The U.S. Department of Health and Human Services (HHS) released an additional $487 million to supplement first-year funding through its State Opioid Response (SOR) grant program. The awards to states and territories are part of HHS’s Five-Point Opioid Strategy to combat the opioid crisis.
Together with the $933 million in second-year, continuation awards to be provided under this program later this year, the total amount of SOR grants to states and territories this year will total more than $1.4 billion.
This funding will expand access to treatment that works, especially to medication-assisted treatment (MAT) with appropriate social supports.
The State Opioid Response grants administered by HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) aim to address the opioid crisis by increasing access to MAT using the three Food and Drug Administration (FDA) approved medications for the treatment of opioid use disorder, reducing unmet treatment need, and reducing opioid overdose-related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder.
"Strategies such as employing psychosocial supports, community recovery services and MAT using medicines approved by the FDA constitute the gold standard of treatment for opioid use disorders," said Dr. Elinore F. McCance-Katz, Assistant Secretary for Mental Health and Substance Use.
Last summer, SAMHSA announced the first year of SOR funding. States and territories received funding based on a formula, with a 15 percent set-aside for the 10 states with the highest mortality rates related to drug overdose deaths.
Other funding, including $50 million for tribal communities under the Tribal Opioid Response (TOR) grant program, has been awarded separately. These programs are built from the foundations laid in the $1 billion provided to states and territories through SAMHSA’s Opioid State Targeted Response (STR) program. SAMHSA has complemented the work of the STR program with a national center of excellence that provides technical assistance and training to leverage local subject matter experts at the community level to sharpen treatment access and delivery.
SAMHSA also operates a 24/7, national Helpline that people can call to find treatment referral resources for mental health or substance use disorders: 800-662-HELP (4357). People can visit https://findtreatment.samhsa.gov/ to locate those resources, as well.
To learn more about SAMHSA-supported resources, please visit SAMHSA's Prescription Drug Misuse and Abuse page ...
Together with the $933 million in second-year, continuation awards to be provided under this program later this year, the total amount of SOR grants to states and territories this year will total more than $1.4 billion.
This funding will expand access to treatment that works, especially to medication-assisted treatment (MAT) with appropriate social supports.
The State Opioid Response grants administered by HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) aim to address the opioid crisis by increasing access to MAT using the three Food and Drug Administration (FDA) approved medications for the treatment of opioid use disorder, reducing unmet treatment need, and reducing opioid overdose-related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder.
"Strategies such as employing psychosocial supports, community recovery services and MAT using medicines approved by the FDA constitute the gold standard of treatment for opioid use disorders," said Dr. Elinore F. McCance-Katz, Assistant Secretary for Mental Health and Substance Use.
Last summer, SAMHSA announced the first year of SOR funding. States and territories received funding based on a formula, with a 15 percent set-aside for the 10 states with the highest mortality rates related to drug overdose deaths.
Other funding, including $50 million for tribal communities under the Tribal Opioid Response (TOR) grant program, has been awarded separately. These programs are built from the foundations laid in the $1 billion provided to states and territories through SAMHSA’s Opioid State Targeted Response (STR) program. SAMHSA has complemented the work of the STR program with a national center of excellence that provides technical assistance and training to leverage local subject matter experts at the community level to sharpen treatment access and delivery.
SAMHSA also operates a 24/7, national Helpline that people can call to find treatment referral resources for mental health or substance use disorders: 800-662-HELP (4357). People can visit https://findtreatment.samhsa.gov/ to locate those resources, as well.
To learn more about SAMHSA-supported resources, please visit SAMHSA's Prescription Drug Misuse and Abuse page ...
Food and Drug Administration Commissioner Scott Gottlieb called for tighter scrutiny of electronic health records systems, which have prompted thousands of reports of patient injuries and other safety problems over the past decade.
"What we really need is a much more tailored approach, so that we have appropriate oversight of EHRs when they’re doing things that could create risk for patients," Gottlieb said in an interview with Kaiser Health News.
Gottlieb was responding to "Botched Operation," a report published this week by KHN and Fortune magazine.
The investigation found that the federal government has spent more than $36 billion over the past 10 years to switch doctors and hospitals from paper to digital records systems. In that time, electronic health records have created a host of risks to patient safety.
Patient harm: Electronic health records have created a host of risks to patient safety. Alarming reports of deaths, serious injuries and near misses - thousands of them - tied to software glitches, user errors or other system flaws have piled up for years in government and private repositories. Yet no central database exists to compile and study these incidents to improve safety.
One example, an electronic health records system, or EHR, made by eClinicalWorks (eCW), one of the leading sellers of record-keeping software for physicians in America, currently used by 850,000 health professionals in the U.S. It didn’t take long for Foster to assemble a dossier of troubling reports - Better Business Bureau complaints, issues flagged on an eCW user board, and legal cases filed around the country - suggesting the company’s technology didn’t work quite the way it said it did.
In May 2017, eCW paid a $155 million settlement to the government over alleged false claims and kickbacks - one physician made tens of thousands of dollars - to clients who promoted its product. Despite the record settlement, the company denied wrongdoing
Signs of fraud: Federal officials say the software can be misused to overcharge, a practice known as "upcoding." Some doctors and health systems are alleged to have overstated their use of the new technology, a potentially enormous fraud against Medicare and Medicaid likely to take years to unravel. Two software makers have paid a total of more than $200 million to settle fraud allegations.
Gaps in interoperability: Proponents of electronic health records expected a seamless system so patients could share computerized medical histories in a flash with doctors and hospitals anywhere in the country. That has yet to materialize, largely because officials allowed hundreds of competing firms to sell medical records software unable to exchange information.
Doctor burnout: Many doctors say they spend half their day or more clicking pulldown menus and typing rather than interacting with patients. An emergency room doctor can be saddled with making up to 4,000 mouse clicks per shift. This has fueled concerns about doctor burnout, which in January the Harvard T.H. Chan School of Public Health and Massachusetts Medical Society called a "public health crisis."
Web of secrets: Entrenched policies continue to keep software failures out of public view. Vendors of electronic health records have imposed contractual "gag clauses" that discourage buyers from speaking out about safety issues and disastrous software installations - and some hospitals fight to withhold records from injured patients or their families.
For an in-depth examination of electronic health records, read "Death By 1,000 Clicks: Where Electronic Health Records Went Wrong." ...
"What we really need is a much more tailored approach, so that we have appropriate oversight of EHRs when they’re doing things that could create risk for patients," Gottlieb said in an interview with Kaiser Health News.
Gottlieb was responding to "Botched Operation," a report published this week by KHN and Fortune magazine.
The investigation found that the federal government has spent more than $36 billion over the past 10 years to switch doctors and hospitals from paper to digital records systems. In that time, electronic health records have created a host of risks to patient safety.
Patient harm: Electronic health records have created a host of risks to patient safety. Alarming reports of deaths, serious injuries and near misses - thousands of them - tied to software glitches, user errors or other system flaws have piled up for years in government and private repositories. Yet no central database exists to compile and study these incidents to improve safety.
One example, an electronic health records system, or EHR, made by eClinicalWorks (eCW), one of the leading sellers of record-keeping software for physicians in America, currently used by 850,000 health professionals in the U.S. It didn’t take long for Foster to assemble a dossier of troubling reports - Better Business Bureau complaints, issues flagged on an eCW user board, and legal cases filed around the country - suggesting the company’s technology didn’t work quite the way it said it did.
In May 2017, eCW paid a $155 million settlement to the government over alleged false claims and kickbacks - one physician made tens of thousands of dollars - to clients who promoted its product. Despite the record settlement, the company denied wrongdoing
Signs of fraud: Federal officials say the software can be misused to overcharge, a practice known as "upcoding." Some doctors and health systems are alleged to have overstated their use of the new technology, a potentially enormous fraud against Medicare and Medicaid likely to take years to unravel. Two software makers have paid a total of more than $200 million to settle fraud allegations.
Gaps in interoperability: Proponents of electronic health records expected a seamless system so patients could share computerized medical histories in a flash with doctors and hospitals anywhere in the country. That has yet to materialize, largely because officials allowed hundreds of competing firms to sell medical records software unable to exchange information.
Doctor burnout: Many doctors say they spend half their day or more clicking pulldown menus and typing rather than interacting with patients. An emergency room doctor can be saddled with making up to 4,000 mouse clicks per shift. This has fueled concerns about doctor burnout, which in January the Harvard T.H. Chan School of Public Health and Massachusetts Medical Society called a "public health crisis."
Web of secrets: Entrenched policies continue to keep software failures out of public view. Vendors of electronic health records have imposed contractual "gag clauses" that discourage buyers from speaking out about safety issues and disastrous software installations - and some hospitals fight to withhold records from injured patients or their families.
For an in-depth examination of electronic health records, read "Death By 1,000 Clicks: Where Electronic Health Records Went Wrong." ...
Kentucky Attorney General Andy Beshear has launched an investigation into allegations that state pharmacy benefit managers (PBMs) have overcharged the state health insurance programs for prescription drugs and discriminated against independent pharmacies.
Beshear is seeking details on how the PBMs, hired by state Medicaid managed-care organizations and the state employee health plan, have determined, billed and paid drug reimbursement rates over the past five years in Kentucky.
A report released last month by the state indicated two PBMs took in $123.5 million last year from the state Medicaid program by paying pharmacies a lower rate to fill prescriptions, while charging the state more for the same drugs.
Beshear said he is investigating PBMs because he wants to identify and recover any profits improperly retained at the expense of the Commonwealth and its taxpayers and ensure Kentucky families have affordable and accessible health care.
"I am demanding answers for Kentucky families and community pharmacies who want greater accountability and transparency surrounding the cost of prescription drugs," said Beshear. "The current system is failing Kentuckians who just want a straightforward answer on whether they are receiving and paying a fair price."
Beshear said PBMs were originally established to help companies and government programs better manage pharmacy costs, but have grown into powerful industry middlemen that go to great lengths to hide and complicate drug pricing information.
Last year, Sen. Max Wise, R-Campbellsville, introduced Senate Bill 5, because he said one of the state’s largest PBMs - CVS Caremark, which also owns its own chain of pharmacies - was not paying independent pharmacists enough, putting many at risk of closing.
At the time, discussion centered around the significant decrease in the PBM’s professional dispensing fee of 85 cents per prescription, when the Centers for Medicare and Medicaid Services stated that the fee should be around $10.64, plus the cost of the drug being dispensed.
The provisions of that legislation lead to the recent report by the state and allow the Department for Medicaid Services to have greater oversight of pharmacy benefits once existing contracts expire.
The Ohio attorney general sued to recover nearly $16 million in prescription overcharges to the state for the cost of prescription drugs negotiated by PBMs.
...
Beshear is seeking details on how the PBMs, hired by state Medicaid managed-care organizations and the state employee health plan, have determined, billed and paid drug reimbursement rates over the past five years in Kentucky.
A report released last month by the state indicated two PBMs took in $123.5 million last year from the state Medicaid program by paying pharmacies a lower rate to fill prescriptions, while charging the state more for the same drugs.
Beshear said he is investigating PBMs because he wants to identify and recover any profits improperly retained at the expense of the Commonwealth and its taxpayers and ensure Kentucky families have affordable and accessible health care.
