A new study, Correlates of Opioid Dispensing, published by the Workers Compensation Research Institute (WCRI) identifies characteristics of injured workers and their employers that are associated with differences in opioid dispensing rates.

The study analyzed a range of possible correlates, including worker (age, gender), injury (type of injury), industry (industry group and employer’s payroll size), and location (county-level opioid dispensing rate, urban-rural classification, and health insurance coverage rate) characteristics. The following are some sample findings from the study:

- Industry: For the same injuries, workers employed in mining and construction who received pain medications were more likely to receive opioids, as well as to receive opioids on a longer-term basis and at higher doses.
- Location: Injured workers residing in counties with higher amounts of opioids dispensed per person and those residing in rural and very rural counties were more likely to receive opioid prescriptions.
- Worker’s Age: Older workers were more likely to receive opioid prescriptions compared with younger workers.
- Injury Type: A higher proportion of workers who sustained fractures, carpal tunnel, and neurologic spine pain received at least one opioid prescription for pain relief.

The data used for this analysis included 1.4 million pain medication prescriptions filled within 18 months postinjury for injuries that occurred between October 1, 2014, and September 30, 2015, in 27 states.

The states are Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

The study was authored by WCRI’s Dr. Vennela Thumula and Te-Chun Liu. WCRI received funding from the Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health to support this study. To learn more about this study or to purchase a copy, visit WCRI’s website at https://www.wcrinet.org/reports/correlates-of-opioid-dispensing.

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CVS Health Corp’s Aetna and a host of other health insurers announced that they have partnered with IBM Corp to create a blockchain network aimed at cutting costs in the healthcare industry.

Big Blue is joined in this effort by Aetna (acquired last November by pharmacy and health plan provider CVS Health), health plan provider Anthem, Health Care Service Corporation (the largest customer-owned health insurance provider in the U.S.) and PNC Bank. These providers combined account for close to 100 million healthcare plans.

IBM said additional members will join the Health Utility Network in the coming months, including other health organizations, healthcare providers, startups, and technology companies.

The aim is to create an inclusive blockchain network that can benefit multiple members of the healthcare ecosystem in a highly secure, shared environment. The goal is to allow the blockchain network to enable healthcare companies to build, share and deploy solutions that drive digital transformation in the industry.

The collaboration members intend to use blockchain to address a range of industry challenges, including promoting efficient claims and payment processing, to enable secure and frictionless healthcare information exchanges, and to maintain current and accurate provider directories.

However, IBM is far from the only tech firm trying to leverage the immutability and transparency of blockchain for the siloed and fragmented healthcare industry. Other prominent names in blockchain healthcare include Change Healthcare, Hashed Health, Guardtime, Gem and SimplyVital - to name a few.

In such a busy space it’s not surprising IBM is faced with some consortia competition. For example, in April of last year, Humana and United Health Group, two of the largest health insurers, teamed up on a blockchain pilot with data providers Quest Diagnostics, Multiplan and Optum.

Another healthcare blockchain called ProCredEx launched in November last year. It focuses on storing and sharing the credentials of medical and dental practitioners and is expected to save time and costs within the industry.

Outside of healthcare, PNC Bank has been public about its blockchain activities, joining a group of banks exploring Ripple’s xCurrent payment system for cross-border transactions.
...

Members of a federal task force have arrested an attorney on narcotics distribution charges after detectives spent months following the woman and monitoring her drug sales on Craigslist. Prosecutors allege she illegally sold oxycodone pills after offering drugs for sale.

Jackie Ferrari, 36, a resident of Downey, who investigators believe recently started a new job at a Beverly Hills law firm, was arrested late Friday without incident by law enforcement officers affiliated with the High Intensity Drug Trafficking Area (HIDTA) Task Force, which operates under the direction of the Drug Enforcement Administration.

The criminal complaint filed on January 15 and unsealed this week specifically charges Ferrari with one count of distributing a controlled substance.

The affidavit in support of the complaint states that a law enforcement source with a long history of purchasing narcotics from Ferrari made a buy earlier this month in which Ferrari sold the informant 50 oxycodone pills for $1,200. Ferrari subsequently sent the informant and other likely customers a text message that she "recently obtained a new supply of oxycodone and [had] other drugs available for sale," according to the affidavit.

The investigation into Ferrari began after a 22-year-old woman died in August of a fentanyl overdose, and text messages on the victim’s phone initially indicated she may have purchased the narcotics from Ferrari. While investigators currently do not believe that Ferrari sold the narcotics that led to the overdose death, they have continued to investigate her based on evidence that she is a large-scale trafficker in opiates via the website Craigslist.

The affidavit also notes that records obtained from Craigslist pursuant to a subpoena demonstrate Ferrari’s long history of posting advertisements for the sale of narcotics using coded names such as "roxy dolls" (i.e., Roxicodone, a short-acting version of oxycodone), "Chinese **White** Rice" (i.e., "China white" or powdered heroin, which is often mixed with fentanyl) and "Black Rice" (i.e., black tar heroin).

Ferrari waived the option of a preliminary hearing and was released on $25,000 bond, said Thom Mrozek, a spokesman for the U.S. attorney’s office. If convicted of the charge in the criminal complaint, Ferrari would face a statutory maximum sentence of 20 years in federal prison ...

