Supply chain issues in the United States and particularly the role ports in Los Angeles and Long Beach play, have become a hot topic in the news cycle.
Dwell time for containers at terminals is six days, the wait time for on-dock rail is nearly 12 days and it takes 8.5 days on average for containers on the street to find dock space at warehouses. The situation is so bad that a few weeks ago about 65 container vessels were stacked up along the coast waiting to berth and unload.
In addition to the nationwide labor shortage, ports in California face state-specific challenges.
Last week President Biden announced that the Port of Los Angeles will join the Port of Long Beach in operating 24/7 in an attempt to clear the shipyards of cargo containers and allow the dozens of ships anchored offshore to offload their cargo. That should do the trick, right? Only for people who don’t understand how a supply chain works.
According to the California Trucking Association (CTA), there are more than 70,000 predominantly minority-owned independent truckers operating in California. About 17,000 truckers are registered to bring goods into the Los Angeles and Long Beach ports. Many of those are contractors who own or lease their trucks and don’t receive workers’ compensation or other benefits enjoyed by full-time employees.
Many of these independent contractors are hired by large, well known trucking companies, many of them contract with multiple trucking companies, both large and small. Many of the independent contractors are small businesses themselves and utilize employees and contractors. This business model has existed at California ports for many decades.
However, AB5, enacted in 2019, changes the rules for the California trucking industry model of doing business. It sets as law the ABC test for determining whether a worker is an employee or a true independent contractor. And for trucking, the B prong is viewed as making it difficult to hire independent owner-operators as drivers, because it defines a person engaged in the primary activity of the hiring company - like a trucking company hiring a truck driver - as an employee.
There were two AB5/trucking-related cases on the U.S. Supreme Court docket for this term; on October 5 the Court denied certiorari in the Cal Cartage case, but hasn’t yet ruled on another case brought by the California Trucking Association (CTA).
In that case, a federal judge issued an injunction in January 2020 blocking the implementation of the law in the trucking industry until legal challenges could wind their way through the courts. In April the 9th Circuit Court of Appeals ruled against CTA, but enforcement of that order has been stayed pending SCOTUS’ decision, which means the January 2020 injunction is still in effect.
According to an article by Compliance Navigation Specialists, carriers that have been taking the "wait and see" approach on the law and the court’s process are now facing a near-term reality that the independent contractor system might not be possible and will have to face an increase in costs to hire the drivers.Other carriers have been cutting ties with California as the cost of doing business in the state are greater than the reward and pull out of any California operations to shield themselves from the impact of the AB5 law.
And, depending on how SCOTUS rules on a pending case regarding how California’s AB5 applies to the trucking industry, the problem will only get worse. If owner-operators who contract with larger freight companies must be classified as employees there will likely be a huge contraction in trucking capacity in California ...
Dwell time for containers at terminals is six days, the wait time for on-dock rail is nearly 12 days and it takes 8.5 days on average for containers on the street to find dock space at warehouses. The situation is so bad that a few weeks ago about 65 container vessels were stacked up along the coast waiting to berth and unload.
In addition to the nationwide labor shortage, ports in California face state-specific challenges.
Last week President Biden announced that the Port of Los Angeles will join the Port of Long Beach in operating 24/7 in an attempt to clear the shipyards of cargo containers and allow the dozens of ships anchored offshore to offload their cargo. That should do the trick, right? Only for people who don’t understand how a supply chain works.
According to the California Trucking Association (CTA), there are more than 70,000 predominantly minority-owned independent truckers operating in California. About 17,000 truckers are registered to bring goods into the Los Angeles and Long Beach ports. Many of those are contractors who own or lease their trucks and don’t receive workers’ compensation or other benefits enjoyed by full-time employees.
Many of these independent contractors are hired by large, well known trucking companies, many of them contract with multiple trucking companies, both large and small. Many of the independent contractors are small businesses themselves and utilize employees and contractors. This business model has existed at California ports for many decades.
However, AB5, enacted in 2019, changes the rules for the California trucking industry model of doing business. It sets as law the ABC test for determining whether a worker is an employee or a true independent contractor. And for trucking, the B prong is viewed as making it difficult to hire independent owner-operators as drivers, because it defines a person engaged in the primary activity of the hiring company - like a trucking company hiring a truck driver - as an employee.
There were two AB5/trucking-related cases on the U.S. Supreme Court docket for this term; on October 5 the Court denied certiorari in the Cal Cartage case, but hasn’t yet ruled on another case brought by the California Trucking Association (CTA).
In that case, a federal judge issued an injunction in January 2020 blocking the implementation of the law in the trucking industry until legal challenges could wind their way through the courts. In April the 9th Circuit Court of Appeals ruled against CTA, but enforcement of that order has been stayed pending SCOTUS’ decision, which means the January 2020 injunction is still in effect.
According to an article by Compliance Navigation Specialists, carriers that have been taking the "wait and see" approach on the law and the court’s process are now facing a near-term reality that the independent contractor system might not be possible and will have to face an increase in costs to hire the drivers.Other carriers have been cutting ties with California as the cost of doing business in the state are greater than the reward and pull out of any California operations to shield themselves from the impact of the AB5 law.
And, depending on how SCOTUS rules on a pending case regarding how California’s AB5 applies to the trucking industry, the problem will only get worse. If owner-operators who contract with larger freight companies must be classified as employees there will likely be a huge contraction in trucking capacity in California ...
A Calabasas physician was sentenced to 14 months in federal prison for accepting nearly $800,000 in bribes and kickbacks as part of a conspiracy that unlawfully billed the worker's compensation system for compounded medication prescriptions.
Dr. Amir Friedman, 56, pleaded guilty in October 2019 to one count of conspiracy to commit honest services mail and wire fraud, and to violate the Travel Act, a federal law that - among other things - forbids the use of the U.S. mail for the purpose of aiding bribery.
Friedman, a licensed anesthesiologist, violated the fiduciary duty he owed to his patients by accepting kickbacks and bribes for writing prescriptions for compounded medications for his patients.
Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient.
From August 2013 to May 2015, Friedman conspired with New Age Pharmaceuticals Inc., a Beverly Hills-based company, and a marketer - listed in court documents as "Marketer A" - to violate federal law.
According to a related 2016 indictment, Hootan Melamed allegedly operated and was the de facto owner of New Age Pharmaceuticals Inc.. He also had business interests in other pharmacies, including RoxSan Pharmacy Inc., Concierge Compounding Pharmaceuticals, Inc , Alexso, Inc. and Portland Professional Pharmacy, Melamed entered into a plea agreement in 2020, and was sentenced to 6 months in prison on March 29, 2021.
Insurance companies under the California Workers’ Compensation System reimbursed New Age for dispensing prescription drugs and other pharmaceuticals. Marketer A was paid commissions for facilitating the referral of compounded drug prescriptions.
Marketer A provided pre-printed prescription pads for compounded drugs to Friedman and offered Friedman kickbacks and bribes for each prescription he wrote. After Friedman wrote the kickback-tainted prescriptions, New Age dispensed the compounded drugs, billed insurance companies for reimbursement and shipped through the mail the compounded drugs to patients.
In total, Friedman accepted $788,140 in kickbacks and bribes - a sum he received in the form of approximately 28 check payments that represented illicit proceeds from the conspiracy. He admitted in his plea agreement that he was aware that the compounded drugs he prescribed were far more expensive than equivalents.
The FBI investigated this matter. Assistant United States Attorney Poonam G. Kumar of the Major Frauds Section prosecuted this case ...
Dr. Amir Friedman, 56, pleaded guilty in October 2019 to one count of conspiracy to commit honest services mail and wire fraud, and to violate the Travel Act, a federal law that - among other things - forbids the use of the U.S. mail for the purpose of aiding bribery.
Friedman, a licensed anesthesiologist, violated the fiduciary duty he owed to his patients by accepting kickbacks and bribes for writing prescriptions for compounded medications for his patients.
Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient.
From August 2013 to May 2015, Friedman conspired with New Age Pharmaceuticals Inc., a Beverly Hills-based company, and a marketer - listed in court documents as "Marketer A" - to violate federal law.
According to a related 2016 indictment, Hootan Melamed allegedly operated and was the de facto owner of New Age Pharmaceuticals Inc.. He also had business interests in other pharmacies, including RoxSan Pharmacy Inc., Concierge Compounding Pharmaceuticals, Inc , Alexso, Inc. and Portland Professional Pharmacy, Melamed entered into a plea agreement in 2020, and was sentenced to 6 months in prison on March 29, 2021.
Insurance companies under the California Workers’ Compensation System reimbursed New Age for dispensing prescription drugs and other pharmaceuticals. Marketer A was paid commissions for facilitating the referral of compounded drug prescriptions.
Marketer A provided pre-printed prescription pads for compounded drugs to Friedman and offered Friedman kickbacks and bribes for each prescription he wrote. After Friedman wrote the kickback-tainted prescriptions, New Age dispensed the compounded drugs, billed insurance companies for reimbursement and shipped through the mail the compounded drugs to patients.
In total, Friedman accepted $788,140 in kickbacks and bribes - a sum he received in the form of approximately 28 check payments that represented illicit proceeds from the conspiracy. He admitted in his plea agreement that he was aware that the compounded drugs he prescribed were far more expensive than equivalents.
The FBI investigated this matter. Assistant United States Attorney Poonam G. Kumar of the Major Frauds Section prosecuted this case ...
The National Academy of Social Insurance is a non-profit, non-partisan organization made up of the nation’s leading experts on social insurance. Its mission is to advance solutions to challenges facing the nation by increasing public understanding of how social insurance contributes to economic security.
Social insurance encompasses broad-based systems that help workers and their families pool risks to avoid loss of income due to retirement, death, disability, or unemployment, and to ensure access to health care.
The Academy just published its Workers’ Compensation Benefits, Costs, and Coverage - 2019 Data. These data range from benefits, costs, and coverage to Department of Labor data on injuries and fatalities, and data on the overlaps between Social Security disability insurance and the workers’ compensation system. This latest report is issued annually by the National Academy of Social Insurance.
Drawing on data from surveys of workers’ compensation agencies from all 50 states and the District of Columbia, as well as from A.M. Best and the National Council on Compensation Insurance, this is the only report of its kind available free-of-charge for researchers and students, state and federal agencies, workers’ rights and employer advocates, and others.
While overall, total benefits paid rose slightly over the five-year study period from 2015 to 2019, standardized benefits fell, continuing a ten-year trend. Total benefits paid rose 0.4%. Cash benefits increased by 2.0%, but medical benefits declined by 1.1%. Standardized cash and medical benefits fell by 14.0% and 16.7%, respectively, combining for a 15.4% decline in total standardized benefits between 2015 and 2019.
While medical benefits as a share of total benefits have increased in recent decades (with the share attributable to cash benefits shrinking), the national average masks enormous variation across states. In 2019, for example, medical benefits constituted 49.6% of all workers’ compensation benefits paid out, yet they are only 29.8% of benefits in D.C. and 79.1% of benefits paid in Wisconsin.
There are considerable cross-state differences within standardized benefits, where only one state, Hawaii, saw an increase over the study period. Declines ranged from 2.4% in Massachusetts to 30.5% in Tennessee and 33.1% in Oklahoma. Over that period, 24 states observed standardized benefit declines exceeding 15%, and 11 of those states, exceeding 20%.
Total employer costs for workers’ compensation in 2019 were $100.2 billion.