"I am demanding answers for Kentucky families and community pharmacies who want greater accountability and transparency surrounding the cost of prescription drugs," said Beshear. "The current system is failing Kentuckians who just want a straightforward answer on whether they are receiving and paying a fair price."
Beshear said PBMs were originally established to help companies and government programs better manage pharmacy costs, but have grown into powerful industry middlemen that go to great lengths to hide and complicate drug pricing information.
Last year, Sen. Max Wise, R-Campbellsville, introduced Senate Bill 5, because he said one of the state’s largest PBMs - CVS Caremark, which also owns its own chain of pharmacies - was not paying independent pharmacists enough, putting many at risk of closing.
At the time, discussion centered around the significant decrease in the PBM’s professional dispensing fee of 85 cents per prescription, when the Centers for Medicare and Medicaid Services stated that the fee should be around $10.64, plus the cost of the drug being dispensed.
The provisions of that legislation lead to the recent report by the state and allow the Department for Medicaid Services to have greater oversight of pharmacy benefits once existing contracts expire.
The Ohio attorney general sued to recover nearly $16 million in prescription overcharges to the state for the cost of prescription drugs negotiated by PBMs.
...
Many gig workers, whether in new occupations such as ride-hail driver, or traditional ones such as janitor or truck driver, could soon become employees in California after a ground breaking state Supreme Court ruling last year.
The Dynamex case implemented a simple criteria called the ABC test under which someone is an employee if a company controls what they do; if their work is linked to a company’s primary business; and if they do not have an independent business performing that work.
Assemblywoman Lorena Gonzalez, D-San Diego, is sponsoring a labor-backed bill that would codify that test. But numerous companies have lined up against it, saying it would undermine the flexibility that both they and gig workers value.
A separate case based on different criteria was decided in the U.S. Supreme Court this week. The high court declined to hear an appeal by the California Trucking Association, leaving intact a decision that could result in widespread reclassification of state truck drivers as employees.
Gig workers lack a whole list of protections afforded employees, including minimum wage, overtime, paid breaks, family and medical leave, paid sick leave, unemployment insurance and workers’ compensation. Those costs would add about 41 percent on top of the cost of wages, according to Bureau of Labor Statistics studies.
A new report from the UC Berkeley Labor Center examined demographics and wages, as well as employers’ classification practices, with an eye to the impact that changing workers’ status might have. Independent contractors - the status most gig workers have - don’t get benefits and must pay their own employment taxes, among other differences.
According to the summary prepared by the San Francisco Chronicle "These industries that are some of the worst offenders in California (for misclassification) have a disproportionate share of workers of color, immigrants and low-wage workers," said Sarah Thomason, a research and policy associate at the Labor Center who co-authored the report. "These workers are in vulnerable positions and being exploited."
Contracted janitors, for instance, make a median hourly wage of $12.22, and are 80.9 percent Latino and 3.7 percent black. Almost half live in households defined as low income (below 200 percent of the federal poverty line).
The report estimated that 19 percent of California janitors are independent contractors, without suggesting how many are misclassified.
Among truck drivers, the median hourly wage was higher at $19.70 but drivers have high expenses, with many having to purchase a truck and pay for fuel, insurance, maintenance and repair. About 60 percent were Latino and 6 percent were black. About a fifth live in low-income households.
The report quoted a National Employment Law Project report that about four-fifths of drivers at ports are classified as independent contractors, with the majority misclassified.
For construction workers, median hourly pay is $14.98 with 73.2 percent being Latino and 2.3 percent black. About 40 percent live in low-income households.
If the ABC criteria becomes more widely applied, "definitely misclassification would not happen as frequently," Thomason said.
...
The Dynamex case implemented a simple criteria called the ABC test under which someone is an employee if a company controls what they do; if their work is linked to a company’s primary business; and if they do not have an independent business performing that work.
Assemblywoman Lorena Gonzalez, D-San Diego, is sponsoring a labor-backed bill that would codify that test. But numerous companies have lined up against it, saying it would undermine the flexibility that both they and gig workers value.
A separate case based on different criteria was decided in the U.S. Supreme Court this week. The high court declined to hear an appeal by the California Trucking Association, leaving intact a decision that could result in widespread reclassification of state truck drivers as employees.
Gig workers lack a whole list of protections afforded employees, including minimum wage, overtime, paid breaks, family and medical leave, paid sick leave, unemployment insurance and workers’ compensation. Those costs would add about 41 percent on top of the cost of wages, according to Bureau of Labor Statistics studies.
A new report from the UC Berkeley Labor Center examined demographics and wages, as well as employers’ classification practices, with an eye to the impact that changing workers’ status might have. Independent contractors - the status most gig workers have - don’t get benefits and must pay their own employment taxes, among other differences.
According to the summary prepared by the San Francisco Chronicle "These industries that are some of the worst offenders in California (for misclassification) have a disproportionate share of workers of color, immigrants and low-wage workers," said Sarah Thomason, a research and policy associate at the Labor Center who co-authored the report. "These workers are in vulnerable positions and being exploited."
Contracted janitors, for instance, make a median hourly wage of $12.22, and are 80.9 percent Latino and 3.7 percent black. Almost half live in households defined as low income (below 200 percent of the federal poverty line).
The report estimated that 19 percent of California janitors are independent contractors, without suggesting how many are misclassified.
Among truck drivers, the median hourly wage was higher at $19.70 but drivers have high expenses, with many having to purchase a truck and pay for fuel, insurance, maintenance and repair. About 60 percent were Latino and 6 percent were black. About a fifth live in low-income households.
The report quoted a National Employment Law Project report that about four-fifths of drivers at ports are classified as independent contractors, with the majority misclassified.
For construction workers, median hourly pay is $14.98 with 73.2 percent being Latino and 2.3 percent black. About 40 percent live in low-income households.
If the ABC criteria becomes more widely applied, "definitely misclassification would not happen as frequently," Thomason said.
...
Brown & Brown, Inc. is a provider of insurance and reinsurance products and services to general business, corporate, governmental and quasi-governmental, institutional, professional, trade association and individual clients. Its headquarters are in Daytona Beach, Florida.
The company is currently ranked as the sixth largest independent insurance intermediary organization in the U.S. and eighth largest in the world based on the July 2018 ranking by Business Insurance magazine.
Brown & Brown is also one of the selected companies that comprise S&P 400 stock market index. In September 2007, Brown & Brown was ranked #10 on Forbes's "The 100 Best Mid-Cap Stocks in America" list in 2007.
The company has reach from coast to coast, with several offices in California. And they are rapidly extending this reach with mergers and acquisitions this year.
J. Scott Penny, Chief Acquisitions Officer of Brown & Brown, Inc. announced that The Advocator Group, LLC, a wholly owned subsidiary of Brown & Brown, Inc., has acquired MEDVAL, LLC.
MEDVAL provides a suite of MSP-compliant services, which services incorporate front-line claims negotiation and comprehensive settlement solutions. MEDVAL has annual revenues of approximately $10,000,000.
The MEDVAL team will continue to operate from their offices in California, Pennsylvania and Maryland, as MEDVAL, LLC, under the leadership of Jon Gunter and the experienced MEDVAL team. MEDVAL leadership will report to Julie Turpin, Chief Executive Officer of The Advocator Group.
And it announced this month that Brown & Brown Insurance Services of California, Inc. has acquired substantially all of the assets of Austin & Austin Insurance Services, to serve the insurance needs of real estate professionals in the Bay Area of California. The firm specializes in providing errors and omissions insurance coverage to real estate brokers throughout California and has annual revenues of approximately $2 million.
Brown & Brown revenues for the fourth quarter of 2018 were $508.7 million, increasing $34.4 million, or 7.3%, compared to the fourth quarter of the prior year, with commissions and fees increasing by 7.2%.
...
The company is currently ranked as the sixth largest independent insurance intermediary organization in the U.S. and eighth largest in the world based on the July 2018 ranking by Business Insurance magazine.
Brown & Brown is also one of the selected companies that comprise S&P 400 stock market index. In September 2007, Brown & Brown was ranked #10 on Forbes's "The 100 Best Mid-Cap Stocks in America" list in 2007.
The company has reach from coast to coast, with several offices in California. And they are rapidly extending this reach with mergers and acquisitions this year.
J. Scott Penny, Chief Acquisitions Officer of Brown & Brown, Inc. announced that The Advocator Group, LLC, a wholly owned subsidiary of Brown & Brown, Inc., has acquired MEDVAL, LLC.
MEDVAL provides a suite of MSP-compliant services, which services incorporate front-line claims negotiation and comprehensive settlement solutions. MEDVAL has annual revenues of approximately $10,000,000.
The MEDVAL team will continue to operate from their offices in California, Pennsylvania and Maryland, as MEDVAL, LLC, under the leadership of Jon Gunter and the experienced MEDVAL team. MEDVAL leadership will report to Julie Turpin, Chief Executive Officer of The Advocator Group.
And it announced this month that Brown & Brown Insurance Services of California, Inc. has acquired substantially all of the assets of Austin & Austin Insurance Services, to serve the insurance needs of real estate professionals in the Bay Area of California. The firm specializes in providing errors and omissions insurance coverage to real estate brokers throughout California and has annual revenues of approximately $2 million.
Brown & Brown revenues for the fourth quarter of 2018 were $508.7 million, increasing $34.4 million, or 7.3%, compared to the fourth quarter of the prior year, with commissions and fees increasing by 7.2%.
...
More than 100 insurance-fraud bills are pending state action. Major state supreme court cases also could have a dramatic impact on fighting fraud. Privacy of consumer data - and how it affects fraud investigations - should be also be closely watched this year.
The California legislature rushed through AB 375, the nation’s most sweeping data privacy law last June. The California Consumer Privacy Act of 2018 (CCPA) takes effect Jan. 1, 2020.
The CCPA applies to insurers and all other businesses in the state and has very severe restrictions on the use of private data. It is not clear what impact it might or might not have on an insurer’s ability to even report fraud.
California legislators rushed a bill through to avoid a ballot initiative proposed by Alastair Mactaggart. Mactaggart agreed to withdraw the initiative if a law was signed by the Governor. Legislators in other states will watch closely for how California’s more-sweeping law moves forward.
The NAIC approved its model data security law. The model already was adopted last year by South Carolina, Ohio, and Michigan. Many other states will likely debate adopting versions of the NAIC model this year.
And there is relentless push back from the applicant/plaintiff attempting to impose personal bad-faith liability. Insurer employees can be sued personally for bad faith in Washington state, a lower court ruled.
Keodalah v. Allstate Insurance arose from a motorcycle collision with a pickup truck in Seattle, resulting in an uninsured motorist claim. The appeals court ruled that Tracey Smith, the Allstate adjuster, can be sued personally, including claims for treble damages and attorney fees. Liability also would extend to outside experts who assist insurers, such as IME physicians, third-party investigators and defense attorneys.
Keodalah addressed a split of authority in Washington. Several federal court judges issued rulings from 2005 through 2016 that non-insurer entities were exempt from bad faith claims and Consumer Protection Act claims.
