The state Senate voted in favor of the bill - dubbed Assembly Bill 5 (AB5) - that would ensure gig economy workers in companies like Uber, Lyft, and DoorDash are entitled to minimum wage, workers‘ compensation, and other benefits.
The contentious bill was passed in a 29 to 11 vote as the legislative session was about to end for the year. AB5 had passed the State Assembly on May 29 with a 53-11 vote. It is expected to be signed by California Governor Gavin Newsom, and will go into effect starting January 1, 2020.
The business models of these companies are already under severe strain. Although the extent to which AB5 could impact these platforms is unknown, it’s expected to drive their labor costs up by 30 percent, according to a report by San Francisco Chronicle.
Last month, Uber reported a record second quarter loss of $5.2 billion, its largest ever quarterly loss. The company laid off 435 employees across its engineering and product teams yesterday, on top of the 400 marketing team employees who were handed pink slips in late July in an attempt to cut costs.
Litigation is now likely to follow passage of the new law. Uber said Wednesday that it was confident that its drivers will retain their independent status when the measure goes into effect on Jan. 1. "Several previous rulings have found that drivers’ work is outside the usual course of Uber’s business, which is serving as a technology platform for several different types of digital marketplaces," said Tony West, Uber’s chief legal officer. He added that the company was "no stranger to legal battles."
California has at least one million workers who work as contractors and are likely to be affected by the measure, including nail salon workers, janitors and construction workers. Unlike contractors, employees are covered by minimum-wage and overtime laws. Businesses must also contribute to unemployment insurance and workers’ compensation funds on their employees’ behalf.
In California, religious groups said they feared that small churches and synagogues would not be able to afford making pastors and rabbis employees. Winemakers and franchise owners said they were worried they could be ensnared by the law, too.
Historically, if workers thought they had been misclassified as a contractor, it was up to them to fight the classification in court. But the bill allows cities to sue companies that don’t comply.
San Francisco’s city attorney, Dennis Herrera, has indicated that he may take action. "Ensuring workers are treated fairly is one of the trademarks of this office," he said in a statement.
And California may be only the beginning, as lawmakers elsewhere, including New York, move to embrace such policies. Legislators in Oregon and Washington State said they believed that California’s approval gave new momentum to similar bills that they had drafted ...
The contentious bill was passed in a 29 to 11 vote as the legislative session was about to end for the year. AB5 had passed the State Assembly on May 29 with a 53-11 vote. It is expected to be signed by California Governor Gavin Newsom, and will go into effect starting January 1, 2020.
The business models of these companies are already under severe strain. Although the extent to which AB5 could impact these platforms is unknown, it’s expected to drive their labor costs up by 30 percent, according to a report by San Francisco Chronicle.
Last month, Uber reported a record second quarter loss of $5.2 billion, its largest ever quarterly loss. The company laid off 435 employees across its engineering and product teams yesterday, on top of the 400 marketing team employees who were handed pink slips in late July in an attempt to cut costs.
Litigation is now likely to follow passage of the new law. Uber said Wednesday that it was confident that its drivers will retain their independent status when the measure goes into effect on Jan. 1. "Several previous rulings have found that drivers’ work is outside the usual course of Uber’s business, which is serving as a technology platform for several different types of digital marketplaces," said Tony West, Uber’s chief legal officer. He added that the company was "no stranger to legal battles."
California has at least one million workers who work as contractors and are likely to be affected by the measure, including nail salon workers, janitors and construction workers. Unlike contractors, employees are covered by minimum-wage and overtime laws. Businesses must also contribute to unemployment insurance and workers’ compensation funds on their employees’ behalf.
In California, religious groups said they feared that small churches and synagogues would not be able to afford making pastors and rabbis employees. Winemakers and franchise owners said they were worried they could be ensnared by the law, too.
Historically, if workers thought they had been misclassified as a contractor, it was up to them to fight the classification in court. But the bill allows cities to sue companies that don’t comply.
San Francisco’s city attorney, Dennis Herrera, has indicated that he may take action. "Ensuring workers are treated fairly is one of the trademarks of this office," he said in a statement.
And California may be only the beginning, as lawmakers elsewhere, including New York, move to embrace such policies. Legislators in Oregon and Washington State said they believed that California’s approval gave new momentum to similar bills that they had drafted ...
OxyContin maker Purdue Pharma LP has reached a tentative multibillion-dollar agreement with some plaintiffs aimed at settling thousands of lawsuits over its alleged role in the U.S. opioid crisis, Reuters reported on Wednesday, citing people familiar with the matter.
On Wednesday, lead lawyers representing more than 2,000 cities, counties and other plaintiffs suing Purdue, along with 23 states and three U.S. territories, were on board with an offer from the company and its controlling Sackler family to settle lawsuits in a deal valued at up to $12 billion, the people said.
More than a dozen other states remain opposed or uncommitted to the deal, setting the stage for a legal battle over Purdue’s efforts to contain the litigation in bankruptcy court. New York, Massachusetts and Connecticut, where privately-held Purdue is based, are among states opposed to the current offer and have pushed the family to guarantee $4.5 billion, the people said.
Last weekend, the Sacklers "refused to budge" after attorneys general in North Carolina and Tennessee presented them with counterproposals they said had widespread support from other states, according to correspondence reviewed by Reuters.
With negotiations over the family’s contribution to a settlement at loggerheads, Purdue is preparing to file for bankruptcy protection as soon as this weekend or next with the outlines of a settlement in hand.
Purdue would then ask a U.S. bankruptcy judge to halt litigation while settlement discussions continue, a move some states said they are likely to challenge. A bankruptcy judge could force holdouts to accept a settlement as part of Purdue's reorganization plan if enough other plaintiffs agree.
In a related development, a federal judge on Wednesday approved the substance of a proposal by lawyers representing cities and counties suing drug companies over the U.S. opioid epidemic that would bring every state and municipality in the country into their settlement talks.
U.S. District Judge Dan Polster, in Cleveland, Ohio, federal court, said that the plan, which was opposed by 37 states and the District of Columbia, "does not interfere with the states settling their own cases any way they want."
"This process simply provides an option - and in the court’s opinion, it is a powerful, creative and helpful one," the judge wrote.
The proposal, part of litigation consolidating about 2,000 lawsuits against opioid manufacturers, retailers and others seeking damages for the epidemic, calls for creating a class of up to 3,000 counties and 30,000 cities, towns and villages that could vote on whether to accept any settlement the plaintiffs reach with the defendants ...
On Wednesday, lead lawyers representing more than 2,000 cities, counties and other plaintiffs suing Purdue, along with 23 states and three U.S. territories, were on board with an offer from the company and its controlling Sackler family to settle lawsuits in a deal valued at up to $12 billion, the people said.
More than a dozen other states remain opposed or uncommitted to the deal, setting the stage for a legal battle over Purdue’s efforts to contain the litigation in bankruptcy court. New York, Massachusetts and Connecticut, where privately-held Purdue is based, are among states opposed to the current offer and have pushed the family to guarantee $4.5 billion, the people said.
Last weekend, the Sacklers "refused to budge" after attorneys general in North Carolina and Tennessee presented them with counterproposals they said had widespread support from other states, according to correspondence reviewed by Reuters.
With negotiations over the family’s contribution to a settlement at loggerheads, Purdue is preparing to file for bankruptcy protection as soon as this weekend or next with the outlines of a settlement in hand.
Purdue would then ask a U.S. bankruptcy judge to halt litigation while settlement discussions continue, a move some states said they are likely to challenge. A bankruptcy judge could force holdouts to accept a settlement as part of Purdue's reorganization plan if enough other plaintiffs agree.
In a related development, a federal judge on Wednesday approved the substance of a proposal by lawyers representing cities and counties suing drug companies over the U.S. opioid epidemic that would bring every state and municipality in the country into their settlement talks.
U.S. District Judge Dan Polster, in Cleveland, Ohio, federal court, said that the plan, which was opposed by 37 states and the District of Columbia, "does not interfere with the states settling their own cases any way they want."
"This process simply provides an option - and in the court’s opinion, it is a powerful, creative and helpful one," the judge wrote.
The proposal, part of litigation consolidating about 2,000 lawsuits against opioid manufacturers, retailers and others seeking damages for the epidemic, calls for creating a class of up to 3,000 counties and 30,000 cities, towns and villages that could vote on whether to accept any settlement the plaintiffs reach with the defendants ...
Both Politico and now the Los Angeles Times report concerns about California’s state insurance commissioner who has stuck taxpayers with thousands of dollars in bills to cover the cost of renting an apartment in Sacramento while he maintains his primary residence in Los Angeles - a break from other statewide elected officials that is alarming ethics watchdogs.
And Lara's decision to file for rental reimbursement breaks precedent with two previous insurance commissioners. Republican Steve Poizner, who is from the Bay Area, did not charge living expenses to the state during his tenure as insurance commissioner. Neither did Democrat Dave Jones, though he did not have to commute far as a Sacramento resident.
Gov. Arnold Schwarzenegger, whose main residence was in Southern California, lived at the Hyatt Regency while in Sacramento but had his expenses paid by an outside foundation. Gov. Gavin Newsom, a former San Francisco mayor, recently moved from the Bay Area to a Sacramento suburb with his family at his own expense.
The revelation could add another headache for Commissioner Ricardo Lara, who is already under scrutiny for his campaign fundraising and perceived coziness with the insurance industry.
The Sacramento Bee claims the California’s top regulator of insurance companies sought campaign contributions from the industry and partied with one of its lobbyists after winning his election last year, according to records and social media posts obtained by The Sacramento Bee.
Three months after taking office, Insurance Commissioner Ricardo Lara scheduled a March 12 lunch with insurance company executives with a pending matter before his department.
A memo to the commissioner said the meeting had a specific purpose: "Relationship building" for his re-election campaign.
Executives "will be joining you for a relationship-building lunch in support of your Ricardo Lara for Insurance Commissioner 2022 campaign," fundraising consultant Dan Weitzman wrote in the memo.
Lara had pledged not to take money from the insurance industry as he ran for the post last year.
Weeks following the lunch, he broke his promise. In April, he accepted more than $50,000 in campaign donations from insurance representatives and their spouses. Some of the money came from out-of-state donors who have ties to one of the companies scheduled to be represented at the lunch.
Social media posts shared with The Bee show Lara also counts insurance lobbyists among his friends. The former state lawmaker partied with a Farmers Insurance lobbyist in London on New Year’s Eve just a week before his inauguration.
And the San Francisco Chronicle characterizes his apology about the contribution ethical problems and blame shifting on his staff as "underwhelming." ...