Like benefits, standardized employer costs vary substantially across states from the 15.0% national-average decline over the study period. In Hawaii, standardized costs rose by 1.9%. Decreases in the other states range from 4.5% in Massachusetts to 30.8% in Oklahoma and a massive 40.2% figure in Tennessee. In all, standardized costs declined by more than 15% in 31 states, and by more than 20% in 13 states.
Coverage continued to increase, largely because the labor force has continued to expand, a fairly consistent trend, at very different rates. The only five exceptions are Alaska, Louisiana, North Dakota, West Virginia, and Wyoming. Even in those states, covered wages increased.
In 2019, workers’ compensation covered 144,407,000 jobs across the country, with a total of $8.6 billion in covered wages. Measured by covered jobs, workers’ compensation coverage increased by 3.2% from 2015 to 2017, and by 2.8% in the following two years, for a total increase of 6.2%.
Certain source data are available upon request to Griffin Murphy, gmurphy@nasi.org, or Jay Patel, jpatel@nasi.org ...
Social insurance encompasses broad-based systems that help workers and their families pool risks to avoid loss of income due to retirement, death, disability, or unemployment, and to ensure access to health care.
The Academy just published its Workers’ Compensation Benefits, Costs, and Coverage - 2019 Data. These data range from benefits, costs, and coverage to Department of Labor data on injuries and fatalities, and data on the overlaps between Social Security disability insurance and the workers’ compensation system. This latest report is issued annually by the National Academy of Social Insurance.
Drawing on data from surveys of workers’ compensation agencies from all 50 states and the District of Columbia, as well as from A.M. Best and the National Council on Compensation Insurance, this is the only report of its kind available free-of-charge for researchers and students, state and federal agencies, workers’ rights and employer advocates, and others.
While overall, total benefits paid rose slightly over the five-year study period from 2015 to 2019, standardized benefits fell, continuing a ten-year trend. Total benefits paid rose 0.4%. Cash benefits increased by 2.0%, but medical benefits declined by 1.1%. Standardized cash and medical benefits fell by 14.0% and 16.7%, respectively, combining for a 15.4% decline in total standardized benefits between 2015 and 2019.
While medical benefits as a share of total benefits have increased in recent decades (with the share attributable to cash benefits shrinking), the national average masks enormous variation across states. In 2019, for example, medical benefits constituted 49.6% of all workers’ compensation benefits paid out, yet they are only 29.8% of benefits in D.C. and 79.1% of benefits paid in Wisconsin.
There are considerable cross-state differences within standardized benefits, where only one state, Hawaii, saw an increase over the study period. Declines ranged from 2.4% in Massachusetts to 30.5% in Tennessee and 33.1% in Oklahoma. Over that period, 24 states observed standardized benefit declines exceeding 15%, and 11 of those states, exceeding 20%.
Total employer costs for workers’ compensation in 2019 were $100.2 billion.
Like benefits, standardized employer costs vary substantially across states from the 15.0% national-average decline over the study period. In Hawaii, standardized costs rose by 1.9%. Decreases in the other states range from 4.5% in Massachusetts to 30.8% in Oklahoma and a massive 40.2% figure in Tennessee. In all, standardized costs declined by more than 15% in 31 states, and by more than 20% in 13 states.
Coverage continued to increase, largely because the labor force has continued to expand, a fairly consistent trend, at very different rates. The only five exceptions are Alaska, Louisiana, North Dakota, West Virginia, and Wyoming. Even in those states, covered wages increased.
In 2019, workers’ compensation covered 144,407,000 jobs across the country, with a total of $8.6 billion in covered wages. Measured by covered jobs, workers’ compensation coverage increased by 3.2% from 2015 to 2017, and by 2.8% in the following two years, for a total increase of 6.2%.
Certain source data are available upon request to Griffin Murphy, gmurphy@nasi.org, or Jay Patel, jpatel@nasi.org ...
Mitchell, Genex and Coventry announced the creation of their new parent brand, Enlyte. The three businesses have been moving towards this unification since the merger of Mitchell and Genex in 2018, followed by the acquisition of Coventry in 2020.
Mitchell International, Inc. delivers smart technology solutions and services to the auto insurance, collision repair and workers' compensation markets. Each month, Mitchell processes tens of millions of transactions for more than 300 insurance providers, 20,000 collision repair facilities and 70,000 pharmacies.
Genex serves the top underwriters of workers' compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis.
Coventry Workers' Comp Services offers workers' compensation, provider network and specialty network solutions for employers, insurance carriers, and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 35 years of industry experience, knowledge, and data analytics.
The announcement said that this new alignment allows the family of businesses to better serve the industry with a holistic point of view and expanded reach, while remaining focused on the individual needs of clients in the Auto Physical Damage, Auto Casualty, Workers' Compensation and Disability spaces.
"We are so pleased to share the exciting work our people have been doing to bring our family of businesses even closer together," said CEO, Alex Sun. "Uniting our teams under Enlyte will make it easier for us to help customers manage costs while delivering quality service with an expansive collection of Mitchell, Genex and Coventry solutions from first-notice-of-loss to recovery."
The new team will be led by Nina Smith, who currently serves as Executive Vice President and General Manager of Mitchell's Casualty Solutions Group.
The changes were shared yesterday with an invite-only audience of Mitchell, Genex and Coventry customers at the 2021 Virtual mPower Conference. Attendees were given a first-look at the new brand, and heard directly from Sun and other leaders about the new organization and the promise of a future united. "Aligning under a single, unified brand, while keeping the greatness of our legacy companies, reminds us that we must continue to deliver on our strategic vision of bringing an ever-expanding set of capabilities that positively impact claims outcomes."
The three businesses have a combined organization of nearly 6,000 associates committed to simplifying and optimizing property, casualty and disability claims processes and services.
...
Mitchell International, Inc. delivers smart technology solutions and services to the auto insurance, collision repair and workers' compensation markets. Each month, Mitchell processes tens of millions of transactions for more than 300 insurance providers, 20,000 collision repair facilities and 70,000 pharmacies.
Genex serves the top underwriters of workers' compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis.
Coventry Workers' Comp Services offers workers' compensation, provider network and specialty network solutions for employers, insurance carriers, and third-party administrators. With roots in both clinical and network services, Coventry leverages more than 35 years of industry experience, knowledge, and data analytics.
The announcement said that this new alignment allows the family of businesses to better serve the industry with a holistic point of view and expanded reach, while remaining focused on the individual needs of clients in the Auto Physical Damage, Auto Casualty, Workers' Compensation and Disability spaces.
"We are so pleased to share the exciting work our people have been doing to bring our family of businesses even closer together," said CEO, Alex Sun. "Uniting our teams under Enlyte will make it easier for us to help customers manage costs while delivering quality service with an expansive collection of Mitchell, Genex and Coventry solutions from first-notice-of-loss to recovery."
The new team will be led by Nina Smith, who currently serves as Executive Vice President and General Manager of Mitchell's Casualty Solutions Group.
The changes were shared yesterday with an invite-only audience of Mitchell, Genex and Coventry customers at the 2021 Virtual mPower Conference. Attendees were given a first-look at the new brand, and heard directly from Sun and other leaders about the new organization and the promise of a future united. "Aligning under a single, unified brand, while keeping the greatness of our legacy companies, reminds us that we must continue to deliver on our strategic vision of bringing an ever-expanding set of capabilities that positively impact claims outcomes."
The three businesses have a combined organization of nearly 6,000 associates committed to simplifying and optimizing property, casualty and disability claims processes and services.
...
The California Attorney General announced the filing of criminal charges in Sacramento County Superior Court against Alma Hernandez and Jose Moscoso as a result of a multiagency investigation by the Tax Recovery in the Underground Economy (TRUE) Task Force.
Investigators say the leader of SEIU California and her husband embezzled from a union-run PAC and lied on their taxes for half a decade. Facing multiple felonies, Alma Hernandez resigned her union post Wednesday. SEIU California represents over 700,000 employees in every county of the state.
The California Department of Justice’s Bureau of Investigation began looking into the married couple after an investigation by the Fair Political Practices Commission revealed Hernandez, who was the Executive Director of SEIU California, allegedly embezzled money from an SEIU California-sponsored political action committee (PAC).
The California Franchise Tax Board uncovered alleged underreporting of Hernandez's and Moscoso's income from 2014 to 2019. The Employment Development Department (EDD) also identified that Moscoso’s air duct cleaning business allegedly failed to report employees’ wages from 2017 to 2020.
Hernandez previously served as the treasurer of the Working Families for Solorio for Senate 2014 PAC. The complaint alleges that in October 2014, two checks totaling $11,700 were approved by Hernandez and issued by the PAC’s bank account to Moscoso for services he did not provide.
According to the complaint, Moscoso and Hernandez also allegedly filed false joint income tax returns when they underreported $1,427,874 of income to the FTB for tax years 2014 through 2018. The couple are alleged to owe $143,483 in unpaid income tax.
According to court documents, Moscoso allegedly did not disclose to EDD that he employed multiple individuals to work in his air duct cleaning business, resulting in more than $300,000 in unreported wages. Additionally, from 2017 through 2020, Moscoso allegedly failed to file quarterly reports with EDD and failed to pay more than $16,000 in employment taxes.
It would be reasonable to assume that perhaps workers' compensation premium fraud arose out of the payroll fraud. However, the Attorney General did NOT include workers' compensation premium fraud as a charge. It is not known if it was investigated or ruled out.
Hernandez faces two counts of grand theft, one count of perjury and five counts of filing a false income tax return with intent to evade.
Moscoso is also charged with five counts of filing a false income tax return with intent to evade, one count of failure to file a report with the Employment Development Department, one count of failure to pay unemployment insurance and training tax, one count of failure to pay disability insurance, one count of failure to file employment tax returns with intent to evade paying taxes, and one count of failure to collect and pay personal income tax.
Both Hernandez and Moscoso are charged with a special allegation of aggravated white collar crime with loss over $100,000.
Arraignment has been set for Friday morning in Sacramento County Superior Court ...
Investigators say the leader of SEIU California and her husband embezzled from a union-run PAC and lied on their taxes for half a decade. Facing multiple felonies, Alma Hernandez resigned her union post Wednesday. SEIU California represents over 700,000 employees in every county of the state.
The California Department of Justice’s Bureau of Investigation began looking into the married couple after an investigation by the Fair Political Practices Commission revealed Hernandez, who was the Executive Director of SEIU California, allegedly embezzled money from an SEIU California-sponsored political action committee (PAC).
The California Franchise Tax Board uncovered alleged underreporting of Hernandez's and Moscoso's income from 2014 to 2019. The Employment Development Department (EDD) also identified that Moscoso’s air duct cleaning business allegedly failed to report employees’ wages from 2017 to 2020.
Hernandez previously served as the treasurer of the Working Families for Solorio for Senate 2014 PAC. The complaint alleges that in October 2014, two checks totaling $11,700 were approved by Hernandez and issued by the PAC’s bank account to Moscoso for services he did not provide.
According to the complaint, Moscoso and Hernandez also allegedly filed false joint income tax returns when they underreported $1,427,874 of income to the FTB for tax years 2014 through 2018. The couple are alleged to owe $143,483 in unpaid income tax.
According to court documents, Moscoso allegedly did not disclose to EDD that he employed multiple individuals to work in his air duct cleaning business, resulting in more than $300,000 in unreported wages. Additionally, from 2017 through 2020, Moscoso allegedly failed to file quarterly reports with EDD and failed to pay more than $16,000 in employment taxes.
