The Physicians Foundation released the 2021 Survey of America’s Physicians, COVID-19 Impact Edition: A Year Later, that examines how COVID-19 has affected the nation’s physicians more than a year since the start of the pandemic, from increased burnout rates to the continued epidemic of physician suicide.
Over the past year, COVID-19 has greatly impacted physician wellbeing and mental health, with over 6 in 10 physicians (61%) reporting they experienced feelings of burnout.
This is a significant increase from the 40% of reported physicians in 2018. Yet only 14% of physicians reported they sought medical attention for their mental health symptoms.
Additionally, 8% of physicians indicated they have increased their use of medications, alcohol or illicit drugs weekly as a result of COVID-19’s effects on their practice or employment situation.
A total of 46% of physicians said they have isolated or withdrawn from other people in the last year, more than one in three said they felt hopeless or without a purpose, and 57% reported experiencing "inappropriate episodes of anger, tearfulness, or anxiety."
The report stated that "difficult working conditions such as a lack of personal protective equipment (PPE) and caring for patients who may be seriously ill for weeks -- along with burdensome administrative tasks, long hours, and grief over losing patients -- have become the norm, but little has been done to alleviate the heavy mental health toll on physicians."
Additional findings from the 2021 Survey include:
- - A significantly larger proportion of younger (64%) and female (69%) physicians reported frequently feeling burnout as compared to older (59%) and male (57%) physicians.
- - Physicians who were employed by hospitals or health systems experienced more frequent feelings of burnout (64%) as compared to independent physicians (56%).
- - Nearly 8 in 10 physicians indicated they experienced changes to their practice or employment as a result of COVID-19.
- - Almost half of physicians (49%) reported a reduction in income while 32% reported a reduction in staff as a result of the pandemic.
- - Nearly 70% of physicians indicated they anticipate continuing the use of telehealth in their ongoing practice.
- - Despite the high rates of burnout, nearly half (46%) of physicians said they would still recommend medicine as a career option to young people.
A total of 23% of physicians, across a range of demographics, said they want to retire in the next year, a drop from the 38% who reported wanting to retire in 2020 ...
Over the past year, COVID-19 has greatly impacted physician wellbeing and mental health, with over 6 in 10 physicians (61%) reporting they experienced feelings of burnout.
This is a significant increase from the 40% of reported physicians in 2018. Yet only 14% of physicians reported they sought medical attention for their mental health symptoms.
Additionally, 8% of physicians indicated they have increased their use of medications, alcohol or illicit drugs weekly as a result of COVID-19’s effects on their practice or employment situation.
A total of 46% of physicians said they have isolated or withdrawn from other people in the last year, more than one in three said they felt hopeless or without a purpose, and 57% reported experiencing "inappropriate episodes of anger, tearfulness, or anxiety."
The report stated that "difficult working conditions such as a lack of personal protective equipment (PPE) and caring for patients who may be seriously ill for weeks -- along with burdensome administrative tasks, long hours, and grief over losing patients -- have become the norm, but little has been done to alleviate the heavy mental health toll on physicians."
Additional findings from the 2021 Survey include:
- - A significantly larger proportion of younger (64%) and female (69%) physicians reported frequently feeling burnout as compared to older (59%) and male (57%) physicians.
- - Physicians who were employed by hospitals or health systems experienced more frequent feelings of burnout (64%) as compared to independent physicians (56%).
- - Nearly 8 in 10 physicians indicated they experienced changes to their practice or employment as a result of COVID-19.
- - Almost half of physicians (49%) reported a reduction in income while 32% reported a reduction in staff as a result of the pandemic.
- - Nearly 70% of physicians indicated they anticipate continuing the use of telehealth in their ongoing practice.
- - Despite the high rates of burnout, nearly half (46%) of physicians said they would still recommend medicine as a career option to young people.
A total of 23% of physicians, across a range of demographics, said they want to retire in the next year, a drop from the 38% who reported wanting to retire in 2020 ...
At least $63 billion in improper payments, much of it fraud, have been distributed by the Federal government since the pandemic struck in March 2020. In California alone, state officials admitted that as much as 27% of unemployment benefits payments may have been fraudulent.
"Unemployment insurance fraud is probably the biggest fraud issue hitting banks today," says Naftali Harris, co-founder and CEO at San Francisco’s SentiLink, which just closed a $70 million round of venture capital to expand its business of helping financial institutions detect fake and stolen identities for new account applications.
According to the report in Forbes, Craft Ventures, a San Francisco-based venture firm, led the Series B round which brings SentiLink’s total capital raised to date to $85 million. Felicis, Andreessen Horowitz and NYCA also joined SentiLink’s latest capital infusion.
SentiLink plans to use the capital raised to continue to help institutions with this recent increase in fraud instances spurred by the CARES Act. They also plan to expand their fraud toolkit to prevent other types of scams, such as "J1 fraud" and "same name" fraud, and investigate new ones.
Harris’ team has seen a huge uptick in fraud rates affecting their clients, as high as 90% among new applications, associated with the CARES Act COVID relief. Fraudsters have been using the same name, social security number or date of birth in several applications, filing in high volumes in several states.
According to Harris, his team is currently verifying around a million account openings per day, and is working with more than 100 financial institutions - due to a non-disclosure agreement Harris could not comment on which financial institutions his company serves.
The company says that beyond simply using artificial intelligence to detect fraud, they have a risk operations team that catches in real time cases of synthetic fraud - a form of identity theft in which the defrauder combines a stolen Social Security Number (SSN) and fake information to create a false identity - that would normally go unnoticed by their clients.
Harris discovered this type of fraud when he was working as a data scientist at Affirm in 2017. At the time, synthetic fraud was relatively unknown, so when he saw that crooks were creating brand new identities instead of stealing existing ones to apply for credit, he founded SentiLink to focus on tackling this new scam. "We realized this was a really big issue and that nobody in the financial services industry was talking about it," says Harris.
Now, criminals are creating new identities or stealing existing ones to tap into unemployment benefits. Harris says the problem is not only them stealing from the government, but uncovering the tactics they use to deposit the stolen funds.
"What a lot of people don’t realize is that as a fraudster you have to be able to use the money stolen, and put it into the financial system," Harris says ...
"Unemployment insurance fraud is probably the biggest fraud issue hitting banks today," says Naftali Harris, co-founder and CEO at San Francisco’s SentiLink, which just closed a $70 million round of venture capital to expand its business of helping financial institutions detect fake and stolen identities for new account applications.
According to the report in Forbes, Craft Ventures, a San Francisco-based venture firm, led the Series B round which brings SentiLink’s total capital raised to date to $85 million. Felicis, Andreessen Horowitz and NYCA also joined SentiLink’s latest capital infusion.
SentiLink plans to use the capital raised to continue to help institutions with this recent increase in fraud instances spurred by the CARES Act. They also plan to expand their fraud toolkit to prevent other types of scams, such as "J1 fraud" and "same name" fraud, and investigate new ones.
Harris’ team has seen a huge uptick in fraud rates affecting their clients, as high as 90% among new applications, associated with the CARES Act COVID relief. Fraudsters have been using the same name, social security number or date of birth in several applications, filing in high volumes in several states.
According to Harris, his team is currently verifying around a million account openings per day, and is working with more than 100 financial institutions - due to a non-disclosure agreement Harris could not comment on which financial institutions his company serves.
The company says that beyond simply using artificial intelligence to detect fraud, they have a risk operations team that catches in real time cases of synthetic fraud - a form of identity theft in which the defrauder combines a stolen Social Security Number (SSN) and fake information to create a false identity - that would normally go unnoticed by their clients.
Harris discovered this type of fraud when he was working as a data scientist at Affirm in 2017. At the time, synthetic fraud was relatively unknown, so when he saw that crooks were creating brand new identities instead of stealing existing ones to apply for credit, he founded SentiLink to focus on tackling this new scam. "We realized this was a really big issue and that nobody in the financial services industry was talking about it," says Harris.
Now, criminals are creating new identities or stealing existing ones to tap into unemployment benefits. Harris says the problem is not only them stealing from the government, but uncovering the tactics they use to deposit the stolen funds.
"What a lot of people don’t realize is that as a fraudster you have to be able to use the money stolen, and put it into the financial system," Harris says ...
The U.S. Department of Justice just published its 124 page Annual Report of the Departments of Health and Human Services and Justice - Health Care Fraud and Abuse Control Program FY 2020.
The Annual Report of the Attorney General and the Secretary detailing expenditures and revenues under the Health Care Fraud and Abuse Control Program for fiscal year 2020 is provided as required by the Social Security Act.
During Fiscal Year 2020, the Federal Government won or negotiated more than $1.8 billion in health care fraud judgments and settlements, in addition to other health care administrative impositions.
Because of these efforts, as well as those of preceding years, almost $3.1 billion was returned to the Federal Government or paid to private persons in 2020. Of this $3.1 billion, the Medicare Trust Funds received transfers of approximately $2.1 billion during this period, in addition to the $128.2 million in Federal Medicaid money that was similarly transferred separately to the Treasury due to these efforts.
In 2020, the Department of Justice opened 1,148 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 412 cases involving 679 defendants. A total of 440 defendants were convicted of health care fraud related crimes during the year.
Also, in 2020, DOJ opened 1,079 new civil health care fraud investigations and had 1,498 civil health care fraud matters pending at the end of the fiscal year.
Federal Bureau of Investigation (FBI) investigative efforts resulted in over 407 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 101 health care fraud criminal enterprises.
In 2020, investigations conducted by HHS’s Office of Inspector General resulted in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 781 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters.
The Report highlights many of the major prosecutions starting on page 15 of the report. Many of them involved California companies.
The first ever kickback action against an EHR developer for receipt of remuneration from a pharmaceutical company involved Practice Fusion Inc., a health information technology developer based in San Francisco.
In 2020, it agreed to pay $145.0 million to resolve criminal and civil liability based on its solicitation and receipt of kickbacks from a major opioid company in exchange for implementing clinical decision support alerts in its EHR software that were designed to increase prescriptions for the drug company’s products, and agreed to pay over $26.0 million in criminal fines and forfeiture ...
The Annual Report of the Attorney General and the Secretary detailing expenditures and revenues under the Health Care Fraud and Abuse Control Program for fiscal year 2020 is provided as required by the Social Security Act.
During Fiscal Year 2020, the Federal Government won or negotiated more than $1.8 billion in health care fraud judgments and settlements, in addition to other health care administrative impositions.
Because of these efforts, as well as those of preceding years, almost $3.1 billion was returned to the Federal Government or paid to private persons in 2020. Of this $3.1 billion, the Medicare Trust Funds received transfers of approximately $2.1 billion during this period, in addition to the $128.2 million in Federal Medicaid money that was similarly transferred separately to the Treasury due to these efforts.
In 2020, the Department of Justice opened 1,148 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 412 cases involving 679 defendants. A total of 440 defendants were convicted of health care fraud related crimes during the year.
Also, in 2020, DOJ opened 1,079 new civil health care fraud investigations and had 1,498 civil health care fraud matters pending at the end of the fiscal year.
