The Division of Workers’ Compensation has received notification from the Office of Administrative Law that the final version of the proposed Medical-Legal Fee Schedule was forwarded on March 30, 2021 to the office of the Secretary of State for filing and printing.
This action represents official adoption of the new fee schedule, which has an effective date of April 1, 2021. All medical-legal evaluations that occur on or after April 1, 2021 will be subject to the new MLFS.
DWC has posted on its website the final rulemaking documents filed with OAL. The documents include the final text of the new MLFS.
The MLFS provides that a declaration to the physician accounting for the records that were provided is required by the proposed regulations for evaluations that occur on or after April 1, 2021.
The language states: "Any documents sent to the physician for record review must be accompanied by a declaration under penalty of perjury that the provider of the documents has complied with the provisions of Labor Code section 4062.3 before providing the documents to the physician. The declaration must also contain an attestation as to the total page count of the documents provided. A physician may not bill for review of documents that are not provided with this accompanying required declaration from the document provider. Any documents or records that are sent to the physician without the required declaration and attestation shall not be considered available to the physician or received by the physician for purposes of any regulatory or statutory duty of the physician regarding records and report writing.'
DWC realizes that there are Qualified Medical Evaluator evaluations currently scheduled for April that may not comply with the provisions of the attestation requirement for medical records under the new Medical-Legal Fee Schedule. The parties to these evaluations should communicate with each other to reach agreement on the handling of these evaluations ...
This action represents official adoption of the new fee schedule, which has an effective date of April 1, 2021. All medical-legal evaluations that occur on or after April 1, 2021 will be subject to the new MLFS.
DWC has posted on its website the final rulemaking documents filed with OAL. The documents include the final text of the new MLFS.
The MLFS provides that a declaration to the physician accounting for the records that were provided is required by the proposed regulations for evaluations that occur on or after April 1, 2021.
The language states: "Any documents sent to the physician for record review must be accompanied by a declaration under penalty of perjury that the provider of the documents has complied with the provisions of Labor Code section 4062.3 before providing the documents to the physician. The declaration must also contain an attestation as to the total page count of the documents provided. A physician may not bill for review of documents that are not provided with this accompanying required declaration from the document provider. Any documents or records that are sent to the physician without the required declaration and attestation shall not be considered available to the physician or received by the physician for purposes of any regulatory or statutory duty of the physician regarding records and report writing.'
DWC realizes that there are Qualified Medical Evaluator evaluations currently scheduled for April that may not comply with the provisions of the attestation requirement for medical records under the new Medical-Legal Fee Schedule. The parties to these evaluations should communicate with each other to reach agreement on the handling of these evaluations ...
Senate Bill 95’s supplemental COVID paid sick leave requirement goes into effect as of March 19, 2021. The new law mandates that employers provide employees with supplemental paid sick leave for COVID-related leave in addition to other paid time off obligations under existing federal, state, or local statutes.
The obligation to provide paid COVID related sick leave is also retroactive to January 1, 2021. Upon an oral or written request by an employee, the employer is obligated to reimburse an employee who took leave between January 1, 2021, and March 29, 2021, that would have otherwise qualified under SB 95.
Under Labor Code 248.2 all employers with 26 or more employees must allow all employees who are unable to work or telework due to COVID use of the new supplemental paid sick leave. The employee qualifies for leave if the employee:
A. Is subject to a quarantine or isolation period related to COVID.
B. Has been advised by a health care provider to self-quarantine due to concerns related to COVID.
C. Is attending an appointment to receive a vaccine for protection against contracting COVID.
D. Is experiencing symptoms related to a COVID vaccine that prevent the employee from being able to work or telework.
E. Is experiencing symptoms of COVID and seeking a medical diagnosis.
F. Is caring for a family member who is subject t ho a quarantine or isolation period related to COVID; or who has been advised to self-quarantine by a health care provider.
G. Is caring for a child whose school or place of care is closed or otherwise unavailable for reasons related to COVID on the premises.
Full-time qualified employees are eligible for up to 80 hours of supplemental paid sick leave. Non-full-time employees with normal weekly schedules receive the total number of hours they are normally scheduled to work over two weeks. Employees who work a variable number of hours, whose tenure is six months or more, receive 14 times the average number of hours they worked each day in the six months preceding their leave date.
In addition, as with all other paid sick leave requirements mandated by law in California, there are posting requirements and a requirement that the leave hours be available on paystubs or other written notices to employees received on payday.
SB 95 is nuanced and specific with regard to the qualifications, exemptions, and obligations.
The firm of Roxborough Pomerance Nye & Adreani LLP has invited employers to contact members of the firm about this new law if necessary If your company has any questions about the new paid sick leave requirements, please contact Nicholas Roxborough at (818) 992-9999, ext. 222, Drew Pomerance at ext. 212, Michael Adreani, at ext. 234, Marina Vitek, at ext. 236, or Trevor Witt, at ext. 224 ...
The obligation to provide paid COVID related sick leave is also retroactive to January 1, 2021. Upon an oral or written request by an employee, the employer is obligated to reimburse an employee who took leave between January 1, 2021, and March 29, 2021, that would have otherwise qualified under SB 95.
Under Labor Code 248.2 all employers with 26 or more employees must allow all employees who are unable to work or telework due to COVID use of the new supplemental paid sick leave. The employee qualifies for leave if the employee:
A. Is subject to a quarantine or isolation period related to COVID.
B. Has been advised by a health care provider to self-quarantine due to concerns related to COVID.
C. Is attending an appointment to receive a vaccine for protection against contracting COVID.
D. Is experiencing symptoms related to a COVID vaccine that prevent the employee from being able to work or telework.
E. Is experiencing symptoms of COVID and seeking a medical diagnosis.
F. Is caring for a family member who is subject t ho a quarantine or isolation period related to COVID; or who has been advised to self-quarantine by a health care provider.
G. Is caring for a child whose school or place of care is closed or otherwise unavailable for reasons related to COVID on the premises.
Full-time qualified employees are eligible for up to 80 hours of supplemental paid sick leave. Non-full-time employees with normal weekly schedules receive the total number of hours they are normally scheduled to work over two weeks. Employees who work a variable number of hours, whose tenure is six months or more, receive 14 times the average number of hours they worked each day in the six months preceding their leave date.
In addition, as with all other paid sick leave requirements mandated by law in California, there are posting requirements and a requirement that the leave hours be available on paystubs or other written notices to employees received on payday.
SB 95 is nuanced and specific with regard to the qualifications, exemptions, and obligations.
The firm of Roxborough Pomerance Nye & Adreani LLP has invited employers to contact members of the firm about this new law if necessary If your company has any questions about the new paid sick leave requirements, please contact Nicholas Roxborough at (818) 992-9999, ext. 222, Drew Pomerance at ext. 212, Michael Adreani, at ext. 234, Marina Vitek, at ext. 236, or Trevor Witt, at ext. 224 ...
A Santa Clarita Valley man pleaded guilty to perpetrating a scheme to fraudulently obtain approximately $1.8 million in COVID-19 relief guaranteed by the Small Business Administration (SBA) through the Economic Injury Disaster Loan (EIDL) program and the Paycheck Protection Program (PPP).
According to court documents, Hassan Kanyike, 29, of Santa Clarita, admitted that he submitted six fraudulent PPP loan applications and two fraudulent EIDL applications.
The applications sought funds to purportedly pay the salaries of employees whom he claimed worked for two of his businesses. Kanyike successfully obtained approximately $1 million through four PPP loans, and another $300,000 through two EIDL loans.
In support of the fraudulent PPP loan applications, Kanyike submitted fake federal tax filings and payroll reports.
For example, in one loan application, Kanyike falsely claimed the business had 26 employees and an average monthly payroll of $168,000, and he submitted a fabricated IRS tax form claiming Falcon Motors had paid $2,022,300 in payroll in 2019.
But Kanyike admitted during his plea that the company had substantially fewer employees and substantially lower payroll. Kanyike further admitted that he obtained additional Employer Identification Numbers from the IRS in April and May 2020, so that he could apply for multiple loans for the same used-car business. Kanyike then used a substantial portion of the PPP loan proceeds for his own personal benefit.
Kanyike was arrested in December 2020 at Los Angeles International Airport just before he was about to board a flight to Dubai. At the time of his arrest, Kanyike had transferred approximately $762,000 to Uganda, his country of citizenship, from one of the business accounts that had received the loan proceeds, in violation of the terms of the PPP and EIDL program.
Kanyike pleaded guilty to one count of wire fraud before United States District Judge Virginia A. Phillips. He is scheduled to be sentenced on August 23 and faces a maximum penalty of 20 years in prison.
As part of his guilty plea, Kanyike is required to pay approximately $1.3 million in restitution.
Homeland Security Investigations and Treasury Inspector General for Tax Administration investigated the case.
...
According to court documents, Hassan Kanyike, 29, of Santa Clarita, admitted that he submitted six fraudulent PPP loan applications and two fraudulent EIDL applications.
The applications sought funds to purportedly pay the salaries of employees whom he claimed worked for two of his businesses. Kanyike successfully obtained approximately $1 million through four PPP loans, and another $300,000 through two EIDL loans.
In support of the fraudulent PPP loan applications, Kanyike submitted fake federal tax filings and payroll reports.