It would be reasonable to assume that perhaps workers' compensation premium fraud arose out of the payroll fraud. However, the Attorney General did NOT include workers' compensation premium fraud as a charge. It is not known if it was investigated or ruled out.
Hernandez faces two counts of grand theft, one count of perjury and five counts of filing a false income tax return with intent to evade.
Moscoso is also charged with five counts of filing a false income tax return with intent to evade, one count of failure to file a report with the Employment Development Department, one count of failure to pay unemployment insurance and training tax, one count of failure to pay disability insurance, one count of failure to file employment tax returns with intent to evade paying taxes, and one count of failure to collect and pay personal income tax.
Both Hernandez and Moscoso are charged with a special allegation of aggravated white collar crime with loss over $100,000.
Arraignment has been set for Friday morning in Sacramento County Superior Court ...
The Division of Workers’ Compensation has posted the 2020 DWC Audit Unit annual report on its website. The Audit Unit annual report provides information on how claims administrators audited by the DWC performed and includes the Administrative Director’s ranking report for audits conducted in calendar year 2020.
The DWC Audit & Enforcement Unit completed 60 audits, of which 33 were routinely selected for PAR. In addition, another 27 audits were selected, of which three were target audits based on the failure of a prior audit, and 24 audits were based on credible referrals and/or complaints filed with the Audit Unit. The PAR audit subjects consisted of 9 insurance companies, 11 self-administered/self-insured employers, 33 third-party administrators (TPA), and seven insurance companies/third-party administrators that combined claims-adjusting locations.
The DWC Administrative Director’s 2020 Audit Ranking Report lists, in ascending order by performance rating, the administrators audited in calendar year 2020. Congratulations to the following who were ranked among the top 10 administrative entities at the end of this years Audit:
1. RICA & RICC - Republic Indemnity / Calabasas
2. Sedgwick Claims Management Services / Rancho Cordova
3. City of Glendale / Glendale
4. The Traveler's Companies, Inc. / Rancho Cordova
5. Golden State Risk Management Authority / Willows
6. ICW Group / San Diego
7. Matrix Absence Management, Inc. / Santa Clara
8. Athens Administrators / Concord
9. Murphy & Beane, Inc. / Culver City
10. City of Santa Monica / Santa Monica
Twenty-one audit subjects (64%) met or exceeded the PAR 2020 performance standard and therefore had no penalty citations assessed. However, these audit subjects were ordered to pay all unpaid compensation.
Twelve audit subjects (36%) failed to meet or exceed the PAR standard, and their audits expanded into full compliance audits of indemnity claims (FCA stage 1).
Five of them failed to meet or exceed the FCA 2020 performance standard, and their audits expanded into full compliance audits of indemnity claims (FCA stage 2), and samples of denied claims to be audited were added. These audit subjects were assessed administrative penalties for all penalty citations.
The other seven met or exceeded the FCA 2020 performance standard and therefore had penalty citations assessed for unpaid and late payment of indemnity ...
The DWC Audit & Enforcement Unit completed 60 audits, of which 33 were routinely selected for PAR. In addition, another 27 audits were selected, of which three were target audits based on the failure of a prior audit, and 24 audits were based on credible referrals and/or complaints filed with the Audit Unit. The PAR audit subjects consisted of 9 insurance companies, 11 self-administered/self-insured employers, 33 third-party administrators (TPA), and seven insurance companies/third-party administrators that combined claims-adjusting locations.
The DWC Administrative Director’s 2020 Audit Ranking Report lists, in ascending order by performance rating, the administrators audited in calendar year 2020. Congratulations to the following who were ranked among the top 10 administrative entities at the end of this years Audit:
1. RICA & RICC - Republic Indemnity / Calabasas
2. Sedgwick Claims Management Services / Rancho Cordova
3. City of Glendale / Glendale
4. The Traveler's Companies, Inc. / Rancho Cordova
5. Golden State Risk Management Authority / Willows
6. ICW Group / San Diego
7. Matrix Absence Management, Inc. / Santa Clara
8. Athens Administrators / Concord
9. Murphy & Beane, Inc. / Culver City
10. City of Santa Monica / Santa Monica
Twenty-one audit subjects (64%) met or exceeded the PAR 2020 performance standard and therefore had no penalty citations assessed. However, these audit subjects were ordered to pay all unpaid compensation.
Twelve audit subjects (36%) failed to meet or exceed the PAR standard, and their audits expanded into full compliance audits of indemnity claims (FCA stage 1).
Five of them failed to meet or exceed the FCA 2020 performance standard, and their audits expanded into full compliance audits of indemnity claims (FCA stage 2), and samples of denied claims to be audited were added. These audit subjects were assessed administrative penalties for all penalty citations.
The other seven met or exceeded the FCA 2020 performance standard and therefore had penalty citations assessed for unpaid and late payment of indemnity ...
Over the past weekend, Southwest Airlines canceled more than 2,000 flights. The mass flight cancellations sparked unsubstantiated claims from some social media users and politicians, including Texas Senator Ted Cruz, that pilots and air traffic controllers had either walked off their jobs or called in sick to protest federal vaccination mandates.
"Joe Biden's illegal vaccine mandate at work!" Cruz tweeted Sunday. "Suddenly, we're short on pilots & air traffic controllers. #ThanksJoe."
Southwest said that bad weather and air traffic control issues were to blame for the cancellations. Southwest, the Southwest Airlines Pilots Association and Federal Aviation Administration have all denied there is any truth to the theories that employee pushback was to blame for the weekend's issues. Both the company and union have not said how many of the airline's employees missed work over the past weekend.
Notwithstanding theories about the massive flight cancellations, this October Southwest Airlines Pilots Association (SWAPA) filed a motion for temporary and preliminary injunctive relief against Southwest's newly announced vaccination mandate in its ongoing lawsuit with Southwest Airlines, initially filed on Aug. 30, and then amended on October 6.
Neither Southwest Airlines or the Southwest Airlines Pilots Association know how many pilots remain unvaccinated against COVID-19, according to union president Casey Murray. The airline told employees last week that they would be required to get the vaccine by December 8, leaving less than two months to enforce the requirement.
The original complaint asserts the airlines are in violation of the Railway Labor Act (RLA), among other things, Sec. 6, which requires the parties to maintain "status quo" until a new agreement is reached. The lawsuit maintains that the carrier can not alter pay rates, rules, and working conditions until a new agreement is reached.
SWAPA alleges that "Most recently, on Oct. 4, 2021, Southwest Airlines unilaterally rolled out a new and non-negotiated COVID vaccine mandate for all employees, including SWAPA. The new vaccine mandate unlawfully imposes new conditions of employment, and the new policy threatens termination of any pilot not fully vaccinated by Dec. 8, 2021. Southwest Airlines’ additional new and unilateral modifications of the parties’ collective bargaining agreement is in clear violation of the RLA."
"The new vaccine mandate unlawfully imposes new conditions of employment and the new policy threatens termination of any pilot not fully vaccinated by December 8, 2021," the Southwest Airlines Pilots Association’s lawyers wrote in their legal filing. "Southwest Airlines’ additional new and unilateral modification of the parties’ collective bargaining agreement is in clear violation of the [Railway Labor Act]."
The amended complaint has two counts. Count I, "Failure to Maintain the Status Quo During the Ongoing ‘Major’ Dispute," and Count II, "Failure to Exert Every Reasonable Effort to Reach Agreement."
In a statement on the union’s website, its leadership stipulates: "We want to be perfectly clear: SWAPA is not anti-vaccination, but we do believe that, under all circumstances, it is our role to represent the health and safety of our Pilots and bring their concerns to the company."
A Southwest spokesperson told The Epoch Times that the firm "disagrees with SWAPA’s claims that any COVID-related changes over the past several months require negotiation" and "remains committed to [it’s] employees’ health and welfare and to working with SWAPA, and our other union partners, as we continue navigating the challenges presented by the ongoing pandemic." ...
"Joe Biden's illegal vaccine mandate at work!" Cruz tweeted Sunday. "Suddenly, we're short on pilots & air traffic controllers. #ThanksJoe."
Southwest said that bad weather and air traffic control issues were to blame for the cancellations. Southwest, the Southwest Airlines Pilots Association and Federal Aviation Administration have all denied there is any truth to the theories that employee pushback was to blame for the weekend's issues. Both the company and union have not said how many of the airline's employees missed work over the past weekend.
Notwithstanding theories about the massive flight cancellations, this October Southwest Airlines Pilots Association (SWAPA) filed a motion for temporary and preliminary injunctive relief against Southwest's newly announced vaccination mandate in its ongoing lawsuit with Southwest Airlines, initially filed on Aug. 30, and then amended on October 6.
Neither Southwest Airlines or the Southwest Airlines Pilots Association know how many pilots remain unvaccinated against COVID-19, according to union president Casey Murray. The airline told employees last week that they would be required to get the vaccine by December 8, leaving less than two months to enforce the requirement.
The original complaint asserts the airlines are in violation of the Railway Labor Act (RLA), among other things, Sec. 6, which requires the parties to maintain "status quo" until a new agreement is reached. The lawsuit maintains that the carrier can not alter pay rates, rules, and working conditions until a new agreement is reached.
SWAPA alleges that "Most recently, on Oct. 4, 2021, Southwest Airlines unilaterally rolled out a new and non-negotiated COVID vaccine mandate for all employees, including SWAPA. The new vaccine mandate unlawfully imposes new conditions of employment, and the new policy threatens termination of any pilot not fully vaccinated by Dec. 8, 2021. Southwest Airlines’ additional new and unilateral modifications of the parties’ collective bargaining agreement is in clear violation of the RLA."
"The new vaccine mandate unlawfully imposes new conditions of employment and the new policy threatens termination of any pilot not fully vaccinated by December 8, 2021," the Southwest Airlines Pilots Association’s lawyers wrote in their legal filing. "Southwest Airlines’ additional new and unilateral modification of the parties’ collective bargaining agreement is in clear violation of the [Railway Labor Act]."
The amended complaint has two counts. Count I, "Failure to Maintain the Status Quo During the Ongoing ‘Major’ Dispute," and Count II, "Failure to Exert Every Reasonable Effort to Reach Agreement."
In a statement on the union’s website, its leadership stipulates: "We want to be perfectly clear: SWAPA is not anti-vaccination, but we do believe that, under all circumstances, it is our role to represent the health and safety of our Pilots and bring their concerns to the company."
A Southwest spokesperson told The Epoch Times that the firm "disagrees with SWAPA’s claims that any COVID-related changes over the past several months require negotiation" and "remains committed to [it’s] employees’ health and welfare and to working with SWAPA, and our other union partners, as we continue navigating the challenges presented by the ongoing pandemic." ...
A Los Angeles County Superior Court judge has dismissed felony fraud and grand theft charges against a Baldwin Park Unified School District employee accused of misrepresenting her COVID-19 symptoms to collect more than $33,000 in workers’ compensation benefits.
Judge Craig Richman cited a lack of evidence in dismissing the case against Stephanie Medrano, who was charged with two felony charges of insurance fraud and one felony charge of grand theft. Deputy District Attorney Melinda Murray supported the judge’s decision at Medrano’s preliminary hearing on Oct. 8.
She was charged with multiple counts of grand theft and insurance fraud after allegedly making misrepresentations following a COVID-19 diagnosis in an attempt to collect over $33,000 in undeserved workers’ compensation insurance benefits.
