A strategically coordinated, six-week nationwide federal law enforcement action has resulted in criminal charges against 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States for their alleged participation in various health care fraud schemes that resulted in approximately $1.4 billion in alleged losses.

The enforcement action includes criminal charges against four defendants in the Southern District of California, involving more than $129 million in intended losses.

Nationwide, this action includes more than $1.1 billion in fraud committed using telemedicine, more than $29 million in COVID-19 health care fraud, more than $133 million connected to substance abuse treatment facilities, or "sober homes," and more than $160 million connected to other health care fraud and illegal opioid distribution schemes across the country

Telemedicine Fraud Cases - The largest amount of alleged fraud loss charged in connection with the announced - over $1.1 billion in allegedly false and fraudulent claims submitted by more than 50 criminal defendants in 11 judicial districts nationwide - relates to schemes involving telemedicine: the use of telecommunications technology to provide health care services remotely.

COVID-19 Fraud Cases - Nine defendants are alleged to have engaged in various health care fraud schemes designed to exploit the COVID-19 pandemic, which resulted in the submission of over $29 million in false billings.

In the Southern District of California, Roselia Kubeck and Rosario Gonzalez pleaded guilty to having approached residents of senior complexes in El Centro and Calexico, California, who were Medicare beneficiaries, and offering COVID-19 screening tests for the residents. The defendants knew at the time that the tests would not actually test for COVID-19 but would be a general respiratory pathogens screening panel that tested for the presence of several kinds of respiratory pathogens. They also took urine samples from the Medicare beneficiaries without explaining that the urine samples were not necessary to conduct a COVID-19 test. The defendants then completed requisition forms for tests on the nasal swabs and urine samples, and inaccurately indicated on the forms that the beneficiaries needed the respiratory tests because they were suffering from acute respiratory infections and needed urine tests because the beneficiaries were long-term users of opiates or had urinary tract infections. The laboratories that performed the tests subsequently submitted inaccurate and medically unnecessary claims to Medicare based on the inaccurate diagnoses that the defendants put on the requisition forms.

Sober Homes Cases - The sober homes cases are announced on the one-year anniversary of the first ever national sober homes initiative in 2020, which included charges against more than a dozen criminal defendants in connection with more than $845 million of allegedly false and fraudulent claims for tests and treatments for vulnerable patients seeking treatment for drug and/or alcohol addiction. The over $133 million in false and fraudulent claims that are additionally alleged in cases just announced reflect the continued effort by the National Rapid Response Strike Force and the Health Care Fraud Unit’s Los Angeles Strike Force, with the participation of the U.S. Attorney’s Offices for the Central District of California and the Southern District of Florida, to prosecute those who participated in illegal kickback and bribery schemes involving the referral of patients to substance abuse treatment facilities; those patients could be subjected to medically unnecessary drug testing - often billing thousands of dollars for a single test - and therapy sessions that frequently were not provided, and which resulted in millions of dollars of false and fraudulent claims being submitted to private insurers.

Cases Involving the Illegal Prescription and/or Distribution of Opioids and Cases Involving Traditional Health Care Fraud Schemes

In the Southern District of California, Ronald Charles Green Jr. and Melinda Elizabeth Green were charged with conspiring to defraud TRICARE and Medicare out of more than $129 million. In connection with a compounding pharmacy fraud, the defendants allegedly engaged in a scheme involving the submission of false and fraudulent claims to TRICARE for expensive and medically unnecessary pain creams, scar creams and multi-vitamins, which were billed through compound pharmacies. Thereafter, the defendants allegedly launched multiple durable medical equipment companies, and carried out a scheme to defraud Medicare through the submission of false and fraudulent claims for expensive durable medical equipment which were induced through a system of illegal kickbacks. Out of the $129 million in claims, Medicare paid the defendants’ companies more than $69 million.

Prior to the charges announced as part of the nationwide enforcement action and since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,600 defendants who have collectively billed the Medicare program for approximately $23 billion.
...