For example, in one loan application, Kanyike falsely claimed the business had 26 employees and an average monthly payroll of $168,000, and he submitted a fabricated IRS tax form claiming Falcon Motors had paid $2,022,300 in payroll in 2019.
But Kanyike admitted during his plea that the company had substantially fewer employees and substantially lower payroll. Kanyike further admitted that he obtained additional Employer Identification Numbers from the IRS in April and May 2020, so that he could apply for multiple loans for the same used-car business. Kanyike then used a substantial portion of the PPP loan proceeds for his own personal benefit.
Kanyike was arrested in December 2020 at Los Angeles International Airport just before he was about to board a flight to Dubai. At the time of his arrest, Kanyike had transferred approximately $762,000 to Uganda, his country of citizenship, from one of the business accounts that had received the loan proceeds, in violation of the terms of the PPP and EIDL program.
Kanyike pleaded guilty to one count of wire fraud before United States District Judge Virginia A. Phillips. He is scheduled to be sentenced on August 23 and faces a maximum penalty of 20 years in prison.
As part of his guilty plea, Kanyike is required to pay approximately $1.3 million in restitution.
Homeland Security Investigations and Treasury Inspector General for Tax Administration investigated the case.
...
Despite the softening of rates and the challenges of the coronavirus pandemic, the Insurance Journal reports that one Midwest-based workers’ compensation insurance provider that opened its doors just over three years ago reports that it not only has experienced significant growth during that time, it simultaneously has managed to maintain a loss ratio that is one of the lowest in the industry.
Since its launch in October 2017, Omaha National, based in Omaha, Nebraska, has gone from $0 to $100 million of in-force premium and grown from a six-person operation to one with more than 150 employees.
That brisk pace of growth is expected to continue, says Reagan Pufall, president and CEO of the managing general agent (MGA) / insurance carrier. The company will move into a new office building this summer "because we’ve run out of room where we are," he said. "Five years from now, we expect to be well over $400 million in-force premium."
Omaha National launched as an MGA with California as its initial target market. It is now offering coverage in 14 states and will continue to expand into other states, including New York this year, Pufall said. It also established Omaha National Insurance Co., which currently "acts as a reinsurer for a portion of the risk that we write. So even as an MGA, we are already on the risk, which is what we like."
However, "the intention has always been to become a direct writer. And we’re now approaching the time when it looks like we will be able to initiate that transition to becoming a carrier," he said.
A complementary division of the company is its payroll service. "It’s an optional part of what we offer. Any company that is insured by us, if they choose, they can also make use of us as their payroll service," Pufall said.
Small- to mid-size companies operating in industries where employees work with their hands are Omaha National’s core customers - landscapers, framers, electricians, plumbers, parcel delivery services, for example. "We like to say that we insure the companies that build America," Pufall said.
The falling rates in the workers’ compensation line are a challenge as they are for any insurer, Pufall said. "But we designed this company to prosper throughout the market cycle, in hard markets and soft markets. None of what we’re encountering or anything we see in the future causes us substantial concern. Of course, we will look forward to the day when the market cycle changes, and the rates are rising again. But until then, we’re doing just fine, even during this soft market." ...
Since its launch in October 2017, Omaha National, based in Omaha, Nebraska, has gone from $0 to $100 million of in-force premium and grown from a six-person operation to one with more than 150 employees.
That brisk pace of growth is expected to continue, says Reagan Pufall, president and CEO of the managing general agent (MGA) / insurance carrier. The company will move into a new office building this summer "because we’ve run out of room where we are," he said. "Five years from now, we expect to be well over $400 million in-force premium."
Omaha National launched as an MGA with California as its initial target market. It is now offering coverage in 14 states and will continue to expand into other states, including New York this year, Pufall said. It also established Omaha National Insurance Co., which currently "acts as a reinsurer for a portion of the risk that we write. So even as an MGA, we are already on the risk, which is what we like."
However, "the intention has always been to become a direct writer. And we’re now approaching the time when it looks like we will be able to initiate that transition to becoming a carrier," he said.
A complementary division of the company is its payroll service. "It’s an optional part of what we offer. Any company that is insured by us, if they choose, they can also make use of us as their payroll service," Pufall said.
Small- to mid-size companies operating in industries where employees work with their hands are Omaha National’s core customers - landscapers, framers, electricians, plumbers, parcel delivery services, for example. "We like to say that we insure the companies that build America," Pufall said.
The falling rates in the workers’ compensation line are a challenge as they are for any insurer, Pufall said. "But we designed this company to prosper throughout the market cycle, in hard markets and soft markets. None of what we’re encountering or anything we see in the future causes us substantial concern. Of course, we will look forward to the day when the market cycle changes, and the rates are rising again. But until then, we’re doing just fine, even during this soft market." ...
Driven by the reopening of restaurants and the tourism industry, California unemployment dropped to 8.5% in February, the Golden State’s lowest mark of the pandemic.
With the state loosening business restrictions incrementally since the holiday spike of Covid-19 cases dwindled, the hospitality and leisure industry added over 100,000 jobs last month. In total, California employers hired 141,000 new employees, nearly erasing the deficit accrued in December and January under Governor Gavin Newsom’s most recent lockdown order.
California registered the third largest jobless rate decrease in February of any state, but its estimated 8.5% mark remains well above the nationwide figure of 6.2%.
State officials celebrated Friday’s U.S. Department of Labor release, calling it a "milestone" in what has thus far been a slow economic recovery for the nation’s most populous and richest state.
The state’s improvement was led by the hospitality and leisure industry, which resumed offering indoor dining in some parts of the state last month and combined to add 102,000 jobs. The hiring surge was a positive sign for the hard-hit industry that is still down nearly 700,000 jobs compared to February 2020.
Overall, seven of California’s 11 industries added jobs including other services (14,100), education and health services (13,000), manufacturing (8,900), trade, transportation and utilities (8,200) and professional and business services (5,400). Meanwhile, the agriculture industry added nearly 3,000 jobs, tallying gains for the seventh straight month.
February’s performance will likely be repeated or enhanced in March and April, assuming Covid-19 cases continue to drop, says Jeffrey Clemens, economics professor at University of California, San Diego.
The hospitality industry’s February hiring-spree was certainly encouraging, but Clemens emphasized the enormity of the job losses suffered in California over the last year.
"The jobs market is climbing out of a deep hole," Clemens added, referencing the fact California is still down 1.6 million total jobs.
Statewide unemployment may have sunk a half-point in February, but nearly a dozen of the state’s 58 counties still have double-digit unemployment.
Los Angeles County’s rate fell to 10.9% from 12.7% the previous month, but it remains the only urban county in the double digits. The rest of the list consists of mostly rural, agricultural-producing counties like Kern (10.8%), Imperial (15.9%) and Monterey (10.9%) ...
With the state loosening business restrictions incrementally since the holiday spike of Covid-19 cases dwindled, the hospitality and leisure industry added over 100,000 jobs last month. In total, California employers hired 141,000 new employees, nearly erasing the deficit accrued in December and January under Governor Gavin Newsom’s most recent lockdown order.
California registered the third largest jobless rate decrease in February of any state, but its estimated 8.5% mark remains well above the nationwide figure of 6.2%.
State officials celebrated Friday’s U.S. Department of Labor release, calling it a "milestone" in what has thus far been a slow economic recovery for the nation’s most populous and richest state.
The state’s improvement was led by the hospitality and leisure industry, which resumed offering indoor dining in some parts of the state last month and combined to add 102,000 jobs. The hiring surge was a positive sign for the hard-hit industry that is still down nearly 700,000 jobs compared to February 2020.
Overall, seven of California’s 11 industries added jobs including other services (14,100), education and health services (13,000), manufacturing (8,900), trade, transportation and utilities (8,200) and professional and business services (5,400). Meanwhile, the agriculture industry added nearly 3,000 jobs, tallying gains for the seventh straight month.
February’s performance will likely be repeated or enhanced in March and April, assuming Covid-19 cases continue to drop, says Jeffrey Clemens, economics professor at University of California, San Diego.
The hospitality industry’s February hiring-spree was certainly encouraging, but Clemens emphasized the enormity of the job losses suffered in California over the last year.
"The jobs market is climbing out of a deep hole," Clemens added, referencing the fact California is still down 1.6 million total jobs.
Statewide unemployment may have sunk a half-point in February, but nearly a dozen of the state’s 58 counties still have double-digit unemployment.
Los Angeles County’s rate fell to 10.9% from 12.7% the previous month, but it remains the only urban county in the double digits. The rest of the list consists of mostly rural, agricultural-producing counties like Kern (10.8%), Imperial (15.9%) and Monterey (10.9%) ...
The wave of COVID-19 claims that hit the California workers’ compensation system at the end of 2020 has subsided for the time being as the number of claims reported to the state Division of Workers’ Compensation for February fell to the lowest level in a year, an analysis by the California Workers’ Compensation Institute Shows.
The CWCI report shows the projected ultimate claim count for February came in at 4,533 cases, down nearly 90% from the record 43,158 claims projected for December.
The figures from CWCI’s COVID-19/Non-COVID-19 Interactive Application show that after surging to an all-time high in December, the monthly COVID-19 claim count fell by more than 50% in January, a decrease that coincided with the steep drop in new coronavirus cases in the state.