Charges were filed against Max Humberto Matos M.D.,Jeffrey Scott Catanzarite D.C., Ronald Lee Martin and Veronica Martin by Orange County prosecutors . They were released on bail on January 8, and an arraignment is scheduled in Orange County Superior Court on February 18, at 8:30 am.

The Felony Complaint in case 18CF3512 alleges that Jeffrey Scott Catanzarite is a California licensed chiropractor, who incorporated the Center for Better Health, A Medical Group, Inc., as a Medical Professional Corporation. He operated a medical clinic in Costa Mesa, and Riverside California, that provided treatment to workers' compensation claimants.

Between 2008 and 2016, he operated the Center for Better Health under the name Southland Spine and Rehabilitation Medical Center, Inc..

To comply with the laws of Medical Professional Corporations, Catanzarite listed himself at all times as a 49-percent owner of Center for Better Health/Southland Spine, while also holding the positions of President and Secretary.

In 2012, Catanzarite promoted Max Humberto Matos, M.D., a treating physician for Center for Better Health/Southland Spine to be its Vice President, Medical Director and gave him a 51 percent ownership interest on paper. But prosecutors allege that despite Matos's listed ownership interest, Catanzarite was the sole actual owner of Center for Better Health/Southland Spine, controlling its finances, and being responsible for making all substantive decisions.

Catanzarite employed Ronald Lee Martin and Veronica Martin through their company Priority One Health Resources, to run Center for Better Health/Southland Spine's marketing department.

The Center for Better Health/ Southland Spine allegedly contracted to pay Grupo Medlegal LA and subsequently Medlegal Network, Inc. $1000 for each patient provided to Center for Better Health/Southland Spine for which it could bill workers' compensation insurers. It typically paid Grupo Medlegal LA and Medlegal Network, Inc. $4,000 per week for 4 patient referrals.

The defendants also contracted to pay Providence Scheduling, for each patient provided to Center for Better Health/Southland Spine for which it could bill insurers. They typically paid Providence Scheduling Inc. $10,000 to $15,000 every 45 days for patient referrals.

Prosecutors claim that between January 3, 2011, and October 13, 2015, Catanzarite paid Grupo Medlegal LA $92,014.66 and Medlegal Network, Inc. $1,324,219.68 for unlawful patient referrals.

Prosecutors allege a number of crimes as a result of the defendants failure to disclose this information to a list of worker's compensation insurance carriers and third party administrators who paid benefits on these claims ...

A Riverside County judge has unsealed indictments against eight people accused of operating an international conspiracy to defraud the California workers’ compensation system of more than $123 million.

In March 2017, the Riverside and San Bernardino County District Attorney’s Offices began an investigation into Blue Oak Medical Group. The evidence was presented to a Riverside County criminal grand jury which, after hearing six weeks of testimony, handed down indictments on Jan. 17, 2019.

The indictments, which were unsealed by Superior Court Judge O.G. Magno on Tuesday, name Kenneth Amodeo, 60, of Agoura Hills; Rosa Bernal, 46, of Covina; Shannon Devane, 41, of Downey; Janek Hunt, a 44-year-old Estonian national; Edgar Lozano, 52, of Porter Ranch; Matthew Rifat, 49, of El Cajon; Hector Sandoval, 54, of Sherman Oaks; and Munir Uwaydah, a 52-year-old Lebanese national.

Amodeo is a pharmacist, Rifat is an attorney, and Uwaydah is a physician whose license currently is not active. Uwaydah has been under indictment in Los Angeles County in a related case since 2015.

The next court date for Amodeo, Bernal, and Lozano is Feb. 6, 2019, for arraignment and the next court date for Devane, Hunt, and Rifat, is Feb. 26, 2019, for a trial readiness conference. Defendants Sandoval and Uwaydah are not in custody and arrest warrants have been issued.

The eight defendants in this case are charged with a variety of counts including conspiracy, fraud, and money laundering and sentence-enhancing white-collar crime allegations.

Amodeo, Bernal and Lozano were each being held in lieu of $4.7 million bail at the Smith Correctional Facility in Banning; Devane and Rifat were each being held in lieu of $4.7 million at the Robert Presley Jail in Riverside; and Hunt was being held in lieu of $4.7 million at the Byrd Detention Center in Murrieta. Arrest warrants are pending against Sandoval and Uwaydah, neither of whom were in custody.

Based on information found in publically filed documents, the defendants used the sham clinics to take advantage of thousands of patients by prescribing nearly all of them the same high priced cocktail of unnecessary medications, regardless of the patients’ condition. Many of the medications were produced by pharmacies under the control of the defendants and the patients often received little, if any, of the medicine they were prescribed.

The defendants funneled the fraudulently obtained proceeds from the scam through a network of shell companies, ultimately sending the money to co-conspirators throughout Southern California, Europe, and the Middle East.

The investigation in this case involved multiple agencies including the Riverside County District Attorney’s Office, the San Bernardino County District Attorney’s Office, the Orange County District Attorney’s Office, and the California Pharmacy Board.

The cases, RIF1990022 and RIF1990023, are being prosecuted by Riverside County Deputy District Attorneys Matthew Murray, Erika Mulhere, and Kristen Allison of the DA’s Insurance Fraud Team, and San Bernardino County Deputy District Attorney Michael Chiriatti ...

The Medical Board of California has launched investigations into doctors who prescribed opioids to patients who, perhaps months or years later, fatally overdosed, according to a report by Kaiser Health News.