And Lara's decision to file for rental reimbursement breaks precedent with two previous insurance commissioners. Republican Steve Poizner, who is from the Bay Area, did not charge living expenses to the state during his tenure as insurance commissioner. Neither did Democrat Dave Jones, though he did not have to commute far as a Sacramento resident.
Gov. Arnold Schwarzenegger, whose main residence was in Southern California, lived at the Hyatt Regency while in Sacramento but had his expenses paid by an outside foundation. Gov. Gavin Newsom, a former San Francisco mayor, recently moved from the Bay Area to a Sacramento suburb with his family at his own expense.
The revelation could add another headache for Commissioner Ricardo Lara, who is already under scrutiny for his campaign fundraising and perceived coziness with the insurance industry.
The Sacramento Bee claims the California’s top regulator of insurance companies sought campaign contributions from the industry and partied with one of its lobbyists after winning his election last year, according to records and social media posts obtained by The Sacramento Bee.
Three months after taking office, Insurance Commissioner Ricardo Lara scheduled a March 12 lunch with insurance company executives with a pending matter before his department.
A memo to the commissioner said the meeting had a specific purpose: "Relationship building" for his re-election campaign.
Executives "will be joining you for a relationship-building lunch in support of your Ricardo Lara for Insurance Commissioner 2022 campaign," fundraising consultant Dan Weitzman wrote in the memo.
Lara had pledged not to take money from the insurance industry as he ran for the post last year.
Weeks following the lunch, he broke his promise. In April, he accepted more than $50,000 in campaign donations from insurance representatives and their spouses. Some of the money came from out-of-state donors who have ties to one of the companies scheduled to be represented at the lunch.
Social media posts shared with The Bee show Lara also counts insurance lobbyists among his friends. The former state lawmaker partied with a Farmers Insurance lobbyist in London on New Year’s Eve just a week before his inauguration.
And the San Francisco Chronicle characterizes his apology about the contribution ethical problems and blame shifting on his staff as "underwhelming." ...
Luis Enrique Perez, 49, owned and operated several temporary employee staffing companies. He lost his workers compensation insurance in July 2013, but continued to operate his businesses. Soon, Orange County prosecutors charged Perez and two other defendants with defrauding a workers’ compensation insurance company by misrepresenting uninsured injured workers as employees of a different company.
The defendants were accused of conspiring to fraudulently report 47 injured employees to American International Group, Inc. (AIG) to avoid liability for its employees who were injured at work, to hide failure to obtain workers’ compensation insurance as mandated by law. As a result, AIG became liable for approximately $393,000 worth of expenses for claims of individuals not covered by their insurance policy.
Perez has now been named at the end of August in a federal grand jury indictment that charges him with tax evasion for failing to pay to the Internal Revenue Service nearly $30 million in payroll taxes, penalties and interest related to money that had been withheld from the salaries of employees of his various temporary worker companies.
Perez - who has maintained residences in Anaheim Hills, Yorba Linda and Dove Canyon - is charged with one felony count of tax evasion in an indictment returned by a grand jury on August 28, 2019.
Perez’s companies - which include Checkmates Staffing Inc.; Staffaide Inc.; BaronHR, LLC; and Fortress Holding Group, LLC - were required to withhold taxes from employee wages and to pay the withheld amounts to the IRS on a periodic basis. These withheld taxes, sometimes known as "trust fund taxes," include income taxes and Federal Insurance Contributions Act (FICA) taxes that fund Social Security and Medicare.
The indictment alleges that for the tax years 2001, 2002, 2003, 2006, 2007, 2008 and 2010, Perez’s companies failed to pay the IRS the payroll taxes, including trust fund taxes that Perez’s companies withheld from employees’ paychecks. Beginning in June 2007, the IRS attempted to collect Perez’s outstanding tax liability, including penalties and interest. By February 2017, the outstanding balance had grown to $29,593,378, which included the unpaid taxes, interest and the "Trust Fund Recovery Penalty."
The indictment alleges that Perez attempted to thwart the IRS’s collection efforts by purchasing luxury items - including numerous cars and a boat - and concealing his ownership by placing the titles of these items in the names of his businesses and other individuals. Those luxury items included a 2005 Ferrari 360 Spider F, a 2007 Rolls Royce Phantom, a Duffy D 22 Bay Island boat, a 2011 Mercedes-Benz SLS, a 2015 Mercedes-Benz G-Class, and a 2014 Lamborghini Aventador ...
The defendants were accused of conspiring to fraudulently report 47 injured employees to American International Group, Inc. (AIG) to avoid liability for its employees who were injured at work, to hide failure to obtain workers’ compensation insurance as mandated by law. As a result, AIG became liable for approximately $393,000 worth of expenses for claims of individuals not covered by their insurance policy.
Perez has now been named at the end of August in a federal grand jury indictment that charges him with tax evasion for failing to pay to the Internal Revenue Service nearly $30 million in payroll taxes, penalties and interest related to money that had been withheld from the salaries of employees of his various temporary worker companies.
Perez - who has maintained residences in Anaheim Hills, Yorba Linda and Dove Canyon - is charged with one felony count of tax evasion in an indictment returned by a grand jury on August 28, 2019.
Perez’s companies - which include Checkmates Staffing Inc.; Staffaide Inc.; BaronHR, LLC; and Fortress Holding Group, LLC - were required to withhold taxes from employee wages and to pay the withheld amounts to the IRS on a periodic basis. These withheld taxes, sometimes known as "trust fund taxes," include income taxes and Federal Insurance Contributions Act (FICA) taxes that fund Social Security and Medicare.
The indictment alleges that for the tax years 2001, 2002, 2003, 2006, 2007, 2008 and 2010, Perez’s companies failed to pay the IRS the payroll taxes, including trust fund taxes that Perez’s companies withheld from employees’ paychecks. Beginning in June 2007, the IRS attempted to collect Perez’s outstanding tax liability, including penalties and interest. By February 2017, the outstanding balance had grown to $29,593,378, which included the unpaid taxes, interest and the "Trust Fund Recovery Penalty."
The indictment alleges that Perez attempted to thwart the IRS’s collection efforts by purchasing luxury items - including numerous cars and a boat - and concealing his ownership by placing the titles of these items in the names of his businesses and other individuals. Those luxury items included a 2005 Ferrari 360 Spider F, a 2007 Rolls Royce Phantom, a Duffy D 22 Bay Island boat, a 2011 Mercedes-Benz SLS, a 2015 Mercedes-Benz G-Class, and a 2014 Lamborghini Aventador ...
The Court of Appeal published decision in Department of Corrections and Rehabilitation v. Workers’ Compensation Appeals Board (Fitzpatrick (2018) 27 Cal. App. 5th 607 [238 Cal. Rptr.3d 224, 83 Cal. Comp. Cases 1680] pertained to an injury before SB 863 in 2013.
The case rejected a 100 percent disability award that did not first rate a case using the AMA Guides, and then follow the steps outlined in the 2005 Rating Schedule, and then a rational why some other scheme should be used instead.
The Court of Appeal concluded that Section 4660 addresses how the determination on the facts shall be made in each case for injuries occurring before January 1, 2013. Indeed, section 4660 expressly applies to the determination of the percentages of permanent disability. A final permanent disability rating is obtained by going through the steps outlined in the 2005 Schedule.
The logic of the Fitzpatrick case would seem to equally apply to injuries after 2013, on the theory that the scheme for rating permanent disabilities is prima facie evidence to be rebutted only by more compelling evidence that it is inappropriate in a given case.
However, recent panel decisions show a willingness of the WCAB to award total disability based solely on a vocational rehabilitation report without any discussion of why the AMA Guides rating would be inappropriate. Here is a recent example.
On January 23, 2015 Rafael Sandoval suffered an admitted industrial injury to his cervical and lumbar spine while employed as an iron worker by The Conco Companies.
Dr. Mandell, the AME in orthopedics, described applicant's injury as severe spinal stenosis and disc herniation in the cervical spine and lumbar disc disease with radiculopathy, requiring four level laminoplasty from C3-C7, with hardware implantation, as well as a subsequent cervical discectomy.
Mr. Van de Bittner, applicant's vocational expert, evaluated applicant on December 15, 2016, and issued a report on applicant's vocational feasibility, employability and earning capacity. Mr. Van de Bittner concluded that applicant was not capable of returning to the labor market due to his physical limitations, noting that he lacked transferrable skills without consideration of non-industrial factors, per the requirements of Ogilvie.
The WCJ found applicant sustained 100% permanent disability. The WCAB Decision.After Reconsideration, affirmed the WCJ's Findings, Award and Order in the case of Sandoval v The Conco Companies. Neither the Report and Recomendation on Petition for Reconsideration by the WCJ, or the Opinion and Order Granting Reconsideration report what the rating using the AMA Guides and 2005 Rating Schedule would have been, nor why it would be rejected in favor of the Vocational Rehabilitation Expert. The decision went directly to the simple metrics of a vocational evaluation seemingly unfettered by the logic of the Fitzpatrick decision by the Court of Appeal.
There is no way of knowing what steps are required, if any, to ignore the AMA Guides, the Rating Schedule, and case law in favor of another scheme of awarding total disability.
...
The case rejected a 100 percent disability award that did not first rate a case using the AMA Guides, and then follow the steps outlined in the 2005 Rating Schedule, and then a rational why some other scheme should be used instead.
The Court of Appeal concluded that Section 4660 addresses how the determination on the facts shall be made in each case for injuries occurring before January 1, 2013. Indeed, section 4660 expressly applies to the determination of the percentages of permanent disability. A final permanent disability rating is obtained by going through the steps outlined in the 2005 Schedule.
The logic of the Fitzpatrick case would seem to equally apply to injuries after 2013, on the theory that the scheme for rating permanent disabilities is prima facie evidence to be rebutted only by more compelling evidence that it is inappropriate in a given case.
However, recent panel decisions show a willingness of the WCAB to award total disability based solely on a vocational rehabilitation report without any discussion of why the AMA Guides rating would be inappropriate. Here is a recent example.
On January 23, 2015 Rafael Sandoval suffered an admitted industrial injury to his cervical and lumbar spine while employed as an iron worker by The Conco Companies.
Dr. Mandell, the AME in orthopedics, described applicant's injury as severe spinal stenosis and disc herniation in the cervical spine and lumbar disc disease with radiculopathy, requiring four level laminoplasty from C3-C7, with hardware implantation, as well as a subsequent cervical discectomy.