"Claim counts from December through February are still incomplete as additional claims for those months are still being reported, but the COVID-19 claim totals reported as of March 8 show that the DWC has recorded 40,188 claims with December injury dates and 19,493 claims with January injury dates, but just 2,747 COVID-19 claims with February injury dates," the CWCI report states.
The addition of the February figure pushed the number of virus claims reported to the DWC since the pandemic began to 135,566, including 751 death claims, and COVID-19 clams have accounted for just 9% of all claims reported thus far for February, though they have accounted for 18.8% of all claims since the first claims were reported in January of 2020, according to the CWCI.
The latest results are from the March 11 update to CWCI’s COVID-19/Non-COVID-19 Interactive Claim App, which integrates data from CWCI, DWC, and the Bureau of Labor and Statistics to provide current and historical data on California work injury claims.
The app includes COVID-19 data dating back to January 2020, as well as from the most recent 12 months, and is available to the public ...
The CWCI report shows the projected ultimate claim count for February came in at 4,533 cases, down nearly 90% from the record 43,158 claims projected for December.
The figures from CWCI’s COVID-19/Non-COVID-19 Interactive Application show that after surging to an all-time high in December, the monthly COVID-19 claim count fell by more than 50% in January, a decrease that coincided with the steep drop in new coronavirus cases in the state.
"Claim counts from December through February are still incomplete as additional claims for those months are still being reported, but the COVID-19 claim totals reported as of March 8 show that the DWC has recorded 40,188 claims with December injury dates and 19,493 claims with January injury dates, but just 2,747 COVID-19 claims with February injury dates," the CWCI report states.
The addition of the February figure pushed the number of virus claims reported to the DWC since the pandemic began to 135,566, including 751 death claims, and COVID-19 clams have accounted for just 9% of all claims reported thus far for February, though they have accounted for 18.8% of all claims since the first claims were reported in January of 2020, according to the CWCI.
The latest results are from the March 11 update to CWCI’s COVID-19/Non-COVID-19 Interactive Claim App, which integrates data from CWCI, DWC, and the Bureau of Labor and Statistics to provide current and historical data on California work injury claims.
The app includes COVID-19 data dating back to January 2020, as well as from the most recent 12 months, and is available to the public ...
The Division of Workers’ Compensation (DWC) has posted an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.
The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update order adopts the following Centers for Medicare & Medicaid Services (CMS) Medicare changes:
April 2021 Quarterly Update
- - The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) April 2021 Addendum A quarterly update
- - The CMS Medicare OPPS April 2021 Addendum B quarterly update
- - The CMS Ambulatory Surgical Center Payment System, April 2021 ASC Approved HCPCS Code and Payment Rates - Column A entitled "HCPCS Code" of "Apr 2021 ASC AA" and Column A entitled "HCPCS Code" of "Apr 2021 ASC EE"
- - Certain sections of the CMS Medicare OPPS April 2021 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V212.R0
The order adopting the OMFS adjustments is effective for services rendered on or after April 1, 2021 and is posted on the DWC website ...
The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update order adopts the following Centers for Medicare & Medicaid Services (CMS) Medicare changes:
April 2021 Quarterly Update
- - The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) April 2021 Addendum A quarterly update
- - The CMS Medicare OPPS April 2021 Addendum B quarterly update
- - The CMS Ambulatory Surgical Center Payment System, April 2021 ASC Approved HCPCS Code and Payment Rates - Column A entitled "HCPCS Code" of "Apr 2021 ASC AA" and Column A entitled "HCPCS Code" of "Apr 2021 ASC EE"
- - Certain sections of the CMS Medicare OPPS April 2021 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V212.R0
The order adopting the OMFS adjustments is effective for services rendered on or after April 1, 2021 and is posted on the DWC website ...
The Division of Workers’ Compensation has posted proposed changes to Disability Evaluation Unit (DEU) regulations to the online forum where members of the public may review and comment on the proposal. Comments will be accepted on the forum until 5 p.m. on April 7, 2021.
The proposed changes update commutation tables and delete references to services no longer provided by the DEU. Other proposed changes include updating two forms used for requesting consultative ratings and reconsideration of summary ratings.
The Labor Code provides for the determination and payment of permanent disability benefits and mandates life pensions for certain cases. Injured workers are allowed to petition the Workers’ Compensation Appeals Board (WCAB) for a commutation of future weekly permanent disability and life pension benefits in order to receive a lump sum amount.
The proposed changes update the commutation tables to reflect updated life tables which offer a more accurate present value of lifetime benefits. As life expectancy has increased, it is estimated that this update will provide a general 5% increase of commutations for life pensions and permanent total disability.
The Commutation Instructions provide examples to illustrate various methods of commuting permanent disability and life pension benefits. The most common commutation is for attorney fees when settling cases at the WCAB.
The DEU will continue to provide formal rating determinations, summary rating determinations and consultative rating determinations, but will no longer provide informal rating determinations.
The new proposed forms are:
- - Summary Rating by the Administrative Director - DWC-AD Form 103.
- - Request for Consultative Rating - DWC-AD Form 104 (DEU).
The forum can be found online on the DWC forums page under "current forums." ...
The proposed changes update commutation tables and delete references to services no longer provided by the DEU. Other proposed changes include updating two forms used for requesting consultative ratings and reconsideration of summary ratings.
The Labor Code provides for the determination and payment of permanent disability benefits and mandates life pensions for certain cases. Injured workers are allowed to petition the Workers’ Compensation Appeals Board (WCAB) for a commutation of future weekly permanent disability and life pension benefits in order to receive a lump sum amount.
The proposed changes update the commutation tables to reflect updated life tables which offer a more accurate present value of lifetime benefits. As life expectancy has increased, it is estimated that this update will provide a general 5% increase of commutations for life pensions and permanent total disability.
The Commutation Instructions provide examples to illustrate various methods of commuting permanent disability and life pension benefits. The most common commutation is for attorney fees when settling cases at the WCAB.
The DEU will continue to provide formal rating determinations, summary rating determinations and consultative rating determinations, but will no longer provide informal rating determinations.
The new proposed forms are:
- - Summary Rating by the Administrative Director - DWC-AD Form 103.
- - Request for Consultative Rating - DWC-AD Form 104 (DEU).
The forum can be found online on the DWC forums page under "current forums." ...
23 year old Angel Maces, who lives in San Jacinto, was arraigned for felony insurance fraud after allegedly misrepresenting symptoms following a work-related injury, in order to receive over $42,000 in fraudulently obtained workers’ compensation benefits.
On September 7, 2018, Maces, while working for a Temecula landscaping company, was laying artificial turf at a private residence in the City of Duarte, when a piece of turf slipped and struck his knee.
Maces filed a workers’ compensation claim with his employer’s insurance company that same day and immediately began receiving benefits.
On April 28, 2020, the California Department of Insurance began an investigation after his employer’s insurance company suspected fraud.
The investigation found Maces misrepresented the seriousness of his knee injury and his physical limitations in order to not return to work and collect $42,888 in workers’ compensation benefits.
Surveillance during the investigation showed Maces conducting activities that contradicted the physical limitations he described to his doctor and his employer.
On multiple occasions Maces was seen not using a cane or crutches, even though he claimed he had to use them 100 percent of the time because of the injury.
Maces self-surrendered and was arraigned on February 26, 2021.
The Riverside County District Attorney’s Office is prosecuting this case ...
On September 7, 2018, Maces, while working for a Temecula landscaping company, was laying artificial turf at a private residence in the City of Duarte, when a piece of turf slipped and struck his knee.
Maces filed a workers’ compensation claim with his employer’s insurance company that same day and immediately began receiving benefits.
On April 28, 2020, the California Department of Insurance began an investigation after his employer’s insurance company suspected fraud.
The investigation found Maces misrepresented the seriousness of his knee injury and his physical limitations in order to not return to work and collect $42,888 in workers’ compensation benefits.
Surveillance during the investigation showed Maces conducting activities that contradicted the physical limitations he described to his doctor and his employer.
On multiple occasions Maces was seen not using a cane or crutches, even though he claimed he had to use them 100 percent of the time because of the injury.
Maces self-surrendered and was arraigned on February 26, 2021.
The Riverside County District Attorney’s Office is prosecuting this case ...
Last month, Walmart Inc. was hit with class allegations in California that it ran afoul of federal and state labor law by failing to pay workers for time spent on mandatory pre-shift COVID-19 screenings.
And this week, Arizona Walmart workers hit the retail giant with a $5 million proposed class action Monday, alleging Walmart required employees to arrive at their shifts early to undergo COVID-19 screenings but flouted the law by failing to fully compensate them for their time.
Workers filed the putative class action in Arizona federal court, claiming the Arkansas-based retail behemoth required them to arrive at their shifts 10 to 15 minutes early to undergo mandatory COVID-19 screening but didn't compensate them for all that time.
Plaintiff attorneys say the screenings involved standing in line with co-workers to get temperature readings and answering questions about health conditions, recent travel and potential exposures to anyone with the virus. After passing the screening, workers were given masks and gloves. Only then were they allowed to clock in for the day, they allege.
Walmart, however, maintains that it has compensated its hourly retail associates for pre-shift time spent undergoing COVID-19 screenings. A Walmart spokesperson told Law360 on Monday that its workers have received compensation for the "extra time" they spent being screened for symptoms of the virus.