The effort, dubbed "the Death Certificate Project," has sparked a conflict with physicians in California and beyond, in part because the doctors being investigated did not necessarily write the prescriptions leading to a death. The project is one of a kind nationally, although a much more limited program is operated by North Carolina’s board.

So far, the board has launched investigations into the practices of about 450 physicians and referred the names of 72 nurse practitioners, physician assistants and osteopathic physicians to their respective licensing boards. To date, the regulators have formally accused at least 23 doctors of negligent prescribing, and more accusations are expected.

Using terms such as "witch hunt" and "inquisition," many doctors said the project is leading them or their peers to refuse patients’ requests for painkiller prescriptions - no matter how well documented the need - out of fear their practices will come under disciplinary review.

The project, first reported by MedPage Today, has struck a nerve among medical associations. Dr. Barbara McAneny, the American Medical Association president and an Albuquerque, N.M., oncologist whose cancer patients sometimes need treatment for acute pain, called the project "terrifying." She said "it will only discourage doctors from taking care of patients with pain."

The influential California Health Care Foundation also has pushed back against the project, saying it could harm patients.

Unusually aggressive for the board, the program is a reaction to the by now well-known phenomenon of physicians overprescribing opioids. Nationally, a host of policy changes and educational efforts have driven down the rate of opioid prescriptions in recent years.

The goal of California’s program, quietly launched four years ago, is not necessarily to link a doctor’s specific prescription to a specific patient’s death - although many of the cases do - but to find doctors whose patterns of prescribing are so dangerous they may lead to patients’ ultimately fatal addictions.

Kimberly Kirchmeyer, executive director of the Medical Board of California, defended the project. She said the effort has found patterns of "gross negligence," incompetence and excessive prescribing.

"I understand their frustrations," she said of the complaining doctors, "but we do have to continue our role with consumer protection." She noted that part of the point of the project is to educate doctors and, through probation requirements, change the behavior of those who prescribe excessively. "That’s education that could potentially save patients in the future," said Kirchmeyer, whose agency licenses some 141,000 doctors.

Some consumer groups consider the board’s bold effort to find overprescribing doctors not aggressive enough.

"It’s long overdue," said Carmen Balber, executive director of the nonprofit Consumer Watchdog. The board should investigate opioid-related deaths that occurred more recently, she said: "They need to get their act together and speed things up."

McAneny, of the AMA, noted that prescribing practices now deemed unacceptable came out of public policies years ago that "compelled doctors to treat pain more aggressively for the comfort of our patients." Also, payers have measured quality of care by whether their patients answered surveys about whether their pain was well-controlled.

Similarly, Dr. David Aizuss, a Los Angeles ophthalmologist who is president of the California Medical Association, said state and federal guidelines that took effect in 2014 and 2016 impose much more stringent prescribing precautions than "what was going on six or seven years ago."

The crackdown on doctors has created fear, said Dr. Robert Wailes, a pain medicine specialist in Encinitas and chair of the California Medical Association’s Board of Trustees. "What we’re finding is that more and more primary care doctors are afraid to prescribe and more of those patients are showing up on our doorsteps," he said.

Officially, the CMA stops short of saying the medical board should stop the project, perhaps to avoid any perception that the association condones overprescribing. But it has asked the board to hire an independent reviewer to assess the criteria the board is using to decide which physicians to investigate, and whether physicians in certain specialties or regions of the state are being targeted more than others ...

Walgreens Boots Alliance Inc. has entered into an agreement with federal prosecutors in Manhattan to settle Medicaid and Medicare fraud allegations in two separate actions brought against the national pharmacy chain, according to court records unsealed by U.S. District Judge Paul Crotty of the Southern District of New York.

The first settlement, approved on January 16, 2019 requires Walgreens to pay $209.2 million to resolve allegations that it improperly billed Medicare, Medicaid, and other federal healthcare programs for hundreds of thousands of insulin pens it knowingly dispensed to program beneficiaries who did not need them.

The second settlement, approved on January 15, 2019, requires Walgreens to pay $60 million to resolve allegations that it overbilled Medicaid by failing to disclose to and charge Medicaid the lower drug prices that Walgreens offered the public through a discount program.

The settlement requires Walgreens to pay approximately $168 million to the United States, and Walgreens has agreed separately to pay approximately $41.2 million to state governments.

In both settlements, prosecutors say Walgreens admitted and accepted responsibility for conduct the Government alleged in its complaints under the False Claims Act.

According to federal prosecutors, the insulin fraud occurred through two specific Walgreens policies. First, the company’s electronic management system prevented pharmacists from dispensing partial boxes of insulin pens, even when a patient didn’t require that much insulin.

Second, when the amount distributed exceeded what was prescribed for a total number of daily doses, Walgreens falsely stated in reimbursement forms that what was handed out did not go over that limit. As part of the other fraudulent scheme, Walgreens used its Prescription Savings Program to overcharge federal health care programs, according to prosecutors.

While it was providing customers a discount on drugs ordered through the program, Walgreens was failing to tell Medicaid what the prices were when it billed for reimbursement. This led to Medicaid paying more than it should have for the discounted medications.

In a statement provided by a Walgreens spokesman, the company said it was pleased to have the issues resolved. The company claimed to have fully cooperated with the government, and to have admitted to no wrongdoing ...

Tess Viceral, Cristina Cornell, and Imelda Canovas were long-term employees of the Department of Industrial Relations (DIR). Viceral worked as a supervisor under manager Cora Lee at times relevant to this appeal.

