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The Risk Management Division of the City of Santa Monica compiles its Workers’ Compensation Annual Report every year in an effort to provide local stakeholders with information and statistics related to the city’s medical and indemnity payments, claim settlements as well as general claim and cost trends.

As it has every year since 2009, the city’s Workers’ Compensation Program once again saw an increase to its total program liabilities, according to a report recently presented to City Council.

"In summary, in FY 2018-19, medical and indemnity payments increased 23% from the prior year, claim settlements were up 53% over the prior year and total program liabilities - the total value of all open claims from 1979 forward - grew to $32.6 million by June 30, 2019," Risk Manager Oles Gordeev said in the report. This was an 8.3 percent or $2.4 million increase from the prior year.

"The lion’s share of this increase was attributable to the Police Department and reflects the impact of an aging workforce," Gordeev said. "Fortunately, first-quarter data from (this fiscal year) shows that total liabilities are again on the decline," and staff is hopeful this trend will continue.

The city settled 150 claims with a total value of about $4 million during the 2018-2019 fiscal year, which was up from the 98 claim settlements that were worth a total value of $2.3 million the year before. City staff said the increased number of settlements in FY 2018-19 represented an improvement over the past year and reflects the city’s commitment to resolving claims in a timely manner.

"Further, there were two significant and positive trends that emerged in FY 2018-19," the report states, before addressing the "impressive results" of the Big Blue Bus’ Third-Party Administrator pilot program.

"In short, the TPA’s efforts have resulted in a significant reduction in BBB’s total program liabilities - the single most important financial performance measure for a workers’ compensation program," Gordeev said in the report, describing how the three-year pilot program came to fruition back in 2017. Despite a 28% increase in claim frequency since its inception, the pilot has resulted in a reduction of total program liabilities from $7.44 million to $6 million.

The key challenges the City faces are steep increases in pension costs over the next seven years as the effects of the California Public Employees’ Retirement System (CalPERS) discount rate decrease from 7.5% to 7.0% impact pension contribution rates starting in FY 2018-19, and continued increases in workers’ compensation costs and healthcare costs, all of which are outpacing revenue growth.

Even without an economic downturn in the next two years, the report warns that the "City will face increasingly hard choices in the next budget cycle." ...
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/ 2020 News, Daily News
Kain Kumar, 56, of Encino, a former doctor was sentenced to 24 months in federal prison for engaging in a multi-faceted Medicare fraud scheme, and also for illegal prescribing thousands of opioid painkillers and muscle relaxants.

Kumar pleaded guilty in April 2019 to one count of health care fraud and one count of distribution of hydrocodone. He practiced internal medicine, maintained medical offices in Palmdale, Rosamond, and Ridgecrest and surrendered his medical license last year.

Kumar was also ordered to pay financial penalties totaling more than $1 million, consisting of $509,365 in restitution, $494,900 in asset forfeiture, and a $72,000 fine.

Kumar defrauded the Medicare health care benefit program by prescribing unnecessary home health services in exchange for the payment of illegal kickbacks to him from a La Verne-based home health agency called Star Home Health Resources, Inc. According to the indictment in this case, Medicare paid $4,398,599 to Star based on the illegal kickback-tainted referrals from Kumar.

In furtherance of this scheme, Kumar caused false and fraudulent claims for reimbursement to be submitted to Medicare for Medicare beneficiaries that he did not personally examine or for patients he only briefly examined. Kumar also prescribed drugs that were not medically necessary and which were paid for by the Medicare Part D program.

Kumar admitted in his plea agreement that he illegally prescribed 23,826 pills of the opioid drug hydrocodone (commonly sold under the brand name Vicodin or Norco) and 38,459 pills of the muscle-relaxer carisoprodol (sold under the brand name Soma). Kumar directed his office staff - who were not medical professionals - to issue prescriptions for these drugs to patients even though Kumar had not examined the patients.