The California Department of Insurance launched an investigation after receiving a claim of suspected fraud from Medrano’s employer, the Baldwin Park Unified School District, on August 21, 2020.
Investigators claimed Medrano made multiple misrepresentations in order to extend a workers’ compensation insurance claim submitted to her employer after she was diagnosed with COVID-19.
Medrano was reportedly exposed to COVID-19 while in the workplace and subsequently filed a workers’ compensation claim. She told her employer that she self-quarantined from July 6, 2020 to August 3, 2020, and reported she only left her house twice to buy medicine for her mother and sister, who were also diagnosed with COVID-19. Medrano reported her symptoms related to the COVID-19 diagnosis were so severe she was unable to work.
The investigation found that during the time Medrano claimed she was self-quarantining, she was seen shopping at multiple stores for several hours a day and interacting with people from outside her immediate household without face masks.
Further, investigators uncovered that Medrano traveled to Lake Havasu with people who live outside her household just two days after she reported she was still experiencing symptoms to the doctor overseeing her claim.
Judge Richman found no relevance to the fact Medrano went grocery shopping and on a weekend getaway the weekend before she returned to work, said Medrano’s attorney, Warren Ellis. He solely blames the school district, which is self-insured, for the misguided prosecution of his client.
The Pasadena Star reports that the prosecutor, declined to comment Tuesday, as did officials at the California Department of Insurance, which disseminated a press release following Medrano’s arraignment in February, claiming their investigation and Medrano’s subsequent arrest thwarted the potential loss of $33,516 to the school district. Officials at the Baldwin Park Unified School District also did not respond to a request for comment on Tuesday ...
Judge Craig Richman cited a lack of evidence in dismissing the case against Stephanie Medrano, who was charged with two felony charges of insurance fraud and one felony charge of grand theft. Deputy District Attorney Melinda Murray supported the judge’s decision at Medrano’s preliminary hearing on Oct. 8.
She was charged with multiple counts of grand theft and insurance fraud after allegedly making misrepresentations following a COVID-19 diagnosis in an attempt to collect over $33,000 in undeserved workers’ compensation insurance benefits.
The California Department of Insurance launched an investigation after receiving a claim of suspected fraud from Medrano’s employer, the Baldwin Park Unified School District, on August 21, 2020.
Investigators claimed Medrano made multiple misrepresentations in order to extend a workers’ compensation insurance claim submitted to her employer after she was diagnosed with COVID-19.
Medrano was reportedly exposed to COVID-19 while in the workplace and subsequently filed a workers’ compensation claim. She told her employer that she self-quarantined from July 6, 2020 to August 3, 2020, and reported she only left her house twice to buy medicine for her mother and sister, who were also diagnosed with COVID-19. Medrano reported her symptoms related to the COVID-19 diagnosis were so severe she was unable to work.
The investigation found that during the time Medrano claimed she was self-quarantining, she was seen shopping at multiple stores for several hours a day and interacting with people from outside her immediate household without face masks.
Further, investigators uncovered that Medrano traveled to Lake Havasu with people who live outside her household just two days after she reported she was still experiencing symptoms to the doctor overseeing her claim.
Judge Richman found no relevance to the fact Medrano went grocery shopping and on a weekend getaway the weekend before she returned to work, said Medrano’s attorney, Warren Ellis. He solely blames the school district, which is self-insured, for the misguided prosecution of his client.
The Pasadena Star reports that the prosecutor, declined to comment Tuesday, as did officials at the California Department of Insurance, which disseminated a press release following Medrano’s arraignment in February, claiming their investigation and Medrano’s subsequent arrest thwarted the potential loss of $33,516 to the school district. Officials at the Baldwin Park Unified School District also did not respond to a request for comment on Tuesday ...
Sanjoy Banerjee M.D.provided billings and doctor’s reports concerned medical services to workers' compensation patients through three entities that Banerjee owned and operated from a single location in Wildomar California: (1) Sanjoy Banerjee, M.D., Inc., doing business as Pacific Pain Care Consultants (PPCC); (2) Kensington Diagnostics, LLC (Kensington); and (3) Rochester Imperial Surgical Center, LLC (Rochester).
Banerjee presented billings totaling $157,797.01 to Berkshire Hathaway Homestate Companies payable pursuant to the state’s workers’ compensation system, through Kensington and Rochester, for services that Banerjee provided to patients between 2014 and 2016. BHHC paid less than 10 percent of the $157,797.01 amount billed.
Each doctor’s report included the following attestation near the end of the report: "I have not violated Labor Code section 139.3, and the contents of this report and bill are . . . true and correct to the best of my knowledge. This statement is made under penalty of perjury."
Banerjee was charged with two counts of insurance fraud and three counts of perjury. The charges are based on Banerjee’s alleged violations of Labor Code section 139.3(a), which prohibits physician self referrals to entities where the physician owns a specified financial interest.
According to a BHHC investigator who testified as the only witness at his preliminary hearing, Banerjee was obligated to disclose his financial interests in Kensington and Rochester to BHHC, and BHHC had no business records indicating that Banerjee had made this disclosure.
The superior court denied Banerjee’s motion to dismiss the information as unsupported by reasonable or probable and set a trial on the merits. The Court of Appeal granted his petitions for a writ of prohibition and dismissed the perjury charges, but rejected the petition to the fraud charges (for overbilling) in the published case of Banerjee v. Superior Court.
To date, no published court decision has interpreted Labor Code sections 139.3 or 139.31. The statutes were enacted in 1993 as part of Assembly Bill No. 110, part of a comprehensive package of legislation that reformed the state’s workers’ compensation laws. It was intended to reduce costs and strengthen conflict of interest rules in the workers’ compensation system.
Section 139.3(a) makes it unlawful for a physician to refer a person for specified services "if the physician or his or her immediate family has a financial interes with the person or in, the entity that receives the referral." A violation of section 139.3(a) is a misdemeanor.
Section 139.31(e) provides: "The prohibition of section 139.3 shall not apply to any service for a specific patient that is performed within, or goods that are that are supplied by, a physician’s office, or the office of a group practice. . . ." The Court's interpretation of section 139.31(e) means that the physician’s office exception applies to Banerjee’s financially interested "self-referrals" to his two other legal entities since they are both located in his same Widomar office. Since his alleged violations of section 139.3(a) was the only basis to support the perjury charges, the perjury charges must be dismissed.
The record also supports a strong suspicion that Kensington and Rochester were sham entities, and that Banerjee formed Kensington and Rochester with the specific intent to defraud BHHC through his Kensington and Rochester billings. The Kensington and Rochester billings gave the appearance that the entities were not part of Banerjee’s medical practice but were stand alone, diagnostic testing and surgical centers, operating independently of any physician’s office.
Even though the evidence does not show that Banerjee violated section 139.3(a), the evidence supports a strong suspicion that Banerjee specifically intended to present false and fraudulent claims for health care benefits, in violation of Penal Code section 550, subdivision (a)(6), by billing the workers’ compensation insurer substantially higher amounts through his two other legal entities, between 2014 and 2016, than he previously and customarily billed the insurer for the same services he formerly rendered through his professional corporation and his former group practice.
Thus, the Court granted the writ as to the perjury charges but denied it as to the insurance fraud charges ...
Banerjee presented billings totaling $157,797.01 to Berkshire Hathaway Homestate Companies payable pursuant to the state’s workers’ compensation system, through Kensington and Rochester, for services that Banerjee provided to patients between 2014 and 2016. BHHC paid less than 10 percent of the $157,797.01 amount billed.
Each doctor’s report included the following attestation near the end of the report: "I have not violated Labor Code section 139.3, and the contents of this report and bill are . . . true and correct to the best of my knowledge. This statement is made under penalty of perjury."
Banerjee was charged with two counts of insurance fraud and three counts of perjury. The charges are based on Banerjee’s alleged violations of Labor Code section 139.3(a), which prohibits physician self referrals to entities where the physician owns a specified financial interest.
According to a BHHC investigator who testified as the only witness at his preliminary hearing, Banerjee was obligated to disclose his financial interests in Kensington and Rochester to BHHC, and BHHC had no business records indicating that Banerjee had made this disclosure.
The superior court denied Banerjee’s motion to dismiss the information as unsupported by reasonable or probable and set a trial on the merits. The Court of Appeal granted his petitions for a writ of prohibition and dismissed the perjury charges, but rejected the petition to the fraud charges (for overbilling) in the published case of Banerjee v. Superior Court.
To date, no published court decision has interpreted Labor Code sections 139.3 or 139.31. The statutes were enacted in 1993 as part of Assembly Bill No. 110, part of a comprehensive package of legislation that reformed the state’s workers’ compensation laws. It was intended to reduce costs and strengthen conflict of interest rules in the workers’ compensation system.
Section 139.3(a) makes it unlawful for a physician to refer a person for specified services "if the physician or his or her immediate family has a financial interes with the person or in, the entity that receives the referral." A violation of section 139.3(a) is a misdemeanor.
Section 139.31(e) provides: "The prohibition of section 139.3 shall not apply to any service for a specific patient that is performed within, or goods that are that are supplied by, a physician’s office, or the office of a group practice. . . ." The Court's interpretation of section 139.31(e) means that the physician’s office exception applies to Banerjee’s financially interested "self-referrals" to his two other legal entities since they are both located in his same Widomar office. Since his alleged violations of section 139.3(a) was the only basis to support the perjury charges, the perjury charges must be dismissed.
The record also supports a strong suspicion that Kensington and Rochester were sham entities, and that Banerjee formed Kensington and Rochester with the specific intent to defraud BHHC through his Kensington and Rochester billings. The Kensington and Rochester billings gave the appearance that the entities were not part of Banerjee’s medical practice but were stand alone, diagnostic testing and surgical centers, operating independently of any physician’s office.
Even though the evidence does not show that Banerjee violated section 139.3(a), the evidence supports a strong suspicion that Banerjee specifically intended to present false and fraudulent claims for health care benefits, in violation of Penal Code section 550, subdivision (a)(6), by billing the workers’ compensation insurer substantially higher amounts through his two other legal entities, between 2014 and 2016, than he previously and customarily billed the insurer for the same services he formerly rendered through his professional corporation and his former group practice.
Thus, the Court granted the writ as to the perjury charges but denied it as to the insurance fraud charges ...
The Division of Workers' Compensation has launched an update to the online physician education course, "Evaluating California’s Injured Workers: Qualified Medical Evaluators." This course is strongly recommended for all California Qualified Medical Evaluators. It is available to the public and is especially valuable for attorneys, claims administrators and medical providers participating in the California workers' compensation system.
"Evaluating California's Injured Workers: Qualified Medical Evaluators" is an educational module developed for medical doctors, chiropractors and nurses. QMEs play a critical role in resolving disputes within the workers' compensation system.
The online education will cover:
- - How to prepare for an evaluation and outline the components of a quality report
- - The concept of apportionment and how to apportion to causation of disability
- - What constitutes substantial medical evidence and how it applies to apportionment
- - Potential bias and how to avoid it in your medical-legal reports
- - Administrative regulations to stay in compliance as a QME
This activity has been approved for AMA PRA Category 1 Credit as well as 2 hours of QME continuing education credit.
Access to the physician education module can be found on the DWC website. Also, available on the website is an education module, “Caring for California's Injured Workers: Using California's Medical Treatment Utilization Schedule (MTUS).”