In 2017, another Division of Washington’s Court of Appeals in Merriman v. American Guarantee & Liability Ins. Co., held that Washington’s generalized statute requiring good faith in the "business of insurance" applied to the insurer’s third-party administrator.
The Keodalah case has been appealed to the Washington state Supreme Court, and will be closely watched..
Courts in Montana, Texas, Mississippi and Kentucky, have long recognized claims against adjusters for bad faith and violations of statutes governing claim-handling practices. In contrast, numerous other courts - including in Oklahoma, Indiana, Hawaii, Alabama, Tennessee, New Mexico, West Virginia, California, New York and Pennsylvania - have held that adjusters generally cannot be liable for bad faith. Many other jurisdictions are undecided.
The plaintiffs bar has also sought to apply RICO laws as a penalty in workers’ compensation claims in a number of jurisdictions for at least a decade with poor results. The 9th Circuit Court of Appeals just affirmed the dismissal of a California effort in the unpublished case of Black v CorVel Enterprises Comp Inc. ...
The California legislature rushed through AB 375, the nation’s most sweeping data privacy law last June. The California Consumer Privacy Act of 2018 (CCPA) takes effect Jan. 1, 2020.
The CCPA applies to insurers and all other businesses in the state and has very severe restrictions on the use of private data. It is not clear what impact it might or might not have on an insurer’s ability to even report fraud.
California legislators rushed a bill through to avoid a ballot initiative proposed by Alastair Mactaggart. Mactaggart agreed to withdraw the initiative if a law was signed by the Governor. Legislators in other states will watch closely for how California’s more-sweeping law moves forward.
The NAIC approved its model data security law. The model already was adopted last year by South Carolina, Ohio, and Michigan. Many other states will likely debate adopting versions of the NAIC model this year.
And there is relentless push back from the applicant/plaintiff attempting to impose personal bad-faith liability. Insurer employees can be sued personally for bad faith in Washington state, a lower court ruled.
Keodalah v. Allstate Insurance arose from a motorcycle collision with a pickup truck in Seattle, resulting in an uninsured motorist claim. The appeals court ruled that Tracey Smith, the Allstate adjuster, can be sued personally, including claims for treble damages and attorney fees. Liability also would extend to outside experts who assist insurers, such as IME physicians, third-party investigators and defense attorneys.
Keodalah addressed a split of authority in Washington. Several federal court judges issued rulings from 2005 through 2016 that non-insurer entities were exempt from bad faith claims and Consumer Protection Act claims.
In 2017, another Division of Washington’s Court of Appeals in Merriman v. American Guarantee & Liability Ins. Co., held that Washington’s generalized statute requiring good faith in the "business of insurance" applied to the insurer’s third-party administrator.
The Keodalah case has been appealed to the Washington state Supreme Court, and will be closely watched..
Courts in Montana, Texas, Mississippi and Kentucky, have long recognized claims against adjusters for bad faith and violations of statutes governing claim-handling practices. In contrast, numerous other courts - including in Oklahoma, Indiana, Hawaii, Alabama, Tennessee, New Mexico, West Virginia, California, New York and Pennsylvania - have held that adjusters generally cannot be liable for bad faith. Many other jurisdictions are undecided.
The plaintiffs bar has also sought to apply RICO laws as a penalty in workers’ compensation claims in a number of jurisdictions for at least a decade with poor results. The 9th Circuit Court of Appeals just affirmed the dismissal of a California effort in the unpublished case of Black v CorVel Enterprises Comp Inc. ...
New CWCI research shows that since California implemented its workers’ compensation formulary last year, an increasing share of drugs prescribed to injured workers are either "Exempt" from prospective utilization review (UR) or "Not Listed" in the formulary, while "Non-Exempt" drugs that require UR before they can be dispensed account for a declining share of the prescriptions.
In 2015, state lawmakers enacted legislation (AB 1124) requiring that the California Division of Workers’ Compensation (DWC) adopt a formulary that meets evidence-based medicine standards.
After two years of development, the Medical Treatment Utilization Schedule (MTUS) Prescription Drug Formulary took effect on January 1, 2018. The intent of the formulary was to improve quality of care by ensuring that drugs provided to injured workers meet evidence-based medicine standards in terms of frequency, duration, strength, and appropriateness; reduce the amount spent on drugs in the system; and reduce delays and frictional costs associated with prescription drug disputes.
The formulary adopted by the DWC includes Exempt and Non-Exempt Drug Lists, based on the need for prospective UR, while drugs that are not on either list (Not Listed) are allowed if the treating physician can show that their use for the specific injury is supported by the MTUS or other applicable guidelines.
To examine the formulary’s impact on the mix of drugs used in California workers’ compensation and the distribution of prescription drug payments, the authors compared pre-formulary data from prescriptions that were filled in the first half of 2016 and the first half of 2017 to post-formulary data from prescriptions dispensed to injured workers in the first half of 2018.
Among the findings, the study showed that after the formulary took effect:
-- Exempt drugs, which are available without prospective UR, increased to 38.5% of all prescriptions, up from 33.2% and 35.2% prior to the formulary.
-- Non-Exempt drugs, which require prospective UR, fell to 45.1% of the prescriptions, down from 54.3% and 52.9% in the pre-formulary periods.
-- Not Listed drugs rose to 16.4% of the prescriptions, up from 12.4% and 11.9% before the formulary took effect.
-- The mix of prescription drug payments also changed, as Exempt drugs declined from about 22% of the payments to about 19%;
-- Non-Exempt drugs fell from more than half of the payments to 42%; and Not Listed drugs increased from about a quarter of the total drug spend to nearly 39%.
CWCI has issued its study in a Spotlight Report, which includes additional analysis and tables showing the changing distributions of prescriptions for the top 20 drug ingredients overall and for the drugs on the Special Fill and Perioperative drug lists; as well as breakouts showing the changing percentages for the top 20 drugs in the Exempt, Non-Exempt and Not Listed categories ...
In 2015, state lawmakers enacted legislation (AB 1124) requiring that the California Division of Workers’ Compensation (DWC) adopt a formulary that meets evidence-based medicine standards.
After two years of development, the Medical Treatment Utilization Schedule (MTUS) Prescription Drug Formulary took effect on January 1, 2018. The intent of the formulary was to improve quality of care by ensuring that drugs provided to injured workers meet evidence-based medicine standards in terms of frequency, duration, strength, and appropriateness; reduce the amount spent on drugs in the system; and reduce delays and frictional costs associated with prescription drug disputes.
The formulary adopted by the DWC includes Exempt and Non-Exempt Drug Lists, based on the need for prospective UR, while drugs that are not on either list (Not Listed) are allowed if the treating physician can show that their use for the specific injury is supported by the MTUS or other applicable guidelines.
To examine the formulary’s impact on the mix of drugs used in California workers’ compensation and the distribution of prescription drug payments, the authors compared pre-formulary data from prescriptions that were filled in the first half of 2016 and the first half of 2017 to post-formulary data from prescriptions dispensed to injured workers in the first half of 2018.
Among the findings, the study showed that after the formulary took effect:
-- Exempt drugs, which are available without prospective UR, increased to 38.5% of all prescriptions, up from 33.2% and 35.2% prior to the formulary.
-- Non-Exempt drugs, which require prospective UR, fell to 45.1% of the prescriptions, down from 54.3% and 52.9% in the pre-formulary periods.
-- Not Listed drugs rose to 16.4% of the prescriptions, up from 12.4% and 11.9% before the formulary took effect.
-- The mix of prescription drug payments also changed, as Exempt drugs declined from about 22% of the payments to about 19%;
-- Non-Exempt drugs fell from more than half of the payments to 42%; and Not Listed drugs increased from about a quarter of the total drug spend to nearly 39%.
CWCI has issued its study in a Spotlight Report, which includes additional analysis and tables showing the changing distributions of prescriptions for the top 20 drug ingredients overall and for the drugs on the Special Fill and Perioperative drug lists; as well as breakouts showing the changing percentages for the top 20 drugs in the Exempt, Non-Exempt and Not Listed categories ...
Many countries have legalized or decriminalized cannabis use, leading to concerns that this might result in an increase in cannabis use and associated harm.
Indeed, when it comes to "medical marijuana" the litigation and legislative trend seems to focus on the question of "cannabis - yes or no, - without contemplating the related questions of "how long" and "what kind."
As the following study points out, there are highly potent forms of cannabis available in pot shops where an injured worker might fill a prescription. The legislators and litigation outcomes make no reference whatsoever to potent and dangerous types of cannabis which may sit side by side with other types in a pot shop.
Currently, cross-sectional and prospective epidemiological studies as well as biological evidence support a causal link between cannabis use and psychotic disorder. Meta-analysis shows a dose-response association with the highest odds of psychotic disorder in those with the heaviest cannabis use.
Nevertheless, it is not clear whether, at a population level, patterns of cannabis use influence rates of psychotic disorder.
For that reason, researchers aimed to identify patterns of cannabis use with the strongest effect on odds of psychotic disorder across Europe and explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder.
To accomplish this mission, they targeted 901 patients aged 18 - 64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. The results of the study were published online this month in the Lancet Psychiatry.
Differences in frequency of daily cannabis use and in use of high-potency cannabis contributed to the striking variation in the incidence of psychotic disorder across the 11 studied sites. Given the increasing availability of high-potency cannabis, and the researchers say "this has important implications for public health."
Daily cannabis use was associated with increased odds of psychotic disorder compared with never users increasing to nearly five-times increased odds for daily use of high-potency types of cannabis.
Use of high-potency cannabis was a strong predictor of psychotic disorder in Amsterdam, London, and Paris where high-potency cannabis was widely available, by contrast with sites such as Palermo where this type was not yet available. In the Netherlands, the THC content reaches up to 67% in Nederhasj and 22% in Nederwiet; in London, skunk-like cannabis (average THC of 14%) represents 94% of the street market whereas in countries like Italy, France, and Spain, herbal types of cannabis with THC content of less than 10% were still commonly used.
Researchers concluded that their findings are consistent with previous epidemiological and experimental evidence suggesting that the use of cannabis with a high concentration of THC has more harmful effects on mental health than does use of weaker forms.
If high-potency cannabis were no longer available, 12·2% of cases of first-episode psychosis could be prevented across the 11 sites, rising to 30·3% in London and 50·3% in Amsterdam.
...
Indeed, when it comes to "medical marijuana" the litigation and legislative trend seems to focus on the question of "cannabis - yes or no, - without contemplating the related questions of "how long" and "what kind."
As the following study points out, there are highly potent forms of cannabis available in pot shops where an injured worker might fill a prescription. The legislators and litigation outcomes make no reference whatsoever to potent and dangerous types of cannabis which may sit side by side with other types in a pot shop.
Currently, cross-sectional and prospective epidemiological studies as well as biological evidence support a causal link between cannabis use and psychotic disorder. Meta-analysis shows a dose-response association with the highest odds of psychotic disorder in those with the heaviest cannabis use.
Nevertheless, it is not clear whether, at a population level, patterns of cannabis use influence rates of psychotic disorder.
For that reason, researchers aimed to identify patterns of cannabis use with the strongest effect on odds of psychotic disorder across Europe and explore whether differences in such patterns contribute to variations in the incidence rates of psychotic disorder.