Federal Bureau of Investigation (FBI) investigative efforts resulted in over 407 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 101 health care fraud criminal enterprises.
In 2020, investigations conducted by HHS’s Office of Inspector General resulted in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 781 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters.
The Report highlights many of the major prosecutions starting on page 15 of the report. Many of them involved California companies.
The first ever kickback action against an EHR developer for receipt of remuneration from a pharmaceutical company involved Practice Fusion Inc., a health information technology developer based in San Francisco.
In 2020, it agreed to pay $145.0 million to resolve criminal and civil liability based on its solicitation and receipt of kickbacks from a major opioid company in exchange for implementing clinical decision support alerts in its EHR software that were designed to increase prescriptions for the drug company’s products, and agreed to pay over $26.0 million in criminal fines and forfeiture ...
45 year old Frank Simplicio, who lives in Porter Ranch, was arraigned on multiple felony counts of insurance fraud and perjury.
A Department of Insurance investigation revealed Simplicio allegedly claimed to be too injured to work in order to collect over $50,000 in disability payments from one employer’s insurance company while illegally working for other employers.
On May 2, 2017, Simplicio, while working as a greensman, filed a claim with his employer's insurance company stating cumulative trauma to his neck and back. He also claimed the job led to his diabetes, internal injuries and sleep disturbance. He reported the dates of his cumulative trauma injuries as July 19, 1996 through May 29, 2015. The claim however was filed two years after his alleged injuries.
The investigation found that Simplicio was paid Temporary Total Disability payments from February 20, 2018 through September 19, 2018, totaling $32,051. He also received Permanent Disability payments from September 20, 2018 through December 13, 2019, totaling $18,610.
In a deposition, Simplicio stated he was a landscaper, but he had not worked since the date of his injury. However, surveillance footage in October 2018 and February 2019 revealed Simplicio was actively working as a landscaper.
A search warrant was later issued for Simplicio's bank account records, which found he collected checks from clients from June 2015 through December 2019, totaling over $450,000. This does not include possible income from direct deposits through his account.
When told what the investigation found, the Qualified Medical Examiner who handled Simplicio's claim stated Simplicio lied and if they had known about his abilities and concurrent employment they would have never put him on Temporary Total Disability. Simplicio's alleged actions resulted in him receiving $50,661 in undeserved disability payments. The total loss for the insurance company in this case was over $100,000, which includes unnecessary medical, investigative, and legal costs.
Simplicio self-surrendered to the Los Angeles Superior Courthouse and was arraigned on July 29, 2021. The Los Angeles County District Attorney's Office is prosecuting this case ...
A Department of Insurance investigation revealed Simplicio allegedly claimed to be too injured to work in order to collect over $50,000 in disability payments from one employer’s insurance company while illegally working for other employers.
On May 2, 2017, Simplicio, while working as a greensman, filed a claim with his employer's insurance company stating cumulative trauma to his neck and back. He also claimed the job led to his diabetes, internal injuries and sleep disturbance. He reported the dates of his cumulative trauma injuries as July 19, 1996 through May 29, 2015. The claim however was filed two years after his alleged injuries.
The investigation found that Simplicio was paid Temporary Total Disability payments from February 20, 2018 through September 19, 2018, totaling $32,051. He also received Permanent Disability payments from September 20, 2018 through December 13, 2019, totaling $18,610.
In a deposition, Simplicio stated he was a landscaper, but he had not worked since the date of his injury. However, surveillance footage in October 2018 and February 2019 revealed Simplicio was actively working as a landscaper.
A search warrant was later issued for Simplicio's bank account records, which found he collected checks from clients from June 2015 through December 2019, totaling over $450,000. This does not include possible income from direct deposits through his account.
When told what the investigation found, the Qualified Medical Examiner who handled Simplicio's claim stated Simplicio lied and if they had known about his abilities and concurrent employment they would have never put him on Temporary Total Disability. Simplicio's alleged actions resulted in him receiving $50,661 in undeserved disability payments. The total loss for the insurance company in this case was over $100,000, which includes unnecessary medical, investigative, and legal costs.
Simplicio self-surrendered to the Los Angeles Superior Courthouse and was arraigned on July 29, 2021. The Los Angeles County District Attorney's Office is prosecuting this case ...
The Los Angeles Times recently ran a feature story about how the California Medical Board protects negligent doctors. The Times cited at least ten California physicians as examples.
One of the ten examples described in the article was Lokesh Tantuwaya, a San Diego spinal surgeon whose license has been revoked three times by the board, which placed him on probation each time. His license remains valid as he sits in jail awaiting trial on charges that he took more than $3 million in illegal kickbacks for surgeries in one of the biggest insurance scams in state history.
Tantuwaya, is a spinal surgeon who performed so many surgeries at a now-shuttered hospital in Long Beach that he was offered a private jet to commute to the facility, has become the subject of multiple malpractice lawsuits and a federal prosecution for his fraudulent healthcare schemes.
The kickback scheme came to light in 2018 and centered on Pacific Hospital of Long Beach which specialized in spinal and orthopedic procedures. The owner of Pacific Hospital, Michael D. Drobot, "conspired with doctors, chiropractors, and marketers to pay kickbacks in return for the referral of thousands of patients for spinal surgeries and other medical services paid for primarily through the California workers’ compensation system," according to the Department of Justice. During the last five years of its operation, there were more than $500 million in fraudulent medical bills associated with the hospital, and Drobot eventually went to federal prison.
One of Tantuwaya’s patients sued him for malpractice after she went in for a routine back surgery and it went so badly her leg had to be amputated. He was also charged with accepting millions in bribes to perform these surgeries. Yet, despite all of this on his record, the doctor remains licensed.
Tantuwaya was charged with accepting $3.2 million in bribes and was ordered to hand over his passport, a million dollars and the jet. However, he has not yet gone to trial, and has pleaded not guilty. In June of this year, a judge finally ruled he was a flight risk and confined him to Santa Ana jail only after federal agents learned he’d purchased his own private plane and had discussed "fitting it with an extended fuel tank, just in case he needed to go far away," according to a motion to revoke bond.
"If he were in any other profession, his license would be yanked," said Marian Hollingsworth, co-founder of the Patient Safety League, "Any reasonable person would ask, ‘Why does he still have his license?’"
His organization claims that as the battle between would-be reformers and the physicians’ professional association rages regularly in Sacramento. It gained fresh momentum this week in the wake of the Times investigation. "As injured patients and consumer rights groups fight for tougher penalties on grossly negligent doctors, California’s powerful physicians lobby is working hard behind the scenes to water down any proposed reforms. So far, the lobbyists seem to be winning."
For years, reformers have been demanding significant medical license fee increases to beef up enforcement and to alter the balance of the oversight board - from a physician majority to a public member majority - in the hope of getting more patient-friendly decisions in disciplinary cases.
Robert Fellmeth, executive director of the Center for Public Interest Law at the University of San Diego, called the California Medical Assn. a "pernicious cartel" that consistently fights to starve the state medical board of the funds needed to investigate doctors.
The political ties of the medical association have been well documented, particularly since Newsom’s well-publicized blunder sitting next to CMA’s chief executive and top lobbyist at an upscale Napa Valley restaurant last year, seeming to flout COVID-19 safety guidelines the governor had set.
State Senator Richard Roth (D-Riverside) said his bill, SB 806, has strong reforms, such as allowing the board to seek reimbursement from disciplined doctors for investigation and legal costs. The measure is crucial because, with no fee increases in 15 years, the board is "insolvent," Roth noted.
But in a message to members last June, the doctors’ lobbyists - the California Medical Association - claimed they got the ear of the senator sponsoring those reforms.
Gavin Newsom, whose office is responsible for appointing most of the board members, refused to be interviewed about The Times’ findings or to offer comment ...
One of the ten examples described in the article was Lokesh Tantuwaya, a San Diego spinal surgeon whose license has been revoked three times by the board, which placed him on probation each time. His license remains valid as he sits in jail awaiting trial on charges that he took more than $3 million in illegal kickbacks for surgeries in one of the biggest insurance scams in state history.
Tantuwaya, is a spinal surgeon who performed so many surgeries at a now-shuttered hospital in Long Beach that he was offered a private jet to commute to the facility, has become the subject of multiple malpractice lawsuits and a federal prosecution for his fraudulent healthcare schemes.
The kickback scheme came to light in 2018 and centered on Pacific Hospital of Long Beach which specialized in spinal and orthopedic procedures. The owner of Pacific Hospital, Michael D. Drobot, "conspired with doctors, chiropractors, and marketers to pay kickbacks in return for the referral of thousands of patients for spinal surgeries and other medical services paid for primarily through the California workers’ compensation system," according to the Department of Justice. During the last five years of its operation, there were more than $500 million in fraudulent medical bills associated with the hospital, and Drobot eventually went to federal prison.
One of Tantuwaya’s patients sued him for malpractice after she went in for a routine back surgery and it went so badly her leg had to be amputated. He was also charged with accepting millions in bribes to perform these surgeries. Yet, despite all of this on his record, the doctor remains licensed.
Tantuwaya was charged with accepting $3.2 million in bribes and was ordered to hand over his passport, a million dollars and the jet. However, he has not yet gone to trial, and has pleaded not guilty. In June of this year, a judge finally ruled he was a flight risk and confined him to Santa Ana jail only after federal agents learned he’d purchased his own private plane and had discussed "fitting it with an extended fuel tank, just in case he needed to go far away," according to a motion to revoke bond.
"If he were in any other profession, his license would be yanked," said Marian Hollingsworth, co-founder of the Patient Safety League, "Any reasonable person would ask, ‘Why does he still have his license?’"
His organization claims that as the battle between would-be reformers and the physicians’ professional association rages regularly in Sacramento. It gained fresh momentum this week in the wake of the Times investigation. "As injured patients and consumer rights groups fight for tougher penalties on grossly negligent doctors, California’s powerful physicians lobby is working hard behind the scenes to water down any proposed reforms. So far, the lobbyists seem to be winning."
For years, reformers have been demanding significant medical license fee increases to beef up enforcement and to alter the balance of the oversight board - from a physician majority to a public member majority - in the hope of getting more patient-friendly decisions in disciplinary cases.
Robert Fellmeth, executive director of the Center for Public Interest Law at the University of San Diego, called the California Medical Assn. a "pernicious cartel" that consistently fights to starve the state medical board of the funds needed to investigate doctors.
The political ties of the medical association have been well documented, particularly since Newsom’s well-publicized blunder sitting next to CMA’s chief executive and top lobbyist at an upscale Napa Valley restaurant last year, seeming to flout COVID-19 safety guidelines the governor had set.
State Senator Richard Roth (D-Riverside) said his bill, SB 806, has strong reforms, such as allowing the board to seek reimbursement from disciplined doctors for investigation and legal costs. The measure is crucial because, with no fee increases in 15 years, the board is "insolvent," Roth noted.
But in a message to members last June, the doctors’ lobbyists - the California Medical Association - claimed they got the ear of the senator sponsoring those reforms.