Mr. Van de Bittner, applicant's vocational expert, evaluated applicant on December 15, 2016, and issued a report on applicant's vocational feasibility, employability and earning capacity. Mr. Van de Bittner concluded that applicant was not capable of returning to the labor market due to his physical limitations, noting that he lacked transferrable skills without consideration of non-industrial factors, per the requirements of Ogilvie.
The WCJ found applicant sustained 100% permanent disability. The WCAB Decision.After Reconsideration, affirmed the WCJ's Findings, Award and Order in the case of Sandoval v The Conco Companies. Neither the Report and Recomendation on Petition for Reconsideration by the WCJ, or the Opinion and Order Granting Reconsideration report what the rating using the AMA Guides and 2005 Rating Schedule would have been, nor why it would be rejected in favor of the Vocational Rehabilitation Expert. The decision went directly to the simple metrics of a vocational evaluation seemingly unfettered by the logic of the Fitzpatrick decision by the Court of Appeal.
There is no way of knowing what steps are required, if any, to ignore the AMA Guides, the Rating Schedule, and case law in favor of another scheme of awarding total disability.
...
The Insurance Journal reports on a panel discussion that concluded that the workers’ compensation market apparently needs to do some catching up where it concerns technology.
"Historically we’ve been really slow to adapt to technology and innovation," said Shaun Jackson, executive director of risk management at Panda Restaurant Group. Jackson was moderating a talk titled "Q&A Panel with Innovative Risk Management Experts" on Thursday during the annual CWC & Risk Conference in Dana Point, Calif.
The Innovative Risk Management panel included Jill Dulich, claims and operations manager at the California Self-Insurers Security Fund, Henry Cabaniss, director of risk management with Southern Glazers Wine and Spirits, and Orit Harrington, senior risk manager with International Coffee & Tea LLC.
Dulich said large insurers and third-party providers have been reluctant to spend money on innovation and have been relying too much instead on vendors to bring new technology and innovation.
Dulich, who covered some of the pros and cons of using telemedicine to treat injured workers, said that while several people want to continue with doctor’s visits, many workers have embraced it. "Convenience is key here," she said.
Harrington said her company started a telemedicine program in January to treat certain injuries with telemedicine with the prior approval of a medical professional.
Nearly half of the 45 employees who were eligible for telemedicine treatment were fine with it, she said. "The majority have one visit and are discharged," she said, adding that the most a worker has needed have been two visits. "It turns out we’re going to save a lot of money."
Workplace safety was another big topic at the conference. "OHSHA Updates - What’s Next on the Horizon," was the title of a panel with Joel Sherman, vice president of safety and corporate affairs for Grimmway, and Robert Cartwright Jr., division manager for Bridgestone.The pair covered new indoor heat regulations for California. The regulations kick in when temperatures reach 82 degrees Fahrenheit, and they address certain clothing that may cause a worker to overheat.
In cases where workers are required to wear clothing that could make them too hot, the regulations could kick in at temperatures below 82 degrees, so companies will have to be mindful even at lower temperatures, Sherman said.
Wildfire smoke emergency regulations, adopted in July, were another topic of discussion, as was new rules for Valley Fever. Valley Fever, also called coccidioidomycosis, comes from fungus that grows in the dirt in some areas of the Southwestern U.S., including California, and can cause flu-like symptoms, including fever, cough, chills, and chest pain.
The rules require companies to take numerous preventative measures to protect workers in areas considered to be endemic, including Madera, Fresno, Tulare, Kern, Kings, Monterey and San Louis Obispo counties.
New workplace violence regulations was another topic the two addressed. Employer requirements include: employee training; creating an emergency action plan; conducting mock training exercises with local law enforcement; and adopting a zero-tolerance policy toward workplace violence.
...
"Historically we’ve been really slow to adapt to technology and innovation," said Shaun Jackson, executive director of risk management at Panda Restaurant Group. Jackson was moderating a talk titled "Q&A Panel with Innovative Risk Management Experts" on Thursday during the annual CWC & Risk Conference in Dana Point, Calif.
The Innovative Risk Management panel included Jill Dulich, claims and operations manager at the California Self-Insurers Security Fund, Henry Cabaniss, director of risk management with Southern Glazers Wine and Spirits, and Orit Harrington, senior risk manager with International Coffee & Tea LLC.
Dulich said large insurers and third-party providers have been reluctant to spend money on innovation and have been relying too much instead on vendors to bring new technology and innovation.
Dulich, who covered some of the pros and cons of using telemedicine to treat injured workers, said that while several people want to continue with doctor’s visits, many workers have embraced it. "Convenience is key here," she said.
Harrington said her company started a telemedicine program in January to treat certain injuries with telemedicine with the prior approval of a medical professional.
Nearly half of the 45 employees who were eligible for telemedicine treatment were fine with it, she said. "The majority have one visit and are discharged," she said, adding that the most a worker has needed have been two visits. "It turns out we’re going to save a lot of money."
Workplace safety was another big topic at the conference. "OHSHA Updates - What’s Next on the Horizon," was the title of a panel with Joel Sherman, vice president of safety and corporate affairs for Grimmway, and Robert Cartwright Jr., division manager for Bridgestone.The pair covered new indoor heat regulations for California. The regulations kick in when temperatures reach 82 degrees Fahrenheit, and they address certain clothing that may cause a worker to overheat.
In cases where workers are required to wear clothing that could make them too hot, the regulations could kick in at temperatures below 82 degrees, so companies will have to be mindful even at lower temperatures, Sherman said.
Wildfire smoke emergency regulations, adopted in July, were another topic of discussion, as was new rules for Valley Fever. Valley Fever, also called coccidioidomycosis, comes from fungus that grows in the dirt in some areas of the Southwestern U.S., including California, and can cause flu-like symptoms, including fever, cough, chills, and chest pain.
The rules require companies to take numerous preventative measures to protect workers in areas considered to be endemic, including Madera, Fresno, Tulare, Kern, Kings, Monterey and San Louis Obispo counties.
New workplace violence regulations was another topic the two addressed. Employer requirements include: employee training; creating an emergency action plan; conducting mock training exercises with local law enforcement; and adopting a zero-tolerance policy toward workplace violence.
...
Renee Skelton sustained an injury to her ankle in July 2012, and an injury to her shoulder in July 2014, while working for the Department of Motor Vehicles. She filed separate applications for workers’ compensation benefits for her injuries. The parties disputed whether Skelton was entitled to TDI for wage loss for time missed at work to attend medical appointments. Skelton sought to be reimbursed for her wage loss for time missed at work for medical treatment and for medical evaluations. Skelton continued working after each injury. She missed work to attend appointments with her treating physicians and to attend two visits with the panel qualified medical evaluator (QME). Skelton’s work hours were not flexible, and she could not visit her doctors on weekends. She initially used her sick and vacation leave, but eventually her paycheck was reduced for missed time at work. Her ankle injury was not yet permanent and stationary at the time of the hearing. SCIF contended that under Department of Rehabilitation v. Workers’ Comp. Appeals Bd. (2003) 30 Cal.4th 1281 (Department of Rehabilitation), Skelton was not entitled to TDI to compensate her for taking time off from work for medical treatment, but it acknowledged that Skelton was entitled to compensation for wage loss for attending medical-legal evaluations. Skelton contended that under Department of Rehabilitation, an employee is entitled to TDI unless the employee has returned to work and the employee’s injury is permanent and stationary. Because her injury was not permanent and stationary, Skelton argued that she was entitled to compensation, including “full reimbursement of sick and vacation time used,” for time spent attending medical treatment with her treating physicians and medical evaluations with the QME. The WCJ issued a joint findings and order, concluding that Skelton was not entitled to TDI to attend medical treatment based on Department of Rehabilitation. After reconsideration, a WCAB majority in a split panel decision stated that Skelton was entitled to TDI for wage loss to attend medical-legal evaluations, but that based on Department of Rehabilitation and Ward v. Workers’ Compensation Appeals Bd. (2004) 69 Cal.Comp.Cases 1179 (Ward) [writ denied], she was not entitled to TDI for wage loss to attend medical treatment following her return to work. The Court of Appeal concluded that Skelton was not entitled to TDI after she returned to work full time in the published case of Skelton v Department of Motor Vehicles. "Neither Skelton’s time off from work nor her wage loss was due to an incapacity to work. Rather, these circumstances were due to scheduling issues and her employer’s leave policy. Because Skelton’s injuries did not render her incapable of working during the time she took off from work and suffered wage loss, Skelton was not entitled to TDI for that time off or wage loss." ...
American film studios today collectively generate several hundred films every year, making the United States one of the most prolific producers of films in the world. Most shooting now takes place in California, New York, Louisiana, Georgia and North Carolina.
California was the shooting location for 10 of the top 100 box office performers last year, trailing Canada, the U.K., and Georgia. Canada was by far the top-ranked location with 20 films, including 11 that were shot in British Columbia, noting that Canada pioneered the use of production tax credits during the 1990s. The U.K. and Georgia followed with 15 movies each.
California ramped up its tax credit program in 2015 by expanding its annual allocation of credits from $100 million to $330 million, and establishing a selection system that gave priority to the jobs created by the films. The California tax credit total as high as 25% of production costs - which is still short of the incentives elsewhere. California Gov. Jerry Brown signed legislation that extended the program for five years into 2025.
Still, California’s yearly allocation for tax credits is dwarfed by the U.K., with $822 million invested in 2017 - the largest film incentive program worldwide. Georgia had $800 million invested last year.
At this point it seems that California has given up trying to stop the exodus of California filmmaking. Instead, a new law simply requires costs of benefits for social systems of film workers who are temporarily working out of state - to shift to California employers.
California Gov. Gavin Newsom has signed a bill to ensure film and TV workers operating out of state for their jobs will have full access to the state’s unemployment insurance, disability insurance and paid family leave.
He signed the measure, SB 271, late Thursday and it will become law in January. The legislation is aimed at addressing uncertainties for California-based film and TV production workers who often must travel outside California.
"The bill would provide, for purposes of determining employment of a motion picture production worker when the service is not localized in the state but some of the service is performed in the state, that the worker’s entire service qualifies as employment if their residence is in the state," the legislation states.
The California International Alliance of Theatrical Stage Employees Council and Entertainment Union Coalition co-sponsored the bill. The council represents over 50,000 members of the entertainment industry, while the coalition has roughly 150,000 members and comprises 17 local unions, including SAG-AFTRA.
"We can now protect thousands of our members and their families who depend upon these benefit programs, often in times of great need and economic stress because they are unexpectedly or suddenly out of work, disabled as a result of an injury or illness, or are responsible for the care of family members," the groups said.