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the California Medical Association (CMA) through the joint providership of the Center for Occupational and Environmental Health (COEH) and State of California Department of Industrial Relations’ Division of Workers’ Compensation. The Center for Occupational and Environmental Health is accredited by the CMA to provide continuing medical education for physicians.
The Center for Occupational and Environmental Health designates this enduring material for a maximum of 2 AMA PRA category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity ...
"Evaluating California's Injured Workers: Qualified Medical Evaluators" is an educational module developed for medical doctors, chiropractors and nurses. QMEs play a critical role in resolving disputes within the workers' compensation system.
The online education will cover:
- - How to prepare for an evaluation and outline the components of a quality report
- - The concept of apportionment and how to apportion to causation of disability
- - What constitutes substantial medical evidence and how it applies to apportionment
- - Potential bias and how to avoid it in your medical-legal reports
- - Administrative regulations to stay in compliance as a QME
This activity has been approved for AMA PRA Category 1 Credit as well as 2 hours of QME continuing education credit.
Access to the physician education module can be found on the DWC website. Also, available on the website is an education module, “Caring for California's Injured Workers: Using California's Medical Treatment Utilization Schedule (MTUS).”
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the California Medical Association (CMA) through the joint providership of the Center for Occupational and Environmental Health (COEH) and State of California Department of Industrial Relations’ Division of Workers’ Compensation. The Center for Occupational and Environmental Health is accredited by the CMA to provide continuing medical education for physicians.
The Center for Occupational and Environmental Health designates this enduring material for a maximum of 2 AMA PRA category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity ...
The Los Angeles Times reports that a group of 500 Los Angeles firefighters filed a lawsuit Friday against the city over its requirement that L.A. employees be vaccinated against COVID-19.
The lawsuit, filed in Los Angeles County Superior Court, claims the city’s mandate is a violation of employees’ constitutionally protected autonomous privacy rights.
The lawsuit was filed on behalf of the Firefighters 4 Freedom Foundation, a nonprofit representing 529 members, said Kevin McBride, the group’s attorney.
The firefighters are "pawns in a political chess match, ordered by thirteen politicians on the Los Angeles City Council to inject themselves with an experimental vaccine - over their objections - or lose their jobs," the lawsuit states.
A group of employees in the Los Angeles Police Department also sued last week over the vaccination mandate.
The city of L.A. moved to require city employees to be fully vaccinated against COVID-19 by early October, while granting exemptions to employees with medical conditions or "sincerely held religious beliefs."
More than 460 exemption requests have been submitted by LAFD employees, according to city data - a number equal to 12.5% of the department workforce. However, it is possible that some employees may have turned in multiple requests.
The lawsuit filed Friday claims that the city mandate violates the firefighters’ right to privacy under the California Constitution. It seeks a temporary restraining order prohibiting the city’s vaccination mandate from going into effect until a preliminary injunction hearing and further order of the court.
The lawsuit alleges the city doesn’t have the power to "order forced vaccinations of its employees or residents" and that "the vaccine mandate is both unnecessary and ineffective in protecting the public."
A LAFD spokesman told The Times on Friday that 58.5% of the sworn members have been fully vaccinated and 66% have received at least one dose.
The total number of LAFD employees who have tested positive for COVID-19 is 1,079, according to city data. A total of 1,056 LAFD employees have recovered and returned to duty. Two firefighters have died after contracting COVID-19.
City Atty. Mike Feuer said he was confident the city would prevail. "The U.S. Supreme Court and courts across the country have upheld vaccination mandates by government and they’ve done so because they said the greater good compels it," Feuer said. "The greater good compels this right now." ...
The lawsuit, filed in Los Angeles County Superior Court, claims the city’s mandate is a violation of employees’ constitutionally protected autonomous privacy rights.
The lawsuit was filed on behalf of the Firefighters 4 Freedom Foundation, a nonprofit representing 529 members, said Kevin McBride, the group’s attorney.
The firefighters are "pawns in a political chess match, ordered by thirteen politicians on the Los Angeles City Council to inject themselves with an experimental vaccine - over their objections - or lose their jobs," the lawsuit states.
A group of employees in the Los Angeles Police Department also sued last week over the vaccination mandate.
The city of L.A. moved to require city employees to be fully vaccinated against COVID-19 by early October, while granting exemptions to employees with medical conditions or "sincerely held religious beliefs."
More than 460 exemption requests have been submitted by LAFD employees, according to city data - a number equal to 12.5% of the department workforce. However, it is possible that some employees may have turned in multiple requests.
The lawsuit filed Friday claims that the city mandate violates the firefighters’ right to privacy under the California Constitution. It seeks a temporary restraining order prohibiting the city’s vaccination mandate from going into effect until a preliminary injunction hearing and further order of the court.
The lawsuit alleges the city doesn’t have the power to "order forced vaccinations of its employees or residents" and that "the vaccine mandate is both unnecessary and ineffective in protecting the public."
A LAFD spokesman told The Times on Friday that 58.5% of the sworn members have been fully vaccinated and 66% have received at least one dose.
The total number of LAFD employees who have tested positive for COVID-19 is 1,079, according to city data. A total of 1,056 LAFD employees have recovered and returned to duty. Two firefighters have died after contracting COVID-19.
City Atty. Mike Feuer said he was confident the city would prevail. "The U.S. Supreme Court and courts across the country have upheld vaccination mandates by government and they’ve done so because they said the greater good compels it," Feuer said. "The greater good compels this right now." ...
In a sweeping expansion of existing law, Fisher Phillips reports that Governor Gavin Newsom signed legislation that broadly prohibits non-disclosure clauses in settlement agreements involving workplace harassment or discrimination on any protected bases, not just sex.
SB 331 - known as the "Silenced No More Act" - takes what state lawmakers believe will be a final stand against employers preventing employees from discussing unlawful acts in the workplace. The new law, which takes effect on January 1, 2022, will nullify and make void provisions within any agreement entered on or after that date that prevent or restrict an employee from disclosing factual information on any type of harassment, discrimination, or retaliation.
SB 331 builds on SB 820, also known as the STAND (Stand Together Against Non-Disclosure) Act, which California passed in 2018 in response to the #MeToo movement. To address what advocates of the movement coined as "secret settlements" used to cover up cases of sexual harassment involving high-profile executives, the STAND Act prohibited the use of confidentiality provisions in settlement agreements for actions including claims based on sex. As such, for several years, the STAND Act has allowed employees to discuss factual information relating to sexual harassment in the workplace.
Primarily, SB 331 amends Code of Civil Procedure Section 1001 (previously enacted by SB 820 in 2018) to expand the prohibition of confidentiality provisions in agreements entered into on or after the effective date for all acts of workplace discrimination or harassment, not only based on sex. For example, this includes acts based on race, religion, color, national origin, ancestry, disability, medical condition, familial status, sex, gender, age and other protected characteristics as described in various subdivisions of Sections 12940 and 12955 of the Government Code.
With its substantial changes, the new law importantly preserves the existing protection against disclosure of the settlement amount. While employees may discuss the underlying facts of the case, employers can still insist on clauses that prevent disclosure of the amount of money paid to settle the claim. Therefore, employers remain somewhat shielded against current and former employees "piggybacking" off a settlement with the aim of seeking a similar payout.
As another slight reprieve, employers may still include non-disparagement clauses or similar provisions in agreements provided there is specific language stating the employee’s right to disclose information about unlawful acts in the workplace. Absent that language, the provision would be against public policy and unenforceable. Certainly, crafting such language to ensure enforceability is best handled by consulting with legal counsel.
For those employees with privacy concerns who wish to protect themselves against public attention, the Silenced No More Act leaves untouched the exception allowing claimants to maintain privacy. Therefore, at the request of the claimant, a settlement agreement may still include a provision that shields the claimant’s identity and all facts that could lead to the discovery of their identity. Consistent with prior law, this exception does not apply if a government agency or public official is a party to the settlement agreement ...
SB 331 - known as the "Silenced No More Act" - takes what state lawmakers believe will be a final stand against employers preventing employees from discussing unlawful acts in the workplace. The new law, which takes effect on January 1, 2022, will nullify and make void provisions within any agreement entered on or after that date that prevent or restrict an employee from disclosing factual information on any type of harassment, discrimination, or retaliation.
SB 331 builds on SB 820, also known as the STAND (Stand Together Against Non-Disclosure) Act, which California passed in 2018 in response to the #MeToo movement. To address what advocates of the movement coined as "secret settlements" used to cover up cases of sexual harassment involving high-profile executives, the STAND Act prohibited the use of confidentiality provisions in settlement agreements for actions including claims based on sex. As such, for several years, the STAND Act has allowed employees to discuss factual information relating to sexual harassment in the workplace.
Primarily, SB 331 amends Code of Civil Procedure Section 1001 (previously enacted by SB 820 in 2018) to expand the prohibition of confidentiality provisions in agreements entered into on or after the effective date for all acts of workplace discrimination or harassment, not only based on sex. For example, this includes acts based on race, religion, color, national origin, ancestry, disability, medical condition, familial status, sex, gender, age and other protected characteristics as described in various subdivisions of Sections 12940 and 12955 of the Government Code.
With its substantial changes, the new law importantly preserves the existing protection against disclosure of the settlement amount. While employees may discuss the underlying facts of the case, employers can still insist on clauses that prevent disclosure of the amount of money paid to settle the claim. Therefore, employers remain somewhat shielded against current and former employees "piggybacking" off a settlement with the aim of seeking a similar payout.
As another slight reprieve, employers may still include non-disparagement clauses or similar provisions in agreements provided there is specific language stating the employee’s right to disclose information about unlawful acts in the workplace. Absent that language, the provision would be against public policy and unenforceable. Certainly, crafting such language to ensure enforceability is best handled by consulting with legal counsel.
For those employees with privacy concerns who wish to protect themselves against public attention, the Silenced No More Act leaves untouched the exception allowing claimants to maintain privacy. Therefore, at the request of the claimant, a settlement agreement may still include a provision that shields the claimant’s identity and all facts that could lead to the discovery of their identity. Consistent with prior law, this exception does not apply if a government agency or public official is a party to the settlement agreement ...
Federal prosecutors announced the indictment of 18 former professional basketball players and one spouse, who are accused of submitting fraudulent reimbursement claims for fictitious medical and dental expenses.
The alleged "ringleader" of the scheme was said to be Terrence Williams. He was drafted by the then-New Jersey Nets as their 11th overall pick in 2009. Williams allegedly recruited other NBA health plan participants into the scheme, providing them with falsified invoices to claim medical and dental services that were never rendered.
Terrence Williams, Alan Anderson, Anthony Allen, Desiree Allen (Alan's wife), Shannon Brown, William Bynum, Ronald Glen Davis, Christopher Douglas-Roberts, a/k/a "Supreme Bey," Melvin Ely (former Fresno State standout), Jamario Moon, Darius Miles, Milton Palacio, Ruben Pattierson, Eddie Robinson, Gregory Smith, Sebastian Telfair, Charles Watson Jr., Antoine Wright, and Anthony Wroten are each charged with one count of conspiracy to commit health care fraud and wire fraud, which carries a maximum sentence of 20 years in prison. Tennence Williams is also charged with one count of aggravated identity theft, which carries a mandatory minimum sentence of two years in prison.
Ronald Glen Davis will be prosecuted in the Central District of California. The other defendants will be prosecuted in other jurisdictions. Anthony Allen Douglas-Roberts, and Robinson remain at large. Milt Palacio, a current Trail Blazers assistant coach, was put on administrative leave by the team after being one of the 18 players arrested.