Gavin Newsom, whose office is responsible for appointing most of the board members, refused to be interviewed about The Times’ findings or to offer comment ...
The U.S. Department of Labor has awarded a $10 million State Apprenticeship Expansion, Equity and Innovation grant to the Department of Industrial Relations (DIR) to support the development and expansion of new and existing registered apprenticeship programs. DIR is one of five applicants that received the maximum $10 million in funds.
"DAS continues to be a leader in using new strategies to engage with employers and attract a diverse workforce," said Division of Apprenticeship Standards Chief, Eric Rood. "This award recognizes our dedication to apprenticeship and funds our ability to provide more career opportunities to all Californians."
The grant will help support DIR and its Division of Apprenticeship Standards’ (DAS) efforts to expand equity in apprenticeships to non-traditional industries by creating new ways to engage with employers, academic institutions and workforce development organizations.
This grant supports the following goals:
- - Expand the development, modernization and diversification of registered apprenticeship programs.
- - Increase the number of active enrolled apprentices.
- - Develop innovative programs and recruitment strategies.
The funds awarded will be used to foster regional collaborations in specific industries, such as the Inland Empire Cybersecurity Apprenticeship Consortium pilot program that launched this past May. The initiative addresses the 56% vacancy rate for cybersecurity jobs in the Inland Empire to fill the 70,000 cybersecurity vacancies throughout the state.
The consortium was the result of months of DAS engagement with stakeholders in the region, including employers, academic institutions, apprenticeship intermediaries and community-based organizations. Robert Half, one of the world’s largest staffing firms, was one of the businesses that participated.
"As a workforce development partner in the Inland Empire Cybersecurity Apprenticeship Consortium, Robert Half is excited to work alongside the State of California to accelerate the adoption of apprenticeships across many professional occupations," said Lynne Smith, senior vice president of human relations at Robert Half. "Apprenticeships mean more career opportunities and offer companies the chance to develop, diversify and retain talent in critical functions."
The Department of Industrial Relations’ Division of Apprenticeship Standards consults with employers to develop a skilled workforce, by establishing innovative apprenticeship programs that offer training to create viable career pathways for Californians ...
"DAS continues to be a leader in using new strategies to engage with employers and attract a diverse workforce," said Division of Apprenticeship Standards Chief, Eric Rood. "This award recognizes our dedication to apprenticeship and funds our ability to provide more career opportunities to all Californians."
The grant will help support DIR and its Division of Apprenticeship Standards’ (DAS) efforts to expand equity in apprenticeships to non-traditional industries by creating new ways to engage with employers, academic institutions and workforce development organizations.
This grant supports the following goals:
- - Expand the development, modernization and diversification of registered apprenticeship programs.
- - Increase the number of active enrolled apprentices.
- - Develop innovative programs and recruitment strategies.
The funds awarded will be used to foster regional collaborations in specific industries, such as the Inland Empire Cybersecurity Apprenticeship Consortium pilot program that launched this past May. The initiative addresses the 56% vacancy rate for cybersecurity jobs in the Inland Empire to fill the 70,000 cybersecurity vacancies throughout the state.
The consortium was the result of months of DAS engagement with stakeholders in the region, including employers, academic institutions, apprenticeship intermediaries and community-based organizations. Robert Half, one of the world’s largest staffing firms, was one of the businesses that participated.
"As a workforce development partner in the Inland Empire Cybersecurity Apprenticeship Consortium, Robert Half is excited to work alongside the State of California to accelerate the adoption of apprenticeships across many professional occupations," said Lynne Smith, senior vice president of human relations at Robert Half. "Apprenticeships mean more career opportunities and offer companies the chance to develop, diversify and retain talent in critical functions."
The Department of Industrial Relations’ Division of Apprenticeship Standards consults with employers to develop a skilled workforce, by establishing innovative apprenticeship programs that offer training to create viable career pathways for Californians ...
The United States has intervened in six complaints pending in Northern California federal court, alleging that members of the Kaiser Permanente consortium violated the False Claims Act by submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees in order to receive higher reimbursements.
The Kaiser Permanente consortium members (collectively Kaiser) are Kaiser Foundation Health Plan Inc., Kaiser Foundation Health Plan of Colorado, The Permanente Medical Group Inc., Southern California Permanente Medical Group Inc. and Colorado Permanente Medical Group P.C. Kaiser is headquartered in Oakland, California.
Under Medicare Advantage, also known as the Medicare Part C program, Medicare beneficiaries have the option of enrolling in managed care insurance plans called Medicare Advantage Plans (MA Plans). MA Plans are paid a per-person amount to provide Medicare-covered benefits to beneficiaries who enroll in one of their plans.
The Centers for Medicare and Medicaid Services (CMS), which oversees the Medicare program, adjusts the payments to MA Plans based on demographic information and the diagnoses of each plan beneficiary. The adjustments are commonly referred to as "risk scores." In general, a beneficiary with more severe diagnoses will have a higher risk score, and CMS will make a larger risk-adjusted payment to the MA Plan for that beneficiary.
Medicare requires that, for outpatient medical encounters, MA Plans submit diagnoses to CMS only for conditions that required or affected patient care, treatment or management during an in-person encounter in the service year.
In order to increase its Medicare reimbursements, Kaiser allegedly pressured its physicians to create addenda to medical records after the patient encounter, often months or over a year later, to add risk-adjusting diagnoses that patients did not actually have and/or were not actually considered or addressed during the encounter, in violation of Medicare requirements.
The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to receive a share of any recovery.
The False Claims Act also permits the government to intervene in such lawsuits, as it has done, in part, in these cases. The cases are consolidated in the Northern District of California and captioned United States ex rel. Osinek v. Kaiser Permanente, 3:13-cv-03891 (N.D. Cal.); United States ex rel. Taylor v. Kaiser Permanente, et al., 3:21-cv-03894 (N.D. Cal.); United States ex rel. Arefi, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-01558 (N.D. Cal.); United States ex rel. Stein, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-05337 (N.D. Cal.); United States ex rel. Bryant v. Kaiser Permanente, et al., 3:18-cv-01347 (N.D. Cal.); and United States ex rel. Bicocca v. Permanente Med. Group, Inc., et al., No. 3:21-cv-03124 (N.D. Cal.).
This matter was investigated by the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Offices for the Northern District of California and the District of Colorado, with assistance from HHS-OIG.
The claims in which the United States has intervened are allegations only, and there has been no determination of liability ...
The Kaiser Permanente consortium members (collectively Kaiser) are Kaiser Foundation Health Plan Inc., Kaiser Foundation Health Plan of Colorado, The Permanente Medical Group Inc., Southern California Permanente Medical Group Inc. and Colorado Permanente Medical Group P.C. Kaiser is headquartered in Oakland, California.
Under Medicare Advantage, also known as the Medicare Part C program, Medicare beneficiaries have the option of enrolling in managed care insurance plans called Medicare Advantage Plans (MA Plans). MA Plans are paid a per-person amount to provide Medicare-covered benefits to beneficiaries who enroll in one of their plans.
The Centers for Medicare and Medicaid Services (CMS), which oversees the Medicare program, adjusts the payments to MA Plans based on demographic information and the diagnoses of each plan beneficiary. The adjustments are commonly referred to as "risk scores." In general, a beneficiary with more severe diagnoses will have a higher risk score, and CMS will make a larger risk-adjusted payment to the MA Plan for that beneficiary.
Medicare requires that, for outpatient medical encounters, MA Plans submit diagnoses to CMS only for conditions that required or affected patient care, treatment or management during an in-person encounter in the service year.
In order to increase its Medicare reimbursements, Kaiser allegedly pressured its physicians to create addenda to medical records after the patient encounter, often months or over a year later, to add risk-adjusting diagnoses that patients did not actually have and/or were not actually considered or addressed during the encounter, in violation of Medicare requirements.
The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to receive a share of any recovery.
The False Claims Act also permits the government to intervene in such lawsuits, as it has done, in part, in these cases. The cases are consolidated in the Northern District of California and captioned United States ex rel. Osinek v. Kaiser Permanente, 3:13-cv-03891 (N.D. Cal.); United States ex rel. Taylor v. Kaiser Permanente, et al., 3:21-cv-03894 (N.D. Cal.); United States ex rel. Arefi, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-01558 (N.D. Cal.); United States ex rel. Stein, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-05337 (N.D. Cal.); United States ex rel. Bryant v. Kaiser Permanente, et al., 3:18-cv-01347 (N.D. Cal.); and United States ex rel. Bicocca v. Permanente Med. Group, Inc., et al., No. 3:21-cv-03124 (N.D. Cal.).
This matter was investigated by the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Offices for the Northern District of California and the District of Colorado, with assistance from HHS-OIG.
The claims in which the United States has intervened are allegations only, and there has been no determination of liability ...
The Workers’ Compensation Insurance Rating Bureau of California has published the September 1, 2021 update to the loss elimination ratios that were used in computation of classification relativities in the recently approved September 1, 2021 Regulatory Filing.
This annual update reflects the most current claim severity and benefit on-leveling factors. Additionally, the WCIRB has updated other tables included in the advisory California Retrospective Rating Plan, California Large Risk Deductible Plan and California Small Deductible Plan.
View the updated tables for the most current version of the advisory plans at the following links:
- - California Retrospective Rating Plan.
- - California Large Risk Deductible Plan.
- - California Small Deductible Plan.
In a Retrospective Rating Plan the insurance company typically issues a policy with both a minimum and maximum premium for the policy along with a rating formula. The actual, or final, premium is determined at the end of the policy period by the using the formula based on the rating factors and the actual losses. In essence, the plan is loss sensitive and the employer is participating in the cost of actual losses as well as the potential savings for lower than expected losses.
A Deductible Plan sets the amount of each loss that the employer must pay for each claim. Typically, the insurer pays the full amount of the loss and then bills the employer for the deductible amount.
Advisory plans are developed by the WCIRB for the convenience of its members. These plans were submitted to the Insurance Commissioner for informational purposes, but do not bear the official approval of the California Department of Insurance and are not a regulation. An insurer must make an independent assessment regarding its use of these plans based upon its particular facts and circumstances ...
This annual update reflects the most current claim severity and benefit on-leveling factors. Additionally, the WCIRB has updated other tables included in the advisory California Retrospective Rating Plan, California Large Risk Deductible Plan and California Small Deductible Plan.
View the updated tables for the most current version of the advisory plans at the following links:
- - California Retrospective Rating Plan.
- - California Large Risk Deductible Plan.
- - California Small Deductible Plan.
In a Retrospective Rating Plan the insurance company typically issues a policy with both a minimum and maximum premium for the policy along with a rating formula. The actual, or final, premium is determined at the end of the policy period by the using the formula based on the rating factors and the actual losses. In essence, the plan is loss sensitive and the employer is participating in the cost of actual losses as well as the potential savings for lower than expected losses.
A Deductible Plan sets the amount of each loss that the employer must pay for each claim. Typically, the insurer pays the full amount of the loss and then bills the employer for the deductible amount.