Viceral supervised Cornell and Canovas who were employed as Workers’ Compensation Consultants (WCCs). WCCs have the authority to settle workers’ compensation claims up to $75,000 and select third-party vendors to handle the claims.

DIR has policies against gifts received by a DIR employee from vendors with whom the DIR employee regularly does business if the gift is intended to reward the DIR employee for doing business with the gift giver.

This policy was not strictly enforced until Lee became manager in November 2012. Since the policy was not strictly enforced, vendors would sometimes take DIR employees to lunch, give gift cards, and bring edible treats to DIR offices.

Lee met with Viceral in late 2012 to remind Viceral of the gift policy and instructed Viceral to relay the message to the WCCs under her supervision, but Viceral failed to do so. Viceral and the WCCs continued to attend lunches and accept promotional gifts, and vendors continued to bring food to DIR offices.

Lee again reminded Viceral of the gift policy and sent her a confirming memorandum in early March 2013. A week or so later, Viceral finally held a meeting with the WCCs, reminding them of the gift policy and instructing them not to accept gifts from vendors. However, this did not seem to stop Viceral and the WCCs from attending lunches, and Canovas from handing out vendor gift cards.

An investigation was launched by DIR’s human resources division. Ultimately, Canovas, Cornell, and Viceral received notices of adverse action terminating their employment for improperly accepting gifts, falsifying their statements of economic interest, falsifying timesheets, and being dishonest in their investigatory interviews. Other WCCs involved either were not disciplined or had their terminations revoked after admitting dishonesty and settling for suspensions.

Canovas, Cornell, and Viceral appealed their terminations to the State Personnel Board. The ALJ found that Appellants were dishonest and that retaliation was not the primary basis for the termination, and he upheld the termination as proper. The Superior Court denied a petition for a writ of mandate. The Court of Appeal affirmed the termination in the unpublished case of Canovas v. State Personnel Bd.

The Court of Appeal concluded that the administrative hearing was fundamentally fair after noting that the appellants raised "a plethora of complaints, most of which are barely coherent." ...

When can companies in California classify their workers as independent contractors instead of employees?

According to a report by KQED, that’s the question that's been hot on the minds of California lawmakers, labor unions and tech companies since April, when the California Supreme Court ruled that businesses must satisfy three guidelines to classify workers as contractors.

In Dynamex Operations West, Inc. v. Superior Court, the state Supreme Court ruled that a worker can be considered a contractor only if: A. The worker is free from the control and direction of the hirer in connection with the performance of the work. B. The worker performs work that is outside the usual course of the hiring entity’s business. C. The worker is customarily engaged in an independently established trade, occupation, or business. This is now known as the ABC Test.

Allan Zaremberg, head of the California Chamber of Commerce, said the ruling puts the Legislature in a unique position. A state law could override the court decision and return California to the pre-Dynamex test for employee status.

The court’s decision is especially concerning to tech companies like Uber, Lyft and Instacart, whose businesses rely heavily on a revolving army of contractors. They're among a group of tech firms partnering with the state Chamber of Commerce to lobby for legislation that would loosen restrictions on who could be included as a contractor.

Without a new law, these companies would have to abide by the court's guidelines.

Uber, which has long been the largest and most influential on-demand gig company in the country, has always insisted that its drivers are not employees. The San Francisco-based company argues that it’s not a taxi company, but rather a tech firm that creates a platform or marketplace to connect riders to independent drivers. In other words, it says, its employees are the people who build its technology, not the one who drive people around.

It's the second requirement of the Dynamex ruling that poses the biggest dilemma for big gig-focussed companies like Uber. Because the San Francisco-based firm is in the business of giving rides, and its drivers are the ones who provide them, the company would be hard-pressed, under the court's guidelines, to classify those workers as anything but employees.

"Some companies feel like that test is going to alter their business model, and in some cases that's true," said Steve Smith, a spokesman for the California Labor Federation, which would like to see more workers classified as employees. If that presents a hardship for some tech companies, that’s just too bad, Smith added.

Assemblywoman Lorena Gonzalez, D-San Diego, authored AB 5, a bill that would require companies to follow the court's guidelines. It might not make sense for all workers to be classified as employees, she said, but gig workers still need some protections.

Another bill, AB 71, would roll back the court's recent decision.

Uber and other gig companies have taken various steps in recent years to ensure that they can continue categorizing their workers as contractors. In some cases, like New York, they have set up drivers' organizations, which have less power than union organizations. Many workers don’t see this as a sufficient solution.

This fight also places Gov. Gavin Newsom, who received campaign support from both labor and the tech industry, in a particularly tricky position. He contends the issue should have been resolved before it went to court, and has urged both sides to find common ground.

He recently said his administration is even considering the creation of a committee to address the issue. "Because we could have been making determinations before that case ended up at the court,” he said ...

American Labor Alliance (ALA) and CompOne USA are subsidiaries of Agricultural Contracting Services Association, which is a Nevada not-for-profit corporation headquartered in Clovis, Calif.,

The ALA attracted customers by marketing low workers’ compensation premium rates. Its membership surged after it introduced its workers’ comp benefit. It had more than 400 employers with 30,000 members as of February 2017. Two-thirds of those employees are seasonal agricultural workers employed by roughly 50 farm labor contractors.