"All hourly associates have extra COVID screening time systematically added to their daily shifts and paychecks. This is in addition to our manual process for adding extra time if there ever is a reason this additional time is not sufficient. We will respond as appropriate with the court once we have been served with the complaint," the Walmart spokesperson said.
Walmart workers aren't the only ones seeking compensation for virus screenings.
Earlier this month, Apple was found to owe a class of California retail store workers for time they spent working off the clock undergoing bag checks. The amount of damages will be determined in a jury trial.
This March, a New Jersey federal judge ruled that Amazon warehouse workers seeking compensation for time spent in obligatory security screenings could amend their complaint to include a claim for compensation of pre-shift time spent undergoing COVID-19 screenings. The amended complaint alleges the tech giant should pay workers for the time they spend getting their temperatures taken and answering a COVID-19 questionnaire prior to their shifts.
That same month, workers sued a California tennis company seeking compensation for time they spent undergoing mandatory temperature checks as a precaution during the pandemic.
The Merchant of Tennis Inc., which operates retail tennis stores in the U.S., has been allegedly underpaying workers at its facility in San Bernardino, California, the overtime wages to which they're entitled and made the workers undergo temperature checks while they were off the clock, according to the complaint filed earlier this month by one of its employees.
And back in June, Converse reached a $1.87 million settlement to resolve claims that it failed to pay workers for time they spent clearing post-shift security checks ...
And this week, Arizona Walmart workers hit the retail giant with a $5 million proposed class action Monday, alleging Walmart required employees to arrive at their shifts early to undergo COVID-19 screenings but flouted the law by failing to fully compensate them for their time.
Workers filed the putative class action in Arizona federal court, claiming the Arkansas-based retail behemoth required them to arrive at their shifts 10 to 15 minutes early to undergo mandatory COVID-19 screening but didn't compensate them for all that time.
Plaintiff attorneys say the screenings involved standing in line with co-workers to get temperature readings and answering questions about health conditions, recent travel and potential exposures to anyone with the virus. After passing the screening, workers were given masks and gloves. Only then were they allowed to clock in for the day, they allege.
Walmart, however, maintains that it has compensated its hourly retail associates for pre-shift time spent undergoing COVID-19 screenings. A Walmart spokesperson told Law360 on Monday that its workers have received compensation for the "extra time" they spent being screened for symptoms of the virus.
"All hourly associates have extra COVID screening time systematically added to their daily shifts and paychecks. This is in addition to our manual process for adding extra time if there ever is a reason this additional time is not sufficient. We will respond as appropriate with the court once we have been served with the complaint," the Walmart spokesperson said.
Walmart workers aren't the only ones seeking compensation for virus screenings.
Earlier this month, Apple was found to owe a class of California retail store workers for time they spent working off the clock undergoing bag checks. The amount of damages will be determined in a jury trial.
This March, a New Jersey federal judge ruled that Amazon warehouse workers seeking compensation for time spent in obligatory security screenings could amend their complaint to include a claim for compensation of pre-shift time spent undergoing COVID-19 screenings. The amended complaint alleges the tech giant should pay workers for the time they spend getting their temperatures taken and answering a COVID-19 questionnaire prior to their shifts.
That same month, workers sued a California tennis company seeking compensation for time they spent undergoing mandatory temperature checks as a precaution during the pandemic.
The Merchant of Tennis Inc., which operates retail tennis stores in the U.S., has been allegedly underpaying workers at its facility in San Bernardino, California, the overtime wages to which they're entitled and made the workers undergo temperature checks while they were off the clock, according to the complaint filed earlier this month by one of its employees.
And back in June, Converse reached a $1.87 million settlement to resolve claims that it failed to pay workers for time they spent clearing post-shift security checks ...
Grocery employees in dozens of cities from San Francisco to Santa Ana have successfully lobbied their council members to pass ordinances requiring employers to temporarily give hazard or "hero" pay, typically $3 to $5 an hour. Both proponents and opponents of the hazard pay movement expect more cities to adopt the policy. Similar ordinances may soon come up to a vote in cities from Fresno to Pasadena.
The movement is growing, labor leaders said, covering more workers affected by the pandemic. Coachella has already passed an ordinance giving hazard pay to farmworkers, the first in the nation to do so.
Companies boosted grocery workers' pay at the peak of the pandemic last year. But most - with the exception of companies such as Save Mart and Trader Joe's - had ended the practice by June, according to a report from the Brookings Institution.
Long Beach was the first to pass an ordinance, giving workers at large grocery stores an extra $4 per hour for at least 120 days. In response, the California Grocers Association filed a federal lawsuit saying such ordinances are unconstitutional, and Kroger closed two grocery stores in the city.
Though Sacramento has been the site of protests calling for higher wages and better safety conditions for workers, neither the county Board of Supervisors nor City Council has proposed hazard pay ordinances. But the policy has spread to nearly a dozen cities in Southern California and several more in Northern California.
Fresno so far is the only city in Central California to consider hazard pay, but Fresno City Council President Luis Chavez said he has gotten calls from officials in surrounding cities. Chavez has proposed extra pay of $3 an hour for 120 days for the city's grocery workers.
Many businesses have come out against hazard pay, saying the policy will only lead to more closures and layoffs.
For unionized grocery workers, it should be collective bargaining agreements, not city ordinances, that decide their wages, said Ron Fong, president and CEO of the California Grocers Association.
Other workers are pushing for hazard pay as well.
Coachella in February approved "hero" pay for farmworkers and workers at grocery stores, pharmacy stores and restaurants. Only those who employ 300 or more workers nationally and more than five employees in the city would need to provide hazard pay.
Large fast-food chain restaurants have stayed open during the pandemic, with employees going to work every day, said Megan Beaman-Jacinto, a Coachella councilwoman and workers' rights attorney. She also pushed to include farmworkers, saying they have often been excluded from the protections provided by labor laws.
Healthcare workers are also pushing for extra pay, through a bill introduced by Assemblyman Al Muratsuchi, D-Torrance.
Assembly Bill 650 would require private health care companies to provide a $10,000 bonus to a non-executive employee who is working during the pandemic and staying in the industry through 2022. Part-time employees would get up to $6,000.
SEIU Local 2015, which represents 400,000 long-term caregivers, is also calling for hazard pay as part of its campaign promoting mass vaccination and calling on local officials to improve working condition for the union's members.
Workers could also get some help from the coronavirus relief package that President Joe Biden signed March 11. A provision in the bill allows states to give "premium pay" of up to $13 per hour on top of their typical wages to employees deemed essential. The money would come out of the $26 billion the law allocates to California state government.
...
The movement is growing, labor leaders said, covering more workers affected by the pandemic. Coachella has already passed an ordinance giving hazard pay to farmworkers, the first in the nation to do so.
Companies boosted grocery workers' pay at the peak of the pandemic last year. But most - with the exception of companies such as Save Mart and Trader Joe's - had ended the practice by June, according to a report from the Brookings Institution.
Long Beach was the first to pass an ordinance, giving workers at large grocery stores an extra $4 per hour for at least 120 days. In response, the California Grocers Association filed a federal lawsuit saying such ordinances are unconstitutional, and Kroger closed two grocery stores in the city.
Though Sacramento has been the site of protests calling for higher wages and better safety conditions for workers, neither the county Board of Supervisors nor City Council has proposed hazard pay ordinances. But the policy has spread to nearly a dozen cities in Southern California and several more in Northern California.
Fresno so far is the only city in Central California to consider hazard pay, but Fresno City Council President Luis Chavez said he has gotten calls from officials in surrounding cities. Chavez has proposed extra pay of $3 an hour for 120 days for the city's grocery workers.
Many businesses have come out against hazard pay, saying the policy will only lead to more closures and layoffs.
For unionized grocery workers, it should be collective bargaining agreements, not city ordinances, that decide their wages, said Ron Fong, president and CEO of the California Grocers Association.
Other workers are pushing for hazard pay as well.
Coachella in February approved "hero" pay for farmworkers and workers at grocery stores, pharmacy stores and restaurants. Only those who employ 300 or more workers nationally and more than five employees in the city would need to provide hazard pay.
Large fast-food chain restaurants have stayed open during the pandemic, with employees going to work every day, said Megan Beaman-Jacinto, a Coachella councilwoman and workers' rights attorney. She also pushed to include farmworkers, saying they have often been excluded from the protections provided by labor laws.
Healthcare workers are also pushing for extra pay, through a bill introduced by Assemblyman Al Muratsuchi, D-Torrance.
Assembly Bill 650 would require private health care companies to provide a $10,000 bonus to a non-executive employee who is working during the pandemic and staying in the industry through 2022. Part-time employees would get up to $6,000.
SEIU Local 2015, which represents 400,000 long-term caregivers, is also calling for hazard pay as part of its campaign promoting mass vaccination and calling on local officials to improve working condition for the union's members.
Workers could also get some help from the coronavirus relief package that President Joe Biden signed March 11. A provision in the bill allows states to give "premium pay" of up to $13 per hour on top of their typical wages to employees deemed essential. The money would come out of the $26 billion the law allocates to California state government.
...
New cases of Covid-19 are once again on the rise across more than half of the United States as officials race to vaccinate additional people before highly contagious variants become prevalent in the country.