To accomplish this mission, they targeted 901 patients aged 18 - 64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. The results of the study were published online this month in the Lancet Psychiatry.
Differences in frequency of daily cannabis use and in use of high-potency cannabis contributed to the striking variation in the incidence of psychotic disorder across the 11 studied sites. Given the increasing availability of high-potency cannabis, and the researchers say "this has important implications for public health."
Daily cannabis use was associated with increased odds of psychotic disorder compared with never users increasing to nearly five-times increased odds for daily use of high-potency types of cannabis.
Use of high-potency cannabis was a strong predictor of psychotic disorder in Amsterdam, London, and Paris where high-potency cannabis was widely available, by contrast with sites such as Palermo where this type was not yet available. In the Netherlands, the THC content reaches up to 67% in Nederhasj and 22% in Nederwiet; in London, skunk-like cannabis (average THC of 14%) represents 94% of the street market whereas in countries like Italy, France, and Spain, herbal types of cannabis with THC content of less than 10% were still commonly used.
Researchers concluded that their findings are consistent with previous epidemiological and experimental evidence suggesting that the use of cannabis with a high concentration of THC has more harmful effects on mental health than does use of weaker forms.
If high-potency cannabis were no longer available, 12·2% of cases of first-episode psychosis could be prevented across the 11 sites, rising to 30·3% in London and 50·3% in Amsterdam.
...
The Division of Workers’ Compensation has posted an order adopting regulations to update the evidence-based treatment guidelines of the Medical Treatment Utilization Schedule (MTUS).
The updates, effective for medical treatment services rendered on or after April 18, 2019, incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent treatment guidelines to the Clinical Topics section of the MTUS.
"We are publishing this Administrative Order one month before its effective date to give the public, especially treating physicians and utilization review physicians, 30 days to prepare before these evidence-based updates become effective," said DWC Administrative Director George Parisotto.
The ACOEM guidelines that are incorporated by reference into the MTUS are:
-- Ankle and Foot Disorders Guideline (ACOEM July 16, 2018)
-- Cervical and Thoracic Spine Disorders Guideline (ACOEM October 17, 2018)
-- Elbow Disorders Guideline (ACOEM August 23, 2018)
-- Hand, Wrist, and Forearm Disorders Guideline (ACOEM January 7, 2019)
-- Workplace Mental Health: Posttraumatic Stress Disorder and Acute Stress Disorder Guideline (ACOEM December 18, 2018)
"DWC has incorporated the most recent guidelines to ensure the MTUS contain the most recent, state-of-the-art current evidence-based recommendations," said DWC Executive Medical Director Dr. Raymond Meister. The administrative order consists of the order and two addendum:
-- Addendum one shows the regulatory amendments directly related to the evidence-based updates to the MTUS.
-- Addendum two contains hyperlinks to the updated ACOEM guidelines adopted and incorporated into the MTUS by reference.
Health care providers treating, evaluating (QME), or reviewing (UR or IMR) in the California workers’ compensation system may access the MTUS (ACOEM) Guidelines and MTUS Drug List at no cost by registering for an account ...
The updates, effective for medical treatment services rendered on or after April 18, 2019, incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent treatment guidelines to the Clinical Topics section of the MTUS.
"We are publishing this Administrative Order one month before its effective date to give the public, especially treating physicians and utilization review physicians, 30 days to prepare before these evidence-based updates become effective," said DWC Administrative Director George Parisotto.
The ACOEM guidelines that are incorporated by reference into the MTUS are:
-- Ankle and Foot Disorders Guideline (ACOEM July 16, 2018)
-- Cervical and Thoracic Spine Disorders Guideline (ACOEM October 17, 2018)
-- Elbow Disorders Guideline (ACOEM August 23, 2018)
-- Hand, Wrist, and Forearm Disorders Guideline (ACOEM January 7, 2019)
-- Workplace Mental Health: Posttraumatic Stress Disorder and Acute Stress Disorder Guideline (ACOEM December 18, 2018)
"DWC has incorporated the most recent guidelines to ensure the MTUS contain the most recent, state-of-the-art current evidence-based recommendations," said DWC Executive Medical Director Dr. Raymond Meister. The administrative order consists of the order and two addendum:
-- Addendum one shows the regulatory amendments directly related to the evidence-based updates to the MTUS.
-- Addendum two contains hyperlinks to the updated ACOEM guidelines adopted and incorporated into the MTUS by reference.
Health care providers treating, evaluating (QME), or reviewing (UR or IMR) in the California workers’ compensation system may access the MTUS (ACOEM) Guidelines and MTUS Drug List at no cost by registering for an account ...
The United States Attorney’s Office for the Central District of California collected over $317 million in criminal, civil and forfeiture actions in Fiscal Year 2018.
Last year’s collections also include over $235 million worth of assets forfeited to the United States for crimes committed both here and abroad, And $21.2 million was secured through civil enforcement matters in which prosecutors recovered federal funds lost primarily through fraud or other misconduct.
Additionally, the office’s Civil Division worked with other U.S. Attorney’s Offices and colleagues in Washington to collect an additional $162.2 million in civil cases that were pursued in conjunction with these other Justice Department components, a figure that includes a $65 million settlement with Prime Healthcare Services and its chief executive officer to resolve allegations of Medicare fraud.
Prime Healthcare Services, Inc.; Prime Healthcare Foundation, Inc.; Prime Healthcare Management, Inc.; and Prime’s Founder and chief executive officer, Dr. Prem Reddy, agreed to pay the United States the $65 million to settle allegations that 14 Prime hospitals in California knowingly submitted false claims to Medicare by admitting patients who required only less costly, outpatient care and by billing for more expensive patient diagnoses than the patients had (a practice known as "up-coding").
Prime Healthcare Services and the not-for-profit Prime Healthcare Foundation constitute one of the largest hospital systems in the nation, with 45 acute-care hospitals located in 14 states. It is headquartered in Ontario, California,
The 10 California hospital defendants owned by Prime Healthcare Services are parties to the settlement agreement: Alvarado Hospital Medical Center, Garden Grove Medical Center, La Palma Intercommunity Hospital, Desert Valley Hospital, Chino Valley Medical Center, Paradise Valley Hospital, San Dimas Community Hospital, Shasta Regional Medical Center, West Anaheim Medical Center and Centinela Hospital Medical Center. Four other hospital defendants owned by Prime Healthcare Foundation are also parties to the settlement agreement: Sherman Oaks Hospital, Montclair Hospital Medical Center, Huntington Beach Hospital and Encino Hospital Medical Center. Prime Healthcare Management, a subsidiary of Prime Healthcare Services, provides management, consulting and support services to hospitals owned and operated by Prime.
"We are focused on securing restitution for crime victims, recovering taxpayer money obtained by fraud, and stripping criminals of their ill-gotten gains," said United States Attorney Nick Hanna. "The hundreds of millions of dollars we recovered in 2018 stand as a tribute to the tenacity and hard work of our prosecutors and staff."
The United States Attorney’s Office for the Central District of California is based in Los Angeles and has branch offices in Santa Ana and Riverside. Currently, approximately 275 Assistant United States Attorneys serve about 20 million people who reside in the counties of Los Angeles, Orange, Riverside, San Bernardino, Ventura, Santa Barbara and San Luis Obispo ...
Last year’s collections also include over $235 million worth of assets forfeited to the United States for crimes committed both here and abroad, And $21.2 million was secured through civil enforcement matters in which prosecutors recovered federal funds lost primarily through fraud or other misconduct.
Additionally, the office’s Civil Division worked with other U.S. Attorney’s Offices and colleagues in Washington to collect an additional $162.2 million in civil cases that were pursued in conjunction with these other Justice Department components, a figure that includes a $65 million settlement with Prime Healthcare Services and its chief executive officer to resolve allegations of Medicare fraud.
Prime Healthcare Services, Inc.; Prime Healthcare Foundation, Inc.; Prime Healthcare Management, Inc.; and Prime’s Founder and chief executive officer, Dr. Prem Reddy, agreed to pay the United States the $65 million to settle allegations that 14 Prime hospitals in California knowingly submitted false claims to Medicare by admitting patients who required only less costly, outpatient care and by billing for more expensive patient diagnoses than the patients had (a practice known as "up-coding").
Prime Healthcare Services and the not-for-profit Prime Healthcare Foundation constitute one of the largest hospital systems in the nation, with 45 acute-care hospitals located in 14 states. It is headquartered in Ontario, California,
The 10 California hospital defendants owned by Prime Healthcare Services are parties to the settlement agreement: Alvarado Hospital Medical Center, Garden Grove Medical Center, La Palma Intercommunity Hospital, Desert Valley Hospital, Chino Valley Medical Center, Paradise Valley Hospital, San Dimas Community Hospital, Shasta Regional Medical Center, West Anaheim Medical Center and Centinela Hospital Medical Center. Four other hospital defendants owned by Prime Healthcare Foundation are also parties to the settlement agreement: Sherman Oaks Hospital, Montclair Hospital Medical Center, Huntington Beach Hospital and Encino Hospital Medical Center. Prime Healthcare Management, a subsidiary of Prime Healthcare Services, provides management, consulting and support services to hospitals owned and operated by Prime.
"We are focused on securing restitution for crime victims, recovering taxpayer money obtained by fraud, and stripping criminals of their ill-gotten gains," said United States Attorney Nick Hanna. "The hundreds of millions of dollars we recovered in 2018 stand as a tribute to the tenacity and hard work of our prosecutors and staff."
The United States Attorney’s Office for the Central District of California is based in Los Angeles and has branch offices in Santa Ana and Riverside. Currently, approximately 275 Assistant United States Attorneys serve about 20 million people who reside in the counties of Los Angeles, Orange, Riverside, San Bernardino, Ventura, Santa Barbara and San Luis Obispo ...
Hospitals are rapidly consolidating into regional delivery networks. Whether these multihospital networks leverage their combined assets to improve quality and provide a uniform standard of care has not been explored. So, what is the consistency of surgical quality across hospitals that are affiliated with the 2018 US News & World Report Honor Roll hospitals?
This question was asked, and likely answered in a report by researchers published this month in the JAMA Surgery.
This longitudinal analysis of 87 hospitals that participated in 1 of 16 networks that are affiliated with US News & World Report Honor Roll hospitals used data from Medicare beneficiaries who were undergoing colectomy, coronary artery bypass graft, or hip replacement. The task was to evaluate the variation in risk-adjusted surgical outcomes at Honor Roll and affiliated hospitals within and across networks.
The outcomes measured were thirty-day postoperative complications, mortality, failure to rescue, and re-admissions.
The new study shows "you shouldn’t assume that a hospital that is affiliated with a very well known medical center is able to offer the same services," said the study’s lead author, Dr. Kyle Sheetz, a research fellow at the Center for Healthcare Outcomes and Policy at the University of Michigan in Ann Arbor. "It may, but it may not. You just can’t make that assumption."
As it turns out, the Honor Roll hospitals didn’t always have consistently better outcomes than their network affiliates, Sheetz and colleagues found. They tended to have higher complication rates compared to affiliated hospitals: 22 percent versus 18 percent. But this may be because the Honor Roll hospitals were getting the more complicated cases, Sheetz said.