Advisory plans are developed by the WCIRB for the convenience of its members. These plans were submitted to the Insurance Commissioner for informational purposes, but do not bear the official approval of the California Department of Insurance and are not a regulation. An insurer must make an independent assessment regarding its use of these plans based upon its particular facts and circumstances ...
Hundreds of staffers at two major hospitals in San Francisco have tested positive for coronavirus in July, with most of them being breakthrough cases of the highly infectious Delta variant, The New York Times reported Saturday evening.
By the CDC's definition, a breakthrough infection is a COVID case that occurs in someone who is fully vaccinated, meaning 14 or more days after completing the recommended doses of an authorized vaccine. Some say the word "breakthrough" is a euphemism for a vaccine failure.
The University of California, San Francisco Medical Center told media outlets that 183 of its 35,000 staffers tested positive. Of those infected, 84% were fully vaccinated, and just two vaccinated staff members required hospitalization for their symptoms.
At Zuckerberg San Francisco General Hospital, at least 50 members out of the total 7,500 hospital staff were infected, with 75-80% of them vaccinated. None of those staffers required hospitalization.
UCSF's chief medical officer, Dr. Lukejohn Day, told The Times the numbers from his hospital showed just how important and effective vaccinations are.
"What we're seeing is very much what the data from the vaccines showed us: You can still get COVID, potentially. But if you do get it, it's not severe at all," Day said.
Day also told ABC7 News that at least 99% of the cases at UCSF were traced back to community spread, but that hospital officials are still investigating and conducting contact tracing.
He added that most of the cases presented mild to moderate symptoms, and some were completely asymptomatic. He said the cases were spread among doctors, nurses, and ancillary staff.
"We sort of are seeing that across the board," he said. "We have so far not detected any patient-to-staff or staff-to-patient transmission right now."
The highly infectious Delta variant has been deemed more transmissible than the viruses that cause the common cold, Ebola, and smallpox, and is equally as contagious as chickenpox, the US Centers for Disease Control and Prevention said in internal documents.
The Delta variant has also been known to spread among vaccinated people in breakthrough cases, prompting the recommendation, if not requirement,that even fully vaccinated people wear masks indoors in areas with high transmission rates ...
By the CDC's definition, a breakthrough infection is a COVID case that occurs in someone who is fully vaccinated, meaning 14 or more days after completing the recommended doses of an authorized vaccine. Some say the word "breakthrough" is a euphemism for a vaccine failure.
The University of California, San Francisco Medical Center told media outlets that 183 of its 35,000 staffers tested positive. Of those infected, 84% were fully vaccinated, and just two vaccinated staff members required hospitalization for their symptoms.
At Zuckerberg San Francisco General Hospital, at least 50 members out of the total 7,500 hospital staff were infected, with 75-80% of them vaccinated. None of those staffers required hospitalization.
UCSF's chief medical officer, Dr. Lukejohn Day, told The Times the numbers from his hospital showed just how important and effective vaccinations are.
"What we're seeing is very much what the data from the vaccines showed us: You can still get COVID, potentially. But if you do get it, it's not severe at all," Day said.
Day also told ABC7 News that at least 99% of the cases at UCSF were traced back to community spread, but that hospital officials are still investigating and conducting contact tracing.
He added that most of the cases presented mild to moderate symptoms, and some were completely asymptomatic. He said the cases were spread among doctors, nurses, and ancillary staff.
"We sort of are seeing that across the board," he said. "We have so far not detected any patient-to-staff or staff-to-patient transmission right now."
The highly infectious Delta variant has been deemed more transmissible than the viruses that cause the common cold, Ebola, and smallpox, and is equally as contagious as chickenpox, the US Centers for Disease Control and Prevention said in internal documents.
The Delta variant has also been known to spread among vaccinated people in breakthrough cases, prompting the recommendation, if not requirement,that even fully vaccinated people wear masks indoors in areas with high transmission rates ...
The National Safety Council is America’s leading nonprofit safety advocate - and has been for over 100 years.
As a mission-based organization, it works to eliminate the leading causes of preventable death and injury, focusing its efforts on the workplace.
It hopes to create a culture of safety to not only keep people safer at work, but also beyond the workplace so they can live their fullest lives.
The National Safety Council just announced 33 organizations will receive Industry Leader Awards in 2021 for excellent safety performance within their industries.
The Industry Leader Awards are one component of the NSC Occupational Awards Program, which recognizes outstanding safety achievements of NSC members and represents the top 5% of member companies that qualified for the NSC 2021 Occupational Excellence Achievement Award (based on 2020 calendar year data).
Winners are selected based on the North American Industry Classification System (NAICS) code, lowest total incidence rate and employee work hours.
One of the 33 award recipients is a California employer, California Resources Corporation. CRC is an oil and natural gas exploration and production company committed to environmentally sustainable and responsible development.
CRC explores for, produces, gathers, processes and markets crude oil, natural gas and natural gas liquids. it has a large portfolio of lower-risk conventional opportunities in each of California’s four major oil and gas basins: San Joaquin, Los Angeles, Ventura and Sacramento., LA Basin Operations, Long Beach, California.
The director of membership at the National Safety Council said that "It is truly an honor to recognize these 33 organizations for their commitment to advancing safety."
She added that "In an unprecedented year, these winners went above and beyond to exemplify what it means to protect employees from death and injury at work."
A sincere thank you and congratulations to each of these organizations, and CRC in our state, on prioritizing safety and saving lives ...
As a mission-based organization, it works to eliminate the leading causes of preventable death and injury, focusing its efforts on the workplace.
It hopes to create a culture of safety to not only keep people safer at work, but also beyond the workplace so they can live their fullest lives.
The National Safety Council just announced 33 organizations will receive Industry Leader Awards in 2021 for excellent safety performance within their industries.
The Industry Leader Awards are one component of the NSC Occupational Awards Program, which recognizes outstanding safety achievements of NSC members and represents the top 5% of member companies that qualified for the NSC 2021 Occupational Excellence Achievement Award (based on 2020 calendar year data).
Winners are selected based on the North American Industry Classification System (NAICS) code, lowest total incidence rate and employee work hours.
One of the 33 award recipients is a California employer, California Resources Corporation. CRC is an oil and natural gas exploration and production company committed to environmentally sustainable and responsible development.
CRC explores for, produces, gathers, processes and markets crude oil, natural gas and natural gas liquids. it has a large portfolio of lower-risk conventional opportunities in each of California’s four major oil and gas basins: San Joaquin, Los Angeles, Ventura and Sacramento., LA Basin Operations, Long Beach, California.
The director of membership at the National Safety Council said that "It is truly an honor to recognize these 33 organizations for their commitment to advancing safety."
She added that "In an unprecedented year, these winners went above and beyond to exemplify what it means to protect employees from death and injury at work."
A sincere thank you and congratulations to each of these organizations, and CRC in our state, on prioritizing safety and saving lives ...
The Division of Workers’ Compensation has issued a Notice of Public Hearing to amend the Copy Service Price Schedule. The Zoom public hearing is scheduled for Monday, August 30, 2021 at 10 a.m.
The proposed updates to the regulations include:
- - An increase of the flat rate for copy services from $180 to $225 for records up to 500 pages, and includes all associated services such as pagination, witness fees for delivery of records, and subpoena preparation.
- - Several provisions to address improper payments, such as a preclusion for medical providers to improperly charge for inspection of records, maximum witness fees from third party release of information services, and an increase for bills not paid within 30 days of billing.
- - A procedure to object to services provided within 30 days of a request by an injured worker to an employer, claims administrator or workers’ compensation insurer for copies of records in the employer’s possession that are relevant to the claim. It is not uncommon for an employee’s attorney to subpoena records even though they have been subpoenaed by defendant. The 30-day waiting period is triggered when the copy service advises the claims administrator of an intent to copy records from a specific location for a specific dispute. The parties would then have an opportunity to object within the waiting period. Once an objection is raised, the parties must meet and confer to resolve the objection.
- - DWC will also charge and collect retrieval costs for records requested under the Public Records Act.
The proposed amendments to the Copy Service Price Schedule are exempt from the rulemaking provisions of the Administrative Procedure Act. DWC is required to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period, and publish the order adopting the regulations online. Members of the public may review and comment on the proposal until August 30, 2021.
Members of the public may attend the public meeting:
Access Information
- - Join from PC, Mac, Linux, iOS or Android: https://dir-ca-gov.zoom.us/j/83062005767
- - Or Telephone:
- - Dial: USA 216 706 7005
- - USA 8664345269 (US Toll Free)
- - Conference code: 956474
Find local AT&T Numbers: ...
The proposed updates to the regulations include:
- - An increase of the flat rate for copy services from $180 to $225 for records up to 500 pages, and includes all associated services such as pagination, witness fees for delivery of records, and subpoena preparation.
- - Several provisions to address improper payments, such as a preclusion for medical providers to improperly charge for inspection of records, maximum witness fees from third party release of information services, and an increase for bills not paid within 30 days of billing.
- - A procedure to object to services provided within 30 days of a request by an injured worker to an employer, claims administrator or workers’ compensation insurer for copies of records in the employer’s possession that are relevant to the claim. It is not uncommon for an employee’s attorney to subpoena records even though they have been subpoenaed by defendant. The 30-day waiting period is triggered when the copy service advises the claims administrator of an intent to copy records from a specific location for a specific dispute. The parties would then have an opportunity to object within the waiting period. Once an objection is raised, the parties must meet and confer to resolve the objection.
- - DWC will also charge and collect retrieval costs for records requested under the Public Records Act.
The proposed amendments to the Copy Service Price Schedule are exempt from the rulemaking provisions of the Administrative Procedure Act. DWC is required to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period, and publish the order adopting the regulations online. Members of the public may review and comment on the proposal until August 30, 2021.
Members of the public may attend the public meeting:
Access Information
- - Join from PC, Mac, Linux, iOS or Android: https://dir-ca-gov.zoom.us/j/83062005767
- - Or Telephone:
- - Dial: USA 216 706 7005
- - USA 8664345269 (US Toll Free)
- - Conference code: 956474
Find local AT&T Numbers: ...
A new study from the Workers Compensation Research Institute examines the effects of must-access prescription drug monitoring programs (PDMPs) and recent regulations limiting the duration of initial opioid prescriptions on various outcomes for workers with work-related injuries.
"The policies examined were part of an extensive effort by stakeholders at local, state, and national levels to address potential excessive opioid prescribing and opioid abuse," said John Ruser, president and CEO of WCRI. "Must-access PDMPs reduced the amount of opioids prescribed to workers without changing the likelihood that workers had any opioid prescriptions."
The study, Effects of Opioid-Related Policies on Opioid Utilization, Nature of Medical Care, and Duration of Disability, explores how policies limiting access to opioid prescriptions contributed to changes in opioid utilization and how they altered other medical care related to the management of pain. The study estimates the effects of state-level opioid policies by comparing outcomes in states that adopted the policies relative to states that did not, while accounting for other factors that could have influenced changes in opioid utilization and the other outcomes studied.