A number of other business entities were affiliates or subsidiaries of ALA, including CompOne USA, ALA Trust, California Analytics, Farmworkers Enterprise Foundation, Recruiters of America, CompassPilot, ALTA, and Life Abundantly/"LiBu."

The California Insurance Commissioner issued a Decision and Order imposing a $4,345,000 penalty on American Labor Alliance and CompOne USA for selling workers’ compensation and liability policies to employers of farmworkers without being properly licensed with the Department of Insurance.

FBI agents on behalf of the U.S. Department of Labor served warrants for workplace injury benefit program records in July 2017 at the headquarters office of American Labor Alliance.

Prosecutors have now filed a Grand Jury indictment against American Labor Alliance, Marcus Asay the Co-Founder, chairman, and controlling individual behind ALA. And Antonio Gastelum who served a variety of supervisory roles regarding ALA, including at various times serving as ALA's chief operations officer, overseeing legal compliance matters for ALA, and controlling a number of ALA's financial affairs, working directly under defendant Asay.

In addition to selling workers' compensation insurance, the Indictment claims that from at least 2011 onward, defendant ALA offered what it purported to be a retirement pension plan to its clients, known by a variety of names including the "ALA Trust," the "ALA Retirement Plan Trust," or the "ALA Retirement Plan & Trust." (ALA Trust).

The defendants caused ALA to issue Certificates of Liability to the clients that purported to provide "Workers Compensation and Employers' Liability" coverage. The defendants further caused the Certificates to list one or more of the National Insurance Companies as "insurers." The Certificates were signed by defendant Asay.

Prosecutors allege that "Defendants caused the Certificates to contain materially false and fraudulent statements. The National Insurance Companies did not provide Workers' Compensation insurance to ALA's clients as the defendants purported in the Certificates. In some cases, the National Insurance Companies had issued liability policies or bonds to ALA itself, but would not have paid Worker's Compensation benefits to any ALA client whose employee was injured or died."

"In many of these cases, ALA-issued Certificates of Liability that contained a false policy number, not the real policy or bond number that pertained to ALA's corporate coverage." ...

The Employer's Fraud Task Force will discuss "The NEW 2019 Employment Laws That Will Impact Your Workplace" at its next luncheon meeting on January 22. Registration begins at 11:00 am.

Those who attend will learn about the new 2019 Employment Laws of California, most of which will became effective January 2019. Training will include an Overview of:

- The New #Metoo Harassment Laws
- The New Harassment Training Requirements
- Miscellaneous Employment Related Laws

The speaker is Bernadette O’Brien, ESQ .She is a Partner at Floyd Skeren Manukian Langevin, LLP and an SPHR certified/SHRM-SCP Human Resources Executive.

Ms. O’Brien serves as general counsel and executive advisor to the law firm’s Human Resources Department and is Managing Attorney of the firm’s Employment Law Department and HR Consultation Department. She is the Managing Attorney-Employment Law Department of the firm.

Ms. O’Brien is author of the popular LexisNexis publication Labor and Employment in California: A Guide to Employment Laws, Regulations and Practices, co-author of California Leave Law: A Practical Guide for Employers, and co-author of California Unemployment Insurance and Disability Compensation Programs.

Ms. O’Brien has been a frequent contributor to, and reporter for, the LexisNexis employment law newsletter Bender’s California Labor & Employment Bulletin.

She is also editor and developer of Floyd Skeren Manukian Langevin’s employment related websites: www.employmentlawweekly.com, www.worklawreport.com, and www.floydskerenhrtraining.com, which provide the latest news and information related to employment law.

The meeting will take place at the Steven's Steak House, located at 5332 Steven’s Place in Commerce, California. If you plan to attend, you may register online at the EFTF website ...

The Division of Workers’ Compensation (DWC) has issued a notice of public hearing for proposed evidence-based updates to the Medical Treatment Utilization Schedule (MTUS), which can be found at California Code of Regulations, title 8, section 9792.23.

The public hearing is scheduled for Friday, February 15 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland. Members of the public may review and comment on the proposed updates no later than February 15.

The proposed evidence-based updates to the MTUS incorporate by reference the latest published guidelines from American College of Occupational and Environmental Medicine (ACOEM) for the following:

- Cervical and Thoracic Spine Disorders Guideline (ACOEM October 17, 2018)
- Elbow Disorders Guideline (ACOEM August 23, 2018)
- Hand, Wrist, and Forearm Guideline (ACOEM January 7, 2019)
- Ankle and Foot Disorders Guideline (ACOEM July 16, 2018)
- Workplace Mental Health: Posttraumatic Stress Disorder and Acute Stress Disorder Guideline (ACOEM December 18, 2018)

The proposed evidence-based updates to the MTUS regulations are exempt from Labor Code sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act.

However, DWC is required under Labor Code section 5307.27 to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period and publish the order adopting the updates online ...

DWC posts additional adjustments to Official Medical Fee Schedule for Pathology and Clinical Laboratory, for Hospital Outpatient Departments / Ambulatory Surgical Centers, for Physician Services/Non-Physician Practitioner Services, and posts updated MTUS Drug List Effective February 15.

The order is the second Administrative Director order for the January 2019 annual update to the Pathology and Clinical Laboratory Fee Schedule. The Centers for Medicare and Medicaid Services issued a revised 2019 Pathology and Clinical Laboratory Fee Schedule file on January 15, 2019.

The revised file corrects various technical errors and supersedes the original file.