Kumar directed his office staff to sign his name on prescriptions for opioid drugs and also provided his staff with pre-signed prescriptions. In one instance, although Kumar examined a patient only once on the patient’s very first visit, and thereafter he caused prescriptions to be issued to the patient for hydrocodone and carisoprodol on a monthly basis for approximately a year and a half even though Kumar did not actually see the patient for any subsequent physician examination.

Kumar is the fifth and final defendant sentenced in this case. Elaine C. Lat, 50, of Fontana, was Star’s chief operating officer and the case’s lead defendant. She is serving a 30-month prison sentence in this matter after pleading guilty in May 2017 to one count of conspiracy and four counts of paying illegal kickbacks. Three other defendants, including Lat’s parents, each pleaded guilty to criminal charges and were sentenced in this matter.

This conviction was a violation of the terms of his probation with the California Medical Board arising out of a 2014 finding of gross negligence in the care of a 16 year old patient. He surrendered his medical license in September 2019 following a Medical Board disciplinary action seeking to revoke his probation ...
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/ 2020 News, Daily News
The State Compensation Insurance Fund has recruited a high-priced team of former executives from the private sector to turn it around after years of scandal and financial problems.

But MSN reports that the hires are earning six-figure salaries that dwarf others in state government, drawing concerns from some in the state Capitol who question the cost as the agency rebuilds following investigations in years past that led to the removal of top managers and mass layoffs forced by loss of business.

The State Fund, has also been criticized for hiring the spouses and adult children of agency managers. Its 11-member board of directors, which is appointed by the governor and legislative leaders, has become a soft landing spot for former lawmakers and other political insiders.

Bonuses and incentives awarded by State Fund’s board have boosted compensation to more than $500,000 each for its seven top managers including its CEO, whose annual pay is some $732,000 - more than three times the $210,000 salary of the governor. The salaries have prompted some lawmakers to call for an oversight hearing to determine whether the compensation is justified.

Agency officials including Board Chairman David M. Lanier say the compensation is warranted because of the unique mission of State Fund, which was created by the Legislature in 1914 to provide workers’ compensation insurance to businesses in the state, including those who can’t afford coverage from the private sector.

"The challenge we have is it’s a billion-dollar insurance company," Lanier said. "There’s not another one of those in state government, so we need and value talent and expertise from the insurance industry."

The agency’s biggest troubles began in 2007, when State Fund’s board fired its president and vice president after an audit found questionable financial practices involving the sale of discounted policies through outside associations linked to some board members. The scandal also resulted in the resignation of two board members whose private companies collected at least $265 million over 10 years from State Fund for administering group policy programs.

In 2011, State Fund laid off 25% of its 6,800 workers in response to its loss of market share. And its workforce has continued to drop, sitting now at 4,270 employees.

In the years after the scandal, the board of directors sought to expand its powers by persuading the Legislature to increase from one to 16 the number of executive positions exempt from civil service rules and pay scales.

In 2014, the board appointed Vernon Steiner as president and CEO of State Fund, who touted his 30 years of experience in the insurance industry. He received a base salary of $450,000 as well as various performance-linked bonuses.

In November, the State Fund board approved raises in base salary, bonuses and incentive payments for 17 managers, including Steiner, whose base pay this year has been increased by $36,000, or 7%, to $544,450. By comparison, State Fund’s then-CEO was paid $273,000 in 2007 ...
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/ 2020 News, Daily News
Last year, California enacted AB-5, legislation that could force app-based companies to make anyone who finds work on their platforms employees. The law has already created confusion and unintended consequences for dozens of industries.

California’s broad-based, blunt-instrument law, has resulted in independent musicians being warned they’ll no longer be able to record in many studios and truck drivers learning that their pay could fall significantly. A few weeks ago, Vox announced it would lay off 200 freelance journalists in an effort to comply with the law.

Despite the issues California’s legislation has already created, the New York Daily News reports that many New York legislators seem interested in passing a similar law.