In February 2020, NCCI published the article "Comparing the Quantity and Prices of Physician Services Between Workers Compensation and Group Health." A newly published article extends that work by also looking at a mix of services.

A model of component cost differentials of physician services between WC and GH for 12 common WC injuries showed that:

- - WC costs more than GH to treat comparable injuries, after controlling for claim characteristics such as age and gender
- - Utilization differences account for about 78% of the overall cost differential for WC
- - Chronic pain-related injuries, such as bursitis and back disorders, have larger differentials amongst the 12 injuries studied

It also found that:

- - Unit price differentials vary principally by state, with most states having higher unit prices for WC than for GH
- - Utilization differentials vary principally by type of injury, with all 12 injuries showing higher WC utilization
- - A WC physician fee schedule in a state is often associated with prices that are competitive with, or even below, GH prices

There are distinct patterns of medical services by service category. Comparing WC to GH:

- - Evaluation, management, and physical medicine costs are higher for WC due to greater utilization
- - For WC, the greatest proportional component difference is in the utilization of physical medicine
- - For chronic cases, radiology and surgery cost more for WC due to both higher unit prices and greater utilization

A greater volume of services is the primary driver of higher treatment costs for WC over GH for primary care (office visits and physical therapy). For specialty care (radiology and surgery), greater volume combines with a more expensive mix of procedures to drive WC treatment costs higher, especially on more complex injuries. For all age groups, quantity dominates mix in driving WC costs higher than GH and are greatest after age 40. For males and females and for all four physician service categories, the cost differential model has WC costs higher than GH; however, differences are greater for males than for females. More referral - based services, on average, to treat an injury drive greater differences for males ...

The delta variant of the coronavirus roared into California midsummer, striking hard even in places where many people were vaccinated. Cases spiked. Hospitals again began to swell with patients. The daily death toll climbed into the triple digits for the first time in months.

But after a season in which the highly transmissible variant wreaked havoc on the nation, the Washington Post reports that California is reporting sustained progress against delta. And this is also good news for workers' compensation claims in the state.

Earlier this week, California dropped from "high" to "substantial" virus spread, according to the Centers for Disease Control and Prevention. It later bounced back up, but total new cases per 100,000 residents are still lower than any other state. The change in CDC designation - a barometer of how well states are doing in combating the virus - was celebrated by public health officials, who suggested it was a signal that California could be close to a turning point.

An aggressive push for vaccines, coupled with masks mandates at the local level and a public largely willing to go along with them, appear to have helped flatten the state’s curve, experts said.

"California, as compared to many other states in the nation, took rapid steps to recognize the extent of the problem and to apply more covid control measures," said Robert Kim-Farley, a infectious-disease expert at UCLA Fielding School of Public Health. "I think if California had not taken these steps to curb transmission, we could have ended up with much higher levels."

The fight against delta is far from over in the Golden State, which still faces a host of challenges in containing cases. Though infections have dropped in California’s population hubs in recent weeks, they remain high in parts of the Central Valley and rural north. An influx of patients has overwhelmed some intensive care units in those regions.

Compounding the problem, California hospitals are facing staffing shortages. Medical workers have struggled with burnout, and surges in other states have created intense competition for nurses, said Bryan Bucklew, president and chief executive of Hospital Council of Northern & Central California, a nonprofit trade association.

"The numbers may be flattening, but the impact to the health-care system is extremely challenging," he said. "We have a good handle on how to treat covid, with monoclonal antibodies, vaccines. We just have a lot less staff. It’s more of a workforce issue for us than a covid issue."

Statewide, infections are still far higher than they were early in the summer, averaging about 9,300 new cases per day compared with 758 on July according to tracking by The Washington Post.

But they’re down from a summer peak of about 14,400 per day on average, the data shows. Hospitalizations have fallen statewide by about 10 percent over the past week. Positivity rates have also dropped recently, at a time when the state is administering more tests than at almost any point in the pandemic - another indicator that the spread is slowing.