As of Sunday, the seven-day average of new cases rose by 5% or more in 27 states, according to a CNBC analysis of data compiled by Johns Hopkins University. Across the U.S., the nation logged an average of 54,308 new cases per day over the past week - a 1% rise from the prior week after months of rapidly declining case numbers, according to the data.
Even as the U.S. picks up the pace of vaccinations, giving about 2.5 million shots every day, some health officials have warned the country remains in a precarious spot. The lifting of restrictions in many states and the spread of more contagious variants in the U.S. threaten to undo the nation’s progress, which has seen cases, hospitalizations and deaths all fall dramatically since the peak earlier this year.
Lifting restrictions is a "serious threat to the progress we have made," Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, told reporters at a news briefing Monday. Walensky said she’s worried about an unavoidable surge in cases. "We are at a critical point in this pandemic, a fork in the road."
Daily new deaths continue to fall, likely helped by the prioritization for vaccination of the elderly and those with comorbid conditions who are most likely to die of Covid-19. About 68.8% of those 65 and older have received at least one shot of a vaccine as of Sunday, according to the CDC. In total, more than 124.4 million doses have been administered, but most of those are for two-dose vaccines.
As optimism around the steady rise in vaccinations picks up, many states have begun to ease restrictions on businesses and gatherings, despite warnings from the CDC not to do so. Though some states, such as New Jersey, are beginning to consider holding off on further reopening as cases begin to rise.
White House Chief Medical Advisor Dr. Anthony Fauci urged states last week not to declare victory prematurely. Fauci said he was concerned about a number of states and cities that were pulling back on public health measures and dropping mask mandates.
Adding to the urgency of the need to get people vaccinated quickly is the looming threat of new variants, which appear to have already caused severe surges across much of Europe and other parts of the world. The CDC has projected that the more contagious and potentially more deadly B.1.1.7 variant, which was discovered in the United Kingdom, could become the dominant strain in the U.S. by the end of the month.
Some health officials have said that the B.1.1.7 variant could be what’s behind some particularly worrying surges seen in various states, including Michigan, where cases have risen dramatically in recent days. According to data from Johns Hopkins, Michigan is reporting an average of almost 3,000 new cases per day, up by about 50% from a week ago.
...
As of Sunday, the seven-day average of new cases rose by 5% or more in 27 states, according to a CNBC analysis of data compiled by Johns Hopkins University. Across the U.S., the nation logged an average of 54,308 new cases per day over the past week - a 1% rise from the prior week after months of rapidly declining case numbers, according to the data.
Even as the U.S. picks up the pace of vaccinations, giving about 2.5 million shots every day, some health officials have warned the country remains in a precarious spot. The lifting of restrictions in many states and the spread of more contagious variants in the U.S. threaten to undo the nation’s progress, which has seen cases, hospitalizations and deaths all fall dramatically since the peak earlier this year.
Lifting restrictions is a "serious threat to the progress we have made," Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, told reporters at a news briefing Monday. Walensky said she’s worried about an unavoidable surge in cases. "We are at a critical point in this pandemic, a fork in the road."
Daily new deaths continue to fall, likely helped by the prioritization for vaccination of the elderly and those with comorbid conditions who are most likely to die of Covid-19. About 68.8% of those 65 and older have received at least one shot of a vaccine as of Sunday, according to the CDC. In total, more than 124.4 million doses have been administered, but most of those are for two-dose vaccines.
As optimism around the steady rise in vaccinations picks up, many states have begun to ease restrictions on businesses and gatherings, despite warnings from the CDC not to do so. Though some states, such as New Jersey, are beginning to consider holding off on further reopening as cases begin to rise.
White House Chief Medical Advisor Dr. Anthony Fauci urged states last week not to declare victory prematurely. Fauci said he was concerned about a number of states and cities that were pulling back on public health measures and dropping mask mandates.
Adding to the urgency of the need to get people vaccinated quickly is the looming threat of new variants, which appear to have already caused severe surges across much of Europe and other parts of the world. The CDC has projected that the more contagious and potentially more deadly B.1.1.7 variant, which was discovered in the United Kingdom, could become the dominant strain in the U.S. by the end of the month.
Some health officials have said that the B.1.1.7 variant could be what’s behind some particularly worrying surges seen in various states, including Michigan, where cases have risen dramatically in recent days. According to data from Johns Hopkins, Michigan is reporting an average of almost 3,000 new cases per day, up by about 50% from a week ago.
...
According to a report in the Associated Press, Oregon officials continue to refuse to publicly disclose how much money the state has lost to unemployment insurance fraud during the pandemic, despite the fact that neighboring states Washington and California have reported huge sums of money wrongly paid after their systems were targeted by sophisticated hackers.
The Oregon Employment Department says it is not "comfortable" disclosing the information because it could provide criminals an opening to exploit their systems further.
"Although some other states have shared fraud-related data, the Oregon Employment Department is not sharing any dollar amounts - including broad estimates - for how much we have identified as fraud, or breakdowns of other numbers," said Melanni Rosales, the communications director for the department.
Nationwide fraud has overwhelmed state unemployment agencies and antiquated benefit systems that are easy targets for persistent criminals. It has delayed legitimate payments and turned thousands of Americans into victims of identity theft. A review by The Associated Press found that many states have failed to adequately safeguard their systems.
California has been the biggest target, having distributed an estimated $11 billion in fraudulent payments and an additional $19 billion in suspect accounts. Other estimates, according to AP’s reporting across the states, range from several hundred thousand dollars in smaller states such as Alaska and Wyoming to $6.5 million in Colorado and to hundreds of millions in more populous states such as Massachusetts and Ohio.
Washington state was among the first hit with fraudulent unemployment claims believed to be tied to a West African scam ring using identities stolen in prior data breaches, such as the massive 2017 Equifax breach. More than 122,000 fraudulent claims made in the state siphoned $600 million. As of January, Washington was able to recover $357 million.
While officials from the Oregon Employment Department say the state is not facing the same scale of fraudulent claims as seen in Washington or California, in terms of dollar amounts or percentage, they refuse to disclose how much the state has lost, details about ongoing fraud prevention tactics, investigations, or the scope of potentially fraudulent activity.
Gov. Kate Brown agrees with the decision not to release the information, saying that the goal is to preserve the integrity of the unemployment insurance system and trust fund.
"This means, we must use every tool available to us to help prevent and combat fraud," said Liz Merah, the governor’s press secretary. "At this point, we are not willing to jeopardize this foothold by disclosing information that would make it easier for bad actors to game the system." ...
The Oregon Employment Department says it is not "comfortable" disclosing the information because it could provide criminals an opening to exploit their systems further.
"Although some other states have shared fraud-related data, the Oregon Employment Department is not sharing any dollar amounts - including broad estimates - for how much we have identified as fraud, or breakdowns of other numbers," said Melanni Rosales, the communications director for the department.
Nationwide fraud has overwhelmed state unemployment agencies and antiquated benefit systems that are easy targets for persistent criminals. It has delayed legitimate payments and turned thousands of Americans into victims of identity theft. A review by The Associated Press found that many states have failed to adequately safeguard their systems.
California has been the biggest target, having distributed an estimated $11 billion in fraudulent payments and an additional $19 billion in suspect accounts. Other estimates, according to AP’s reporting across the states, range from several hundred thousand dollars in smaller states such as Alaska and Wyoming to $6.5 million in Colorado and to hundreds of millions in more populous states such as Massachusetts and Ohio.
Washington state was among the first hit with fraudulent unemployment claims believed to be tied to a West African scam ring using identities stolen in prior data breaches, such as the massive 2017 Equifax breach. More than 122,000 fraudulent claims made in the state siphoned $600 million. As of January, Washington was able to recover $357 million.
While officials from the Oregon Employment Department say the state is not facing the same scale of fraudulent claims as seen in Washington or California, in terms of dollar amounts or percentage, they refuse to disclose how much the state has lost, details about ongoing fraud prevention tactics, investigations, or the scope of potentially fraudulent activity.
Gov. Kate Brown agrees with the decision not to release the information, saying that the goal is to preserve the integrity of the unemployment insurance system and trust fund.
"This means, we must use every tool available to us to help prevent and combat fraud," said Liz Merah, the governor’s press secretary. "At this point, we are not willing to jeopardize this foothold by disclosing information that would make it easier for bad actors to game the system." ...
A federal grand jury handed down a 33-page indictment charging 36 year old Zachary Schulz Apte and 46 year old Jessica Sunshine Richman with multiple federal crimes including conspiracy to commit securities fraud, conspiracy to commit health care fraud, money laundering, and related offenses in connection with alleged schemes to defraud health insurance providers and investors.
According to the indictment, Apte and Richman, both of whom resided in San Francisco at the time, co-founded uBiome in October 2012. Initially, uBiome offered a direct-to-consumer service, called "Gut Explorer," which allowed an individual to submit a fecal sample that uBiome would analyze in its laboratory and produce a report comparing the customer’s microbiome to the microbiomes of others who had submitted fecal samples to uBiome, all for less than $100.