The flip side of this new law is that New York, Louisiana, Georgia and North Carolina will keep the film production revenue, and be protected from the costs of social benefits for workers temporarily earning a good living in their states ...
California was the shooting location for 10 of the top 100 box office performers last year, trailing Canada, the U.K., and Georgia. Canada was by far the top-ranked location with 20 films, including 11 that were shot in British Columbia, noting that Canada pioneered the use of production tax credits during the 1990s. The U.K. and Georgia followed with 15 movies each.
California ramped up its tax credit program in 2015 by expanding its annual allocation of credits from $100 million to $330 million, and establishing a selection system that gave priority to the jobs created by the films. The California tax credit total as high as 25% of production costs - which is still short of the incentives elsewhere. California Gov. Jerry Brown signed legislation that extended the program for five years into 2025.
Still, California’s yearly allocation for tax credits is dwarfed by the U.K., with $822 million invested in 2017 - the largest film incentive program worldwide. Georgia had $800 million invested last year.
At this point it seems that California has given up trying to stop the exodus of California filmmaking. Instead, a new law simply requires costs of benefits for social systems of film workers who are temporarily working out of state - to shift to California employers.
California Gov. Gavin Newsom has signed a bill to ensure film and TV workers operating out of state for their jobs will have full access to the state’s unemployment insurance, disability insurance and paid family leave.
He signed the measure, SB 271, late Thursday and it will become law in January. The legislation is aimed at addressing uncertainties for California-based film and TV production workers who often must travel outside California.
"The bill would provide, for purposes of determining employment of a motion picture production worker when the service is not localized in the state but some of the service is performed in the state, that the worker’s entire service qualifies as employment if their residence is in the state," the legislation states.
The California International Alliance of Theatrical Stage Employees Council and Entertainment Union Coalition co-sponsored the bill. The council represents over 50,000 members of the entertainment industry, while the coalition has roughly 150,000 members and comprises 17 local unions, including SAG-AFTRA.
"We can now protect thousands of our members and their families who depend upon these benefit programs, often in times of great need and economic stress because they are unexpectedly or suddenly out of work, disabled as a result of an injury or illness, or are responsible for the care of family members," the groups said.
The flip side of this new law is that New York, Louisiana, Georgia and North Carolina will keep the film production revenue, and be protected from the costs of social benefits for workers temporarily earning a good living in their states ...
Federal complaints have been filed against 30 Bay Area defendants, including the largest home health care agency, in a patients-for-cash kickback scheme.
The unsealed criminal complaints describe a wide-ranging patients-for-kickback scheme. At the center of the scheme are Amity Home Health Care, the largest home health care provider in the San Francisco Bay Area, and Advent Care, Inc., a provider of hospice care.
According to the complaints, all the defendants participated in the scheme whereby Amity, under the leadership of Chief Executive Officer Ridhima "Amanda" Singh, paid kickbacks to marketers, doctors, and other medical professionals in exchange for the certification or referral of patients for home health or hospice services.
Also charged are 28 people including doctors, nurses, marketers, a social worker, and additional employees of Amity. According to the complaints, every single defendant charged was recorded by law enforcement officers either offering or accepting, or approving illegal payments for patient referrals.
Title 42, United States Code, Section 1320a-7b, makes it a crime for any person to knowingly solicit, offer, or pay a kickback, bribe, or rebate for furnishing services under a Federal health care program. Because many of the patients were insured by Medicare, a taxpayer-funded insurance plan, the referral of patients through the kickback scheme violated the statute.
The criminal complaints describe how Amity and some of its employees bribed individuals associated with hospitals, skilled nursing facilities, and doctors’ offices to induce those individuals to send patients to Amity and Advent. Amity and the other defendants often disguised the kickbacks as payroll, phony medical directorships, and, at other times, as "entertainment," reimbursements," "gifts", or "donations."
Further, several of the defendants are doctors and other health care professionals who allegedly received bribes in exchange for making referrals to Amity and Advent and other home health agencies so that the companies could provide and bill for services. In the case of Amity, Singh and her employees allegedly compensated these professionals in cash for each patient referral and for making introductions to physicians, case managers, or other health care professionals who could refer patients.
In addition, some of the defendants are described as "marketers." Marketers received from Amity and others cash and gifts, such as tickets to Warriors games, in exchange for patient referrals. Marketers had clients that consisted of case managers at hospitals, social workers at skilled nursing facilities, doctors, and office staff at doctors’ offices. Singh allegedly instructed marketers to take clients out to elaborate meals, sporting events, and purchase gifts for individuals willing to provide Amity with patients, mainly Medicare patients. When patient referrals were slow, Singh allegedly directed the marketer to incentivize clients with gifts in an effort to induce them to refer more patients to Amity.
The names and identification information on the specific individuals involved are listed on the Justice Department Website announcement ...
The unsealed criminal complaints describe a wide-ranging patients-for-kickback scheme. At the center of the scheme are Amity Home Health Care, the largest home health care provider in the San Francisco Bay Area, and Advent Care, Inc., a provider of hospice care.
According to the complaints, all the defendants participated in the scheme whereby Amity, under the leadership of Chief Executive Officer Ridhima "Amanda" Singh, paid kickbacks to marketers, doctors, and other medical professionals in exchange for the certification or referral of patients for home health or hospice services.
Also charged are 28 people including doctors, nurses, marketers, a social worker, and additional employees of Amity. According to the complaints, every single defendant charged was recorded by law enforcement officers either offering or accepting, or approving illegal payments for patient referrals.
Title 42, United States Code, Section 1320a-7b, makes it a crime for any person to knowingly solicit, offer, or pay a kickback, bribe, or rebate for furnishing services under a Federal health care program. Because many of the patients were insured by Medicare, a taxpayer-funded insurance plan, the referral of patients through the kickback scheme violated the statute.
The criminal complaints describe how Amity and some of its employees bribed individuals associated with hospitals, skilled nursing facilities, and doctors’ offices to induce those individuals to send patients to Amity and Advent. Amity and the other defendants often disguised the kickbacks as payroll, phony medical directorships, and, at other times, as "entertainment," reimbursements," "gifts", or "donations."
Further, several of the defendants are doctors and other health care professionals who allegedly received bribes in exchange for making referrals to Amity and Advent and other home health agencies so that the companies could provide and bill for services. In the case of Amity, Singh and her employees allegedly compensated these professionals in cash for each patient referral and for making introductions to physicians, case managers, or other health care professionals who could refer patients.
In addition, some of the defendants are described as "marketers." Marketers received from Amity and others cash and gifts, such as tickets to Warriors games, in exchange for patient referrals. Marketers had clients that consisted of case managers at hospitals, social workers at skilled nursing facilities, doctors, and office staff at doctors’ offices. Singh allegedly instructed marketers to take clients out to elaborate meals, sporting events, and purchase gifts for individuals willing to provide Amity with patients, mainly Medicare patients. When patient referrals were slow, Singh allegedly directed the marketer to incentivize clients with gifts in an effort to induce them to refer more patients to Amity.
The names and identification information on the specific individuals involved are listed on the Justice Department Website announcement ...
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 October 7, 2019, incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent Hip and Groin Disorders Guideline (April 24, 2019) to the Clinical Topics section of the MTUS.
The administrative order consists of the order and two addenda:
-- 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 DWC has also posted an adjustment to the inpatient hospital section of the Official Medical Fee Schedule (OMFS) to conform to changes in the 2020 Medicare payment system as required by Labor Code section 5307.1.
The effective date of the changes is November 1, 2019.
Further information and adjustments to the inpatient hospital section of the Official Medical Fee Schedule can be found on the DWC website’s OMFS page ...
The updates, effective for medical treatment services rendered on or after October 7, 2019, incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent Hip and Groin Disorders Guideline (April 24, 2019) to the Clinical Topics section of the MTUS.
The administrative order consists of the order and two addenda:
-- 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 DWC has also posted an adjustment to the inpatient hospital section of the Official Medical Fee Schedule (OMFS) to conform to changes in the 2020 Medicare payment system as required by Labor Code section 5307.1.
The effective date of the changes is November 1, 2019.
Further information and adjustments to the inpatient hospital section of the Official Medical Fee Schedule can be found on the DWC website’s OMFS page ...
Pharmaceutical company Mallinckrodt ARD LLC (formerly known as Mallinckrodt ARD, Inc. and previously Questcor Pharmaceuticals, Inc., has agreed to pay $15.4 million to resolve claims that Questcor paid illegal kickbacks to doctors from 2009 through 2013 in the form of lavish dinners and entertainment, to induce prescriptions of the company’s drug, H.P. Acthar Gel for the treatment of complications from multiple sclerosis.
The Federal Anti-Kickback Statute prohibits a pharmaceutical company from offering or paying, directly or indirectly, any remuneration - which includes money or any other thing of value - with the intent to induce a health care provider to prescribe a drug reimbursed by Medicare. This prohibition extends to such practices as "wining and dining" doctors to induce them to write Medicare prescriptions of a company’s products.
The government alleges that, from 2009 to 2013, twelve Questcor sales representatives marketing Acthar provided illegal remuneration to health care providers in the form of lavish meals and entertainment expenses. The company paid this remuneration, the government alleges, with the intent to induce Acthar Medicare referrals from those health care providers, resulting in a violation of the Anti-Kickback Statute and the submission of false claims to Medicare.
The allegations relevant to this settlement were originally alleged in two cases filed under the whistleblower, or qui tam, provision of the False Claims Act. The act permits private parties to sue for fraud on behalf of the United States and to share in any recovery.
The act also permits the government to intervene in such actions, as the government previously did in the two whistleblower cases, which are captioned United States of America ex rel. Strunck et al. v. Mallinckrodt ARD, Inc., No. 12-CV-0175 (E.D. Pa.), and United States of America ex rel. Clark v. Questor Pharmaceuticals, Inc., No. 13-CV-1776 (E.D. Pa.).
The government’s pursuit of these matters illustrates its emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800 HHS TIPS (800-447-8477). The whistleblowers will receive approximately $2.926 million of the settlement.
This matter is being handled by the Civil Division of the U.S. Attorney’s Office for the Eastern District of Pennsylvania and the Department of Justice’s Commercial Litigation Branch, with assistance from the U.S. Department of Health and Human Services’ Office of Inspector General, the Defense Criminal Investigative Service, the Federal Bureau of Investigation and the Office of Personnel Management.
For the United States Attorney’s Office, the matter is being handled by Assistant United States Attorney Colin Cherico and Auditor George Niedzwicki ...