In California, the prescription drug monitoring program is called Controlled Substance Utilization Review and Evaluation System (CURES). CURES is a database of Schedule II, Schedule III, Schedule IV and Schedule V controlled substance prescriptions dispensed in California. Section 11165.4 of the Health and Safety Code, sets forth the requirements for mandatory consultation of CURES.
The following are among the study’s findings:
- - Must-access PDMPs reduced the amount of opioids prescribed by 12 percent in the first year.
- - Regulations limiting duration of initial opioid prescriptions resulted in a 19 percent decrease in the amount of opioids among claims with opioids.
- - For most injuries, there was little evidence that workers increased the use of other types of care due to must-access PDMPs. However, for neurologic spine pain cases, the policies resulted in an increase in the number of non-opioid pain medications and an increase in whether workers had interventional pain management services.
- - Must-access PDMPs and limits on initial prescriptions had little impact on the duration of temporary disability benefits captured within 12 months after an injury.
The analysis includes information for workers injured between October 1, 2009, and March 31, 2018, in 33 states: Alabama, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin. These states represent 85 percent of benefits paid in 2017.
The authors of this study are David Neumark and Bogdan Savych. To learn more about this study or to download a copy, visit https://www.wcrinet.org/reports/effects-of-opioid-related-policies-on-opioid-utilization-nature-of-medical-care-and-duration-of-disability ...
"The policies examined were part of an extensive effort by stakeholders at local, state, and national levels to address potential excessive opioid prescribing and opioid abuse," said John Ruser, president and CEO of WCRI. "Must-access PDMPs reduced the amount of opioids prescribed to workers without changing the likelihood that workers had any opioid prescriptions."
The study, Effects of Opioid-Related Policies on Opioid Utilization, Nature of Medical Care, and Duration of Disability, explores how policies limiting access to opioid prescriptions contributed to changes in opioid utilization and how they altered other medical care related to the management of pain. The study estimates the effects of state-level opioid policies by comparing outcomes in states that adopted the policies relative to states that did not, while accounting for other factors that could have influenced changes in opioid utilization and the other outcomes studied.
In California, the prescription drug monitoring program is called Controlled Substance Utilization Review and Evaluation System (CURES). CURES is a database of Schedule II, Schedule III, Schedule IV and Schedule V controlled substance prescriptions dispensed in California. Section 11165.4 of the Health and Safety Code, sets forth the requirements for mandatory consultation of CURES.
The following are among the study’s findings:
- - Must-access PDMPs reduced the amount of opioids prescribed by 12 percent in the first year.
- - Regulations limiting duration of initial opioid prescriptions resulted in a 19 percent decrease in the amount of opioids among claims with opioids.
- - For most injuries, there was little evidence that workers increased the use of other types of care due to must-access PDMPs. However, for neurologic spine pain cases, the policies resulted in an increase in the number of non-opioid pain medications and an increase in whether workers had interventional pain management services.
- - Must-access PDMPs and limits on initial prescriptions had little impact on the duration of temporary disability benefits captured within 12 months after an injury.
The analysis includes information for workers injured between October 1, 2009, and March 31, 2018, in 33 states: Alabama, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin. These states represent 85 percent of benefits paid in 2017.
The authors of this study are David Neumark and Bogdan Savych. To learn more about this study or to download a copy, visit https://www.wcrinet.org/reports/effects-of-opioid-related-policies-on-opioid-utilization-nature-of-medical-care-and-duration-of-disability ...
In June 2016, Kirk Hollingsworth was involved in a fatal accident while working for defendant Heavy Transport, Inc. (HT).
Hollingsworth’s wife and son, plaintiffs Leanne and Mark Hollingsworth, filed a wrongful death complaint in superior court against HT and Bragg Investment Company, Inc.
Plaintiffs alleged that HT lacked the required workers’ compensation insurance at the time of the incident, and therefore plaintiffs were entitled to sue Bragg/HT under Labor Code section 3706, which states, "If any employer fails to secure the payment of compensation, any injured employee or his dependents may bring an action at law against such employer for damages . . . ."
Bragg/HT then filed an application for adjudication of claim with the Workers’ Compensation Appeals Board. Only one of these tribunals could have exclusive jurisdiction over plaintiffs’ claims, and in a previous court of appeal opinion, Hollingsworth v. Superior Court (2019) 37 Cal.App.5th 927 (Hollingsworth I), the court held that the superior court, which had exercised jurisdiction first, should resolve the questions that would determine which tribunal had exclusive jurisdiction over plaintiffs’ claims.
Following remand, plaintiffs asserted they were entitled to a jury trial on the factual issues that would determine jurisdiction. The superior court denied plaintiffs’ request and held a hearing in which it received evidence and heard testimony regarding HT’s insurance status. The superior court determined that HT was insured by a workers’ compensation policy at the time of Hollingsworth’s death, and therefore the WCAB had exclusive jurisdiction over the matter. Plaintiffs appealed. The court of appeal affirmed the trial court in the published case of Hollingsworth v. Heavy Transport, Inc.
Plaintiffs assert on appeal, that they were entitled to a jury trial on the fact issues that would determine jurisdiction. The appellate court disagreed.
Although a jury may determine questions relevant to workers’ compensation exclusivity when the issue is raised as an affirmative defense to common law claims, jurisdiction under Labor Code section 3706 is an issue of law for the court to decide.
Citing numerous decisions, the court said that it is the general rule that "[i]n a civil case . . . personal and subject matter jurisdiction ordinarily are issues for the court, not the jury."
Because plaintiffs asserted jurisdiction under Labor Code section 3706, it was appropriate for the court, not a jury, to determine the questions relevant to jurisdiction. Plaintiffs did not have a right to a jury trial on these facts ...
Hollingsworth’s wife and son, plaintiffs Leanne and Mark Hollingsworth, filed a wrongful death complaint in superior court against HT and Bragg Investment Company, Inc.
Plaintiffs alleged that HT lacked the required workers’ compensation insurance at the time of the incident, and therefore plaintiffs were entitled to sue Bragg/HT under Labor Code section 3706, which states, "If any employer fails to secure the payment of compensation, any injured employee or his dependents may bring an action at law against such employer for damages . . . ."
Bragg/HT then filed an application for adjudication of claim with the Workers’ Compensation Appeals Board. Only one of these tribunals could have exclusive jurisdiction over plaintiffs’ claims, and in a previous court of appeal opinion, Hollingsworth v. Superior Court (2019) 37 Cal.App.5th 927 (Hollingsworth I), the court held that the superior court, which had exercised jurisdiction first, should resolve the questions that would determine which tribunal had exclusive jurisdiction over plaintiffs’ claims.
Following remand, plaintiffs asserted they were entitled to a jury trial on the factual issues that would determine jurisdiction. The superior court denied plaintiffs’ request and held a hearing in which it received evidence and heard testimony regarding HT’s insurance status. The superior court determined that HT was insured by a workers’ compensation policy at the time of Hollingsworth’s death, and therefore the WCAB had exclusive jurisdiction over the matter. Plaintiffs appealed. The court of appeal affirmed the trial court in the published case of Hollingsworth v. Heavy Transport, Inc.
Plaintiffs assert on appeal, that they were entitled to a jury trial on the fact issues that would determine jurisdiction. The appellate court disagreed.
Although a jury may determine questions relevant to workers’ compensation exclusivity when the issue is raised as an affirmative defense to common law claims, jurisdiction under Labor Code section 3706 is an issue of law for the court to decide.
Citing numerous decisions, the court said that it is the general rule that "[i]n a civil case . . . personal and subject matter jurisdiction ordinarily are issues for the court, not the jury."
Because plaintiffs asserted jurisdiction under Labor Code section 3706, it was appropriate for the court, not a jury, to determine the questions relevant to jurisdiction. Plaintiffs did not have a right to a jury trial on these facts ...
Three years ago, pharma giant Pfizer paid $24 million to settle federal allegations that it was paying kickbacks and inflating sales by reimbursing Medicare patients for out-of-pocket medication costs.
By making prohibitively expensive medicine essentially free for patients, the company induced them to use Pfizer drugs even as the price of one of those medicines, covered by Medicare and Medicaid, soared 44% to $225,000 a year, the Justice Department alleged.
Now, Kaiser Health News reports that Pfizer is suing the federal authorities to legalize essentially the same practice it was accused of three years ago - a fighting response to a federal crackdown that has resulted in a dozen drug companies being accused of similar practices.
A Pfizer win could cost taxpayers billions of dollars and erase an important control on pharma marketing after decades of regulatory erosion and soaring drug prices, say health policy analysts. A federal judge's ruling is expected any day.
"If this is legal for Pfizer, Pfizer will not be the only pharmaceutical company to use this, and there will effectively be a gold rush," government lawyer Jacob Lillywhite said in oral arguments last month.
Pfizer's legal argument "is aggressive," said Chris Robertson, a professor of health law at Boston University. "But I think they've got such a political tailwind behind them" because of pocketbook pain over prescription medicine - even though it's caused by pharma manufacturers. Pfizer's message, "'We’re just trying to help people afford their drugs,' is pretty attractive," he said.
That's not all that's working in Pfizer's favor. Courts and regulations have been moving pharma's way since the Food and Drug Administration allowed limited TV drug ads in the 1980s. Other companies of all kinds also have gained free speech rights allowing aggressive marketing and political influence that would have been unthinkable decades ago, legal scholars say.
Among other court arguments, Pfizer initially claimed that current regulation violates its speech protections under the First Amendment, essentially saying it should be allowed to communicate freely with third-party charities to direct patient assistance.
"It's infuriating to realize that, as outlandish as they seem, these types of claims are finding a good deal of traction before many courts," said Michelle Mello, a professor of law and medicine at Stanford University. "Drug companies are surely aware that the judicial trend has been toward more expansive recognition of commercial speech rights."
Pfizer's lawsuit, in the Southern District of New York, seeks a judge's permission to directly reimburse patient expenses for two of its heart-failure drugs each costing $225,000 a year. An outside administrator would use Pfizer contributions to cover Medicare copays, deductibles and coinsurance for those drugs, which otherwise would cost patients about $13,000 a year.
Letting pharma companies put money directly into patients' pockets to pay for their own expensive medicines "does induce people to get a specific product" instead of shopping for a cheaper or more effective alternative, said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University. "It's kind of the definition of a kickback."
Government rule-makers have warned against such payments since the launch of Medicare's Part D drug benefit in 2006. Drug companies routinely help privately insured patients with cost sharing through coupons and other means, but private carriers can negotiate the overall price.
Because Congress gave Medicare no control over prescription drug prices, having patients share at least part of the cost is the only economic force guarding against unlimited price hikes and industry profits at taxpayer expense.
At the same time, however, regulators have allowed the industry to help patients with copays by routing money through outside charities - but only as long as the charities are "bona fide, independent" organizations that don't match drugmaker money with specific drugs.
Several charities have blatantly violated that rule in recent years by colluding with pharma companies to subsidize particular drugs, the Justice Department has alleged. A dozen companies have paid more than $1 billion to settle allegations of kickback violations.
...