The defendants eventually expanded uBiome’s business model to include development and marketing of "clinical" tests regarding the gut and vaginal microbiomes, which tests would ostensibly be used by medical professionals to make medical decisions and as to which uBiome would seek reimbursement from health insurance providers in amounts up to nearly $3,000. Apte’s and Richman’s efforts to have uBiome develop clinical tests that could be billed to insurance companies were intended to attract large-scale venture capital investment.
By late 2015, shortly before it raised millions of dollars in its "Series B" fundraising round, uBiome began to market a "clinical" version of a test.
Thereafter, the indictment alleges that Apte and Richman caused uBiome to employ various methods to secure health care provider orders for its clinical gut test and clinical vaginal test, including by having its Chief Medical Officer review test requests from customers and endeavoring to build a network of health care providers external to uBiome.
The defendants ultimately adopted several fraudulent practices with respect to its clinical tests. Specifically, the defendants developed, implemented, and oversaw practices designed to deceive approving health care providers and reimbursing insurance providers regarding tests that were not validated and not medically necessary. The defendants falsified documents and lied about and concealed material facts when insurance providers asked questions to which truthful answers would reveal the fraudulent nature of uBiome’s billing model.
Such practices included fraudulently submitting reimbursement claims for re-tests or re-sequencings of archived samples (referred to internally at uBiome as "upgrades") and utilizing a captive network of doctors and other health care providers who fraudulently were given partial and misleading information about the test requests they were reviewing. They are also accused of fraudulently submitting reimbursement claims with respect to tests that had not been validated under applicable federal standards and/or for which patient test results had not yet been released.
Between 2015 and 2019, uBiome submitted more than $300 million in reimbursement claims to private and public health insurers. Of these reimbursement claims, uBiome was paid more than $35 million ...
According to the indictment, Apte and Richman, both of whom resided in San Francisco at the time, co-founded uBiome in October 2012. Initially, uBiome offered a direct-to-consumer service, called "Gut Explorer," which allowed an individual to submit a fecal sample that uBiome would analyze in its laboratory and produce a report comparing the customer’s microbiome to the microbiomes of others who had submitted fecal samples to uBiome, all for less than $100.
The defendants eventually expanded uBiome’s business model to include development and marketing of "clinical" tests regarding the gut and vaginal microbiomes, which tests would ostensibly be used by medical professionals to make medical decisions and as to which uBiome would seek reimbursement from health insurance providers in amounts up to nearly $3,000. Apte’s and Richman’s efforts to have uBiome develop clinical tests that could be billed to insurance companies were intended to attract large-scale venture capital investment.
By late 2015, shortly before it raised millions of dollars in its "Series B" fundraising round, uBiome began to market a "clinical" version of a test.
Thereafter, the indictment alleges that Apte and Richman caused uBiome to employ various methods to secure health care provider orders for its clinical gut test and clinical vaginal test, including by having its Chief Medical Officer review test requests from customers and endeavoring to build a network of health care providers external to uBiome.
The defendants ultimately adopted several fraudulent practices with respect to its clinical tests. Specifically, the defendants developed, implemented, and oversaw practices designed to deceive approving health care providers and reimbursing insurance providers regarding tests that were not validated and not medically necessary. The defendants falsified documents and lied about and concealed material facts when insurance providers asked questions to which truthful answers would reveal the fraudulent nature of uBiome’s billing model.
Such practices included fraudulently submitting reimbursement claims for re-tests or re-sequencings of archived samples (referred to internally at uBiome as "upgrades") and utilizing a captive network of doctors and other health care providers who fraudulently were given partial and misleading information about the test requests they were reviewing. They are also accused of fraudulently submitting reimbursement claims with respect to tests that had not been validated under applicable federal standards and/or for which patient test results had not yet been released.
Between 2015 and 2019, uBiome submitted more than $300 million in reimbursement claims to private and public health insurers. Of these reimbursement claims, uBiome was paid more than $35 million ...
Donald Siao M.D. faces federal charges that he illegally distributed hydrocodone and oxycodone pills in his medical practice and committed health care fraud.
Siao, 55, of San Jose, is a medical doctor licensed by the state of California who conducted his practice in San Jose. His license authorized him to write prescriptions for Schedule II through V controlled substances for medical care.
A prescription monitoring system identified Siao was a high prescriber, exemplified by a recent year when Siao wrote 8,201 prescriptions for controlled substances, including large quantities of hydrocodone and oxycodone and many instances of the dangerous combination of opioid, muscle relaxant, and benzodiazepine known in the drug world as "the holy trinity."
Undercover law enforcement agents posed as new patients and met with Siao at his medical practice.
During initial visits, the agents complained of pain in vague or general terms. Siao conducted little or no physical examinations. The initial and subsequent visits usually lasted approximately two minutes. In initial visits Siao prescribed hydrocodone or oxycodone, and in follow-up appointments Siao continued to prescribe the same medicine and increased the amounts.
In one example in the complaint, an uncover agent posing as a patient met with Siao at an initial appointment and complained of pain. Following an eight second physical examination, Siao wrote a prescription for 30 pills of Norco, a hydrocodone-acetaminophen combination.
In subsequent visits as short as 2 minutes and 10 seconds, the undercover agent requested larger prescriptions for reasons that included he had given away pills to his employees as work incentives and that he had ran out of pills when he went to a concert. Siao increased the size of the prescriptions, eventually writing a prescription for 90 Norco pills at his last visit.
In another example in the complaint, an undercover agent requested and received a larger prescription of Norco so he could pay back friends with the pills. The agent then requested a prescription for Marinol, explaining he would not take the Marinol but rather would display the prescription at work as a pretext for his positive drug tests, saying "that way it covers the dirty drug test." Siao replied "gotcha" and wrote the prescription.
The complaint also charges Siao with health care fraud and alleges that on May 9, 2018, he wrote alprazolam and oxycodone prescriptions for a patient without any legitimate medical purpose ...
Siao, 55, of San Jose, is a medical doctor licensed by the state of California who conducted his practice in San Jose. His license authorized him to write prescriptions for Schedule II through V controlled substances for medical care.
A prescription monitoring system identified Siao was a high prescriber, exemplified by a recent year when Siao wrote 8,201 prescriptions for controlled substances, including large quantities of hydrocodone and oxycodone and many instances of the dangerous combination of opioid, muscle relaxant, and benzodiazepine known in the drug world as "the holy trinity."
Undercover law enforcement agents posed as new patients and met with Siao at his medical practice.
During initial visits, the agents complained of pain in vague or general terms. Siao conducted little or no physical examinations. The initial and subsequent visits usually lasted approximately two minutes. In initial visits Siao prescribed hydrocodone or oxycodone, and in follow-up appointments Siao continued to prescribe the same medicine and increased the amounts.
In one example in the complaint, an uncover agent posing as a patient met with Siao at an initial appointment and complained of pain. Following an eight second physical examination, Siao wrote a prescription for 30 pills of Norco, a hydrocodone-acetaminophen combination.
In subsequent visits as short as 2 minutes and 10 seconds, the undercover agent requested larger prescriptions for reasons that included he had given away pills to his employees as work incentives and that he had ran out of pills when he went to a concert. Siao increased the size of the prescriptions, eventually writing a prescription for 90 Norco pills at his last visit.
In another example in the complaint, an undercover agent requested and received a larger prescription of Norco so he could pay back friends with the pills. The agent then requested a prescription for Marinol, explaining he would not take the Marinol but rather would display the prescription at work as a pretext for his positive drug tests, saying "that way it covers the dirty drug test." Siao replied "gotcha" and wrote the prescription.
The complaint also charges Siao with health care fraud and alleges that on May 9, 2018, he wrote alprazolam and oxycodone prescriptions for a patient without any legitimate medical purpose ...
The Commission on Health and Safety and Workers’ Compensation (CHSWC) examines the health and safety and workers’ compensation systems in California and makes recommendations to improve their operation. CHSWC is composed of eight members appointed by the Governor, Senate and Assembly to represent employers and labor.
At the request of the Executive Branch, the Legislature and the Commission, CHSWC conducts research, releases public reports, presents findings, and provides information on the health and safety and workers’ compensation systems. They have just released the 247 page 2020 Annual Report.
Some of the highlights of the many topics covered in the Report include:
The Return-to-Work Supplemental Program administers a $120 million fund that makes supplemental payments to workers whose permanent disability benefits are disproportionately low in comparison to their earnings losses. A recent CHSWC study by RAND that evaluated the Return-to-Work Fund found a low rate of receipt of the RTWSP among eligible workers. CHSWC made a number of recommendations including increasing outreach and notification to help increase participation.
Research on the impact of the 2012 workers’ compensation reforms on earnings losses suggests that SB 863 has likely met its primary objective of restoring adequate wage replacement rates, although some inequities still exist in these rates across impairments.
The DWC recently adopted changes in its Physician Services/Non-Physician Practitioner Services Fee Schedule to encourage greater use of telehealth in light of the COVID-19 public health emergency. The Commission recommended that administrators monitor and study the use of telehealth and other medical care changes in WC in light of the COVID-19 pandemic.
In recent years, criminal indictments and prosecutions have highlighted the extent of medical provider fraud in the WC system. Estimates of the cost of this fraud to participants in the WC system are as high as $1 billion per year. They as that officials consider recommendations in the RAND report "Provider Fraud in California Workers’ Compensation" related to provider fraud.