The indictment charges the defendants with conspiracy to commit health care fraud and wire fraud, in connection with a scheme to defraud the National Basketball Associations Health and Welfare Benefit Plan out of nearly $4,000,000.
The National Basketball Association Players’ Health and Welfare Benefit Plan is a health care plan providing benefits to eligible active and former players of the NBA.
From at least 2017, up to about 2020 the defendants engaged in a widespread scheme to defraud the Plan by submitting and causing to be submitted fraudulent claims for reimbursement of medical and dental services that were not actually rendered.
Williams orchestrated the scheme to defraud the Plan. He recruited other Plan participants to defraud the Plan by offering to provide them with false invoices to support their fraudulent claims. Williams provided some of the other defendants with false provider invoices, which those defendants then submitted to the Plan for reimbursement of fraudulent claims. Several of the fake invoices stood out because, "they are not on letterhead, they contain unusual formatting, they have grammatical errors."
Williams provided the other charged defendants fake invoices from a particular Chiropractic Office in California, which were created by individuals working with Williams. In addition, Williams obtained fraudulent invoices from a dentist affiliated with dental offices in Beverly Hills, California, and from a doctor at a Wellness Office in Washington State. The fraudulent invoices purported to document that some of the defendants,and, in some cases, members of their families, had been recipients of expensive medical and dental services.
But the defendants had not received the medical or dental services described in the invoices Williams provided them. In many instances, the defendants were not even located in the vicinity of the service providers on the dates the invoices stated they received medical or dental services. In particular, GPS location information and/or documents, such as flight records, show that the defendants were in locations other than the vicinity of the medical or dental offices falsely claimed as the providers of services.
In return for his provision of false supporting documentation for their fraudulent claims, many of the defendants paid Williams kickbacks, totaling at least $230,000. Williams also used the personal identifying information of an employee of the Administrative Manager, which managed the Plan, in the course of the fraud scheme.
The prosecution of this case is being overseen by the Office’s Complex Frauds and Cybercrime Unit. Assistant United States Attorneys Kristy J. Greenberg and Ryan B. Finkel are in charge of the prosecution ...
The alleged "ringleader" of the scheme was said to be Terrence Williams. He was drafted by the then-New Jersey Nets as their 11th overall pick in 2009. Williams allegedly recruited other NBA health plan participants into the scheme, providing them with falsified invoices to claim medical and dental services that were never rendered.
Terrence Williams, Alan Anderson, Anthony Allen, Desiree Allen (Alan's wife), Shannon Brown, William Bynum, Ronald Glen Davis, Christopher Douglas-Roberts, a/k/a "Supreme Bey," Melvin Ely (former Fresno State standout), Jamario Moon, Darius Miles, Milton Palacio, Ruben Pattierson, Eddie Robinson, Gregory Smith, Sebastian Telfair, Charles Watson Jr., Antoine Wright, and Anthony Wroten are each charged with one count of conspiracy to commit health care fraud and wire fraud, which carries a maximum sentence of 20 years in prison. Tennence Williams is also charged with one count of aggravated identity theft, which carries a mandatory minimum sentence of two years in prison.
Ronald Glen Davis will be prosecuted in the Central District of California. The other defendants will be prosecuted in other jurisdictions. Anthony Allen Douglas-Roberts, and Robinson remain at large. Milt Palacio, a current Trail Blazers assistant coach, was put on administrative leave by the team after being one of the 18 players arrested.
The indictment charges the defendants with conspiracy to commit health care fraud and wire fraud, in connection with a scheme to defraud the National Basketball Associations Health and Welfare Benefit Plan out of nearly $4,000,000.
The National Basketball Association Players’ Health and Welfare Benefit Plan is a health care plan providing benefits to eligible active and former players of the NBA.
From at least 2017, up to about 2020 the defendants engaged in a widespread scheme to defraud the Plan by submitting and causing to be submitted fraudulent claims for reimbursement of medical and dental services that were not actually rendered.
Williams orchestrated the scheme to defraud the Plan. He recruited other Plan participants to defraud the Plan by offering to provide them with false invoices to support their fraudulent claims. Williams provided some of the other defendants with false provider invoices, which those defendants then submitted to the Plan for reimbursement of fraudulent claims. Several of the fake invoices stood out because, "they are not on letterhead, they contain unusual formatting, they have grammatical errors."
Williams provided the other charged defendants fake invoices from a particular Chiropractic Office in California, which were created by individuals working with Williams. In addition, Williams obtained fraudulent invoices from a dentist affiliated with dental offices in Beverly Hills, California, and from a doctor at a Wellness Office in Washington State. The fraudulent invoices purported to document that some of the defendants,and, in some cases, members of their families, had been recipients of expensive medical and dental services.
But the defendants had not received the medical or dental services described in the invoices Williams provided them. In many instances, the defendants were not even located in the vicinity of the service providers on the dates the invoices stated they received medical or dental services. In particular, GPS location information and/or documents, such as flight records, show that the defendants were in locations other than the vicinity of the medical or dental offices falsely claimed as the providers of services.
In return for his provision of false supporting documentation for their fraudulent claims, many of the defendants paid Williams kickbacks, totaling at least $230,000. Williams also used the personal identifying information of an employee of the Administrative Manager, which managed the Plan, in the course of the fraud scheme.
The prosecution of this case is being overseen by the Office’s Complex Frauds and Cybercrime Unit. Assistant United States Attorneys Kristy J. Greenberg and Ryan B. Finkel are in charge of the prosecution ...
A new study, published in the latest issue of the Journal of Occupational and Environmental Medicine, Improving Outcomes for Work-Related Concussions: A Mental Health Screening and Brief Therapy Model, assessed the efficacy of a neurocognitive screening evaluation and brief therapy model to improve RTW outcomes for workers who experienced mild head injuries.
There has been increased interest in both the immediate and long-term consequences of mild head injuries in basic and applied health sciences for the past few decades. To some extent, this interest has been fueled by the very public debate about the dangerousness of sports-related repeated mild head trauma in both children and adults.
There has also been media interest in non-sports-related head trauma in adults especially the elderly due to falls, in military populations, and after motor vehicle accidents.
The increased public attention to these issues has also increased awareness and concern regarding mild head injuries in the workplace. Many patients with work-related mild head trauma show delayed recovery resulting in significant increases in both medical services utilization and work leave.
Neuropsychological assessment to clarify the extent of cognitive features and psychosocial factors can be used effectively to rule out symptom magnification and secondary gain issues, as well as to provide additional objective data to clients about their subjective distress and cognitive complaints.
The current study is a multiple time-line design within an integrated care model combining outpatient medical and mental health services to address delayed recovery from mild Traumatic Brain Injury (mTBI) and Postconcussional Syndrome (PCS ) for 157 injured employees receiving workers compensation benefits.
Based on the outcome of the assessment, clients were either determined to be at MMI and discharged, or treatment recommendations were made for either mental health or Health and Behavior Assessment and Intervention (HBAI services). There were also several clients where biopsychosocial factors were identified which appeared to be affecting the individual's recovery, that is, poor sleep patterns, inactivity, or other health behaviors, or anxiety, depressed mood, psychosomatic or post-traumatic symptoms which did not rise to the level of warranting a mental health diagnosis.
Overall, 155 of the 157 patients (98.7%) returned to work at full duty without further restrictions or accommodations. The findings of this study support the view that prolonged mTBI and PCS are strongly influenced by psychological factors. Conducting a brief and readily accessible neurocognitive assessment to reassure injured workers that their concerns about mTBI/concussion were being carefully considered and thoroughly addressed appeared to have dramatic effects on decreasing chronicity in this study ...
There has been increased interest in both the immediate and long-term consequences of mild head injuries in basic and applied health sciences for the past few decades. To some extent, this interest has been fueled by the very public debate about the dangerousness of sports-related repeated mild head trauma in both children and adults.
There has also been media interest in non-sports-related head trauma in adults especially the elderly due to falls, in military populations, and after motor vehicle accidents.
The increased public attention to these issues has also increased awareness and concern regarding mild head injuries in the workplace. Many patients with work-related mild head trauma show delayed recovery resulting in significant increases in both medical services utilization and work leave.
Neuropsychological assessment to clarify the extent of cognitive features and psychosocial factors can be used effectively to rule out symptom magnification and secondary gain issues, as well as to provide additional objective data to clients about their subjective distress and cognitive complaints.
The current study is a multiple time-line design within an integrated care model combining outpatient medical and mental health services to address delayed recovery from mild Traumatic Brain Injury (mTBI) and Postconcussional Syndrome (PCS ) for 157 injured employees receiving workers compensation benefits.
Based on the outcome of the assessment, clients were either determined to be at MMI and discharged, or treatment recommendations were made for either mental health or Health and Behavior Assessment and Intervention (HBAI services). There were also several clients where biopsychosocial factors were identified which appeared to be affecting the individual's recovery, that is, poor sleep patterns, inactivity, or other health behaviors, or anxiety, depressed mood, psychosomatic or post-traumatic symptoms which did not rise to the level of warranting a mental health diagnosis.
Overall, 155 of the 157 patients (98.7%) returned to work at full duty without further restrictions or accommodations. The findings of this study support the view that prolonged mTBI and PCS are strongly influenced by psychological factors. Conducting a brief and readily accessible neurocognitive assessment to reassure injured workers that their concerns about mTBI/concussion were being carefully considered and thoroughly addressed appeared to have dramatic effects on decreasing chronicity in this study ...
A three-judge Ninth Circuit panel affirmed a federal court dismissal of a lawsuit filed by the American Society of Journalists and Authors and the National Press Photographers Association challenging the State’s passage of Assembly Bill 5 and its various amendments.
The American Society of Journalists and Authors and the National Press Photographers Association filed a federal lawsuit challenging, on First Amendment and Equal Protection grounds, California’s Assembly Bill 5 and its subsequent amendments, which codified the more expansive ABC test previously set forth in Dynamex Operations West, Inc. v. Superior Court of Los Angeles, 416 P.3d 1 (Cal. 2018), for ascertaining whether workers are classified as employees or independent contractors.
AB5 and its subsequent amendments, now codified at section 2778 of the California Labor Code, provides for certain occupational exemptions.
Because freelance writers, photographers and others received a narrower exemption than was offered to certain other professionals, plaintiffs sued, asserting that AB5 effectuates content-based preferences for certain kinds of speech, burdens journalism and burdens the right to film matters of public interest.
The panel in the published case of ASJA v Bonta held that section 2778 regulates economic activity rather than speech. It does not, on its face, limit what someone can or cannot communicate. Nor does it restrict when, where, or how someone can speak.
The statute is aimed at the employment relationship - a traditional sphere of state regulation. The panel further acknowledged that although the ABC classification may indeed impose greater costs on hiring entities, which in turn could mean fewer overall job opportunities for certain workers, such an indirect impact on speech does not necessarily rise to the level of a First Amendment violation.
The panel rejected plaintiffs’ assertion that the law singled out the press as an institution and was not generally applicable.
Addressing the Equal Protection challenge, the panel held that the legislature’s occupational distinctions were rationally related to a legitimate state purpose.
Amicus briefs were filed in this case by Cato Institute, Reason Foundation, Individual Rights Foundation, Goldwater Institute, Independent Institute and Liberty Justice Center ...