By making prohibitively expensive medicine essentially free for patients, the company induced them to use Pfizer drugs even as the price of one of those medicines, covered by Medicare and Medicaid, soared 44% to $225,000 a year, the Justice Department alleged.
Now, Kaiser Health News reports that Pfizer is suing the federal authorities to legalize essentially the same practice it was accused of three years ago - a fighting response to a federal crackdown that has resulted in a dozen drug companies being accused of similar practices.
A Pfizer win could cost taxpayers billions of dollars and erase an important control on pharma marketing after decades of regulatory erosion and soaring drug prices, say health policy analysts. A federal judge's ruling is expected any day.
"If this is legal for Pfizer, Pfizer will not be the only pharmaceutical company to use this, and there will effectively be a gold rush," government lawyer Jacob Lillywhite said in oral arguments last month.
Pfizer's legal argument "is aggressive," said Chris Robertson, a professor of health law at Boston University. "But I think they've got such a political tailwind behind them" because of pocketbook pain over prescription medicine - even though it's caused by pharma manufacturers. Pfizer's message, "'We’re just trying to help people afford their drugs,' is pretty attractive," he said.
That's not all that's working in Pfizer's favor. Courts and regulations have been moving pharma's way since the Food and Drug Administration allowed limited TV drug ads in the 1980s. Other companies of all kinds also have gained free speech rights allowing aggressive marketing and political influence that would have been unthinkable decades ago, legal scholars say.
Among other court arguments, Pfizer initially claimed that current regulation violates its speech protections under the First Amendment, essentially saying it should be allowed to communicate freely with third-party charities to direct patient assistance.
"It's infuriating to realize that, as outlandish as they seem, these types of claims are finding a good deal of traction before many courts," said Michelle Mello, a professor of law and medicine at Stanford University. "Drug companies are surely aware that the judicial trend has been toward more expansive recognition of commercial speech rights."
Pfizer's lawsuit, in the Southern District of New York, seeks a judge's permission to directly reimburse patient expenses for two of its heart-failure drugs each costing $225,000 a year. An outside administrator would use Pfizer contributions to cover Medicare copays, deductibles and coinsurance for those drugs, which otherwise would cost patients about $13,000 a year.
Letting pharma companies put money directly into patients' pockets to pay for their own expensive medicines "does induce people to get a specific product" instead of shopping for a cheaper or more effective alternative, said Stacie Dusetzina, an associate professor of health policy at Vanderbilt University. "It's kind of the definition of a kickback."
Government rule-makers have warned against such payments since the launch of Medicare's Part D drug benefit in 2006. Drug companies routinely help privately insured patients with cost sharing through coupons and other means, but private carriers can negotiate the overall price.
Because Congress gave Medicare no control over prescription drug prices, having patients share at least part of the cost is the only economic force guarding against unlimited price hikes and industry profits at taxpayer expense.
At the same time, however, regulators have allowed the industry to help patients with copays by routing money through outside charities - but only as long as the charities are "bona fide, independent" organizations that don't match drugmaker money with specific drugs.
Several charities have blatantly violated that rule in recent years by colluding with pharma companies to subsidize particular drugs, the Justice Department has alleged. A dozen companies have paid more than $1 billion to settle allegations of kickback violations.
...
The WCIRB just published its 2021 State of the System report. Highlights of the report show the recent changes in premium revenue, claims, and costs.
The sharp and sudden employment drops in 2020 significantly impacted workers’ compensation exposure, the number of claim filings and claims activity. Premium levels dropped sharply in 2020 due to continued insurer rate decreases and the pandemic-related economic slowdown. Premiums are forecast to increase modestly in 2021 with economic recovery and the impact of insurer rate decreases moderating.
The insurance market remains stable and non-concentrated. Insurer charged rates continue to decrease and are now at a 50-year low. Average indemnity claim costs are rising, while average medical claim costs remain relatively flat. The impact of the pandemic on average claim costs in the long-term remains uncertain.
Average insurer rates charged for the first quarter of 2021 are only 2% below the rates charged in 2020, possibly signaling a sign of moderating insurer rate decreases and potential future hardening of the insurance market. Total written premium is forecast to increase modestly in 2021 with the economic recovery and moderation of the impact of declining premium rates, but would still be well below the level from 2014 to 2019.
California had the highest rates in the country until 2018, when rate declines moved it from the top spot. It is now the fourth highest, behind New Jersey, New York, and Vermont.
Almost 150,000 COVID-19 claims have been filed in the California workers’ compensation system. The impact of the filing of so many COVID-19 claims in 2020 on claim frequency was in part offset by a reduction in the number of non-COVID-19 claims filed. Over one-half of the almost 150,000 COVID-19 claims filed in the California workers’ comp system as of June 1, 2021 were within the insured system.
Over time, the ratio of COVID-19 claims relative to statewide infections declined as the COVID- 19 workers’ compensation presumption created by Senate Bill (SB) No. 1159 was more restrictive than the Governor’s Executive Order issued in spring 2020.
The winter surge resulted in over 2 million infections statewide and the largest volume of COVID-19 workers’ compensation claims filed during the pandemic. COVID-19 claims as a percent of all indemnity claims peaked in December 2020 during the winter surge of infections. As vaccines rolled out in spring 2021, the proportion of COVID-19 claims has been very modest. A much higher than projected share of COVID-19 claims has been filed by younger workers. Younger individuals are more likely to have mild COVID-19 symptoms.
Currently projected costs of COVID-19 claims in the insured system for accident years 2020 and 2021 are over $1 billion in total.
Preliminary estimates suggest the CT claim share of indemnity claims for accident years 2020 and 2021 are significantly below the 2018 and 2019 levels. The vast majority of increases in CT claims since 2012 came from the Los Angeles Basin and San Diego areas.
Following the implementation of reforms related to lien filings of SB 863 (in 2013) and SB 1160 and Assembly Bill (AB) 1244 (in 2017), the number of lien filings dropped significantly. The number of liens filed in 2020 is over 70% below the pre- SB 1160 and AB 1244 level.
Combined ratios in California have historically been volatile. Recent industry ratios have been fairly stable, with seven consecutive years of combined ratios below 100% from 2012 to 2019. Combined ratios since 2016 have been increasing primarily due to lower premium levels driven by lower insurer rates and higher expense ratios. The combined ratio for 2020 is the first above 100% since 2012. Excluding the impact of COVID-19 claims, the 2020 combined ratio would be 96% ...
The sharp and sudden employment drops in 2020 significantly impacted workers’ compensation exposure, the number of claim filings and claims activity. Premium levels dropped sharply in 2020 due to continued insurer rate decreases and the pandemic-related economic slowdown. Premiums are forecast to increase modestly in 2021 with economic recovery and the impact of insurer rate decreases moderating.
The insurance market remains stable and non-concentrated. Insurer charged rates continue to decrease and are now at a 50-year low. Average indemnity claim costs are rising, while average medical claim costs remain relatively flat. The impact of the pandemic on average claim costs in the long-term remains uncertain.
Average insurer rates charged for the first quarter of 2021 are only 2% below the rates charged in 2020, possibly signaling a sign of moderating insurer rate decreases and potential future hardening of the insurance market. Total written premium is forecast to increase modestly in 2021 with the economic recovery and moderation of the impact of declining premium rates, but would still be well below the level from 2014 to 2019.
California had the highest rates in the country until 2018, when rate declines moved it from the top spot. It is now the fourth highest, behind New Jersey, New York, and Vermont.
Almost 150,000 COVID-19 claims have been filed in the California workers’ compensation system. The impact of the filing of so many COVID-19 claims in 2020 on claim frequency was in part offset by a reduction in the number of non-COVID-19 claims filed. Over one-half of the almost 150,000 COVID-19 claims filed in the California workers’ comp system as of June 1, 2021 were within the insured system.
Over time, the ratio of COVID-19 claims relative to statewide infections declined as the COVID- 19 workers’ compensation presumption created by Senate Bill (SB) No. 1159 was more restrictive than the Governor’s Executive Order issued in spring 2020.
The winter surge resulted in over 2 million infections statewide and the largest volume of COVID-19 workers’ compensation claims filed during the pandemic. COVID-19 claims as a percent of all indemnity claims peaked in December 2020 during the winter surge of infections. As vaccines rolled out in spring 2021, the proportion of COVID-19 claims has been very modest. A much higher than projected share of COVID-19 claims has been filed by younger workers. Younger individuals are more likely to have mild COVID-19 symptoms.
Currently projected costs of COVID-19 claims in the insured system for accident years 2020 and 2021 are over $1 billion in total.
Preliminary estimates suggest the CT claim share of indemnity claims for accident years 2020 and 2021 are significantly below the 2018 and 2019 levels. The vast majority of increases in CT claims since 2012 came from the Los Angeles Basin and San Diego areas.
Following the implementation of reforms related to lien filings of SB 863 (in 2013) and SB 1160 and Assembly Bill (AB) 1244 (in 2017), the number of lien filings dropped significantly. The number of liens filed in 2020 is over 70% below the pre- SB 1160 and AB 1244 level.
Combined ratios in California have historically been volatile. Recent industry ratios have been fairly stable, with seven consecutive years of combined ratios below 100% from 2012 to 2019. Combined ratios since 2016 have been increasing primarily due to lower premium levels driven by lower insurer rates and higher expense ratios. The combined ratio for 2020 is the first above 100% since 2012. Excluding the impact of COVID-19 claims, the 2020 combined ratio would be 96% ...
The Labor Commissioner’s Office cited three El Super grocery stores in Southern California for failing to provide or delaying supplemental paid sick leave (SPSL) or other benefits to 95 workers impacted by COVID-19. Some of the workers were forced to work while sick, others were told to apply for unemployment while quarantining or in isolation, while others waited months to be paid.
The citations were issued to Bodega Latina Corporation, a Delaware corporation doing business as El Super with 52 stores in California. The following locations in Los Angeles and San Bernardino counties were cited:
- - 1100 W Slauson Avenue, Los Angeles 90044
- - 10721 Atlantic Avenue, Lynwood 90262
- - 14590 Bear Valley Road # 28, Victorville 92395
The 2021 SPSL, which went into effect on March 29 and is retroactive to January 1, 2021, requires that California workers are provided up to two weeks of supplemental paid sick leave if they are affected by COVID-19. Among the key updates in the legislation, leave time also applies to attending a COVID-19 vaccine appointment and recovering from symptoms related to the vaccine.
The law is in effect until September 30, 2021. Small businesses employing 25 or fewer workers are exempt from the law but may offer supplemental paid sick leave and receive a federal tax credit, if eligible.
The Labor Commissioner’s Office opened an investigation on September 9, 2020 after receiving complaints from workers and a referral from the United Food and Commercial Workers International Union representing grocery store workers.
The investigators determined the employer did not consistently inform workers of their rights to SPSL if impacted by COVID-19. In some instances, sick workers were told to come to work until they received their test results even when they had COVID-19 symptoms. To cover isolation time, workers were in some cases told to apply for unemployment or disability. Moreover, many were denied time off to isolate, even though members of their household had tested positive. Some workers were never paid for their time off due to COVID-19.