A CHSWC study found that between $15 billion and $68 billion in payroll is underreported annually. A related study on split class codes found that 25 to 30 percent of low-wage payroll is underreported or misreported.
SB 1159 (2020) would require the Commission on Health and Safety and Workers’ Compensation to conduct a study of the impacts of COVID-19 and the specific presumptions created by this bill and report its findings to the Legislature and the Governor.
SB 1159 provides that a preliminary report from CHSWC is due to the Legislature and the Governor by December 31, 2021, and the final report must be delivered by April 30, 2022 ...
At the request of the Executive Branch, the Legislature and the Commission, CHSWC conducts research, releases public reports, presents findings, and provides information on the health and safety and workers’ compensation systems. They have just released the 247 page 2020 Annual Report.
Some of the highlights of the many topics covered in the Report include:
The Return-to-Work Supplemental Program administers a $120 million fund that makes supplemental payments to workers whose permanent disability benefits are disproportionately low in comparison to their earnings losses. A recent CHSWC study by RAND that evaluated the Return-to-Work Fund found a low rate of receipt of the RTWSP among eligible workers. CHSWC made a number of recommendations including increasing outreach and notification to help increase participation.
Research on the impact of the 2012 workers’ compensation reforms on earnings losses suggests that SB 863 has likely met its primary objective of restoring adequate wage replacement rates, although some inequities still exist in these rates across impairments.
The DWC recently adopted changes in its Physician Services/Non-Physician Practitioner Services Fee Schedule to encourage greater use of telehealth in light of the COVID-19 public health emergency. The Commission recommended that administrators monitor and study the use of telehealth and other medical care changes in WC in light of the COVID-19 pandemic.
In recent years, criminal indictments and prosecutions have highlighted the extent of medical provider fraud in the WC system. Estimates of the cost of this fraud to participants in the WC system are as high as $1 billion per year. They as that officials consider recommendations in the RAND report "Provider Fraud in California Workers’ Compensation" related to provider fraud.
A CHSWC study found that between $15 billion and $68 billion in payroll is underreported annually. A related study on split class codes found that 25 to 30 percent of low-wage payroll is underreported or misreported.
SB 1159 (2020) would require the Commission on Health and Safety and Workers’ Compensation to conduct a study of the impacts of COVID-19 and the specific presumptions created by this bill and report its findings to the Legislature and the Governor.
SB 1159 provides that a preliminary report from CHSWC is due to the Legislature and the Governor by December 31, 2021, and the final report must be delivered by April 30, 2022 ...
The massive Unemployment Insurance fraud during the pandemic, including the estimated $11 billion loss by the California Employment Development Department has apparently triggered federal legislators to act. This month they introduced the Unemployment Insurance Technology Modernization Act to help solve the problem.
One of the bill sponsors, Congressman Steven Horsford (Nevada) provided the following rationale.
"State unemployment insurance systems have been neglected for decades, with many running on technology from the 1960s. The consequence of these broken systems has been millions of jobless workers waiting months to receive their benefits, and struggling to keep a roof over their heads and put food on the table. These outdated systems are also susceptible to attacks from organized criminal networks that have stolen billions of taxpayer dollars from the program. It is clear that an upgrade is long overdue."
"Rather than invest in 53 state systems, the Unemployment Insurance Technology Modernization Act would invest in federal technology capabilities all states could use to administer their unique unemployment insurance programs. Not only will this approach ensure that all states have access to modern, state-of-the-art technology, but investing in a single set of technology capabilities is far more cost-effective than building 53 separate systems."
Specifically, the Unemployment Insurance Technology Modernization Act:
- - Requires the U.S. Department of Labor to work with technology experts to develop, operate, and maintain a modular set of technology capabilities to modernize unemployment compensation technology.
- - States will be able to use all of the capabilities or choose to use only those capabilities that meet their needs.
- - The updated technology will help states ensure timely and accurate delivery of payments and better identify fraudulent claims.
- - Prioritizes user experience, including by requiring consultation and testing with claimants, employers, State workforce agency staff, and other users.
- - Requires a study to evaluate unemployment insurance technology needs, with an emphasis on program accessibility and equity.
- - Establishes a new Department of Labor Digital Services Team to expand the Department’s ability to assist states with technological issues.
- - Ensures the use of best practices in cybersecurity, procurement, and transparency during and after the development of the technology capabilities.
- - Includes accessibility requirements for online claim-filing systems.
- - Ensures that the new technology capabilities do not rely on automated decision systems that may produce biased results without impact assessments and public input.
According to the language of the proposed Act "Not later than 2 years after the date of enactment of this section, the Secretary shall develop, operate, and maintain a modular set of technology capabilities to modernize the delivery of unemployment compensation." ...
One of the bill sponsors, Congressman Steven Horsford (Nevada) provided the following rationale.
"State unemployment insurance systems have been neglected for decades, with many running on technology from the 1960s. The consequence of these broken systems has been millions of jobless workers waiting months to receive their benefits, and struggling to keep a roof over their heads and put food on the table. These outdated systems are also susceptible to attacks from organized criminal networks that have stolen billions of taxpayer dollars from the program. It is clear that an upgrade is long overdue."
"Rather than invest in 53 state systems, the Unemployment Insurance Technology Modernization Act would invest in federal technology capabilities all states could use to administer their unique unemployment insurance programs. Not only will this approach ensure that all states have access to modern, state-of-the-art technology, but investing in a single set of technology capabilities is far more cost-effective than building 53 separate systems."
Specifically, the Unemployment Insurance Technology Modernization Act:
- - Requires the U.S. Department of Labor to work with technology experts to develop, operate, and maintain a modular set of technology capabilities to modernize unemployment compensation technology.
- - States will be able to use all of the capabilities or choose to use only those capabilities that meet their needs.
- - The updated technology will help states ensure timely and accurate delivery of payments and better identify fraudulent claims.
- - Prioritizes user experience, including by requiring consultation and testing with claimants, employers, State workforce agency staff, and other users.
- - Requires a study to evaluate unemployment insurance technology needs, with an emphasis on program accessibility and equity.
- - Establishes a new Department of Labor Digital Services Team to expand the Department’s ability to assist states with technological issues.
- - Ensures the use of best practices in cybersecurity, procurement, and transparency during and after the development of the technology capabilities.
- - Includes accessibility requirements for online claim-filing systems.
- - Ensures that the new technology capabilities do not rely on automated decision systems that may produce biased results without impact assessments and public input.
According to the language of the proposed Act "Not later than 2 years after the date of enactment of this section, the Secretary shall develop, operate, and maintain a modular set of technology capabilities to modernize the delivery of unemployment compensation." ...
Two California district attorneys are teaming up to sue a home cleaning and repair gig company for allegedly misclassifying tens of thousands of workers as independent contractors.
The district attorneys of San Francisco and Los Angeles on Wednesday sued the New York-based company Handy, which operates an online application that allows customers to schedule home-cleaning and repair services.
Handy, a company started by Harvard Business School classmates Oisin Hanrahan and Umang Dua in 2012, has scheduled home-cleaning and repair gigs for tens of thousands of workers in California, according to the San Francisco DA’s office.
The lawsuit filed in San Francisco Superior Court accuses Handy of failing to pay minimum wage and overtime wages or reimburse job-related expenses such as cleaning supplies. It also claims the company denied workers sick leave and did not pay unemployment insurance or payroll taxes.
It further accuses the company of illegally imposing fines on workers and deducting pay from their wages. Additionally, it claims the company did not cover quarterly healthcare expenditures for workers in San Francisco as required by a city ordinance.
In an emailed statement, a Handy spokesperson said the lawsuit "has no merit" and is based on a "fundamental misunderstanding" of California law and the rights of Handy and its workers, which it calls "pros."
"Handy complies with all laws and regulations in California and elsewhere, and we will vigorously defend ourselves in court," the spokesperson said.
Assistant San Francisco DA Scott Stillman, who runs the office’s Economic Crimes Unit, said Handy cannot satisfy the three requirements necessary to classify workers as independent contractors under state law.
The California Supreme Court established a three-pronged standard, known as the "ABC test," for determining a worker’s employment status in its 2018 ruling in Dynamex v. Superior Court. That standard was later written into state law with the passage of Assembly Bill 5 in 2019.
Stillman said Handy directly controls workers by monitoring them through an app for several hours before and after their scheduled shifts. The company allegedly fines workers if they show up to assignments late or leave early. Stillman argued that Handy’s gig workers also support the company’s core business function - providing home-cleaning and repair services.
Handy also requires its workers to sign arbitration agreements waiving their right to sue the company in court. Labor disputes, including ones involving employment status, must be resolved through a private arbitration process instead.
The district attorneys seek a court order requiring Handy to classify workers as employees, pay civil penalties and provide restitution to workers for unpaid wages and job expense reimbursement.
Last year, voters approved a ballot measure backed by Uber and Lyft that exempted app-based transportation and delivery workers from California’s labor law, allowing those companies to continue classifying their workers as independent contractors ...
The district attorneys of San Francisco and Los Angeles on Wednesday sued the New York-based company Handy, which operates an online application that allows customers to schedule home-cleaning and repair services.
Handy, a company started by Harvard Business School classmates Oisin Hanrahan and Umang Dua in 2012, has scheduled home-cleaning and repair gigs for tens of thousands of workers in California, according to the San Francisco DA’s office.