The initial update to the Physician and Non-Physician Practitioner Fee Schedule. effective for services rendered on or after January 1, 2019, was posted to the DWC website on December 10, 2018. The Centers for Medicare and Medicaid Services subsequently issued a revised update to the 2019 Physician Fee Schedule on December 20 that made corrections to the Relative Value Unit file and the Geographic Practice Cost Index file.

This second order adopts those corrections.

The update orders adopting the adjustments can be found on the DWC website.

The changes to the MTUS Drug List, based on the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines, including the following:

- Addition of drugs addressed in the Traumatic Brain Injury Guideline
- New and Revised, Drug Recommendations (related to the Traumatic Brain Injury Guideline)
- Designation of additional drugs as "special fill" eligible, due to treatment recommendation in the Traumatic Brain Injury Guideline

Additional information regarding the MTUS drug formulary may be found on the MTUS Drug Formulary webpage ...

Walgreens Boots Alliance Inc. and Microsoft Corp. have joined forces to develop new health care delivery models, technology and retail innovations to advance and improve the future of health care.

Current health care systems are a complex combination of public- and private-sector organizations, providers, payors, pharmaceutical companies and other adjacent players. While there has been innovation in pockets of health care, there is both a need and an opportunity to fully integrate the system, ultimately making health care more convenient to people through data-driven insights.

The companies have committed to a multiyear research and development investment to build health care solutions, improve health outcomes and lower the cost of care. This investment will include funding, subject-matter experts, technology and tools. The companies will also explore the potential to establish joint innovation centers in key markets.

The companies will focus on connecting WBA stores and health information systems to people wherever they are through their digital devices. This will allow people to access health care services, such as virtual care - when, where and how they need it.

Working with patients’ health care providers, the companies will proactively engage their patients to improve medication adherence, reduce emergency room visits and decrease hospital readmissions. Core to this model is data privacy, security and consent, which will be fundamental design principles, underscored by Microsoft’s investments in building a trusted cloud platform.

WBA and Microsoft will also focus on enabling more personalized health care experiences from preventative self-care to chronic disease management. WBA will pursue lifestyle management solutions in areas such as nutrition and wellness via customers’ delivery method of choice, including digital devices and digital applications or in-store expert advice.

Through a combination of dedicated R&D and external partnerships, a suite of chronic disease management and patient engagement applications are planned for development, alongside a portfolio of connected Internet of Things (IoT) devices for nonacute chronic care management, delivered by Microsoft’s cloud, AI and IoT technologies.

The companies will work to build a seamless ecosystem of participating organizations to better connect consumers, providers - including Walgreens and Boots pharmacists - pharmaceutical manufacturers and payors. Microsoft and WBA will leverage each other’s market research and identify the right partners to develop solutions.

Early last year, Amazon.com Inc, Berkshire Hathaway Inc and JPMorgan Chase & Co had said they will form a company that could eventually negotiate directly with drugmakers and healthcare providers and use their vast databases to get a better handle on costs ...

Close to 44 percent of U.S. physicians are burned out, and 15 percent are depressed and thinking about suicide, according to a survey conducted by Medscape and summarized by Reuters Health.

More than one doctor per day commits suicide - a rate higher than in any other profession and more than twice that of the general population, Medscape reports.

The findings come as no surprise to Dr. Carter Lebares, Director of the Center for Mindfulness in Surgery at the University of California, San Francisco, who has studied burnout among surgical residents but was not involved in the survey.

"There is a passionate argument surrounding the data and discourse about who’s to blame for this situation," Lebares told Reuters Health in an email. “Quotes from respondents in the Medscape survey capture this very poignantly: anger over a broken system, loss of time with patients, being asked to sacrifice dwindling personal time to ‘fix ourselves,’ and demoralization that the only way out is to quit or severely curtail our work."

The Medscape survey found that male physicians are more likely to cope with burnout by exercising (51 percent males vs. 43 percent females), whereas female physicians are more likely to talk with friends and family (52 percent females vs. 37 percent males). More women eat junk food to cope (38 percent vs. 27 percent) and similar percentages of men and women drink alcohol (23 percent men; 21 percent women).

The Medscape survey pinpointed too many administrative tasks as a leading cause of physician burnout (59 percent), as well as spending too many hours at work (34 percent). Other factors included electronic health records (32 percent), insufficient compensation/reimbursement (29 percent) and "feeling like just a cog in a wheel" (20 percent).

"Data are coming to suggest that an institutionally supported network of choices for wellbeing will be the answer - some combination of things like limited EHR time, increased ratio of patient time, better food choices at work and home, room for personal health (like exercise breaks), tailored mindfulness-based interventions, financial planning services or untraditionally structured jobs," Lebares said.

Although the survey did not ask how burnout might affect patient care, "we did ask how depression affects (it)," Leslie Kane, Senior Director of Medscape Business of Medicine told Reuters Health by email. "Fourteen percent of physicians said they made errors they might not ordinarily make; 16 percent are more apt to express frustration in front of the patient; and 26 percent say they are less motivated to be careful taking patient notes."

Depression also affects physicians’ dealings with colleagues or staff, with 47 percent stating that they are more easily exasperated with staff/peers, and 40 percent stating they express their frustration in front of their colleagues.

Yet 64 percent of respondents said they don’t plan to seek help for depression or burnout and they have not sought help in the past.

Comments in the survey suggest that some physicians are retiring earlier because of burnout or depression.