The citations include $114,741.67 in wages, damages and interest for failing to provide leave under 2020 COVID-19 SPSL for food sector workers (Labor Code § 248), and $14,894.66 in wages, damages and interest for failing to provide leave under 2021 COVID-19 SPSL for employers with 26 or more employees (Labor Code § 248.2). In addition, $318,200 was assessed in penalties for nonpayment or late payment of SPSL (Labor Code § 246(n)).
Anyone who currently works or has worked at El Super who believes their employer refused to provide paid sick leave or COVID-19 supplemental paid sick leave as required by law is encouraged to call the Labor Commissioner’s Office confidential Paid Sick Leave Hotline at (855-526-7775) and leave their contact information. All workers can also call the Labor Commissioner’s Office to ask questions or get more information on how to file a wage claim for paid sick leave at 833-LCO-INFO (833-526-4636) ...
The citations were issued to Bodega Latina Corporation, a Delaware corporation doing business as El Super with 52 stores in California. The following locations in Los Angeles and San Bernardino counties were cited:
- - 1100 W Slauson Avenue, Los Angeles 90044
- - 10721 Atlantic Avenue, Lynwood 90262
- - 14590 Bear Valley Road # 28, Victorville 92395
The 2021 SPSL, which went into effect on March 29 and is retroactive to January 1, 2021, requires that California workers are provided up to two weeks of supplemental paid sick leave if they are affected by COVID-19. Among the key updates in the legislation, leave time also applies to attending a COVID-19 vaccine appointment and recovering from symptoms related to the vaccine.
The law is in effect until September 30, 2021. Small businesses employing 25 or fewer workers are exempt from the law but may offer supplemental paid sick leave and receive a federal tax credit, if eligible.
The Labor Commissioner’s Office opened an investigation on September 9, 2020 after receiving complaints from workers and a referral from the United Food and Commercial Workers International Union representing grocery store workers.
The investigators determined the employer did not consistently inform workers of their rights to SPSL if impacted by COVID-19. In some instances, sick workers were told to come to work until they received their test results even when they had COVID-19 symptoms. To cover isolation time, workers were in some cases told to apply for unemployment or disability. Moreover, many were denied time off to isolate, even though members of their household had tested positive. Some workers were never paid for their time off due to COVID-19.
The citations include $114,741.67 in wages, damages and interest for failing to provide leave under 2020 COVID-19 SPSL for food sector workers (Labor Code § 248), and $14,894.66 in wages, damages and interest for failing to provide leave under 2021 COVID-19 SPSL for employers with 26 or more employees (Labor Code § 248.2). In addition, $318,200 was assessed in penalties for nonpayment or late payment of SPSL (Labor Code § 246(n)).
Anyone who currently works or has worked at El Super who believes their employer refused to provide paid sick leave or COVID-19 supplemental paid sick leave as required by law is encouraged to call the Labor Commissioner’s Office confidential Paid Sick Leave Hotline at (855-526-7775) and leave their contact information. All workers can also call the Labor Commissioner’s Office to ask questions or get more information on how to file a wage claim for paid sick leave at 833-LCO-INFO (833-526-4636) ...
A Bronx man allegedly received $1.5 million in just ten months. A California real estate broker raked in more than $500,000 within half a year. A Nigerian government official is accused of pocketing over $350,000 in less than six weeks.
What they all had in common, according to federal prosecutors, was participation in what may turn out to be the biggest fraud wave in U.S. history: filing bogus claims for unemployment insurance benefits during the COVID-19 pandemic. (The broker has pleaded guilty, while the Bronx man and Nigerian official have pleaded not guilty.)
One person, according to the U.S. Department of Labor, used a single Social Security number to file unemployment insurance claims in 40 states. Twenty-nine states paid up, sending $222,532.
But the problem extends far beyond a plague of solo scammers. Bots filing bogus applications in bulk, teams of fraudsters in foreign countries making phony claims, online forums peddling how-to advice on identity theft - all inside the infrastructure of perhaps the largest fraud wave in history.
A ProPublica investigation reveals that much of the fraud has been organized - both in the U.S. and abroad. Fraudsters have used bots to file online claims in bulk. And others, located as far away as China and West Africa, have organized low-wage teams to file phony claims.
The fraud has been enabled by a burgeoning online infrastructure, whose existence has not previously been reported in the mainstream press. Much of it is geared toward exploiting aging or obsolete state unemployment systems whose weaknesses have drawn warnings for decades.
Communities have sprouted on messaging apps such as Telegram, where fraudsters trade tips on how to cash in. Hustlers advertise their techniques - or "sauces" (apparently short for "secret sauce") - for filing bogus claims, along with state-specific instructions on how to get around security checks, according to a ProPublica review of messages on more than 25 such chat forums.
Some of the forums have thousands of participants and regularly offer stolen identities for sale, alongside tech tips, screenshots that ostensibly prove the methods work and advice on which states are easiest to game and which are "lit" - that is, still paying out fake claims. Users have created two Telegram channels in which they trade tips for filing claims in Maryland, whose labor department recently said it detected some 508,000 potentially fraudulent jobless claims between the start of May and mid-June. Participants in those forums have been talking about turning their efforts to Pennsylvania, where officials recently said they have "noticed an uptick" in fraudulent claims.
"From my experience, when this is all said and done, we are going to be counting in the hundreds of billions of dollars, not the tens of billions," said Jon Coss, who heads a unit within Thomson Reuters that is helping states detect fake unemployment insurance claims.
Coss bases that assessment on the widespread fraudulent activity he’s seen. He said one U.S. state, which he declined to name, received fake claims - all purportedly from state residents - that originated from IP addresses in nearly 170 countries. They included countries historically linked to fraud, such as China, Nigeria and Russia, as well as more surprising ones, such as Cuba, Eritrea, Fiji and Monaco.
Overall, Coss said, between 40% and 50% of the claims his group has analyzed seem highly suspect. He added, "It’s mind-boggling the level of fraud that we’re seeing." ...
What they all had in common, according to federal prosecutors, was participation in what may turn out to be the biggest fraud wave in U.S. history: filing bogus claims for unemployment insurance benefits during the COVID-19 pandemic. (The broker has pleaded guilty, while the Bronx man and Nigerian official have pleaded not guilty.)
One person, according to the U.S. Department of Labor, used a single Social Security number to file unemployment insurance claims in 40 states. Twenty-nine states paid up, sending $222,532.
But the problem extends far beyond a plague of solo scammers. Bots filing bogus applications in bulk, teams of fraudsters in foreign countries making phony claims, online forums peddling how-to advice on identity theft - all inside the infrastructure of perhaps the largest fraud wave in history.
A ProPublica investigation reveals that much of the fraud has been organized - both in the U.S. and abroad. Fraudsters have used bots to file online claims in bulk. And others, located as far away as China and West Africa, have organized low-wage teams to file phony claims.
The fraud has been enabled by a burgeoning online infrastructure, whose existence has not previously been reported in the mainstream press. Much of it is geared toward exploiting aging or obsolete state unemployment systems whose weaknesses have drawn warnings for decades.
Communities have sprouted on messaging apps such as Telegram, where fraudsters trade tips on how to cash in. Hustlers advertise their techniques - or "sauces" (apparently short for "secret sauce") - for filing bogus claims, along with state-specific instructions on how to get around security checks, according to a ProPublica review of messages on more than 25 such chat forums.
Some of the forums have thousands of participants and regularly offer stolen identities for sale, alongside tech tips, screenshots that ostensibly prove the methods work and advice on which states are easiest to game and which are "lit" - that is, still paying out fake claims. Users have created two Telegram channels in which they trade tips for filing claims in Maryland, whose labor department recently said it detected some 508,000 potentially fraudulent jobless claims between the start of May and mid-June. Participants in those forums have been talking about turning their efforts to Pennsylvania, where officials recently said they have "noticed an uptick" in fraudulent claims.
"From my experience, when this is all said and done, we are going to be counting in the hundreds of billions of dollars, not the tens of billions," said Jon Coss, who heads a unit within Thomson Reuters that is helping states detect fake unemployment insurance claims.
Coss bases that assessment on the widespread fraudulent activity he’s seen. He said one U.S. state, which he declined to name, received fake claims - all purportedly from state residents - that originated from IP addresses in nearly 170 countries. They included countries historically linked to fraud, such as China, Nigeria and Russia, as well as more surprising ones, such as Cuba, Eritrea, Fiji and Monaco.
Overall, Coss said, between 40% and 50% of the claims his group has analyzed seem highly suspect. He added, "It’s mind-boggling the level of fraud that we’re seeing." ...
The Centers for Disease Control and Prevention (CDC) is set on Tuesday to recommend masks for vaccinated people indoors under certain circumstances.
"Federal officials met on Sunday night to review new evidence that may have prompted the reversal," the report continued. "The new guidance would mark a sharp turnabout from the agency’s position since May that vaccinated people do not need to wear masks in most indoor spaces.
New cases of COVID-19 are popping up in San Francisco and elsewhere in the Bay Area in what local media is calling "clearly a fourth wave of the pandemic", and everyone is clearly anxious and exhausted.
The latest surge in new cases arrived swiftly over the last two weeks, with the numbers in San Francisco still fairly low in the first days of July. The city was averaging 12.6 new cases per day in the month of June, and that rose to an average of 39 per day in the week after the July Fourth holiday. Now, SF's seven-day average, as of Sunday (with a couple of days of delay in the health department's reporting of numbers), was 147 new cases per day. 218 new infections were tallied in SF on Sunday alone, with 196 the previous day, which compares to days in mid-January when we were in the midst of the winter surge. July 20 also saw 215 new cases.
There has not been a day with over 200 new cases in San Francisco since the first week of February.
The number of hospitalized COVID patients has also risen sharply in SF in the last two weeks, rising from 24 on July 1 to 61 as of Saturday, according to state data.
UCSF's Dr. Bob Wachter tweeted a lengthy thread Sunday about the current surge and the precautions he plans to take. He notes that everything they are seeing at UCSF points to the ongoing efficacy of the vaccines, but now 77% of cases they are seeing through routine testing of many patients are among the vaccinated, the chances of encountering the virus in public are much higher in SF now than a month ago. Based on internal data about asymptomatic cases, Wachter says you now have a 1 in 50 chance of encountering an asymptomatic COVID infection while out in the city, compared to about 1 in 1000 back in June.
California Gov. Gavin Newsom announced Monday that his state will be the first in the nation to impose a vaccine mandate on state employees and healthcare workers, requiring they show proof of vaccination or submit to regular tests.
California will also be requiring health care settings to verify that workers are fully vaccinated or tested regularly. Unvaccinated workers will be subject to at least weekly COVID-19 testing and will be required to wear appropriate PPE. This requirement also applies to high-risk congregate settings like adult and senior residential facilities, homeless shelters and jails.
The new policy for state workers will take effect August 2 and testing will be phased in over the next few weeks. The new policy for health care workers and congregate facilities will take effect on August 9, and health care facilities will have until August 23 to come into full compliance ...