The American Society of Journalists and Authors and the National Press Photographers Association filed a federal lawsuit challenging, on First Amendment and Equal Protection grounds, California’s Assembly Bill 5 and its subsequent amendments, which codified the more expansive ABC test previously set forth in Dynamex Operations West, Inc. v. Superior Court of Los Angeles, 416 P.3d 1 (Cal. 2018), for ascertaining whether workers are classified as employees or independent contractors.
AB5 and its subsequent amendments, now codified at section 2778 of the California Labor Code, provides for certain occupational exemptions.
Because freelance writers, photographers and others received a narrower exemption than was offered to certain other professionals, plaintiffs sued, asserting that AB5 effectuates content-based preferences for certain kinds of speech, burdens journalism and burdens the right to film matters of public interest.
The panel in the published case of ASJA v Bonta held that section 2778 regulates economic activity rather than speech. It does not, on its face, limit what someone can or cannot communicate. Nor does it restrict when, where, or how someone can speak.
The statute is aimed at the employment relationship - a traditional sphere of state regulation. The panel further acknowledged that although the ABC classification may indeed impose greater costs on hiring entities, which in turn could mean fewer overall job opportunities for certain workers, such an indirect impact on speech does not necessarily rise to the level of a First Amendment violation.
The panel rejected plaintiffs’ assertion that the law singled out the press as an institution and was not generally applicable.
Addressing the Equal Protection challenge, the panel held that the legislature’s occupational distinctions were rationally related to a legitimate state purpose.
Amicus briefs were filed in this case by Cato Institute, Reason Foundation, Individual Rights Foundation, Goldwater Institute, Independent Institute and Liberty Justice Center ...
AM Best is a global credit rating agency, news publisher and data analytics provider specializing in the insurance industry. According to a new AM Best report underwriters of workers’ compensation insurance have consistently generated better underwriting profits than other property/casualty (P/C) lines of business, again doing so in 2020 amid the pandemic.
The Best’s Market Segment Report, titled, "Workers’ Compensation Still Outpacing Other Lines" states that underwriting results of workers’ compensation insurers remained strong in 2020, despite a 10% decline in bottom-line net premiums written, owing to the substantial drop in payrolls during the second quarter of the year.
The combined ratio of 91.1 in the workers’ compensation segment in 2020 was a few points higher than in 2019, but still comfortably under the breakeven mark of 100.0, reflecting profitable underwriting. Given the decline in premium, expense ratios rose, but the increase was nominal and did not overly dampen underwriting earnings.
Premium volume for workers’ compensation writers also has been constrained by rate decreases in most states. According to the report, some writers are looking to develop new products and explore new markets in other lines of coverage and allowing their workers’ compensation top-line premium to decline in the states where they generate significant premium.
Despite the smaller premium base, workers’ compensation insurers remained highly profitable in comparison with other P/C lines. Workers’ compensation underwriters have benefited from a decline in lost-time claims frequency tied to efforts to improve workplace safety. Other factors that have benefited the line’s profitability are the declines in fraud, workplace accidents and defense costs.
AM Best also analyzes the overall health of the workers’ compensation line of business through its Workers’ Compensation Composite, which is composed of U.S. companies, including state funds, whose workers’ compensation and excess workers’ compensation net premiums constitute 50% or more of their total net premiums. Even with the 2020 decline in workers’ compensation premium due to the pandemic, the market share of these specialists rose to 26.2% in 2020, up considerably from 16.7% in 2011.
AM Best’s negative market segment outlook for the workers’ compensation segment, the largest component of the U.S. commercial lines market, reflects the continued uncertainty about the effects of COVID-19, from an economic and a regulatory perspective, as well as a legislative one as states consider presumptive legislation stemming from the pandemic. Moreover, although the impact of the pandemic on insurers’ balance sheets to date has been tempered, concerns about the prolonged low interest rate environment persist. As a result, investment returns are expected to remain flat, and insurers may begin seeking riskier investments to generate higher yield ...
The Best’s Market Segment Report, titled, "Workers’ Compensation Still Outpacing Other Lines" states that underwriting results of workers’ compensation insurers remained strong in 2020, despite a 10% decline in bottom-line net premiums written, owing to the substantial drop in payrolls during the second quarter of the year.
The combined ratio of 91.1 in the workers’ compensation segment in 2020 was a few points higher than in 2019, but still comfortably under the breakeven mark of 100.0, reflecting profitable underwriting. Given the decline in premium, expense ratios rose, but the increase was nominal and did not overly dampen underwriting earnings.
Premium volume for workers’ compensation writers also has been constrained by rate decreases in most states. According to the report, some writers are looking to develop new products and explore new markets in other lines of coverage and allowing their workers’ compensation top-line premium to decline in the states where they generate significant premium.
Despite the smaller premium base, workers’ compensation insurers remained highly profitable in comparison with other P/C lines. Workers’ compensation underwriters have benefited from a decline in lost-time claims frequency tied to efforts to improve workplace safety. Other factors that have benefited the line’s profitability are the declines in fraud, workplace accidents and defense costs.
AM Best also analyzes the overall health of the workers’ compensation line of business through its Workers’ Compensation Composite, which is composed of U.S. companies, including state funds, whose workers’ compensation and excess workers’ compensation net premiums constitute 50% or more of their total net premiums. Even with the 2020 decline in workers’ compensation premium due to the pandemic, the market share of these specialists rose to 26.2% in 2020, up considerably from 16.7% in 2011.
AM Best’s negative market segment outlook for the workers’ compensation segment, the largest component of the U.S. commercial lines market, reflects the continued uncertainty about the effects of COVID-19, from an economic and a regulatory perspective, as well as a legislative one as states consider presumptive legislation stemming from the pandemic. Moreover, although the impact of the pandemic on insurers’ balance sheets to date has been tempered, concerns about the prolonged low interest rate environment persist. As a result, investment returns are expected to remain flat, and insurers may begin seeking riskier investments to generate higher yield ...
Lion Farms, LLC owned and operated a dried-on-the-vine raisin vineyard in Madera County (Cottonwood Ranch), at which Lion’s employee Isaac Rey Barrientos worked.
On June 10, 2015, Barrientos was killed when he lost control of the Lion-owned ATV he was riding in the vineyard to service Lion’s portable toilets, and the ATV’s right front tire hit an eye ring grape stake, ejecting Barrientos off of the vehicle.
The June 12, 2015, Merced County Sheriff’s Office Report of Autopsy and the Madera County Certificate of Vital Record listed "blunt impact thoracospinal injuries" (not a head injury) as Barrientos’s cause of death. He was not wearing a helmet at the time of his fatal accident.
While Barrientos’s death was not due to the absence of head protection, Division Associate Safety Engineer Randy Chase found that wearing helmets while riding ATV’s would reduce the inherent risk of head injury. However, Chase also found that Lion had no written certification of having conducted a workplace hazard assessment and no requirement that its employees wear helmets as PPE while riding ATV’s.
Lion was therefore cited for violations of workplace safety regulations by the Division of Occupational Safety and Health.
Lion challenged the citations and the penalties by filing an appeal with the Board. Lion engaged the services of a retained industrial safety expert, who opined in his prepared report that a helmet would represent a hazard in itself and should never be worn while riding an ATV in and under the raisin vine "canopy" of hanging fruit and canes, as a helmet would "most probably become tangled within the vines and pull the rider off the vehicle, causing severe injury or death."
Following the hearings, the ALJ upheld the citations, and reconsideration was denied. Lion filed its petition for writ of administrative mandate with the trial court, which was denied after a hearing on the merits. The Court of Appeal affirmed the citations in the unpublished case of Lion Farms v. Cal Occupational Safety and Health etc.
Among other issues, Lion claimed that section 3380 (particularly with respect to PPE required in the context of ATV usage in agricultural settings), as applied on the facts and circumstances of this case violated Lion’s substantive due process protections because the regulations were unconstitutionally vague and ambiguous. The Court of Appeal rejected this argument.
An administrative regulation violates due process of law if it forbids or requires the doing of an act in terms so vague that persons of common intelligence must necessarily guess at its meaning and differ as to its application. In considering a vagueness challenge to an administrative regulation, courts do not view the regulation in the abstract; rather they consider whether it is vague when applied to the complaining party’s conduct in light of the specific facts of the particular case. Standards under a regulation may be refined and developed on a case-by-case basis.
Section 3380(f)(1)(A)’s requirement that employers assess their workplaces to determine if hazards necessitating the use of PPE are present or likely to be present (and if such a determination is affirmatively made, select and make available the types of PPE that will protect affected employees from the hazards identified in the workplace assessment) is not impermissibly vague ...
On June 10, 2015, Barrientos was killed when he lost control of the Lion-owned ATV he was riding in the vineyard to service Lion’s portable toilets, and the ATV’s right front tire hit an eye ring grape stake, ejecting Barrientos off of the vehicle.
The June 12, 2015, Merced County Sheriff’s Office Report of Autopsy and the Madera County Certificate of Vital Record listed "blunt impact thoracospinal injuries" (not a head injury) as Barrientos’s cause of death. He was not wearing a helmet at the time of his fatal accident.
While Barrientos’s death was not due to the absence of head protection, Division Associate Safety Engineer Randy Chase found that wearing helmets while riding ATV’s would reduce the inherent risk of head injury. However, Chase also found that Lion had no written certification of having conducted a workplace hazard assessment and no requirement that its employees wear helmets as PPE while riding ATV’s.
Lion was therefore cited for violations of workplace safety regulations by the Division of Occupational Safety and Health.
Lion challenged the citations and the penalties by filing an appeal with the Board. Lion engaged the services of a retained industrial safety expert, who opined in his prepared report that a helmet would represent a hazard in itself and should never be worn while riding an ATV in and under the raisin vine "canopy" of hanging fruit and canes, as a helmet would "most probably become tangled within the vines and pull the rider off the vehicle, causing severe injury or death."
Following the hearings, the ALJ upheld the citations, and reconsideration was denied. Lion filed its petition for writ of administrative mandate with the trial court, which was denied after a hearing on the merits. The Court of Appeal affirmed the citations in the unpublished case of Lion Farms v. Cal Occupational Safety and Health etc.
Among other issues, Lion claimed that section 3380 (particularly with respect to PPE required in the context of ATV usage in agricultural settings), as applied on the facts and circumstances of this case violated Lion’s substantive due process protections because the regulations were unconstitutionally vague and ambiguous. The Court of Appeal rejected this argument.
An administrative regulation violates due process of law if it forbids or requires the doing of an act in terms so vague that persons of common intelligence must necessarily guess at its meaning and differ as to its application. In considering a vagueness challenge to an administrative regulation, courts do not view the regulation in the abstract; rather they consider whether it is vague when applied to the complaining party’s conduct in light of the specific facts of the particular case. Standards under a regulation may be refined and developed on a case-by-case basis.
Section 3380(f)(1)(A)’s requirement that employers assess their workplaces to determine if hazards necessitating the use of PPE are present or likely to be present (and if such a determination is affirmatively made, select and make available the types of PPE that will protect affected employees from the hazards identified in the workplace assessment) is not impermissibly vague ...
An Orange County pharmacist has been sentenced to 70 months in federal prison for submitting more than $13 million in claims for medically unnecessary compounded medication prescriptions.
42 year old Thu Van Le, a.k.a. "Tony Le," who lives in Placentia, was sentenced by United States District Judge R. Gary Klausner.