New York is already a national leader in providing non-traditional workers access to traditional benefits. Almost 25 years ago, New York created a first-of-its-kind fund, the Black Car Fund, to provide protections to drivers. For decades the fund was limited in the kinds of services it could provide. However, thanks to a groundbreaking piece of legislation signed by Gov. Cuomo in December, it can now offer a broad range of protections and benefits, including health care.

Today, rideshare and for-hire vehicle riders in New York pay a small fee on all their trips that is allocated to the Black Car Fund. In exchange, the fund provides benefits including workers compensation, vision care, telemedicine, mental health care, wellness services and more.

Experts have talked about a portable benefits fund for gig economy workers for years. In many ways, the Black Car Fund was, and remains, the closest thing in the country to a true portable benefits fund. And it works, covering more than 130,000 drivers across more than 400 bases ...
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/ 2020 News, Daily News
A federal judge in California has temporarily halted the start date of AB-5, a law that would potentially change how independent truck drivers are classified. The TRO will remain in effect until Jan. 13, the date of a hearing on a plaintiff’s motion to seek a preliminary injunction against the law.

Judge Roger Benitez from the Southern District Court of California on Dec. 31 issued a temporary restraining order against the implementation of California’s Assembly Bill 5. The legislation, which was set to take effect Jan. 1, potentially would reclassify tens of thousands of independent contractors as employees. Trucking industry officials fear that the law would remove opportunities for drivers to own their own businesses and work as independent owner-operators in California.

The Temporary Restraining Order - which pertains exclusively to the trucking industry - was issued in response to a Dec. 24 request from the California Trucking Association seeking a delay in the law’s implementation.

In November, CTA filed a lawsuit challenging AB 5 in which the group argued that many of the drivers it represents want to remain independent contractors, as this permits them the ability to set their own schedules and otherwise profit from owning their own vehicle. The association said enforcing AB 5 would force these drivers to be treated as employees and forfeit those benefits.

CTA argued that the "B" prong of the ABC test is pre-empted by the Federal Aviation Administration Authorization Act of 1994, which prohibits any state from "enact[ing] or enforc[ing] a law, regulation, or other provision having the force and effect of law related to a price, route, or service of any motor carrier - with respect to the transportation of property."

Judge Benitez said that CTA’s contention warranted further consideration. "Plaintiffs have shown that AB 5’s Prong B is likely pre-empted by the FAAAA because AB 5 effectively mandates that motor carriers treat owner-operators as employees, rather than as the independent contractors that they are," he wrote.

In his order, Benitez wrote, "The court finds that a temporary restraining order is warranted. At this early stage of the proceedings and within the brief amount of time available, plaintiffs have carried their burden for purposes of emergency relief to show (1) that they are likely to succeed on the merits, (2) likely to suffer irreparable harm in the absence of relief, (3) that the balance of equities tips in their favor and (4) that their requested relief is in the public interest."

California Attorney General Xavier Becerra and the International Brotherhood of Teamsters are the defendants in the case ...
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/ 2020 News, Daily News
The ever increasing public outcry over the high price of medicines did little to stop drugmakers from raising prices again for 2020.

Drugmakers including Bristol-Myers Squibb, Gilead Sciences, and Biogen hiked U.S. list prices on more than 50 drugs on Wednesday, bringing total New Year’s Day drug price increases to more than 330 drugs, according to data analyzed by healthcare research firm 3 Axis Advisors.

Companies may be delaying some of those increases to later this month to escape early January scrutiny.

The drug price increases include some blockbuster drugs: the price of Humira, which treats arthritis and other conditions, rose 7.4 percent, and the price of Revlimid, which treats multiple myeloma, rose 6 percent, according to the data.

Drugmakers have traditionally raised prices at the start of a new year, and the data shows that the price increases are continuing, even as outcry over high drug prices rises in Washington. Nearly all of the price increases are below 10%, with the median price increase around 5%, according to 3 Axis.