The lawsuit filed in San Francisco Superior Court accuses Handy of failing to pay minimum wage and overtime wages or reimburse job-related expenses such as cleaning supplies. It also claims the company denied workers sick leave and did not pay unemployment insurance or payroll taxes.
It further accuses the company of illegally imposing fines on workers and deducting pay from their wages. Additionally, it claims the company did not cover quarterly healthcare expenditures for workers in San Francisco as required by a city ordinance.
In an emailed statement, a Handy spokesperson said the lawsuit "has no merit" and is based on a "fundamental misunderstanding" of California law and the rights of Handy and its workers, which it calls "pros."
"Handy complies with all laws and regulations in California and elsewhere, and we will vigorously defend ourselves in court," the spokesperson said.
Assistant San Francisco DA Scott Stillman, who runs the office’s Economic Crimes Unit, said Handy cannot satisfy the three requirements necessary to classify workers as independent contractors under state law.
The California Supreme Court established a three-pronged standard, known as the "ABC test," for determining a worker’s employment status in its 2018 ruling in Dynamex v. Superior Court. That standard was later written into state law with the passage of Assembly Bill 5 in 2019.
Stillman said Handy directly controls workers by monitoring them through an app for several hours before and after their scheduled shifts. The company allegedly fines workers if they show up to assignments late or leave early. Stillman argued that Handy’s gig workers also support the company’s core business function - providing home-cleaning and repair services.
Handy also requires its workers to sign arbitration agreements waiving their right to sue the company in court. Labor disputes, including ones involving employment status, must be resolved through a private arbitration process instead.
The district attorneys seek a court order requiring Handy to classify workers as employees, pay civil penalties and provide restitution to workers for unpaid wages and job expense reimbursement.
Last year, voters approved a ballot measure backed by Uber and Lyft that exempted app-based transportation and delivery workers from California’s labor law, allowing those companies to continue classifying their workers as independent contractors ...
With opioid overdose deaths increasing during the pandemic, the Drug Enforcement Administration announced its 20th Take Back Day scheduled for April 24.
At its last Take Back Day in October, DEA collected a record-high amount of expired, unused prescription medications, with the public turning in close to 500 tons of unwanted drugs.
Over the 10-year span of Take Back Day, DEA has brought in more than 6,800 tons of prescription drugs. With studies indicating a majority of abused prescription drugs come from family and friends, including from home medicine cabinets, clearing out unused medicine is essential.
According to the Centers for Disease Control and Prevention, the U.S. has seen an increase in overdose deaths during the COVID-19 pandemic, with 83,544 Americans overdosing during the 12-month period ending July 1, 2020, the most ever recorded in a 12-month period. The increase in drug overdose deaths appeared to begin prior to the COVID-19 health emergency, but accelerated significantly during the first months of the pandemic.
The public can drop off potentially dangerous prescription medications at collection sites which will adhere to local COVID-19 guidelines and regulations in order to maintain the safety of all participants and local law enforcement.
DEA and its partners will collect tablets, capsules, patches, and other solid forms of prescription drugs. Liquids (including intravenous solutions), syringes and other sharps, and illegal drugs will not be accepted. DEA will continue to accept vaping devices and cartridges at its drop off locations provided lithium batteries are removed.
Helping people dispose of potentially harmful prescription drugs is just one way DEA is working to reduce addiction and stem overdose deaths.
Learn more about the event at https://takebackday.dea.gov/, or by calling 800-882-9539 ...
At its last Take Back Day in October, DEA collected a record-high amount of expired, unused prescription medications, with the public turning in close to 500 tons of unwanted drugs.
Over the 10-year span of Take Back Day, DEA has brought in more than 6,800 tons of prescription drugs. With studies indicating a majority of abused prescription drugs come from family and friends, including from home medicine cabinets, clearing out unused medicine is essential.
According to the Centers for Disease Control and Prevention, the U.S. has seen an increase in overdose deaths during the COVID-19 pandemic, with 83,544 Americans overdosing during the 12-month period ending July 1, 2020, the most ever recorded in a 12-month period. The increase in drug overdose deaths appeared to begin prior to the COVID-19 health emergency, but accelerated significantly during the first months of the pandemic.
The public can drop off potentially dangerous prescription medications at collection sites which will adhere to local COVID-19 guidelines and regulations in order to maintain the safety of all participants and local law enforcement.
DEA and its partners will collect tablets, capsules, patches, and other solid forms of prescription drugs. Liquids (including intravenous solutions), syringes and other sharps, and illegal drugs will not be accepted. DEA will continue to accept vaping devices and cartridges at its drop off locations provided lithium batteries are removed.
Helping people dispose of potentially harmful prescription drugs is just one way DEA is working to reduce addiction and stem overdose deaths.
Learn more about the event at https://takebackday.dea.gov/, or by calling 800-882-9539 ...
Juan Castro sustained injuries when he fell out of a tree he was trimming at an apartment complex owned by Kirby Manor Corporation and managed by Hallmark Realty.
Kirby and Hallmark had an agreement that identified Hallmark as both an independent contractor hired by Kirby and Kirby’s agent. Hallmark had hired Marcos Patino to provide landscaping services, including tree-trimming, and Patino, in turn, had hired Castro to help him trim the trees.
Castro filed this negligence action against Kirby and Hallmark. He alleged that he was an employee of the defendants, that he sustained his injuries in the course of his employment, and that during his employment the defendants "failed to secure any worker’s compensation insurance coverage whatsoever to cover any workplace injuries suffered by" him. Castro alleged the defendants’ failure to obtain a worker’s compensation policy entitled him to bring a civil action for negligence under Labor Code section 3706.
Hallmark and Kirby filed a motion for summary judgment. Hallmark conceded Castro was its employee, but contended that it had workers’ compensation insurance when he suffered his injury and that therefore Castro’s exclusive remedy was through the workers’ compensation system. Hallmark submitted a true and correct copy of Hallmark’s workers’ compensation insurance policy in effect at the time of Castro’s accident.
Castro argued, even assuming "there was a valid workers’ compensation policy," Hallmark had not produced evidence Castro "met the minimum number of hours required to qualify for workers’ compensation coverage."
The trial court granted the motion for summary judgment, and the Court of Appeal affirmed in the unpublished case of Castro v. Knowlton Manners Apartments.
The Exclusive Remedy rule ordinarily protects an employer from suits by an employee for injuries during the course of employment.
One exception to that rule appears in section 3706, which provides that an injured employee may bring a civil action for damages against "any employer [who] fails to secure the payment of compensation" under the Act, as required by section 3700. An employer complies with its obligation under section 3700 to secure the payment of compensation by either purchasing workers' compensation insurance or self-insuring.
In a statutory action under section 3706 of the Labor Code, it is the ‘plaintiff’s obligation to plead and prove violation of section 3700 by his employer’s failure to carry workers’ compensation insurance.
The Court noted that "Castro cites several cases he suggests "indicate that a defendant must show a plaintiff received workers’ compensation benefits for the claimed injuries, before a plaintiff can be barred from pursuing a damages action for the same injuries." None of those cases, however, says anything like that." ...
Kirby and Hallmark had an agreement that identified Hallmark as both an independent contractor hired by Kirby and Kirby’s agent. Hallmark had hired Marcos Patino to provide landscaping services, including tree-trimming, and Patino, in turn, had hired Castro to help him trim the trees.
Castro filed this negligence action against Kirby and Hallmark. He alleged that he was an employee of the defendants, that he sustained his injuries in the course of his employment, and that during his employment the defendants "failed to secure any worker’s compensation insurance coverage whatsoever to cover any workplace injuries suffered by" him. Castro alleged the defendants’ failure to obtain a worker’s compensation policy entitled him to bring a civil action for negligence under Labor Code section 3706.
Hallmark and Kirby filed a motion for summary judgment. Hallmark conceded Castro was its employee, but contended that it had workers’ compensation insurance when he suffered his injury and that therefore Castro’s exclusive remedy was through the workers’ compensation system. Hallmark submitted a true and correct copy of Hallmark’s workers’ compensation insurance policy in effect at the time of Castro’s accident.
Castro argued, even assuming "there was a valid workers’ compensation policy," Hallmark had not produced evidence Castro "met the minimum number of hours required to qualify for workers’ compensation coverage."
The trial court granted the motion for summary judgment, and the Court of Appeal affirmed in the unpublished case of Castro v. Knowlton Manners Apartments.
The Exclusive Remedy rule ordinarily protects an employer from suits by an employee for injuries during the course of employment.
One exception to that rule appears in section 3706, which provides that an injured employee may bring a civil action for damages against "any employer [who] fails to secure the payment of compensation" under the Act, as required by section 3700. An employer complies with its obligation under section 3700 to secure the payment of compensation by either purchasing workers' compensation insurance or self-insuring.
In a statutory action under section 3706 of the Labor Code, it is the ‘plaintiff’s obligation to plead and prove violation of section 3700 by his employer’s failure to carry workers’ compensation insurance.
The Court noted that "Castro cites several cases he suggests "indicate that a defendant must show a plaintiff received workers’ compensation benefits for the claimed injuries, before a plaintiff can be barred from pursuing a damages action for the same injuries." None of those cases, however, says anything like that." ...