The most telling statistic the researchers gathered may have been "failure to rescue rates," a measure of how well hospitals cope with surgical complications. To avoid "failure to rescue," hospital staff need to recognize a complication early "and manage it and prevent the accumulation of other complications," Sheetz explained. "So it’s ‘rescuing’ that patient."
Honor Roll hospitals had lower failure to rescue rates than affiliated hospitals: 13 percent versus 15 percent.
Given the variability within networks, "if patients are within a bigger system, they should realize it’s okay to ask about where and by whom you would have the safest operation," Sheetz said ...
This question was asked, and likely answered in a report by researchers published this month in the JAMA Surgery.
This longitudinal analysis of 87 hospitals that participated in 1 of 16 networks that are affiliated with US News & World Report Honor Roll hospitals used data from Medicare beneficiaries who were undergoing colectomy, coronary artery bypass graft, or hip replacement. The task was to evaluate the variation in risk-adjusted surgical outcomes at Honor Roll and affiliated hospitals within and across networks.
The outcomes measured were thirty-day postoperative complications, mortality, failure to rescue, and re-admissions.
The new study shows "you shouldn’t assume that a hospital that is affiliated with a very well known medical center is able to offer the same services," said the study’s lead author, Dr. Kyle Sheetz, a research fellow at the Center for Healthcare Outcomes and Policy at the University of Michigan in Ann Arbor. "It may, but it may not. You just can’t make that assumption."
As it turns out, the Honor Roll hospitals didn’t always have consistently better outcomes than their network affiliates, Sheetz and colleagues found. They tended to have higher complication rates compared to affiliated hospitals: 22 percent versus 18 percent. But this may be because the Honor Roll hospitals were getting the more complicated cases, Sheetz said.
The most telling statistic the researchers gathered may have been "failure to rescue rates," a measure of how well hospitals cope with surgical complications. To avoid "failure to rescue," hospital staff need to recognize a complication early "and manage it and prevent the accumulation of other complications," Sheetz explained. "So it’s ‘rescuing’ that patient."
Honor Roll hospitals had lower failure to rescue rates than affiliated hospitals: 13 percent versus 15 percent.
Given the variability within networks, "if patients are within a bigger system, they should realize it’s okay to ask about where and by whom you would have the safest operation," Sheetz said ...
The "Medical" Marijuana industry is at the doorsteps of the Workers' Compensation industry. However, according to a report in the Los Angeles Times, political corruption is abundant in an industry that transacts business in green dollar cash. One might wonder if any of that green cash might help push the workers' compensation political doors open to the pot merchants.
California is awash in cannabis cash from inside and out of the state, partly because pot remains an illegal drug under federal law, so banks won’t accept cash from the businesses. The state’s black market for cannabis was estimated to be worth $3.7 billion last year - more than four times the size of the legal market, according to the firm New Frontier Data.
In the more than two years since California voters approved the licensed growing and sale of recreational marijuana, the state has seen a half-dozen government corruption cases as black-market operators try to game the system, through bribery and other means.
Proposition 64, approved in 2016, allowed the state to license businesses to grow and sell pot but required the firms to also get approval from the cities and counties, most of which have outlawed pot operations. Proposition 64 also outlawed the transportation of cannabis out of the state, which was an issue in the Siskiyou County indictments against Chi Yang and his sister, Gaosheng Laitinen.
Yang allegedly approached Jon Lopey, the sheriff in his county office in Yreka in the summer of 2017, and initially suggested the $1 million could go to a foundation headed by Lopey. Lopey notified the FBI.
At one of the subsequent meetings Laitinen allegedly sought assurances about what their payments would buy: "Are we talking about protection from being raided?" she asked the sheriff, according to a DEA agent’s affidavit attached to the criminal charging document. The pair allegedly paid Lopey $10,500, including four $500 cash bonuses, before they were arrested, according to court records.
That case is just one of several that have involved cannabis sellers and growers allegedly bribing or trying to bribe government officials, or public officials acting illegally to get rich from marijuana.
Last year, Jermaine Wright, then the mayor pro tem of Adelanto, was charged with agreeing to accept a bribe to fast-track a marijuana business. Wright’s trial is scheduled for August. In May, FBI agents served search warrants at the home of Rich Kerr, who was mayor of Adelanto at the time, as well as at City Hall and a marijuana retailer.
Also in May, Humboldt County building inspector Patrick Mctigue was arrested and charged with accepting $100,000 in bribes from marijuana businesses seeking expedited help on county permits, according to the Humboldt County Sheriff’s Office.
Last March, a federal jury reached guilty verdicts to bribery and extortion charges against Michael Kimbrew, who was a field representative to then-Rep. Janice Hahn when he accepted cash from an undercover FBI agent while pledging his "undying support" to protect a marijuana dispensary that the city of Compton was trying to close.
This March, developer Dorian Gray was held to answer by a judge in a preliminary hearing on charges of offering bribes to then-Oakland City Council President Larry Reid and Assistant City Administrator Greg Minor, according to court records. Gray allegedly offered the councilman cash to help obtain a cannabis dispensary permit, and Reid reported the offer to authorities. Gray is charged with offering Minor, who oversees marijuana permitting for Oakland, a free trip to Spain.
Not all of the recent cases involve elected officials. Los Angeles County Sheriff's Deputy Marc Antrim pleaded guilty two weeks ago to federal charges stemming from his arrest for robbing a warehouse of a half-ton of marijuana in October.
California was the first state to legalize the sale of marijuana for medical use two decades ago. The former mayor of the city of Cudahy was sentenced to one year in federal prison in 2013 for taking cash bribes in exchange for supporting the opening of a "medical marijuana" store in the city.
The head of the city’s code enforcement division and a city councilman were also convicted of taking part in the corruption scheme.
Law enforcement agencies are currently investigating possible corruption in other Southern California cities, according to Ed Muramoto, a private attorney for medical pot dispensaries that have complained about cities locking them out of competition for permits.
Sam Clauder, the former congressional aide and San Bernardino County Democratic Party official pleaded guilty in 2017 to charges in Texas of possessing 130 pounds of cannabis that he was transporting back east from California ...
California is awash in cannabis cash from inside and out of the state, partly because pot remains an illegal drug under federal law, so banks won’t accept cash from the businesses. The state’s black market for cannabis was estimated to be worth $3.7 billion last year - more than four times the size of the legal market, according to the firm New Frontier Data.
In the more than two years since California voters approved the licensed growing and sale of recreational marijuana, the state has seen a half-dozen government corruption cases as black-market operators try to game the system, through bribery and other means.
Proposition 64, approved in 2016, allowed the state to license businesses to grow and sell pot but required the firms to also get approval from the cities and counties, most of which have outlawed pot operations. Proposition 64 also outlawed the transportation of cannabis out of the state, which was an issue in the Siskiyou County indictments against Chi Yang and his sister, Gaosheng Laitinen.
Yang allegedly approached Jon Lopey, the sheriff in his county office in Yreka in the summer of 2017, and initially suggested the $1 million could go to a foundation headed by Lopey. Lopey notified the FBI.
At one of the subsequent meetings Laitinen allegedly sought assurances about what their payments would buy: "Are we talking about protection from being raided?" she asked the sheriff, according to a DEA agent’s affidavit attached to the criminal charging document. The pair allegedly paid Lopey $10,500, including four $500 cash bonuses, before they were arrested, according to court records.
That case is just one of several that have involved cannabis sellers and growers allegedly bribing or trying to bribe government officials, or public officials acting illegally to get rich from marijuana.
Last year, Jermaine Wright, then the mayor pro tem of Adelanto, was charged with agreeing to accept a bribe to fast-track a marijuana business. Wright’s trial is scheduled for August. In May, FBI agents served search warrants at the home of Rich Kerr, who was mayor of Adelanto at the time, as well as at City Hall and a marijuana retailer.
Also in May, Humboldt County building inspector Patrick Mctigue was arrested and charged with accepting $100,000 in bribes from marijuana businesses seeking expedited help on county permits, according to the Humboldt County Sheriff’s Office.
Last March, a federal jury reached guilty verdicts to bribery and extortion charges against Michael Kimbrew, who was a field representative to then-Rep. Janice Hahn when he accepted cash from an undercover FBI agent while pledging his "undying support" to protect a marijuana dispensary that the city of Compton was trying to close.
This March, developer Dorian Gray was held to answer by a judge in a preliminary hearing on charges of offering bribes to then-Oakland City Council President Larry Reid and Assistant City Administrator Greg Minor, according to court records. Gray allegedly offered the councilman cash to help obtain a cannabis dispensary permit, and Reid reported the offer to authorities. Gray is charged with offering Minor, who oversees marijuana permitting for Oakland, a free trip to Spain.
Not all of the recent cases involve elected officials. Los Angeles County Sheriff's Deputy Marc Antrim pleaded guilty two weeks ago to federal charges stemming from his arrest for robbing a warehouse of a half-ton of marijuana in October.
California was the first state to legalize the sale of marijuana for medical use two decades ago. The former mayor of the city of Cudahy was sentenced to one year in federal prison in 2013 for taking cash bribes in exchange for supporting the opening of a "medical marijuana" store in the city.
The head of the city’s code enforcement division and a city councilman were also convicted of taking part in the corruption scheme.
Law enforcement agencies are currently investigating possible corruption in other Southern California cities, according to Ed Muramoto, a private attorney for medical pot dispensaries that have complained about cities locking them out of competition for permits.
Sam Clauder, the former congressional aide and San Bernardino County Democratic Party official pleaded guilty in 2017 to charges in Texas of possessing 130 pounds of cannabis that he was transporting back east from California ...
Advanced Pain Diagnostic & Solutions Inc. and owner Kayvan Haddadan, M.D. have agreed to pay $860,000 to resolve allegations that the clinics violated the federal False Claims Act by knowingly submitting claims for reimbursement to California’s Medi-Cal program for services rendered by a provider who was excluded from participation in the Medi-Cal program.
At the time of the alleged conduct, Advanced Pain operated pain management clinics in Sacramento, Roseville, and Rocklin. The clinics employed staff physicians and nurse practitioners (NP) who provided medical treatment to patients, including drug therapy and injections. Today’s settlement resolves allegations that Advanced Pain billed Medi-Cal for services rendered by an excluded nurse practitioner under Haddadan’s billing number as if the services had been rendered by Haddadan.
"This settlement is part of our commitment to fight fraud in federal health care programs," said U.S. Attorney Scott. "Health care providers who do not follow the law need to know that we actively investigate this type of fraud and hold accountable those who take advantage of the programs for their own gain."
"HHS OIG maintains a publicly available database of more than 70,000 individuals and organizations excluded from billing federal healthcare programs - based on legislation and regulation," said Steven J. Ryan, Special Agent in Charge of the Office of Inspector General for the U.S. Department of Health and Human Services. "Employers intent on billing for services provided by excluded individuals and entities can expect to pay a high price."
The allegations resolved by this settlement were first raised in a lawsuit filed against Advanced Pain under the qui tam, or whistleblower, provisions of the False Claims Act by a nurse practitioner who worked at Advanced Pain. The False Claims Act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The whistleblower in this matter will receive approximately $154,860 of the recovery proceeds ...