The Federal Anti-Kickback Statute prohibits a pharmaceutical company from offering or paying, directly or indirectly, any remuneration - which includes money or any other thing of value - with the intent to induce a health care provider to prescribe a drug reimbursed by Medicare. This prohibition extends to such practices as "wining and dining" doctors to induce them to write Medicare prescriptions of a company’s products.
The government alleges that, from 2009 to 2013, twelve Questcor sales representatives marketing Acthar provided illegal remuneration to health care providers in the form of lavish meals and entertainment expenses. The company paid this remuneration, the government alleges, with the intent to induce Acthar Medicare referrals from those health care providers, resulting in a violation of the Anti-Kickback Statute and the submission of false claims to Medicare.
The allegations relevant to this settlement were originally alleged in two cases filed under the whistleblower, or qui tam, provision of the False Claims Act. The act permits private parties to sue for fraud on behalf of the United States and to share in any recovery.
The act also permits the government to intervene in such actions, as the government previously did in the two whistleblower cases, which are captioned United States of America ex rel. Strunck et al. v. Mallinckrodt ARD, Inc., No. 12-CV-0175 (E.D. Pa.), and United States of America ex rel. Clark v. Questor Pharmaceuticals, Inc., No. 13-CV-1776 (E.D. Pa.).
The government’s pursuit of these matters illustrates its emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800 HHS TIPS (800-447-8477). The whistleblowers will receive approximately $2.926 million of the settlement.
This matter is being handled by the Civil Division of the U.S. Attorney’s Office for the Eastern District of Pennsylvania and the Department of Justice’s Commercial Litigation Branch, with assistance from the U.S. Department of Health and Human Services’ Office of Inspector General, the Defense Criminal Investigative Service, the Federal Bureau of Investigation and the Office of Personnel Management.
For the United States Attorney’s Office, the matter is being handled by Assistant United States Attorney Colin Cherico and Auditor George Niedzwicki ...
The Trump administration is awarding nearly $2 billion in new funding to states and local governments to help fight the opioid crisis.
Health and Human Services Secretary Alexander Azar says the grants come from money that President Donald Trump secured from Congress last year. Trump says "nothing is more important than defeating the opioid and addiction crisis."
The Substance Abuse Mental Health Services Administration is awarding $932 million to every state and some U.S. territories to help provide treatment and recovery services that meet local needs.
Separately, the Centers for Disease Control and Prevention is getting $900 million under a new, three-year program to help state and local governments better track overdose data. Forty-seven states and the District of Columbia are among jurisdictions sharing $301 million in the first year.
In announcing the move, White House counsel Kellyanne Conway told reporters in a conference call that their administration is trying to interject the word "fentanyl" into the "everyday lexicon" as part of their efforts to increase awareness.
"Central to our effort to stop the flood of fentanyl and other illicit drugs is our unprecedented support for law enforcement and their interdiction efforts," she said. Conway then brought up the DHS seizures of fentanyl last year, which totaled an equivalent to 1.2 billion lethal doses.
Just weeks ago, The White House released a series of private-sector advisories aimed to help businesses protect themselves and their supply chains from inadvertent trafficking of fentanyl and synthetic opioids.
The four advisories aim to stem the production and sale of illicit fentanyl, fentanyl analogs, and other synthetic opioids. The advisories focus on the manufacturing, marketing, movement, and money of illicit fentanyl.
In March last year, the interior Department created a tribal task force aimed to specifically combat the crisis on tribal lands. Since then, the department has arrested over 422 individuals and the seizure of 4,000 pounds of illegal drugs worth $12 million on the street, including over 35,000 fentanyl pills.
Conway, in the conference call, described the epidemic of pain relievers as an "opioid and fentanyl crisis." ...
Health and Human Services Secretary Alexander Azar says the grants come from money that President Donald Trump secured from Congress last year. Trump says "nothing is more important than defeating the opioid and addiction crisis."
The Substance Abuse Mental Health Services Administration is awarding $932 million to every state and some U.S. territories to help provide treatment and recovery services that meet local needs.
Separately, the Centers for Disease Control and Prevention is getting $900 million under a new, three-year program to help state and local governments better track overdose data. Forty-seven states and the District of Columbia are among jurisdictions sharing $301 million in the first year.
In announcing the move, White House counsel Kellyanne Conway told reporters in a conference call that their administration is trying to interject the word "fentanyl" into the "everyday lexicon" as part of their efforts to increase awareness.
"Central to our effort to stop the flood of fentanyl and other illicit drugs is our unprecedented support for law enforcement and their interdiction efforts," she said. Conway then brought up the DHS seizures of fentanyl last year, which totaled an equivalent to 1.2 billion lethal doses.
Just weeks ago, The White House released a series of private-sector advisories aimed to help businesses protect themselves and their supply chains from inadvertent trafficking of fentanyl and synthetic opioids.
The four advisories aim to stem the production and sale of illicit fentanyl, fentanyl analogs, and other synthetic opioids. The advisories focus on the manufacturing, marketing, movement, and money of illicit fentanyl.
In March last year, the interior Department created a tribal task force aimed to specifically combat the crisis on tribal lands. Since then, the department has arrested over 422 individuals and the seizure of 4,000 pounds of illegal drugs worth $12 million on the street, including over 35,000 fentanyl pills.
Conway, in the conference call, described the epidemic of pain relievers as an "opioid and fentanyl crisis." ...
On October 6, 2015, Governor Jerry Brown signed Assembly Bill No. 1124 into law, which directed the DWC to adopt an evidence-based drug formulary in the California workers’ compensation system.
In 2017, the DWC adopted the new drug formulary linked to the California Medical Treatment Utilization Schedule (MTUS) to be effective on January 1, 2018. The drug formulary intends to reduce frictional costs mostly from UR and independent medical review (IMR); restrict inappropriate prescribing, especially that related to opioids; and ensure medically necessary and timely medications for injured workers.
The drug formulary includes an MTUS drug list of about 300 drug ingredients that are assigned a status of exempt or non-exempt from prospective UR.
All opioids and compounded drugs are non-exempt from prospective UR. Additionally, certain non-exempt drugs can be prescribed without prospective UR if fulfilling the requirements of special fill or peri-operative fill policies.
Drugs not listed on the MTUS drug list must obtain authorization through prospective UR prior to dispensing
Even before the implementation of the drug formulary, pharmaceutical costs in California had been declining sharply. Key drivers of the decrease include Senate Bill No. 863 reforms related to IMR and spinal surgeries, changes in the federal government upper-limit pricing levels, anti-fraud efforts and the public reaction to the national opioid epidemic.
While there was an even more significant drop in the utilization and cost of pharmaceuticals in 2018, it was not immediately clear how much of the decline was due to the formulary and how much was due to the continuation of the factors driving the prior year decreases
The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) reviewed the impact of the new drug formulary on prescribing patterns and pharmaceutical costs based on pharmaceutical transaction information through the first year of implementation.
The WCIRB’s findings include:
-- The share of prescriptions of drugs not subject to prospective utilization review (UR) in accordance with the formulary increased by 41 percent compared to the pre-2018 level, while that of drugs subject to UR declined by 18 percent.
-- The use of opioids, compounds, physician-dispensed drugs and brand-name drugs with generic alternatives dropped sharply in 2018, the first year of the formulary.
-- While a number of the aforementioned pharmaceutical components had been declining prior to the implementation of the formulary, the decline accelerated during 2018, suggestive of the effect of the drug formulary ...
In 2017, the DWC adopted the new drug formulary linked to the California Medical Treatment Utilization Schedule (MTUS) to be effective on January 1, 2018. The drug formulary intends to reduce frictional costs mostly from UR and independent medical review (IMR); restrict inappropriate prescribing, especially that related to opioids; and ensure medically necessary and timely medications for injured workers.
The drug formulary includes an MTUS drug list of about 300 drug ingredients that are assigned a status of exempt or non-exempt from prospective UR.
All opioids and compounded drugs are non-exempt from prospective UR. Additionally, certain non-exempt drugs can be prescribed without prospective UR if fulfilling the requirements of special fill or peri-operative fill policies.
Drugs not listed on the MTUS drug list must obtain authorization through prospective UR prior to dispensing
Even before the implementation of the drug formulary, pharmaceutical costs in California had been declining sharply. Key drivers of the decrease include Senate Bill No. 863 reforms related to IMR and spinal surgeries, changes in the federal government upper-limit pricing levels, anti-fraud efforts and the public reaction to the national opioid epidemic.
While there was an even more significant drop in the utilization and cost of pharmaceuticals in 2018, it was not immediately clear how much of the decline was due to the formulary and how much was due to the continuation of the factors driving the prior year decreases
The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) reviewed the impact of the new drug formulary on prescribing patterns and pharmaceutical costs based on pharmaceutical transaction information through the first year of implementation.
The WCIRB’s findings include:
-- The share of prescriptions of drugs not subject to prospective utilization review (UR) in accordance with the formulary increased by 41 percent compared to the pre-2018 level, while that of drugs subject to UR declined by 18 percent.
-- The use of opioids, compounds, physician-dispensed drugs and brand-name drugs with generic alternatives dropped sharply in 2018, the first year of the formulary.
-- While a number of the aforementioned pharmaceutical components had been declining prior to the implementation of the formulary, the decline accelerated during 2018, suggestive of the effect of the drug formulary ...
The Renne Public Policy Group (RPPG) practices throughout California, advising and advocating for public agencies, nonprofit entities, individuals and private entities in need of effective, responsive and creative legal solutions. Former San Francisco City Attorney Louise Renne leads the organization as Chairperson.
The League of California Cities is an association of California city officials who work together to enhance their knowledge and skills, exchange information, and combine resources so that they may influence policy decisions that affect cities. It has retained RPPG on contract to advocate on issues related to workers’ compensation, public sector pensions and other policy areas critical to cities.
The Director of Government Affairs, Dane Hutchings, will lead efforts on this project, working directly with the League.
"Given the importance of pension and labor relations issues for cities, the League appreciates the opportunity to retain the advocacy skills of Dane Hutchings for the balance of the 2019 Session," said Dan Carrigg, Deputy Executive Director and Legislative Director for the League.
"I am excited to lead RPPG’s advocacy efforts for the League and develop political and communication strategies for cities throughout the state," said Mr. Hutchings. "The Renne Public Law Group has been a longtime League partner. RPPG is ready to utilize the law group’s seasoned legal expertise and my lobbying experience to further the best interests of California cities."
RPPG is a full-service lobbying and consulting firm that provides support to public agencies and companies that align with the interest of public agencies ...