Under pressure from politicians and patients, many makers of branded drugs have pledged to keep their U.S. list price increases below 10% a year.

"Double-digit increases largely appear to be a thing of the past," Bloomberg Intelligence analyst Brian Rye said. Many drugmakers have vowed not to increase drug prices by more than 10%. People with insurance generally pay much less than the list price of a drug.

Soaring healthcare costs for U.S. consumers, and prescription drug prices in particular, are expected to again be a central issue in the 2020 presidential campaign for both parties.

The United States, which leaves drug pricing to market competition, has higher prices than in other developed countries where governments directly or indirectly control the costs, making it the world’s most lucrative market for manufacturers ...
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/ 2020 News, Daily News
The mandatory reserve estimate for a lifetime medical award requires an estimate of the remaining life expectancy of the worker. There are many actuarial tables and other information that can be used to justify an estimate.

But, as modern medicine continues to improve and advance at an increasingly rapid rate, people all over the world are enjoying longer lifespans, on average, than ever before. Consequently, age-related dementia and Alzheimer’s disease are becoming common diagnoses in older adults. For example, in the United States alone Alzheimer’s is estimated to affect 5.7 million people.

Now, it appears help may soon be on the way in the form of a potential new vaccine that has shown success in mice testing.

Researchers from the University of California, Irvine believe that this immunotherapy combination vaccine should be ready for human trials within the next few years. The initial version of the vaccine was created by Flinders University professor Nikolai Petrovsky in South Australia, and it works by removing "brain plaque" and tau protein aggregates, both of which have been extensively linked to the development of Alzheimer’s disease.

The study is published in the scientific journal Alzheimer’s Research & Therapy.

Success in 2019 with mice models has opened the door towards more extensive research and development in 2020, researchers say.

If the vaccine can in fact remove accumulated beta-amyloid plaques and tau protein aggregates from human subjects brains, just as it was able to in mice that had already shown signs pathologies, that should, in theory, stop the development of Alzheimer’s disease.

"Taken together, these findings warrant further development of this dual vaccination strategy - for ultimate testing in human Alzheimer’s disease," the study reads.

According to professor Petrovsky, researchers are hopeful they can proceed with human clinical trials in about two years.

This isn’t the first time a possible preventative drug for Alzheimer’s has shown promise, but every one of these drugs has ultimately faltered when it came time for human trials. With this in mind, the research team say they are determined and motivated to establish a successful vaccine that can, at the very least, delay and slow down the progression of Alzheimer’s.
...
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/ 2020 News, Daily News
Better late than never:

On December 31 the Internal Revenue Service issued the 2020 standard mileage rates. Beginning on January 1, 2020, the standard mileage rates for the use of a car, van, pickup or panel truck will be 57.5 cents per mile for business miles driven (down from 58 cents in 2019)

The standard mileage rate is based on an annual study of the fixed and variable costs of operating an automobile.

California Labor Code §4600 (e)(2), working in conjunction with Government Code §19820 and Department of Personnel Administration regulations, requires claims administrators to reimburse injured workers for such expenses at the rate adopted by the Director of the Department of Personnel Administration for non-represented (excluded) state employees, which is tied to the IRS published mileage rate.

As a result, effective for travel on or after January 1, 2020, the rate that California workers’ compensation claims administrators pay injured workers for travel related to medical care or evaluation of their injuries will also decrease to 57.5 cents per mile.

Our WorkCompAcademy.com sister publication, WorkCompApps.com has updated it's FREE mileage calculator which you can use from your desktop, tablet or smart-phone by going to WorkCompApps.com and selecting "Tables/Calculators" and then select "Calculate Mileage" from the drop down menu.

Also, the Division of Workers Compensation has posted an order adjusting the Ambulance Services section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.

The update order is effective for services rendered on or after January 1, 2020, and can be found at the DWC website’s OMFS page ...
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/ 2020 News, Daily News