At the time of the alleged conduct, Advanced Pain operated pain management clinics in Sacramento, Roseville, and Rocklin. The clinics employed staff physicians and nurse practitioners (NP) who provided medical treatment to patients, including drug therapy and injections. Today’s settlement resolves allegations that Advanced Pain billed Medi-Cal for services rendered by an excluded nurse practitioner under Haddadan’s billing number as if the services had been rendered by Haddadan.
"This settlement is part of our commitment to fight fraud in federal health care programs," said U.S. Attorney Scott. "Health care providers who do not follow the law need to know that we actively investigate this type of fraud and hold accountable those who take advantage of the programs for their own gain."
"HHS OIG maintains a publicly available database of more than 70,000 individuals and organizations excluded from billing federal healthcare programs - based on legislation and regulation," said Steven J. Ryan, Special Agent in Charge of the Office of Inspector General for the U.S. Department of Health and Human Services. "Employers intent on billing for services provided by excluded individuals and entities can expect to pay a high price."
The allegations resolved by this settlement were first raised in a lawsuit filed against Advanced Pain under the qui tam, or whistleblower, provisions of the False Claims Act by a nurse practitioner who worked at Advanced Pain. The False Claims Act allows private citizens with knowledge of fraud to bring civil actions on behalf of the government and to share in any recovery. The whistleblower in this matter will receive approximately $154,860 of the recovery proceeds ...
Two brothers who owned a West Los Angeles pharmacy and were convicted of illegally selling prescription opioids and other narcotics to black market customers across the United States were sentenced late Wednesday, with each man being ordered to serve 121 months in federal prison.
Berry Kabov, 48, and his brother Dalibor "Dabo" Kabov, 35, both residents of Brentwood, were sentenced by United States District Judge Dolly M. Gee. The Kabov brothers operated Global Compounding Pharmacy, a pharmacy that was located in West Los Angeles.
Following a three-week jury trial in early 2017, the brothers were convicted of illegally selling the opioid narcotics oxycodone, hydromorphone and hydrocodone. The wide-ranging conspiracy, which also illegally imported anabolic steroids, resulted in the Kabov brothers earning more than $3 million and cheating the Internal Revenue Service by failing to report $1.5 million on their federal tax returns.
Prosecutors argued in court documents that the Kabovs orchestrated a "years-long scheme to exploit the nation’s epidemic-level addiction to powerful prescription opioids," and that the brothers "rose from mail-order drug dealers - sending drug parcels to Ohio for cash - to owners of a Los Angeles pharmacy that sold millions of dollars of oxycodone, hydromorphone, and hydrocodone on the black market."
The Kabov brothers used Global Compounding to sell bulk quantities of oxycodone to customers across the country. During the investigation, authorities seized shipments containing thousands of oxycodone pills sent by the Kabov brothers to customers in and around Columbus, Ohio. These customers in turn made cash deposits into Kabov-controlled bank accounts or simply shipped bulk cash to the brothers in Southern California.
The evidence also included recorded calls between Berry Kabov and a cooperating informant, during which Berry Kabov described oxycodone pills as "gold" selling for as much as "50 bucks a pill" in areas like New York. Berry Kabov offered to ship as many as 4,000 oxycodone pills per week to the informant, bragging that “we have a thing that we can move easy.”
After drug wholesalers cut off Global Compounding, the Kabovs began manufacturing their own opioid pills after obtaining a $20,000 pill press from China and acquiring enough bulk powder to make 100,000 maximum-strength pills. "In total, from the wholesale orders and on-site manufacturing, the Kabovs disseminated over 300,000 pills of opiates to the black market during the conspiracy, which accounts only for what they sold after opening Global Compounding," prosecutors wrote in their sentencing brief.
To conceal the black market drug sales that brought them approximately $3 million, the Kabovs conspired with a doctor to create fraudulent prescriptions in the names of identity theft victims. The Kabovs also reported false information to California authorities making it appear that drugs had been dispensed to those identity theft victims. Prosecutors said in court documents that planting that fraudulent information "ma[de] the victims falsely appear to be narcotic addicts," thus putting them at risk of being denied necessary treatment from a legitimate physician checking their prescription histories. Global Compounding also failed to report sales of 98,000 pills of opiates to California authorities who track prescription drug sales.
As part of the scheme, the brothers also used the names of other identity theft victims - members of a longshoremen labor union’s health insurance plan - to submit fraudulent claims that generated another $2.6 million from the plan, prosecutors said in court papers. In October 2017, the owner of a Long Beach "medi-spa" involved in the fraud scheme, Erica Carey, pleaded guilty to a federal wire fraud charge and admitted conspiring with the Kabovs in exchange for more than $300,000 in kickbacks.
The investigation into the Kabov brothers and Global Compounding was conducted by the Drug Enforcement Administration, IRS Criminal Investigation, the United States Postal Inspection Service, the Los Angeles Police Department, and the California Board of Pharmacy.
The case is being prosecuted by Assistant United States Attorney Benjamin R. Barron of the Organized Crime Drug Enforcement Task Force, and Assistant United States Attorney Matthew O’Brien of the Environmental and Community Safety Crimes Section ...
Berry Kabov, 48, and his brother Dalibor "Dabo" Kabov, 35, both residents of Brentwood, were sentenced by United States District Judge Dolly M. Gee. The Kabov brothers operated Global Compounding Pharmacy, a pharmacy that was located in West Los Angeles.
Following a three-week jury trial in early 2017, the brothers were convicted of illegally selling the opioid narcotics oxycodone, hydromorphone and hydrocodone. The wide-ranging conspiracy, which also illegally imported anabolic steroids, resulted in the Kabov brothers earning more than $3 million and cheating the Internal Revenue Service by failing to report $1.5 million on their federal tax returns.
Prosecutors argued in court documents that the Kabovs orchestrated a "years-long scheme to exploit the nation’s epidemic-level addiction to powerful prescription opioids," and that the brothers "rose from mail-order drug dealers - sending drug parcels to Ohio for cash - to owners of a Los Angeles pharmacy that sold millions of dollars of oxycodone, hydromorphone, and hydrocodone on the black market."
The Kabov brothers used Global Compounding to sell bulk quantities of oxycodone to customers across the country. During the investigation, authorities seized shipments containing thousands of oxycodone pills sent by the Kabov brothers to customers in and around Columbus, Ohio. These customers in turn made cash deposits into Kabov-controlled bank accounts or simply shipped bulk cash to the brothers in Southern California.
The evidence also included recorded calls between Berry Kabov and a cooperating informant, during which Berry Kabov described oxycodone pills as "gold" selling for as much as "50 bucks a pill" in areas like New York. Berry Kabov offered to ship as many as 4,000 oxycodone pills per week to the informant, bragging that “we have a thing that we can move easy.”
After drug wholesalers cut off Global Compounding, the Kabovs began manufacturing their own opioid pills after obtaining a $20,000 pill press from China and acquiring enough bulk powder to make 100,000 maximum-strength pills. "In total, from the wholesale orders and on-site manufacturing, the Kabovs disseminated over 300,000 pills of opiates to the black market during the conspiracy, which accounts only for what they sold after opening Global Compounding," prosecutors wrote in their sentencing brief.
To conceal the black market drug sales that brought them approximately $3 million, the Kabovs conspired with a doctor to create fraudulent prescriptions in the names of identity theft victims. The Kabovs also reported false information to California authorities making it appear that drugs had been dispensed to those identity theft victims. Prosecutors said in court documents that planting that fraudulent information "ma[de] the victims falsely appear to be narcotic addicts," thus putting them at risk of being denied necessary treatment from a legitimate physician checking their prescription histories. Global Compounding also failed to report sales of 98,000 pills of opiates to California authorities who track prescription drug sales.
As part of the scheme, the brothers also used the names of other identity theft victims - members of a longshoremen labor union’s health insurance plan - to submit fraudulent claims that generated another $2.6 million from the plan, prosecutors said in court papers. In October 2017, the owner of a Long Beach "medi-spa" involved in the fraud scheme, Erica Carey, pleaded guilty to a federal wire fraud charge and admitted conspiring with the Kabovs in exchange for more than $300,000 in kickbacks.
The investigation into the Kabov brothers and Global Compounding was conducted by the Drug Enforcement Administration, IRS Criminal Investigation, the United States Postal Inspection Service, the Los Angeles Police Department, and the California Board of Pharmacy.
The case is being prosecuted by Assistant United States Attorney Benjamin R. Barron of the Organized Crime Drug Enforcement Task Force, and Assistant United States Attorney Matthew O’Brien of the Environmental and Community Safety Crimes Section ...
The married owner and manager of Los Gatos Urgent Care Clinic were arraigned today on felony fraud charges after an investigation showed that they massively overbilled clients, in one case billing a patient who stepped on a sea urchin $700 for a pair of foam slippers worth less than $10.
One audit of the business operated by Dr. Farzaneh Tabrizi, 50, and Ali Moayed, 53, revealed a 100% error rate for billing, including "up-coding" - falsely claiming a more serious injury or illness - and billing for services not rendered.
The Monte Sereno couple are charged with filing false insurance claims. If convicted, they may face paying back tens of thousands of dollars in restitution and time in jail.
"People go to medical clinics to get care, not conned," prosecutor Julie Sousa said. "The District Attorney’s Office has no tolerance for those in the medical care profession who take advantage of ill and injured clients to defraud them and their insurance companies."
Spurred by citizen complaints, a DA investigation showed that LGUC patients were billed for diagnostic testing they did not receive.
Another patient came in for drug testing required for a new job. Even though the patient’s company paid for the testing, LGUC illegally charged her a co-pay and her insurance company $425 for a non-existent urinary tract infection.
One of the defrauded insurance companies estimated their loss from LGUC’s fraudulent practice at more than $200,000 ...
One audit of the business operated by Dr. Farzaneh Tabrizi, 50, and Ali Moayed, 53, revealed a 100% error rate for billing, including "up-coding" - falsely claiming a more serious injury or illness - and billing for services not rendered.
The Monte Sereno couple are charged with filing false insurance claims. If convicted, they may face paying back tens of thousands of dollars in restitution and time in jail.
"People go to medical clinics to get care, not conned," prosecutor Julie Sousa said. "The District Attorney’s Office has no tolerance for those in the medical care profession who take advantage of ill and injured clients to defraud them and their insurance companies."
Spurred by citizen complaints, a DA investigation showed that LGUC patients were billed for diagnostic testing they did not receive.
Another patient came in for drug testing required for a new job. Even though the patient’s company paid for the testing, LGUC illegally charged her a co-pay and her insurance company $425 for a non-existent urinary tract infection.
One of the defrauded insurance companies estimated their loss from LGUC’s fraudulent practice at more than $200,000 ...
Public records reflect that Bruce E. Fishman, M.D. was first licensed in California as a physician and Surgeon in 1983. His license was revoked in 1987 based upon his federal conviction of conspiracy to distribute controlled substances. In June, 1990, he was granted a probationary license and in 1994 his certificate was reinstated without restriction.
He was the AME in the landmark Almaraz-Guzman decision in 2009, that paved the way for deviations from a strict interpretation of the AMA Guides.
However, in April, 2018, the DIR issued him a Notice of Provider Suspension from participation in the Workers Compensation system. Fishman pursued his right to request a hearing of that action.