The League of California Cities is an association of California city officials who work together to enhance their knowledge and skills, exchange information, and combine resources so that they may influence policy decisions that affect cities. It has retained RPPG on contract to advocate on issues related to workers’ compensation, public sector pensions and other policy areas critical to cities.
The Director of Government Affairs, Dane Hutchings, will lead efforts on this project, working directly with the League.
"Given the importance of pension and labor relations issues for cities, the League appreciates the opportunity to retain the advocacy skills of Dane Hutchings for the balance of the 2019 Session," said Dan Carrigg, Deputy Executive Director and Legislative Director for the League.
"I am excited to lead RPPG’s advocacy efforts for the League and develop political and communication strategies for cities throughout the state," said Mr. Hutchings. "The Renne Public Law Group has been a longtime League partner. RPPG is ready to utilize the law group’s seasoned legal expertise and my lobbying experience to further the best interests of California cities."
RPPG is a full-service lobbying and consulting firm that provides support to public agencies and companies that align with the interest of public agencies ...
The Sackler family, which grew into one of the nation’s wealthiest dynasties through sales of the widely abused painkiller OxyContin, could emerge from a legal settlement under negotiation with its personal fortunes largely intact, according to an analysis reviewed by The Washington Post and people familiar with the discussions.
Under a novel plan to relinquish control of their company, Purdue Pharma, and resurrect it as a trust whose main purpose would be to combat the opioid epidemic, the Sacklers could raise most, if not all, of their personal share of the $10 billion to $12 billion agreement by selling their international drug conglomerate, Mundipharma, according to the documents and those close to the talks.
The analysis reviewed by The Post offers previously undisclosed information about the proposed settlement.
The proposed settlement - built on the projected value of drugs not yet on the market - offers gains for both sides if the company and more than 2,000 cities, counties, states and others that have sued Purdue and the family can craft a deal.
Purdue would produce millions of doses of badly needed anti-addiction medication and overdose antidotes for the public, free of charge; the company would also contribute hundreds of millions of dollars in cash and insurance policies that could be worth more; what’s left of the company, including its North Carolina production facility and other assets, would change hands.
Much of the benefit to the public would be funded by the continued sales of the powerful narcotic OxyContin, the abuse of which is blamed for contributing to the prescription opioid crisis that has killed more than 200,000 people since 1999.
The Stamford-Conn.-based Purdue Pharma would go into bankruptcy, and the Sacklers would be out of the drug business. They would be required to contribute $3 billion and possibly more, depending on the sale price of Mundipharma, their international drug company, over seven years.
But they would still retain much of their wealth. In fact, they might be able to keep billions of dollars that state attorneys general allege they pulled out of the company.
"No one is going to be happy after this," said Adam J. Levitin, a Georgetown Law School professor who studies bankruptcy. "People are going to be mad that the Sacklers aren’t going to jail, that they will have money left."
The Washington Post reviewed a detailed analysis of the settlement plan that has been valued at $10 billion to $12 billion. The plan has been at the heart of negotiations among the parties for many months. The material was confirmed by three people close to the discussions who spoke on the condition of anonymity because of the sensitivity of the negotiations.
If no deal is reached, Purdue is likely to declare bankruptcy in coming weeks, according to people familiar with the company’s strategy. A huge civil trial against Purdue and as many as two dozen drug companies is scheduled to begin in Cleveland on Oct. 21.
But the documents also indicate that if settlement talks fail and the Sacklers vote to send Purdue into Chapter 11 bankruptcy, the plaintiffs might get as little as $1.2 billion from an auction of the business’s components.
In that scenario, plaintiffs would probably have to jockey for rights to Purdue’s assets. The process could generate enormous legal bills, possibly further reducing any payout to them ...
Under a novel plan to relinquish control of their company, Purdue Pharma, and resurrect it as a trust whose main purpose would be to combat the opioid epidemic, the Sacklers could raise most, if not all, of their personal share of the $10 billion to $12 billion agreement by selling their international drug conglomerate, Mundipharma, according to the documents and those close to the talks.
The analysis reviewed by The Post offers previously undisclosed information about the proposed settlement.
The proposed settlement - built on the projected value of drugs not yet on the market - offers gains for both sides if the company and more than 2,000 cities, counties, states and others that have sued Purdue and the family can craft a deal.
Purdue would produce millions of doses of badly needed anti-addiction medication and overdose antidotes for the public, free of charge; the company would also contribute hundreds of millions of dollars in cash and insurance policies that could be worth more; what’s left of the company, including its North Carolina production facility and other assets, would change hands.
Much of the benefit to the public would be funded by the continued sales of the powerful narcotic OxyContin, the abuse of which is blamed for contributing to the prescription opioid crisis that has killed more than 200,000 people since 1999.
The Stamford-Conn.-based Purdue Pharma would go into bankruptcy, and the Sacklers would be out of the drug business. They would be required to contribute $3 billion and possibly more, depending on the sale price of Mundipharma, their international drug company, over seven years.
But they would still retain much of their wealth. In fact, they might be able to keep billions of dollars that state attorneys general allege they pulled out of the company.
"No one is going to be happy after this," said Adam J. Levitin, a Georgetown Law School professor who studies bankruptcy. "People are going to be mad that the Sacklers aren’t going to jail, that they will have money left."
The Washington Post reviewed a detailed analysis of the settlement plan that has been valued at $10 billion to $12 billion. The plan has been at the heart of negotiations among the parties for many months. The material was confirmed by three people close to the discussions who spoke on the condition of anonymity because of the sensitivity of the negotiations.
If no deal is reached, Purdue is likely to declare bankruptcy in coming weeks, according to people familiar with the company’s strategy. A huge civil trial against Purdue and as many as two dozen drug companies is scheduled to begin in Cleveland on Oct. 21.
But the documents also indicate that if settlement talks fail and the Sacklers vote to send Purdue into Chapter 11 bankruptcy, the plaintiffs might get as little as $1.2 billion from an auction of the business’s components.
In that scenario, plaintiffs would probably have to jockey for rights to Purdue’s assets. The process could generate enormous legal bills, possibly further reducing any payout to them ...
AB 5 is expected to eventually pass the California Legislature, and result an estimated 2 million workers would be transformed from independent contractors to employees. The transformation would increase those covered by workers' compensation, and the industry activity would increase accordingly.
According to an update published by Littler, the California Senate Appropriations Committee briefly considered AB 5 on August 30. The proposed law is the legislature’s response to the California Supreme Court's 2018 opinion in Dynamex v. Superior Court (Dynamex). In Dynamex, the court changed the state’s longstanding law governing worker classification and exposed thousands of California businesses to potential retroactive liability.
AB 5 previously came before the Senate Appropriations Committee on August 12, 2019, when the Committee temporarily put the bill on hold. The Committee has now voted the bill to the Senate floor.
The Appropriations Committee heard no testimony or public comment regarding the bill. Only Committee Chair Portantino spoke very briefly on the subject, stating: "[AB 5] is out with amendments to refine the operation of the ABC test, modify the industrial categories under the Borello test, and make clarifying changes."
Chair Portanino’s brief statement is the first official confirmation that the bill is undergoing further revision.
Assemblymember Gonzalez first introduced AB 5 on December 3, 2018. The initial bill included an expression of intent to "include provisions that would codify [Dynamex] and would clarify the decision’s application in state law. The substantive portion of the bill was 34 words (not including the citation to the Dynamex opinion). There have been four major revisions since then. The current version, published July 11, 2019, contains approximately 2,500 words.
In the weeks after the August 12, 2019 hearing, legislators have reportedly been working behind closed doors to make one more major revision to the bill with no information publicly available.
This revision is likely the final opportunity for interested parties to provide input on the bill. There will be virtually no time for further debate and subsequent revisions. The legislature has only 10 business days (including August 30, 2019) to pass the bill before the legislative session ends on September 13, 2019.
Due to this time pressure, legislators will have to choose between advancing the revised bill or facing potential criticism for failing to pass any legislative "fix" to Dynamex during the current session. It is expected that some legislators who believe changes should be made to the bill may nonetheless vote to pass it this session with the belief that additional changes will be made through separate legislative efforts in the next session.
In the face of growing uncertainty, some employers are eyeing a possible 2020 ballot initiative to advance an AB 5 countermeasure. For now, employers across the country are anxiously awaiting publication of the amended version of AB 5, which is expected to be published after Labor Day ...
According to an update published by Littler, the California Senate Appropriations Committee briefly considered AB 5 on August 30. The proposed law is the legislature’s response to the California Supreme Court's 2018 opinion in Dynamex v. Superior Court (Dynamex). In Dynamex, the court changed the state’s longstanding law governing worker classification and exposed thousands of California businesses to potential retroactive liability.
AB 5 previously came before the Senate Appropriations Committee on August 12, 2019, when the Committee temporarily put the bill on hold. The Committee has now voted the bill to the Senate floor.
The Appropriations Committee heard no testimony or public comment regarding the bill. Only Committee Chair Portantino spoke very briefly on the subject, stating: "[AB 5] is out with amendments to refine the operation of the ABC test, modify the industrial categories under the Borello test, and make clarifying changes."
Chair Portanino’s brief statement is the first official confirmation that the bill is undergoing further revision.
Assemblymember Gonzalez first introduced AB 5 on December 3, 2018. The initial bill included an expression of intent to "include provisions that would codify [Dynamex] and would clarify the decision’s application in state law. The substantive portion of the bill was 34 words (not including the citation to the Dynamex opinion). There have been four major revisions since then. The current version, published July 11, 2019, contains approximately 2,500 words.
In the weeks after the August 12, 2019 hearing, legislators have reportedly been working behind closed doors to make one more major revision to the bill with no information publicly available.
This revision is likely the final opportunity for interested parties to provide input on the bill. There will be virtually no time for further debate and subsequent revisions. The legislature has only 10 business days (including August 30, 2019) to pass the bill before the legislative session ends on September 13, 2019.
Due to this time pressure, legislators will have to choose between advancing the revised bill or facing potential criticism for failing to pass any legislative "fix" to Dynamex during the current session. It is expected that some legislators who believe changes should be made to the bill may nonetheless vote to pass it this session with the belief that additional changes will be made through separate legislative efforts in the next session.
In the face of growing uncertainty, some employers are eyeing a possible 2020 ballot initiative to advance an AB 5 countermeasure. For now, employers across the country are anxiously awaiting publication of the amended version of AB 5, which is expected to be published after Labor Day ...
Ride-hailing companies Uber and Lyft are threatening to launch a ballot measure if they don’t get to rewrite new labor rules dictating who must be treated as an employee, officials at Lyft said Thursday.