In addition to the prison term, Judge Klausner ordered Le to pay $10,982,759 in restitution to Tricare, the U.S. military’s managed health care plan, and $768,488 in restitution to Amplan, Amtrak’s employee health care benefit plan.
Le, a pharmacist who owned TC Medical Pharmacy located at 760 S. Washburn Ave. #1 in Corona California, pleaded guilty on July 12 to one count of health care fraud.
From March 2015 to December 2016, Le’s pharmacy submitted more than $13 million in total claims to Tricare and AmPlan, against which Tricare paid $10,982,759 and AmPlan paid $768,488. Le, in turn, paid so-called "marketers" handsome kickbacks of up to 50 percent of the Tricare reimbursements.
The marketers used personal and insurance information to generate fraudulent prescriptions for compounded medications, according to court documents. Marketers who participated in the scheme solicited beneficiaries of the health plans through misleading cold calls that promised free compounded medications. In some cases, beneficiaries were not contacted at all and simply received expensive medications that they did not order.
Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient.
Le agreed to be bound by Tricare and AmPlan rules for reimbursement of claims for their beneficiaries. Tricare and AmPlan required that medications be medically necessary, that beneficiaries be examined by physicians, and that Le’s pharmacy collect co-payments. The prescriptions were supposed to be for unique patient needs, but they instead were formulated to maximize reimbursements and were prepared on an assembly-line basis.
The Defense Criminal Investigative Service, the FBI, IRS Criminal Investigation, Amtrak’s Office of Inspector General, the Office of Personnel Management’s Office of Inspector General, the United States Department of Labor – Employee Benefits Security Administration, the Department of Health and Human Services, and the California Department of Insurance investigated this matter.
Assistant United States Attorney Mark Aveis of the Major Frauds Section prosecuted this case ...
42 year old Thu Van Le, a.k.a. "Tony Le," who lives in Placentia, was sentenced by United States District Judge R. Gary Klausner.
In addition to the prison term, Judge Klausner ordered Le to pay $10,982,759 in restitution to Tricare, the U.S. military’s managed health care plan, and $768,488 in restitution to Amplan, Amtrak’s employee health care benefit plan.
Le, a pharmacist who owned TC Medical Pharmacy located at 760 S. Washburn Ave. #1 in Corona California, pleaded guilty on July 12 to one count of health care fraud.
From March 2015 to December 2016, Le’s pharmacy submitted more than $13 million in total claims to Tricare and AmPlan, against which Tricare paid $10,982,759 and AmPlan paid $768,488. Le, in turn, paid so-called "marketers" handsome kickbacks of up to 50 percent of the Tricare reimbursements.
The marketers used personal and insurance information to generate fraudulent prescriptions for compounded medications, according to court documents. Marketers who participated in the scheme solicited beneficiaries of the health plans through misleading cold calls that promised free compounded medications. In some cases, beneficiaries were not contacted at all and simply received expensive medications that they did not order.
Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient.
Le agreed to be bound by Tricare and AmPlan rules for reimbursement of claims for their beneficiaries. Tricare and AmPlan required that medications be medically necessary, that beneficiaries be examined by physicians, and that Le’s pharmacy collect co-payments. The prescriptions were supposed to be for unique patient needs, but they instead were formulated to maximize reimbursements and were prepared on an assembly-line basis.
The Defense Criminal Investigative Service, the FBI, IRS Criminal Investigation, Amtrak’s Office of Inspector General, the Office of Personnel Management’s Office of Inspector General, the United States Department of Labor – Employee Benefits Security Administration, the Department of Health and Human Services, and the California Department of Insurance investigated this matter.
Assistant United States Attorney Mark Aveis of the Major Frauds Section prosecuted this case ...
The Los Angeles Times reports that research conducted in Southern California has confirmed the dramatic erosion of the Pfizer-BioNTech COVID-19 vaccine’s protection against "breakthrough" coronavirus infections.
The new study, one of the largest and longest to track the effectiveness of a vaccine in Americans, found that the vaccine’s ability to protect against infection stood at 88% in its first month, then fell to 47% after just five months.
But even as the Delta variant became the predominant strain across the Southland, the vaccine’s effectiveness at preventing COVID-19 hospitalizations held steady at close to 90% for as long as six months. What’s more, it maintained that power across vaccine recipients of all age groups.
The study, funded by Pfizer and published Monday in the journal Lancet, also provides strong new evidence that the waning immunity against infection probably would have been seen with or without the arrival of the Delta variant.
Researchers found that a fresh inoculation with the Pfizer-BioNTech vaccine protected just as well against an infection with the Delta variant as it did against infection with other versions of the coronavirus.
Second, the vaccine’s ability to keep vaccinated people out of the hospital remained high across a span of time when the Delta variant gained ground in Southern California.
And third, breakthrough infections were more closely linked to the amount of time that had lapsed since vaccination than they were to the particular viral variant involved.
By showing that waning immunity, not the Delta variant, was the likely reason for the rise in breakthrough infections, the study suggests it may not be necessary to reformulate a Pfizer-BioNTech booster that specifically targets Delta. For now, at least, a third shot identical to the first two would probably extend the vaccine’s early record of protection against all strains, including Delta.
The protection provided by the Pfizer vaccine beyond six months has been an open question, hinted at only by Israeli studies that suggest COVID-19 hospitalization rates rise in those above 60 years of age.
In another recent study, researchers from Emory University and Stanford found that six months after being inoculated with the Pfizer vaccine, roughly half of 56 young and middle-aged adults had no detectable neutralizing antibodies against the SARS-CoV-2 virus. The reduced immunity was particularly dramatic against the coronavirus variants Delta, Beta and Mu.
That study was posted last week on BioRXiv, a site where researchers share preliminary work before it has been peer-reviewed. But its findings of "a substantial waning of antibody responses" - as well as a drop in the immunity provided by T cells - suggest that a third booster immunization "might be warranted," its authors wrote ...
The new study, one of the largest and longest to track the effectiveness of a vaccine in Americans, found that the vaccine’s ability to protect against infection stood at 88% in its first month, then fell to 47% after just five months.
But even as the Delta variant became the predominant strain across the Southland, the vaccine’s effectiveness at preventing COVID-19 hospitalizations held steady at close to 90% for as long as six months. What’s more, it maintained that power across vaccine recipients of all age groups.
The study, funded by Pfizer and published Monday in the journal Lancet, also provides strong new evidence that the waning immunity against infection probably would have been seen with or without the arrival of the Delta variant.
Researchers found that a fresh inoculation with the Pfizer-BioNTech vaccine protected just as well against an infection with the Delta variant as it did against infection with other versions of the coronavirus.
Second, the vaccine’s ability to keep vaccinated people out of the hospital remained high across a span of time when the Delta variant gained ground in Southern California.
And third, breakthrough infections were more closely linked to the amount of time that had lapsed since vaccination than they were to the particular viral variant involved.
By showing that waning immunity, not the Delta variant, was the likely reason for the rise in breakthrough infections, the study suggests it may not be necessary to reformulate a Pfizer-BioNTech booster that specifically targets Delta. For now, at least, a third shot identical to the first two would probably extend the vaccine’s early record of protection against all strains, including Delta.
The protection provided by the Pfizer vaccine beyond six months has been an open question, hinted at only by Israeli studies that suggest COVID-19 hospitalization rates rise in those above 60 years of age.
In another recent study, researchers from Emory University and Stanford found that six months after being inoculated with the Pfizer vaccine, roughly half of 56 young and middle-aged adults had no detectable neutralizing antibodies against the SARS-CoV-2 virus. The reduced immunity was particularly dramatic against the coronavirus variants Delta, Beta and Mu.
That study was posted last week on BioRXiv, a site where researchers share preliminary work before it has been peer-reviewed. But its findings of "a substantial waning of antibody responses" - as well as a drop in the immunity provided by T cells - suggest that a third booster immunization "might be warranted," its authors wrote ...
Back in May, 2017 a federal grand jury returned an eight-count criminal indictment. charging Dr. Basil Hantash with eight counts of health care billing fraud. The dermatologist is president and medical director of Advanced Skin Institute on Geer Road in Turlock.
According to federal court documents, Dr. Hantash was a dermatologist and the medical director of the Advanced Skin Institute in Turlock California . For about six years Hantash made insurance reimbursement claims to private insurance companies for performing acne surgeries. In fact, however, the indictment states he only performed only cosmetic procedures known as chemical peels or microdermabrasions. The indictment notes Hantash employed estheticians to perform work, but per California law they are prohibited from performing surgeries.
Government records state in 2014 Anthem Blue Cross audited the Advanced Skin Institute. In response Hantash allegedly submitted false documents claiming he did surgeries using surgical blades. In fact, he had not. The indictment includes fraudulent billings submitted to Anthem and Blue Shield.
Then on October 4 2021, the Modesto Bee reported that Federal charges against Dr. Hantash have been dismissed after the doctor complied with a deferred prosecution agreement in the health care billing fraud case. The Department of Justice prosecuted the case in the U.S. District Court in Fresno.
Judge Dale Drozd approved a deferred prosecution agreement in September 2019 obligating Hantash to stop seeking reimbursements from insurance companies for procedures using a dermalinfusion device, unless the practice received prior approval from insurance providers.
Hantash agreed to return insurance company payments received for those procedures between January 2011 and April 2016. According to terms of the agreement, Advanced Skin Institute reimbursed $92,234 to Anthem Blue Cross and $81,515 to Blue Shield of California.
The federal case was dismissed Sept. 27.
Hantash expressed the opinion last week the criminal indictment was not justified. "This was a civil dispute and contractually should have gone to arbitration," the physician said by email.
Federal authorities seized $687,583 in funds from an Advanced Skin Institute account in 2017. The court agreement called for returning $513,804 to Hantash's practice after reimbursements of $173,749 to the insurance companies ...
According to federal court documents, Dr. Hantash was a dermatologist and the medical director of the Advanced Skin Institute in Turlock California . For about six years Hantash made insurance reimbursement claims to private insurance companies for performing acne surgeries. In fact, however, the indictment states he only performed only cosmetic procedures known as chemical peels or microdermabrasions. The indictment notes Hantash employed estheticians to perform work, but per California law they are prohibited from performing surgeries.
Government records state in 2014 Anthem Blue Cross audited the Advanced Skin Institute. In response Hantash allegedly submitted false documents claiming he did surgeries using surgical blades. In fact, he had not. The indictment includes fraudulent billings submitted to Anthem and Blue Shield.
Then on October 4 2021, the Modesto Bee reported that Federal charges against Dr. Hantash have been dismissed after the doctor complied with a deferred prosecution agreement in the health care billing fraud case. The Department of Justice prosecuted the case in the U.S. District Court in Fresno.
Judge Dale Drozd approved a deferred prosecution agreement in September 2019 obligating Hantash to stop seeking reimbursements from insurance companies for procedures using a dermalinfusion device, unless the practice received prior approval from insurance providers.
Hantash agreed to return insurance company payments received for those procedures between January 2011 and April 2016. According to terms of the agreement, Advanced Skin Institute reimbursed $92,234 to Anthem Blue Cross and $81,515 to Blue Shield of California.
The federal case was dismissed Sept. 27.
Hantash expressed the opinion last week the criminal indictment was not justified. "This was a civil dispute and contractually should have gone to arbitration," the physician said by email.
Federal authorities seized $687,583 in funds from an Advanced Skin Institute account in 2017. The court agreement called for returning $513,804 to Hantash's practice after reimbursements of $173,749 to the insurance companies ...