He is also the defendant in a 2018 Qui Tam action brought by Plaintiffs State of California, the Counties of Los Angeles, Kern, San Bernardino, Ventura, Santa Barbara, the Cities of Los Angeles and Bakersfield, the School Districts of Los Angeles, McFarland, Visalia and Kern, the Health Care District of Tehachapi, ex al. Med-Legal Associates, Inc. and CLCI, Inc., alleging, among other things, a violation of the California Insurance Fraud Prevention Act - Insurance Code § 1871.7
He is also involved in litigation against his former Lien Collection and Med-Legal management company which is the subject of an opinion this month by the California Court of Appeal in the unpublished case of Med-Legal Associates, Inc. v. Fishman.
In 2008, Fishman entered into a relationship with Green Lien Collections, Inc., a company owned by Patrick Nazemi, which provided billing, collection, and enforcement services to medical providers in the workers’ compensation field. In 2011, Nazemi formed Med-Legal Associates, Inc. "with the intent to provide management services to med-legal providers."
Paragraph 2.d of the Management Services Agreement provides that MLA would assist Fishman in arranging for advertising and marketing services, and that Fishman is responsible for paying the actual cost and expense of all advertising services. The Agreement also contains an arbitration provision.
Dr. Fishman became dissatisfied with MLA’s services, specifically finding that the medical transcribers, physician assistants, and medical researchers were inadequate and underqualified. As a result, Dr. Fishman spent additional, uncompensated time completing work that he expected MLA’s personnel to complete. Moreover, the advertising services were inadequate.
Perhaps more toxic was the fact that the personal relationship between Dr. Fishman and Mr. Nazemi began to erode.Fishman testified that Mr. Nazemi attempted to extort him by threatening to expose an old felony conviction.
in 1983, Dr. Fishman had been convicted of a federal felony related to the practice of medicine during his medical residency in Michigan and had served a federal prison sentence. As a result, Dr. Fishman’s medical license had been revoked in both California and Michigan. Although California ultimately restored Dr. Fishman’s medical license in 1990, Michigan never did.
A consequence of the felony conviction was that Dr. Fishman did not complete his residency in orthopedic surgery and did not obtain board certification in the field of orthopedic surgery. Instead, Dr. Fishman is board-certified by the American Board of Preventive Medicine (Occupational Medicine) and carries the initials ‘F.I.C.S[.],’ which stand for Fellow of the International College of Surgeons.
On July 20, 2015, MLA filed with JAMS a petition for arbitration against Fishman for breach of contract and fraud. According to MLA, Dr. Fishman’s failure to disclose the felony conviction prior to entering into the MSA was fraud. Had MLA known that Dr. Fishman was not a board certified orthopedic surgeon, it would never have entered into the MSA or introduced Dr. Fishman to its business contacts. Fishman filed a cross-claim for breach of contract and intentional infliction of emotional distress.
According to the arbitrator, the parties were contentious throughout the arbitration process. The arbitrator found that MLA failed to prove all requisite elements of its breach of contract and fraud claims, and that MLA breached the MSA by not providing Fishman with adequate staffing and promotional services, as required by the MSA.The arbitrator awarded Fishman $113,400. As the prevailing party, Fishman was entitled to attorney fees and costs. He claimed over $1.2 million in attorney fees and $128,000 in costs. Ultimately, the arbitrator awarded Fishman one-third of what was requested in attorney fees: $418,257.
Acrimonious litigation continued up to the Court of Appeal which affirmed the arbitrators award in the unpublished case of Med-Legal Associates, Inc. v. Fishman. Following the appeal Fishman was awarded attorney fees and costs on appeal ...
He was the AME in the landmark Almaraz-Guzman decision in 2009, that paved the way for deviations from a strict interpretation of the AMA Guides.
However, in April, 2018, the DIR issued him a Notice of Provider Suspension from participation in the Workers Compensation system. Fishman pursued his right to request a hearing of that action.
He is also the defendant in a 2018 Qui Tam action brought by Plaintiffs State of California, the Counties of Los Angeles, Kern, San Bernardino, Ventura, Santa Barbara, the Cities of Los Angeles and Bakersfield, the School Districts of Los Angeles, McFarland, Visalia and Kern, the Health Care District of Tehachapi, ex al. Med-Legal Associates, Inc. and CLCI, Inc., alleging, among other things, a violation of the California Insurance Fraud Prevention Act - Insurance Code § 1871.7
He is also involved in litigation against his former Lien Collection and Med-Legal management company which is the subject of an opinion this month by the California Court of Appeal in the unpublished case of Med-Legal Associates, Inc. v. Fishman.
In 2008, Fishman entered into a relationship with Green Lien Collections, Inc., a company owned by Patrick Nazemi, which provided billing, collection, and enforcement services to medical providers in the workers’ compensation field. In 2011, Nazemi formed Med-Legal Associates, Inc. "with the intent to provide management services to med-legal providers."
Paragraph 2.d of the Management Services Agreement provides that MLA would assist Fishman in arranging for advertising and marketing services, and that Fishman is responsible for paying the actual cost and expense of all advertising services. The Agreement also contains an arbitration provision.
Dr. Fishman became dissatisfied with MLA’s services, specifically finding that the medical transcribers, physician assistants, and medical researchers were inadequate and underqualified. As a result, Dr. Fishman spent additional, uncompensated time completing work that he expected MLA’s personnel to complete. Moreover, the advertising services were inadequate.
Perhaps more toxic was the fact that the personal relationship between Dr. Fishman and Mr. Nazemi began to erode.Fishman testified that Mr. Nazemi attempted to extort him by threatening to expose an old felony conviction.
in 1983, Dr. Fishman had been convicted of a federal felony related to the practice of medicine during his medical residency in Michigan and had served a federal prison sentence. As a result, Dr. Fishman’s medical license had been revoked in both California and Michigan. Although California ultimately restored Dr. Fishman’s medical license in 1990, Michigan never did.
A consequence of the felony conviction was that Dr. Fishman did not complete his residency in orthopedic surgery and did not obtain board certification in the field of orthopedic surgery. Instead, Dr. Fishman is board-certified by the American Board of Preventive Medicine (Occupational Medicine) and carries the initials ‘F.I.C.S[.],’ which stand for Fellow of the International College of Surgeons.
On July 20, 2015, MLA filed with JAMS a petition for arbitration against Fishman for breach of contract and fraud. According to MLA, Dr. Fishman’s failure to disclose the felony conviction prior to entering into the MSA was fraud. Had MLA known that Dr. Fishman was not a board certified orthopedic surgeon, it would never have entered into the MSA or introduced Dr. Fishman to its business contacts. Fishman filed a cross-claim for breach of contract and intentional infliction of emotional distress.
According to the arbitrator, the parties were contentious throughout the arbitration process. The arbitrator found that MLA failed to prove all requisite elements of its breach of contract and fraud claims, and that MLA breached the MSA by not providing Fishman with adequate staffing and promotional services, as required by the MSA.The arbitrator awarded Fishman $113,400. As the prevailing party, Fishman was entitled to attorney fees and costs. He claimed over $1.2 million in attorney fees and $128,000 in costs. Ultimately, the arbitrator awarded Fishman one-third of what was requested in attorney fees: $418,257.
Acrimonious litigation continued up to the Court of Appeal which affirmed the arbitrators award in the unpublished case of Med-Legal Associates, Inc. v. Fishman. Following the appeal Fishman was awarded attorney fees and costs on appeal ...
Retired WCAB Commissioner Frank Brass passed away on Monday.
Katherine Zalewski, chair of the Workers’ Compensation Appeals Board (WCAB), issued the following statement on the March 11 death of retired WCAB Commissioner Frank Brass:
"We pause today to mark the life and contributions of Frank Brass. Frank served as a WCAB commissioner for 17 years from 2001 to 2018, and had over 40 years of experience as an attorney specializing in workers' compensation."
He began his practice under the tutelage of Lowell A. Airola, a founding member of the California Applicants’ Attorneys Association, and worked in distinguished law firms including Parente and Christopher and Brass and Zuckerman/Fremont Indemnity.
He attended St. Ignatius High School and earned a Juris Doctor degree from the University of San Francisco School of Law and a Bachelor of Science degree from the University of San Francisco.
Frank also served as an infantryman in the U.S. Army from 1952 to 1954.
"Frank was loved and respected by his colleagues at the Board and in the larger workers’ compensation community. We are all saddened by his passing."
He retired as Commissioner of the WCAB in 2018, after having been first appointed in 2001, reappointed in 2008 by Governor Schwarzenegger, and then again by Governor Brown in 2014.
...
Katherine Zalewski, chair of the Workers’ Compensation Appeals Board (WCAB), issued the following statement on the March 11 death of retired WCAB Commissioner Frank Brass:
"We pause today to mark the life and contributions of Frank Brass. Frank served as a WCAB commissioner for 17 years from 2001 to 2018, and had over 40 years of experience as an attorney specializing in workers' compensation."
He began his practice under the tutelage of Lowell A. Airola, a founding member of the California Applicants’ Attorneys Association, and worked in distinguished law firms including Parente and Christopher and Brass and Zuckerman/Fremont Indemnity.
He attended St. Ignatius High School and earned a Juris Doctor degree from the University of San Francisco School of Law and a Bachelor of Science degree from the University of San Francisco.
Frank also served as an infantryman in the U.S. Army from 1952 to 1954.
"Frank was loved and respected by his colleagues at the Board and in the larger workers’ compensation community. We are all saddened by his passing."
He retired as Commissioner of the WCAB in 2018, after having been first appointed in 2001, reappointed in 2008 by Governor Schwarzenegger, and then again by Governor Brown in 2014.
...
Maria Morales filed two claims against her employer. The first was a claim for injury to the left thumb, knees, back, headaches, internal body system, psyche, neck, and "multiples" on September 9, 2000 (ADJ2160716). The second claim was for injury to the internal system, neck, back, knees, upper extremities, psyche, and urinary system through July 31, 2001 (ADJ634371).
On June 13, 2016, the parties entered into a compromise and release in the amount of $118,000.00. Both of applicant's claims were described in Paragraph One (1 ), but the internal system was not listed as a body part, condition or system being settled in ADJ634371. Below Paragraph Ten (10) of the C&R, the parties drew a star and handwrote, "[r]esolves all liability/claims against American Home Assurance Company/AIG for Lifestyle Furnishings."
Approximately 26 days later, applicant notified defendant that she did not believe that the compromise and release resolved the claimed injury to her internal system.
On May 22, 2017, the matter proceeded to trial on the issue of whether the compromise and release barred applicant's claim of injury to her internal system.
The WCJ found that the "Compromise and Release Agreement entered into on June 13, 2016 by AIG Property and Casualty (AIG) resolves applicant's internal claim of injury in addition to all other claims of injury resolved by that agreement" and that the "claims filed against AIG were fully resolved by the Order Approving Compromise and Release dated June 13, 2016."
The WCAB granted reconsideration, and reversed, finding that applicant's claim of internal injury was not resolved as part of the June 13, 2016 Compromise and Release in the panel decision of Morales v. Universal Furniture, AIG.
