Atty. Tony Rackauckas said in a news conference that Robicheaux and Cerissa Laura Riley seemed like "clean-cut, good-looking people" but used their charms to prey on women they would meet in local bars and festivals such as Burning Man.
Robicheaux, 38, and Riley, 31, are accused of drugging their victims and bringing them back to his Newport Beach bachelor’s pad, where they would sexually assault and rape them.
The article in the Los Angeles times reports that Robicheaux appeared in 2014 on the Bravo’s show "Online Dating Rituals of the American Male," which followed him as he looked for a girlfriend. He also was named "Orange County’s Most Eligible Bachelor" by Orange Coast Magazine in 2013.
Rackauckas said detectives with search warrants found a video of the sex acts with one of the two identified victims. But he said they also saw what he describes as numerous other videos and photographs on the pair's phones of other potential victims. "There are a substantial number of videos, I cannot tell you if it is 10s or 100s, it is certainly more than 10s," the top prosecutor said in an interview. "It appears they are highly intoxicated beyond the ability to consent or resist, they are barely responsive to the defendants' sexual advances," he said. Rackauckas said his office cannot make those images public, but everything suggests those women were also victims of assault.
Those videos were recovered this year by Newport Beach detectives. Some of the images come from festivals across the western U.S. including Burning Man and the Splash House in Palm Springs, Rackauckas said.
The surgeon and his girlfriend came to the attention of authorities when a young woman screamed for help and the physician’s neighbor called Newport police on Oct. 2, 2016. A 32-year-old woman met the couple in a local restaurant in April 2016 and they invited her to a party, authorities alleged. She told authorities she consumed large amounts of alcohol before they invited her to Robicheaux’s residence for an afterparty. But once inside, prosecutors allege, they plied her with piles of drugs and then raped her.
The woman immediately contacted the police the next morning to report that she been assaulted and a subsequent test of her blood showed multiple controlled substances in her body, Rackauckas said.
Prosecutors alleged Robicheaux and Riley struck again Oct. 2, 2016. They are accused of drinking alcohol with a second woman at a Newport Beach bar until the alleged victim was no longer conscious. They brought her to Robicheaux's apartment and began "sexually assaulting her with the intent to commit rape," officials said.
A subsequent search of Robicheaux’s home on Jan. 9. 2018, turned up large quantities of illegal drugs along with a small arsenal of firearms.Rackauckas said those drugs included GHB, the so-called date rape drug, MDMA and cocaine ...