"The fact that physicians are retiring earlier may exacerbate the physician shortage that appears to exist," Kane said. "In years past, physicians who ‘retired’ often worked part time or kept a small patient base. However, with high malpractice premiums, rules and regulations, and the stress and aggravation that physicians experience, they are often more likely to just want out."
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The Chairman of the Committee on Oversight and Reform, launched one of the most wide-ranging investigations in decades into the prescription drug industry’s pricing practices.

"The Committee on Oversight and Reform is investigating the actions of drug companies in raising prescription drug prices in the United States, as well as the effects of these actions on federal and state budgets and on American families," Cummings wrote.

"For years, drug companies have been aggressively increasing prices on existing drugs and setting higher launch prices for new drugs while recording windfall profits. The goals of this investigation are to determine why drug companies are increasing prices so dramatically, how drug companies are using the proceeds, and what steps can be taken to reduce prescription drug prices."

Cummings sent letters to 12 drug companies seeking detailed information and documents about the companies’ pricing practices. The letters seek information and communications on price increases, investments in research and development, and corporate strategies to preserve market share and pricing power. The letters are the first step in the Committee’s comprehensive review of pricing practices. The Committee will hold its first of several hearings in the coming weeks to hear from experts, as well as patients affected by rising drug prices.

The Centers for Medicare and Medicaid Services projects that spending on prescription drugs will increase more rapidly than spending on any other health care sector over the next ten years. The federal government bears much of the financial burden of escalating drug prices through Medicare Part D, which provides drug coverage to approximately 43 million people. The government is projected to spend $99 billion on Medicare Part D in 2019. In 2016, the 20 most expensive drugs to Medicare Part D accounted for roughly $37.7 billion in spending.

A review by the Inspector General of the Department of Health and Human Services found that ten of the most expensive brand-name drugs accounted for $15.6 billion of spending in the catastrophic coverage phase of the Medicare Part D benefit in 2015. The Inspector General has also found that Part D payments for brand-name drugs increased by 62% from 2011 to 2015—after taking into account manufacturer rebates—even though the number of prescriptions fell by 17%.

Approximately 94% of widely-used brand-name drugs on the market between 2005 and 2017 more than doubled in price during that time, and the average price increase in 2017 was 8.4% - four times the rate of inflation - according to an analysis conducted by AARP. A recent Associated Press analysis found that more than 4,400 brand-name drugs increased in price in the first seven months of 2018 alone, compared to 46 price decreases.

In today’s letters, Cummings is focusing on drugs that are among the costliest to Medicare Part D, among the costliest per beneficiary, or had the largest price increases over a five-year period.
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Charles Ruben (DOB 9/13/1951), formerly of Simi Valley, pleaded guilty to a felony violation of Insurance Code section 1871.4(a)(l} - making a fraudulent statement of a material fact for the purpose of obtaining workers' compensation benefits. Previously he was President of Cr's Gate Service, Inc.

Cr's Gate Service, Inc. is a California Domestic Corporation filed on March 9, 2006. The company's filing status is listed as Suspended and its File Number is C2869102. The Registered Agent on file for this company is Charles Ronald Ruben and was located at 1596 Kane Ave, Simi Valley, CA 93065-3625.

Between May 11, 2016, and November 23, 2016, Ruben was placed off work for an injury sustained while employed at his electric gate company in Simi Valley.

During that time, he collected disability payments that totaled $34,981.33 and systematically failed to report that he earned $48,686.20 while working as a self-employed contractor.

Sentencing for Ruben is scheduled June 7, 2019, at 9:00 a.m. in courtroom 12 of the Ventura Superior Court, County of Ventura.

He faces a maximum of five years in jail.

At the time he entered his plea, Ruben provided a check to the victim, State Compensation Insurance Fund, for the full amount of restitution due in this case for $41,326.45 ...

Prosecutors alleged that Michael D. Drobot, the former owner of the Pacific Hospital of Long Beach,orchestrated a massive kickback scheme where he paid $50 million dollars in kickbacks to dozens of physicians in order to steer surgeries to his hospital, Pacific Hospital of Long Beach. The kickback scheme was effective and resulted in over $500 million in kickback induced surgeries being performed at Pacific Hospital.

In 2014, Drobot entered into a pre-indictment cooperation plea agreement with the government where he agreed to plead guilty to conspiracy to commit wire/mail fraud (18 U.S.C. § 371) and a violation of the anti- kickback statute (42 U.S.C. § 1320a-7b(b)(2)(A)).

The plea agreement provided that the government would forgo any additional charges against Drobot that could have been filed based on the kickback scheme. The plea agreement required him to cooperate with authorities as well as to obey all Court orders. His "cooperation" lead to the prosecution and conviction of many of his cohorts, including well known physicians in the California workers' Compensation industry.

On January 10, 2018, pursuant to the plea agreement the Court sentenced him to 63 months in prison, and ordered him to forfeit $10 million to the United States and to partially satisfy the forfeiture order as follows: (1) by a date agreed to with the government, paying $300,000 to the government; (2) by a date agreed to with the government, selling properties in Oregon and providing the proceeds to the government, and (3) by a date agreed to with the government, selling defendant’s 1965 Aston Martin, 1958 Porsche, and 1971 Mercedes Benz, and paying the proceeds to the government. Drobot and the government agreed the cars - with an estimated value of nearly $2 million - would be sold by July 5, 2018.