The Sacramento Bee reports that the two companies are proposing some benefits for drivers in exchange for an exemption from proposed labor rules that would allow them to continue classifying drivers as independent contractors. The two companies plan to pour $30 million each into a fund for a ballot measure if they don’t get their way, officials at Lyft said.
Late Thursday, gig economy food-delivery service DoorDash said it would commit another $30 million to the proposed initiative.
The announcements come as the window closes to win an exemption from an existing bill that will force employers to treat independent contractors as employees. That legislation, Assembly Bill 5, would codify a California Supreme Court ruling known as Dynamex that restricts when employers can classify workers as independent contractors and deny them benefits like overtime, sick leave and minimum wage.
AB 5 author, Assemblywoman Lorena Gonzalez, D-San Diego, has made it clear she doesn’t intend to give exemptions to the ride-hailing companies through the bill.
The companies insist that their business model relies on being able to treat employees as independent contractors and that many drivers prefer the flexibility the company offers.
Lyft released a study on Thursday that suggested it would have 300,000 fewer drivers in California if Gonzalez’s bill becomes law and it is compelled to provide schedules, breaks and full employment benefits to drivers.
"We are working on a solution that provides drivers with strong protections that include an earnings guarantee, a system of worker-directed portable benefits, and first-of-its kind industry-wide sectoral bargaining, without jeopardizing the flexibility drivers tell us they value so much," Lyft spokesman Adrian Durbin said in a statement Thursday. "We remain focused on reaching a deal, and are confident about bringing this issue to the voters if necessary."
On Twitter, Gonzalez blasted the tech companies’ plan to challenge the proposed law. "Billionaires who say they can’t pay minimum wages to their workers say they will spend tens of millions to avoid labor laws. Just pay your damn workers," she wrote.
California Labor Federation Executive-Secretary Treasurer Art Pulaski added that state labor would be unified in opposing such a measure and would "meet the gig companies’ absurd political spending with a vigorous worker-led campaign."
Lyft officials are proposing a wage guarantee that drivers would earn at least 32 percent above the local minimum wage plus reimbursement for expenses. Under the proposal, they said drivers would have no limit on their earnings, and tips would be added on top of their guaranteed wages.
The companies are also proposing a fund that could cover benefits for drivers, such as paid sick and family leave. The companies are not suggesting allowing drivers to unionize, but are instead proposing a system of “sectoral bargaining” which would let gig economy drivers negotiate industry-wide benefits.
Officials at labor union SEIU told The Bee Wednesday they are pushing to pass AB 5 without an exemption for ride-hailing companies and fighting to allow Uber and Lyft workers to unionize. They said they were in talks with Gov. Gavin Newsom’s chief of staff Ann O’Leary ...
The Sacramento Bee reports that the two companies are proposing some benefits for drivers in exchange for an exemption from proposed labor rules that would allow them to continue classifying drivers as independent contractors. The two companies plan to pour $30 million each into a fund for a ballot measure if they don’t get their way, officials at Lyft said.
Late Thursday, gig economy food-delivery service DoorDash said it would commit another $30 million to the proposed initiative.
The announcements come as the window closes to win an exemption from an existing bill that will force employers to treat independent contractors as employees. That legislation, Assembly Bill 5, would codify a California Supreme Court ruling known as Dynamex that restricts when employers can classify workers as independent contractors and deny them benefits like overtime, sick leave and minimum wage.
AB 5 author, Assemblywoman Lorena Gonzalez, D-San Diego, has made it clear she doesn’t intend to give exemptions to the ride-hailing companies through the bill.
The companies insist that their business model relies on being able to treat employees as independent contractors and that many drivers prefer the flexibility the company offers.
Lyft released a study on Thursday that suggested it would have 300,000 fewer drivers in California if Gonzalez’s bill becomes law and it is compelled to provide schedules, breaks and full employment benefits to drivers.
"We are working on a solution that provides drivers with strong protections that include an earnings guarantee, a system of worker-directed portable benefits, and first-of-its kind industry-wide sectoral bargaining, without jeopardizing the flexibility drivers tell us they value so much," Lyft spokesman Adrian Durbin said in a statement Thursday. "We remain focused on reaching a deal, and are confident about bringing this issue to the voters if necessary."
On Twitter, Gonzalez blasted the tech companies’ plan to challenge the proposed law. "Billionaires who say they can’t pay minimum wages to their workers say they will spend tens of millions to avoid labor laws. Just pay your damn workers," she wrote.
California Labor Federation Executive-Secretary Treasurer Art Pulaski added that state labor would be unified in opposing such a measure and would "meet the gig companies’ absurd political spending with a vigorous worker-led campaign."
Lyft officials are proposing a wage guarantee that drivers would earn at least 32 percent above the local minimum wage plus reimbursement for expenses. Under the proposal, they said drivers would have no limit on their earnings, and tips would be added on top of their guaranteed wages.
The companies are also proposing a fund that could cover benefits for drivers, such as paid sick and family leave. The companies are not suggesting allowing drivers to unionize, but are instead proposing a system of “sectoral bargaining” which would let gig economy drivers negotiate industry-wide benefits.
Officials at labor union SEIU told The Bee Wednesday they are pushing to pass AB 5 without an exemption for ride-hailing companies and fighting to allow Uber and Lyft workers to unionize. They said they were in talks with Gov. Gavin Newsom’s chief of staff Ann O’Leary ...
The Mexican Navy in the Port of Cardenas discovered 52,000 pounds of fentanyl powder in a mismarked container from a Danish ship arriving from Shanghai, China.
The cargo manifest for the 40-foot ocean container stated that the powder content was 23,368 kilograms of inorganic calcium chloride, commonly used as an electrolyte in sports drinks, beverages, bottled water and as a non-sodium flavoring for pickles. The fentanyl was bound for the Sinaloa Cartel home-base in Culiacan, 300 miles north of the port.
Mexican Customs seized 931 sacks of the substance weighing about 25.75 tons. The total weight of the fentanyl powder seizure is preliminary, with authorities still evaluating the purity of fentanyl seized. But if the seizure is confirmed as pharmaceutical-grade fentanyl, it could be pressed into tens of millions of tablets.
Drug cartels favor fentanyl or fentanyl precursors imported from China because it can be diluted with fillers and marketed by street-dealers as cocaine, heroin or meth. Fentanyl can also be pressed into pills and sold on the street as oxycodone.
The National Institute on Drug Abuse warns that pharmaceutical-grade fentanyl is 50 to 100 times more potent than morphine. Fentanyl is extremely dangerous to handle because as little as 0.25 milligrams absorbed through the skin can be lethal.
The Port of Lazaro Cardenas fentanyl seizure follows the U.S. Drug Enforcement Administration (DEA) Aug. 15 announcement of cumulative year 2019 seizures of 1,138,288 illicitly created fentanyl pills by its Phoenix DEA Field Office in cooperation with Arizona law enforcement agencies. That is nearly triple the 380,000 fentanyl pills seized in year 2018, and over 56 times the 20,000 fentanyl pills seized in year 2016.
Former Sinaloa Cartel crime boss Joaquin Guzman Loera ("El Chapo") was extradited to the United States in January 2017. He was earlier convicted in Mexico for trafficking cocaine, heroin and fentanyl. But he successfully escaped from two Mexican prisons.
Guzman was sentenced by a U.S. district judge in July 2019 to a life term in a maximum-security U.S. prison, with the addition of 30 years, and ordered to pay $12.6 billion in forfeiture for being the principal leader of the Sinaloa Cartel and for 26 drug-related charges, including a murder conspiracy.
...
The cargo manifest for the 40-foot ocean container stated that the powder content was 23,368 kilograms of inorganic calcium chloride, commonly used as an electrolyte in sports drinks, beverages, bottled water and as a non-sodium flavoring for pickles. The fentanyl was bound for the Sinaloa Cartel home-base in Culiacan, 300 miles north of the port.
Mexican Customs seized 931 sacks of the substance weighing about 25.75 tons. The total weight of the fentanyl powder seizure is preliminary, with authorities still evaluating the purity of fentanyl seized. But if the seizure is confirmed as pharmaceutical-grade fentanyl, it could be pressed into tens of millions of tablets.
Drug cartels favor fentanyl or fentanyl precursors imported from China because it can be diluted with fillers and marketed by street-dealers as cocaine, heroin or meth. Fentanyl can also be pressed into pills and sold on the street as oxycodone.
The National Institute on Drug Abuse warns that pharmaceutical-grade fentanyl is 50 to 100 times more potent than morphine. Fentanyl is extremely dangerous to handle because as little as 0.25 milligrams absorbed through the skin can be lethal.
The Port of Lazaro Cardenas fentanyl seizure follows the U.S. Drug Enforcement Administration (DEA) Aug. 15 announcement of cumulative year 2019 seizures of 1,138,288 illicitly created fentanyl pills by its Phoenix DEA Field Office in cooperation with Arizona law enforcement agencies. That is nearly triple the 380,000 fentanyl pills seized in year 2018, and over 56 times the 20,000 fentanyl pills seized in year 2016.
Former Sinaloa Cartel crime boss Joaquin Guzman Loera ("El Chapo") was extradited to the United States in January 2017. He was earlier convicted in Mexico for trafficking cocaine, heroin and fentanyl. But he successfully escaped from two Mexican prisons.
Guzman was sentenced by a U.S. district judge in July 2019 to a life term in a maximum-security U.S. prison, with the addition of 30 years, and ordered to pay $12.6 billion in forfeiture for being the principal leader of the Sinaloa Cartel and for 26 drug-related charges, including a murder conspiracy.
...
Marsha Rosenblum worked for the Lompoc Unified School District in 2008 when she had an admitted right groin and hip injury.
In February 2019 her PTP Christopher Birch, M.D., reported that he reviewed the medical records and x-rays of the right hip. He concluded that, "having failed all the applicable non-operative measures . . . [applicant] meets the criteria for a right total hip arthroplasty." Dr. Birch confirmed his opinion in a subsequent April 2019 report, and submitted an RFA for a right total hip arthroplasty.
The RFA was submitted to UR. On April 8, 2019, a timely UR Determination issued, authorizing the right total hip replacement surgery.
On April 11, 2019, defendant objected to the medical determination made by Dr. Birch. The claims administrator sent a fax to Dr. Birch, stating that a "decision whether to authorize the RFA or send it to medical utilization review" was deferred pursuant to section 4610(g)(7) and Administrative Director rule 9792.9.1(b). It was therefore deferring surgical authorization pending a medical-legal opinion on industrial causation of the hip osteoarthritis pursuant to sections 4061 and 4062, and whether the right hip replacement surgery was related to applicant’s industrial injury.