"Federal officials met on Sunday night to review new evidence that may have prompted the reversal," the report continued. "The new guidance would mark a sharp turnabout from the agency’s position since May that vaccinated people do not need to wear masks in most indoor spaces.
New cases of COVID-19 are popping up in San Francisco and elsewhere in the Bay Area in what local media is calling "clearly a fourth wave of the pandemic", and everyone is clearly anxious and exhausted.
The latest surge in new cases arrived swiftly over the last two weeks, with the numbers in San Francisco still fairly low in the first days of July. The city was averaging 12.6 new cases per day in the month of June, and that rose to an average of 39 per day in the week after the July Fourth holiday. Now, SF's seven-day average, as of Sunday (with a couple of days of delay in the health department's reporting of numbers), was 147 new cases per day. 218 new infections were tallied in SF on Sunday alone, with 196 the previous day, which compares to days in mid-January when we were in the midst of the winter surge. July 20 also saw 215 new cases.
There has not been a day with over 200 new cases in San Francisco since the first week of February.
The number of hospitalized COVID patients has also risen sharply in SF in the last two weeks, rising from 24 on July 1 to 61 as of Saturday, according to state data.
UCSF's Dr. Bob Wachter tweeted a lengthy thread Sunday about the current surge and the precautions he plans to take. He notes that everything they are seeing at UCSF points to the ongoing efficacy of the vaccines, but now 77% of cases they are seeing through routine testing of many patients are among the vaccinated, the chances of encountering the virus in public are much higher in SF now than a month ago. Based on internal data about asymptomatic cases, Wachter says you now have a 1 in 50 chance of encountering an asymptomatic COVID infection while out in the city, compared to about 1 in 1000 back in June.
California Gov. Gavin Newsom announced Monday that his state will be the first in the nation to impose a vaccine mandate on state employees and healthcare workers, requiring they show proof of vaccination or submit to regular tests.
California will also be requiring health care settings to verify that workers are fully vaccinated or tested regularly. Unvaccinated workers will be subject to at least weekly COVID-19 testing and will be required to wear appropriate PPE. This requirement also applies to high-risk congregate settings like adult and senior residential facilities, homeless shelters and jails.
The new policy for state workers will take effect August 2 and testing will be phased in over the next few weeks. The new policy for health care workers and congregate facilities will take effect on August 9, and health care facilities will have until August 23 to come into full compliance ...
In 2006, Daniel Desimone began working for the County of Santa Barbara as a corrections officer.
In October 2007, he injured his lower back. The incident occurred at a private gym inside an apartment complex on a weekend when Desimone was not working and no other County employees were present. Desimone was attempting to lift 350 pounds without a fitness trainer. The injury resulted in permanent damage to his spine. He said that he was lifting weights in hopes of being promoted to Deputy Sheriff.
Desimone continued working as a custody deputy until March 2016. In 2017, he filed an application for disability retirement benefits. Two reporting physicians agreed he was permanently incapacitated, but they disagreed on whether his disability was service connected. Dr. Conwisar opined that it was "within reasonable medical probability" that Desimone’s work activities contributed to the injury. Dr. Ganjianpour opined that Desimone’s disc herniation resulted from the 2007 weight-lifting incident and that his work duties did not "significantly and measurably contribute" to his incapacity.
The Board referred the question of whether the disability was service connected to a referee. The referee found that Desimone’s weight-lifting injury was not work related. A trial court affirmed the Board, and the Court of Appeal affirmed in the unpublished case of Desimone v the Retirement Board of Santa Barbara County.
Desimone argued that pursuant to Ezzy v. Workers’ Comp. Appeals Bd. (1983) 146 Cal.App.3d 252 (Ezzy), that he was entitled to service-connected disability benefits because (1) he believed that his weight-lifting activity was expected by his employer and (2) his belief was objectively reasonable.
In Ezzy, the court of appeal held that a worker’s compensation claimant injured during a company-sponsored softball game was participating in an activity in the course of her employment.
Ezzy, is not controlling authority because it involved a worker’s compensation claim under the Labor Code, and not, as here, a claim for service connected disability retirement benefits under the CERL (Gov. Code, § 31720). The trial court was therefore not required to apply the Ezzy test to determine whether Desimone’s injury was service connected.
But, even under the Ezzy test, Desimone did not prove that his injury was sustained in the course of his employment. He argues that his subjective belief that the County expected him to participate in heavy weight lifting was objectively reasonable.
The specific activity must have a substantial nexus between an employer’s expectations or requirement, or else the scope of coverage becomes virtually limitless. Accordingly, general assertions that it would benefit the employer for, or even that the employer expects, an employee to stay in good physical condition are not sufficient ...
In October 2007, he injured his lower back. The incident occurred at a private gym inside an apartment complex on a weekend when Desimone was not working and no other County employees were present. Desimone was attempting to lift 350 pounds without a fitness trainer. The injury resulted in permanent damage to his spine. He said that he was lifting weights in hopes of being promoted to Deputy Sheriff.
Desimone continued working as a custody deputy until March 2016. In 2017, he filed an application for disability retirement benefits. Two reporting physicians agreed he was permanently incapacitated, but they disagreed on whether his disability was service connected. Dr. Conwisar opined that it was "within reasonable medical probability" that Desimone’s work activities contributed to the injury. Dr. Ganjianpour opined that Desimone’s disc herniation resulted from the 2007 weight-lifting incident and that his work duties did not "significantly and measurably contribute" to his incapacity.
The Board referred the question of whether the disability was service connected to a referee. The referee found that Desimone’s weight-lifting injury was not work related. A trial court affirmed the Board, and the Court of Appeal affirmed in the unpublished case of Desimone v the Retirement Board of Santa Barbara County.
Desimone argued that pursuant to Ezzy v. Workers’ Comp. Appeals Bd. (1983) 146 Cal.App.3d 252 (Ezzy), that he was entitled to service-connected disability benefits because (1) he believed that his weight-lifting activity was expected by his employer and (2) his belief was objectively reasonable.
In Ezzy, the court of appeal held that a worker’s compensation claimant injured during a company-sponsored softball game was participating in an activity in the course of her employment.
Ezzy, is not controlling authority because it involved a worker’s compensation claim under the Labor Code, and not, as here, a claim for service connected disability retirement benefits under the CERL (Gov. Code, § 31720). The trial court was therefore not required to apply the Ezzy test to determine whether Desimone’s injury was service connected.
But, even under the Ezzy test, Desimone did not prove that his injury was sustained in the course of his employment. He argues that his subjective belief that the County expected him to participate in heavy weight lifting was objectively reasonable.
The specific activity must have a substantial nexus between an employer’s expectations or requirement, or else the scope of coverage becomes virtually limitless. Accordingly, general assertions that it would benefit the employer for, or even that the employer expects, an employee to stay in good physical condition are not sufficient ...
Interface Rehab, headquartered and operating in Orange County, has agreed to pay $2 million to resolve allegations that it violated the False Claims Act by causing the submission of claims to Medicare for rehabilitation therapy services that were not reasonable or necessary.
The settlement resolves allegations that, from January 1, 2006, through October 10, 2014, the Placentia-based Interface knowingly submitted or caused the submission of false claims for medically unreasonable and unnecessary "Ultra High" levels of rehabilitation therapy for Medicare Part A residents at 11 Skilled Nursing Facilities.
These facilities include Colonial Care Center, Covina Rehabilitation Center, Crenshaw Nursing Home, Green Acres Lodge, Imperial Care Center, Laurel Convalescent Hospital, Live Oak Rehabilitation Center, Longwood Manor Convalescent Hospital, Monterey Care Center, San Gabriel Convalescent Center, and Whittier Pacific Care Center.
In July 2020, the Department of Justice announced that Longwood Management Corporation and 27 affiliated skilled nursing facilities agreed to pay $16.7 million to the United States to resolve allegations that they violated the False Claims Act by submitting false claims to Medicare for rehabilitation therapy services that were not reasonable or necessary.
This newly announced settlement resolves Interface’s role in that alleged conduct.
During the relevant time period, Medicare reimbursed skilled nursing facilities at a daily rate that reflected the skilled therapy and nursing needs of qualifying patients. The greater the patient’s needs, the higher the level of Medicare reimbursement. The highest level of Medicare reimbursement for skilled nursing facilities was for "Ultra High" therapy patients, who required a minimum of 720 minutes of skilled therapy from two therapy disciplines (e.g., physical, occupational, or speech therapy), one of which had to be provided five days a week.
The United States contends that Interface pressured therapists to increase the amount of therapy provided to patients in order to meet pre-planned targets for Medicare revenue. These alleged targets could only be achieved by billing for a high percentage of patients at the "Ultra High" level without regard to patients’ individualized needs.
This civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Keith Pennetti, a former Director of Rehab at Interface. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. Mr. Pennetti, will receive $360,000 of the settlement proceeds. The qui tam case is captioned United States ex rel. Pennetti v. Interface Rehab, et al., No. CV-14-4133 (C.D. Cal.).
The claims resolved by the settlement are allegations only and there has been no determination of liability ...
The settlement resolves allegations that, from January 1, 2006, through October 10, 2014, the Placentia-based Interface knowingly submitted or caused the submission of false claims for medically unreasonable and unnecessary "Ultra High" levels of rehabilitation therapy for Medicare Part A residents at 11 Skilled Nursing Facilities.
These facilities include Colonial Care Center, Covina Rehabilitation Center, Crenshaw Nursing Home, Green Acres Lodge, Imperial Care Center, Laurel Convalescent Hospital, Live Oak Rehabilitation Center, Longwood Manor Convalescent Hospital, Monterey Care Center, San Gabriel Convalescent Center, and Whittier Pacific Care Center.
In July 2020, the Department of Justice announced that Longwood Management Corporation and 27 affiliated skilled nursing facilities agreed to pay $16.7 million to the United States to resolve allegations that they violated the False Claims Act by submitting false claims to Medicare for rehabilitation therapy services that were not reasonable or necessary.
This newly announced settlement resolves Interface’s role in that alleged conduct.
During the relevant time period, Medicare reimbursed skilled nursing facilities at a daily rate that reflected the skilled therapy and nursing needs of qualifying patients. The greater the patient’s needs, the higher the level of Medicare reimbursement. The highest level of Medicare reimbursement for skilled nursing facilities was for "Ultra High" therapy patients, who required a minimum of 720 minutes of skilled therapy from two therapy disciplines (e.g., physical, occupational, or speech therapy), one of which had to be provided five days a week.
The United States contends that Interface pressured therapists to increase the amount of therapy provided to patients in order to meet pre-planned targets for Medicare revenue. These alleged targets could only be achieved by billing for a high percentage of patients at the "Ultra High" level without regard to patients’ individualized needs.
This civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Keith Pennetti, a former Director of Rehab at Interface. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. Mr. Pennetti, will receive $360,000 of the settlement proceeds. The qui tam case is captioned United States ex rel. Pennetti v. Interface Rehab, et al., No. CV-14-4133 (C.D. Cal.).
The claims resolved by the settlement are allegations only and there has been no determination of liability ...