The parties must clearly identify each injury and list the corresponding body parts in Paragraph One (1) because that section requires that the parties state "with specificity the date(s) of injury(ies) and what part(s) of body, conditions or systems are being settled." (C&R, Paragraph One (1), p. 3, emphasis added.) Further Paragraph One (1) also states that "[b]ody parts, conditions and systems may not be incorporated by reference to medical reports." (Id. at pp. 3, 4, 5, emphasis in original.) Paragraph One (1)· allows the parties to clearly identify the settlement of multiple injuries with corresponding body parts by requiring that the parties list the case number, the type of injury, the date of injury and the settled body parts. (Id.)
Therefore, if parties wish to settle multiple injuries to the same body part, the parties must list that body part under the description of each injury, and the parties may not settle multiple injuries to one body part by listing the body part under the description of one injury but not another.
In Jefferson v. Dept. of Youth Authority (2002) 28 Cal.4th 299 [67 Cal.Comp.Cases 727], the Supreme Court held that a general release in a workers' compensation case will bar other potential claims against the employer that exist at the time of execution of the release unless the employee knows about the claim and expressly excepts it from the release. (Id. at p. 310.) However, approximately six years after the Supreme Court decided that case, the compromise and release form was revised to prevent overbroad releases and thus further the legislative intent of protecting workers who might agree to unfortunate compromises because of economic pressure or lack of competent advice.
The release in Paragraph Two (2) of that form states in relevant part, Upon approval of this compromise agreement . . . and payment in accordance with the provisions hereof, the employee releases and forever discharges the above named employer(s) and insurance carrier(s) from all claims and causes of action, whether now known or ascertained or which may hereafter arise or develop as a result of the above-referenced injury(ies) ...
This release does not bar applicant's claimed internal injury because it is limited to the settlement described in Paragraph One (1), and as discussed above, that paragraph did not settle the claimed internal injury ...
On June 13, 2016, the parties entered into a compromise and release in the amount of $118,000.00. Both of applicant's claims were described in Paragraph One (1 ), but the internal system was not listed as a body part, condition or system being settled in ADJ634371. Below Paragraph Ten (10) of the C&R, the parties drew a star and handwrote, "[r]esolves all liability/claims against American Home Assurance Company/AIG for Lifestyle Furnishings."
Approximately 26 days later, applicant notified defendant that she did not believe that the compromise and release resolved the claimed injury to her internal system.
On May 22, 2017, the matter proceeded to trial on the issue of whether the compromise and release barred applicant's claim of injury to her internal system.
The WCJ found that the "Compromise and Release Agreement entered into on June 13, 2016 by AIG Property and Casualty (AIG) resolves applicant's internal claim of injury in addition to all other claims of injury resolved by that agreement" and that the "claims filed against AIG were fully resolved by the Order Approving Compromise and Release dated June 13, 2016."
The WCAB granted reconsideration, and reversed, finding that applicant's claim of internal injury was not resolved as part of the June 13, 2016 Compromise and Release in the panel decision of Morales v. Universal Furniture, AIG.
The parties must clearly identify each injury and list the corresponding body parts in Paragraph One (1) because that section requires that the parties state "with specificity the date(s) of injury(ies) and what part(s) of body, conditions or systems are being settled." (C&R, Paragraph One (1), p. 3, emphasis added.) Further Paragraph One (1) also states that "[b]ody parts, conditions and systems may not be incorporated by reference to medical reports." (Id. at pp. 3, 4, 5, emphasis in original.) Paragraph One (1)· allows the parties to clearly identify the settlement of multiple injuries with corresponding body parts by requiring that the parties list the case number, the type of injury, the date of injury and the settled body parts. (Id.)
Therefore, if parties wish to settle multiple injuries to the same body part, the parties must list that body part under the description of each injury, and the parties may not settle multiple injuries to one body part by listing the body part under the description of one injury but not another.
In Jefferson v. Dept. of Youth Authority (2002) 28 Cal.4th 299 [67 Cal.Comp.Cases 727], the Supreme Court held that a general release in a workers' compensation case will bar other potential claims against the employer that exist at the time of execution of the release unless the employee knows about the claim and expressly excepts it from the release. (Id. at p. 310.) However, approximately six years after the Supreme Court decided that case, the compromise and release form was revised to prevent overbroad releases and thus further the legislative intent of protecting workers who might agree to unfortunate compromises because of economic pressure or lack of competent advice.
The release in Paragraph Two (2) of that form states in relevant part, Upon approval of this compromise agreement . . . and payment in accordance with the provisions hereof, the employee releases and forever discharges the above named employer(s) and insurance carrier(s) from all claims and causes of action, whether now known or ascertained or which may hereafter arise or develop as a result of the above-referenced injury(ies) ...
This release does not bar applicant's claimed internal injury because it is limited to the settlement described in Paragraph One (1), and as discussed above, that paragraph did not settle the claimed internal injury ...
Uber announced that it settled a pair of lawsuits for $20 million. The case of O’Connor v. Uber, was first brought by a group of Uber drivers in 2013 who argued they should be categorized as employees rather than freelancers.
By classifying drivers as contractors, Uber avoids providing benefits of traditional employment such as health insurance, paid sick time, and workers’ compensation.
It was almost settled in 2016, when Uber agreed to pay as much as $100 million to the roughly 385,000 drivers represented in the class action lawsuit and one other case, so long as it could continue to classify them as freelancers.
But the settlement was later rejected by a federal judge, who argued that the amount was insufficient.
Since then, the tide has shifted in Uber’s favor. The US Supreme Court issued a ruling bolstering the power of employers to force workers to use individual arbitration instead of class action lawsuits.
Last year, the Ninth US Circuit Court of Appeals reversed O’Connor v. Uber’s class certification status, nullifying the decision on the ground that Uber’s arbitration clause prohibits class actions. The appeals court ruling ultimately reduced the size of the class to about 13,600 drivers who will participate in the settlement.
Under the current agreement, drivers will receive $20 million, approximately 37 cents per mile for the miles they have driven for Uber.
The settlement still requires a judge’s approval, but Uber is ready to put the past behind it. "Uber has changed a lot since 2013," a spokesperson said in a statement. "We have made the driver experience even better through improvements like in-app tipping, a redesigned driver app, and new rewards programs like Uber Pro. We’re pleased to reach a settlement on this matter and we’ll continue working hard to improve the quality, security and dignity of independent work." ...
By classifying drivers as contractors, Uber avoids providing benefits of traditional employment such as health insurance, paid sick time, and workers’ compensation.
It was almost settled in 2016, when Uber agreed to pay as much as $100 million to the roughly 385,000 drivers represented in the class action lawsuit and one other case, so long as it could continue to classify them as freelancers.
But the settlement was later rejected by a federal judge, who argued that the amount was insufficient.
Since then, the tide has shifted in Uber’s favor. The US Supreme Court issued a ruling bolstering the power of employers to force workers to use individual arbitration instead of class action lawsuits.
Last year, the Ninth US Circuit Court of Appeals reversed O’Connor v. Uber’s class certification status, nullifying the decision on the ground that Uber’s arbitration clause prohibits class actions. The appeals court ruling ultimately reduced the size of the class to about 13,600 drivers who will participate in the settlement.
Under the current agreement, drivers will receive $20 million, approximately 37 cents per mile for the miles they have driven for Uber.
The settlement still requires a judge’s approval, but Uber is ready to put the past behind it. "Uber has changed a lot since 2013," a spokesperson said in a statement. "We have made the driver experience even better through improvements like in-app tipping, a redesigned driver app, and new rewards programs like Uber Pro. We’re pleased to reach a settlement on this matter and we’ll continue working hard to improve the quality, security and dignity of independent work." ...
Covidien was an Irish-headquartered global health care products company and manufacturer of medical devices and supplies. It was purchased by Medtronic in a transaction that closed in 2015.
Covidien has agreed to pay $17,477,947 to resolve allegations that it violated the False Claims Act by providing free or discounted practice development and market development support to physicians located in California and Florida to induce purchases of Covidien’s vein ablation products.
Under the settlement agreement, Covidien will pay an additional $1,474,892 to California and $1,047,160 to Florida for claims settled by these state Medicaid programs. The Medicaid program is a jointly funded federal and state program.
The United States alleged that Covidien violated the Anti-Kickback Statute and, correspondingly, the False Claims Act by providing practice development and market development support to health care providers located in California and Florida from Jan. 1, 2011, through Sept. 30, 2014, to induce those providers to purchase ClosureFASTTM radiofrequency ablation catheters that were billed to Medicare and to the California and Florida Medicaid programs.
ClosureFastTM catheters are used in procedures that treat venous reflux disease, a disease often marked by the presence of varicose veins.
The practice and market development support Covidien provided included customized marketing plans for specific vein practices; scheduling and conducting "lunch and learn" meetings and dinners with other physicians to drive referrals to specific vein practices; and providing substantial assistance to specific vein practices in connection with planning, promoting, and conducting vein screening events to cultivate new patients for those practices.
The Anti-Kickback Act prohibits the payment of remuneration to induce the referral or use of items or services paid for by federal health care programs. Remuneration includes not only cash payments but also offers or payments made "in kind."
The settlement resolves allegations contained in lawsuits filed by Erin Hayes and Richard Ponder (former sales managers for Covidien) and Shawnea Howerton (a former employee of one of Covidien’s customers), which are pending in federal court in San Francisco, California.
The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the United States for false claims and to share in any recovery. Mr. Hayes and Mr. Ponder will receive $3,146,030 as their share of the federal recovery.
...
Covidien has agreed to pay $17,477,947 to resolve allegations that it violated the False Claims Act by providing free or discounted practice development and market development support to physicians located in California and Florida to induce purchases of Covidien’s vein ablation products.
Under the settlement agreement, Covidien will pay an additional $1,474,892 to California and $1,047,160 to Florida for claims settled by these state Medicaid programs. The Medicaid program is a jointly funded federal and state program.
The United States alleged that Covidien violated the Anti-Kickback Statute and, correspondingly, the False Claims Act by providing practice development and market development support to health care providers located in California and Florida from Jan. 1, 2011, through Sept. 30, 2014, to induce those providers to purchase ClosureFASTTM radiofrequency ablation catheters that were billed to Medicare and to the California and Florida Medicaid programs.
ClosureFastTM catheters are used in procedures that treat venous reflux disease, a disease often marked by the presence of varicose veins.
The practice and market development support Covidien provided included customized marketing plans for specific vein practices; scheduling and conducting "lunch and learn" meetings and dinners with other physicians to drive referrals to specific vein practices; and providing substantial assistance to specific vein practices in connection with planning, promoting, and conducting vein screening events to cultivate new patients for those practices.
The Anti-Kickback Act prohibits the payment of remuneration to induce the referral or use of items or services paid for by federal health care programs. Remuneration includes not only cash payments but also offers or payments made "in kind."
The settlement resolves allegations contained in lawsuits filed by Erin Hayes and Richard Ponder (former sales managers for Covidien) and Shawnea Howerton (a former employee of one of Covidien’s customers), which are pending in federal court in San Francisco, California.
The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private individuals to sue on behalf of the United States for false claims and to share in any recovery. Mr. Hayes and Mr. Ponder will receive $3,146,030 as their share of the federal recovery.
...