On May 7, 2019, the matter proceeded to an expedited hearing on the primary issue of applicant’s need for a right hip replacement surgery as authorized by UR. Defendant contended the UR was fatally flawed because there was no connection between the requested surgery and applicant’s industrial injury. On May 20, 2019, the WCJ issued the disputed Expedited Findings of Fact and Order, finding that the court has no jurisdiction to determine medical treatment authorized by a timely UR. Applicant and defendant each petitioned for reconsideration.
Applicant argued that the WCJ erred by not enforcing the medical treatment authorized by UR and awarding the right hip surgery. Defendant contends the WCJ erred by finding the court lacked jurisdiction over the timely UR authorization for a right hip total arthroplasty, arguing that Labor Code1 sections 4061 and 4062 provide an alternate track to dispute an injured worker’s treatment request. Defendant argues that it properly objected to and withdrew its UR approval for the hip surgery after the UR authorization issued.
Reconsideration was granted and the WCAB addressed these contentions in the panel decision of Rosenblum v Lompoc Unified School District. It dened defendant’s Petition for Reconsideration, and granted applicant’s Petition for Reconsideration, and amend the Expedited Findings of Fact and Order to reflect that applicant is entitled to the medical treatment authorized by timely UR.
"Defendant attempted to override the timely April 8, 2019 UR determination and "withdraw" the authorization. Although section 4610(1) allows for deferral of UR while the employer disputes liability for an injury or treatment, here defendant did not dispute liability until three days after the UR authorized the right hip replacement surgery on April 8, 2019. There is no "alternative track" under section 4062 for an employer to dispute a UR determination. When defendant approved the requested treatment through UR, there was no further dispute as to the necessity of the treatment. (§ 4610.5, subd. (f)(1).) An employer may not bypass the UR process and invoke section 4062 to dispute an employee’s treatment request. (Sandhagen, supra, 44 Cal.4th 230, 237.)" ...
In February 2019 her PTP Christopher Birch, M.D., reported that he reviewed the medical records and x-rays of the right hip. He concluded that, "having failed all the applicable non-operative measures . . . [applicant] meets the criteria for a right total hip arthroplasty." Dr. Birch confirmed his opinion in a subsequent April 2019 report, and submitted an RFA for a right total hip arthroplasty.
The RFA was submitted to UR. On April 8, 2019, a timely UR Determination issued, authorizing the right total hip replacement surgery.
On April 11, 2019, defendant objected to the medical determination made by Dr. Birch. The claims administrator sent a fax to Dr. Birch, stating that a "decision whether to authorize the RFA or send it to medical utilization review" was deferred pursuant to section 4610(g)(7) and Administrative Director rule 9792.9.1(b). It was therefore deferring surgical authorization pending a medical-legal opinion on industrial causation of the hip osteoarthritis pursuant to sections 4061 and 4062, and whether the right hip replacement surgery was related to applicant’s industrial injury.
On May 7, 2019, the matter proceeded to an expedited hearing on the primary issue of applicant’s need for a right hip replacement surgery as authorized by UR. Defendant contended the UR was fatally flawed because there was no connection between the requested surgery and applicant’s industrial injury. On May 20, 2019, the WCJ issued the disputed Expedited Findings of Fact and Order, finding that the court has no jurisdiction to determine medical treatment authorized by a timely UR. Applicant and defendant each petitioned for reconsideration.
Applicant argued that the WCJ erred by not enforcing the medical treatment authorized by UR and awarding the right hip surgery. Defendant contends the WCJ erred by finding the court lacked jurisdiction over the timely UR authorization for a right hip total arthroplasty, arguing that Labor Code1 sections 4061 and 4062 provide an alternate track to dispute an injured worker’s treatment request. Defendant argues that it properly objected to and withdrew its UR approval for the hip surgery after the UR authorization issued.
Reconsideration was granted and the WCAB addressed these contentions in the panel decision of Rosenblum v Lompoc Unified School District. It dened defendant’s Petition for Reconsideration, and granted applicant’s Petition for Reconsideration, and amend the Expedited Findings of Fact and Order to reflect that applicant is entitled to the medical treatment authorized by timely UR.
"Defendant attempted to override the timely April 8, 2019 UR determination and "withdraw" the authorization. Although section 4610(1) allows for deferral of UR while the employer disputes liability for an injury or treatment, here defendant did not dispute liability until three days after the UR authorized the right hip replacement surgery on April 8, 2019. There is no "alternative track" under section 4062 for an employer to dispute a UR determination. When defendant approved the requested treatment through UR, there was no further dispute as to the necessity of the treatment. (§ 4610.5, subd. (f)(1).) An employer may not bypass the UR process and invoke section 4062 to dispute an employee’s treatment request. (Sandhagen, supra, 44 Cal.4th 230, 237.)" ...
This summer, the Sackler family, founders and owners of Purdue Pharma, announced they would pay at least $3 billion of a proposed $12 billion settlement of more than 2000 cases filed by cities, states and local government for its part in the opioid epidemic. The Sackler portion of the settlement money would be obtained by the family selling off Mundipharma, a separate global pharmaceutical company they own.
So this announcement may raise questions about the little known Mudipharma company reportedly owned by the Sacklers. A story just published in the Guardian sheds some light on what the Sacklers might be up to with Mundipharma.
After decades of stringent narcotics laws, borne of debilitating opium epidemics of centuries past, India is a country ready to salve its pain. For-profit pain clinics are opening by the score across Mumbai, Kolkata, Bangalore and other cities in this nation of 1.3 billion people.
And American pharmaceutical companies - architects of the opioid crisis in the United States and avid hunters of new markets - stand at the ready to fuel that demand.
Most large Indian hospitals have added pain management as a specialty in recent years. At the insistence of the professional societies that accredit hospitals in India, nurses and doctors now are required to assess pain as a fifth vital sign, along with pulse, temperature, breathing and blood pressure.
The pharmaceutical industry has kept pace. Twenty years ago only a few pharmaceutical companies marketed pain medicines in India, Today, almost every company is having pain management as a separate division. A salesman for Sun Pharma, India’s largest drugmaker by sales, echoed the point during an interview in Chandigarh, the capital of Punjab and Haryana.
For Indian cancer patients who once writhed in agony, there are fentanyl patches from a subsidiary of Johnson & Johnson. For the country’s vast army of middle-class office workers wracked with back and neck pain, there is buprenorphine from Mundipharma, a network of companies controlled by the Sackler family, the owners of Connecticut-based Purdue Pharma.
And for the hundreds of millions of aging Indians with aching joints and knees, there are shots of tramadol from Abbott Laboratories.
Palliative care advocates, who recount stories of patients enduring excruciating cancer pain or dying in agony, have persuaded reluctant government officials to allow high-powered opioid painkillers into doctors’ offices and on to chemists’ shelves.
But what began as a populist movement to bring inexpensive, Indian-made morphine to the ill has given rise to a pain management industry that promises countless new customers to American pharmaceutical companies facing a government crackdown and mounting lawsuits back home.
The lure of a pain-free life is a revelation in a country where incomes are rising for many city dwellers and 300 million to 400 million people are approaching the middle-class. Newly-minted pain doctors promise aspiring Indians that life has more to offer in a body free from pain.
As major pharmaceutical companies look to capitalize on the opportunity, the playbook unfolding in India seems familiar. Earnest advocates share heartbreaking stories of suffering patients; physicians and pharmaceutical companies champion pain relief for cancer patients and persuade regulators to grant greater access to powerful opioids; well-meaning pain doctors open clinics; shady pain clinics follow; and a spigot of prescription opioids opens - first addressing legitimate medical uses but soon spilling into the streets and onto the black market.
A looming deluge of addictive painkillers terrifies some Indian medical professionals, who are keenly aware that despite government regulations most drugs are available for petty cash at local chemist shops ...
So this announcement may raise questions about the little known Mudipharma company reportedly owned by the Sacklers. A story just published in the Guardian sheds some light on what the Sacklers might be up to with Mundipharma.
After decades of stringent narcotics laws, borne of debilitating opium epidemics of centuries past, India is a country ready to salve its pain. For-profit pain clinics are opening by the score across Mumbai, Kolkata, Bangalore and other cities in this nation of 1.3 billion people.
And American pharmaceutical companies - architects of the opioid crisis in the United States and avid hunters of new markets - stand at the ready to fuel that demand.
Most large Indian hospitals have added pain management as a specialty in recent years. At the insistence of the professional societies that accredit hospitals in India, nurses and doctors now are required to assess pain as a fifth vital sign, along with pulse, temperature, breathing and blood pressure.
The pharmaceutical industry has kept pace. Twenty years ago only a few pharmaceutical companies marketed pain medicines in India, Today, almost every company is having pain management as a separate division. A salesman for Sun Pharma, India’s largest drugmaker by sales, echoed the point during an interview in Chandigarh, the capital of Punjab and Haryana.
For Indian cancer patients who once writhed in agony, there are fentanyl patches from a subsidiary of Johnson & Johnson. For the country’s vast army of middle-class office workers wracked with back and neck pain, there is buprenorphine from Mundipharma, a network of companies controlled by the Sackler family, the owners of Connecticut-based Purdue Pharma.
And for the hundreds of millions of aging Indians with aching joints and knees, there are shots of tramadol from Abbott Laboratories.
Palliative care advocates, who recount stories of patients enduring excruciating cancer pain or dying in agony, have persuaded reluctant government officials to allow high-powered opioid painkillers into doctors’ offices and on to chemists’ shelves.
But what began as a populist movement to bring inexpensive, Indian-made morphine to the ill has given rise to a pain management industry that promises countless new customers to American pharmaceutical companies facing a government crackdown and mounting lawsuits back home.
The lure of a pain-free life is a revelation in a country where incomes are rising for many city dwellers and 300 million to 400 million people are approaching the middle-class. Newly-minted pain doctors promise aspiring Indians that life has more to offer in a body free from pain.
As major pharmaceutical companies look to capitalize on the opportunity, the playbook unfolding in India seems familiar. Earnest advocates share heartbreaking stories of suffering patients; physicians and pharmaceutical companies champion pain relief for cancer patients and persuade regulators to grant greater access to powerful opioids; well-meaning pain doctors open clinics; shady pain clinics follow; and a spigot of prescription opioids opens - first addressing legitimate medical uses but soon spilling into the streets and onto the black market.
A looming deluge of addictive painkillers terrifies some Indian medical professionals, who are keenly aware that despite government regulations most drugs are available for petty cash at local chemist shops ...