In June 2018, Drobot told the government that he was trying to sell the cars but needed an extension through the end of August 2018 so that he could sell them at maximum value at the Pebble Beach car auction. The government granted him an extension and provided Drobot written wiring instructions for the proceeds. The parties also made arrangements for the sale proceeds to be transferred directly from the auction house to the government in order to ensure that the proceeds would go to the government.

The auction house records reveal that Drobot diverted the car sales proceeds on June 22, 2018 by taking a $1 million dollar advance on the sale of the cars And, on September 14, 2018 diverted the remaining $675,795.89 proceeds..

As a result, last October, prosecutors filed a motion asking the Court to find Drobot in breach of his plea agreement.

On January 14, 2019 Federal Judge Josephine Staton found that Drobot "ntentionally violated the Court’s order when he diverted the proceeds from the sale of 1965 Aston Martin and 1971 Mercedes Benz to bank accounts that he controlled and ultimately used the funds for personal purposes. In addition, Defendant has failed to abide by the Court’s order that he sell the 1958 Porsche and provided the proceeds to the Government." ...

Telemedicine is the use of electronic communication technologies to provide clinical services to patients without an in-person visit, with the goal of improving the patient’s health status. The electronic communications or monitoring may be used for follow-up visits, management of chronic conditions, medication management, consultation with specialists, or other clinical services that can be provided remotely via secure video and audio connections.

According to a representative from Kaiser Permanente, a leader in telemedicine services, the number of telemedicine customers is expected to increase to roughly 7 million by 2018 (up from 350,000 in 2013). In 2015, of KP’s 110 million interactions between physicians and members, 56% were virtual, surpassing physical visits for the first time.

The Department of Veterans Affairs, which operates the nation’s largest healthcare system and is recognized as a world leader in the development and use of telehealth services, has achieved better results through telemedicine. According to the VA, telemedicine has increased access to high-quality healthcare services and has proven to be an effective and convenient way for patients to receive—and medical providers to provide—medical care.

A 2014 report by Towers Watson estimated that US businesses could save more than $6 billion a year by using telemedicine

When it comes to legislation and rule changes to advance the use of telemedicine, some states are moving more quickly than others.

In 2017 Harbor Health Systems, a One Call Care Management company, announced that it is one of the first companies to receive approval from the California Department of Workers’ Compensation to offer telemedicine through its medical provider networks. Harbor’s MPN networks cover approximately 2 million employees in the state of California.

In early 2018, Texas proposed a rule that would expand injured workers’ access to telemedicine services by lifting a restriction in the Medicare-based reimbursement policy that limits the use of telemedicine to underserved areas—typically rural regions with few healthcare providers.In April 2018, the Texas Department of Insurance, Division of Workers’ Compensation, announced a new fee schedule applicable to telemedicine and telehealth services provided on or after September 1, 2018.

Also in 2018, legislators in Florida proposed two telehealth-related bills, House Bill 793 and Senate Bill 280. Among other provisions, these bills attempted to establish a standard of care for telehealth providers and authorize them to use telehealth to perform patient evaluations and prescribe certain controlled substances. However, neither bill advanced.

Now in 2019, a bill submitted in New York, SB 1042, proposes creating a task force to study how telehealth and telemedicine might help employees in workers comp, as well as the providers treating them and the businesses employing them ...

Time to re-evaluate medical reserves on open claims.

Johnson & Johnson raised U.S. prices on around two dozen prescription drugs on Thursday, including the psoriasis treatment Stelara, prostate cancer drug Zytiga and blood thinner Xarelto, all among its top-selling products. It joined many other companies that raised U.S. prices on hundreds of prescription medicines earlier this month.

Most of the J&J increases were between 6 percent and 7 percent, according to data from Rx Savings Solutions, which helps health plans and employers seek lower cost prescription medicines. The company does not plan to raise prices on any more drugs this year, J&J spokesman Ernie Knewitz said.

The increases came on the same day that Democratic members of Congress introduced proposed legislation aimed at lowering the cost of prescription drugs for American consumers.

J&J said the average list price increase on its drugs will be 4.2 percent this year. However, it expects the net price it actually receives for its medicines to drop. That is because drugmakers negotiate rebates and discounts off the list price with payers in order to ensure patient access to their products.

Drugmakers kicked off 2019 with U.S. price increases on more than 250 prescription medicines by Jan. 2. That total has almost doubled, with pharmaceutical companies hiking prices on nearly 490 drugs by Jan. 10, according to Rx Savings. This includes insulin price hikes of between 4.4 percent and 5.2 percent by Sanofi and 4.9 percent by Novo Nordisk.

Sanofi said its increases were below the Centers for Medicare & Medicaid Services projections for medical inflation, and that it expects net prices to drop in 2019. Novo Nordisk said its raised list prices help offset increases in rebates to insurers and pharmacy benefit managers.

With pressure from lawmakers and the administration of President Donald Trump intensifying, the pace of drug increases has been slower than last year, when drugmakers raised prices on around 650 drugs over the first 10 days of 2018.

The United States, which leaves drug pricing to market competition, has higher prices than in other countries, where governments directly or indirectly control costs. That makes it by far the world’s most lucrative market for manufacturers.

The U.S. Department of Health and Human Services has proposed policy changes aimed at lowering drug prices and passing on more of the discounts negotiated by health insurers to patients. Those measures are not expected to provide relief to consumers in the short-term, however, and fall short of giving government health agencies direct authority to negotiate or regulate drug prices ...