At its worst point over the summer, cases per 100,000 people in California rose to about 35 per day on average, according to The Post’s analysis of state data. In Florida, where the governor has sought to ban public health mandates, per capita cases topped 100 during the peak of infections, and in Texas they’ve hovered around 60 for weeks, the data shows.

As of Thursday, California had 24 cases per 100,000 residents, less than half as many as Florida, with 55 per capita, and Texas with 59, according to The Post’s data.

John Swartzberg, an infectious-disease expert at the University of California at Berkeley, said California has benefited from a population that’s generally receptive to public health directives. He said the attitude was rooted in the public health response to the AIDS crisis in the early 1980s ...

Zachary Navo, 38, of Visalia, was arraigned on five felony counts of insurance fraud after a Department of Insurance investigation revealed he allegedly underreported wages by over $2.5 million in an attempt to fraudulently reduce workers’ compensation premium payments, resulting in a loss of over $135,000 to his insurance companies.

In December 2017, State Compensation Insurance Fund (SCIF) issued Navo a workers’ compensation insurance policy for his private security business, Element Security Solutions, Inc.

In June 2018, Navo completed a payroll report indicating he had $80,500 in payroll for the first six months of the policy period. Navo failed to submit subsequent payroll information and failed to comply with an end of policy audit.

During the investigation, a review of Employment Development Department (EDD) records for the twelve-month policy period revealed $2,098,394 in payroll was reported to EDD for Element Security Solutions, Inc., which revealed an underreporting of approximately $2 million in payroll to SCIF.

The underreporting resulted in a $134,761 loss in premium owed to SCIF.

Investigators also discovered that Navo is a licensed insurance agent and owns a secondary entity, Navo Financial, Inc., an insurance and financial solutions business, in which Navo reported $504,302 in payroll from 2016 to 2019. However, EDD records for the period of 2016 to 2019, found Navo reported $1,047,482 in payroll to EDD for Navo Financial, Inc., demonstrating an underreporting of $543,180 in payroll and resulting in a $1,164 loss to a different insurance company.

This case is being prosecuted by the Tulare County District Attorney’s Office ...

Back in 2019, Governor Gavin Newsom signed Assembly Bill 51 (Cal. Lab. Code §§ 432.6(a)–(c), 433; Cal. Gov’t Code § 12953), which effectively outlawed mandatory arbitration agreements with employees - a new version of a bill that prior Governor Jerry Brown had vetoed repeatedly while he was in office.

The law allows workers to pursue damages and attorneys’ fees and open criminal cases against employers who discriminate and retaliate against them for declining arbitration contracts.

The contentious bill bars employers from requiring applicants to waive their right to sue under state labor laws as a condition of employment. Going a step further, the bill sponsored by the California Labor Federation and Consumer Attorneys of California opened employers up to civil and criminal penalties for extreme violations.

A federal judge enjoined the state from enforcing Assembly Bill 51 last year, agreeing with the Chamber of Commerce and other employers that it was pre-empted by the Federal Arbitration Act. The decision was hailed by the coalition of business groups who accused California lawmakers of trying to weaken the common tool used to keep employment disputes out of the courts.

In the case of Chamber of Commerce v Rob Bonta, the Attorney General of the State of California, the Ninth Circuit panel ruled in a 2-1 decision, that the state can require all employment arbitration agreements be consensual and reversed the preliminary injunction. It found AB 51 doesn’t discriminate against arbitration agreements or nix their enforcement.

"In light of Congress’ clear purpose to ensure the validity and enforcement of consensual arbitration agreements according to their terms, it is difficult to see how [AB 51], which in no way affects the validity and enforceability of such agreements, could stand as an obstacle to the FAA," U.S. Circuit Judge Carlos Lucero, a Bill Clinton appointee sitting by designation from the 10th Circuit, wrote for the majority.

U.S. Circuit Judge Sandra Segal Ikuta, a George W. Bush appointee, wrote a dissenting opinion. She commenced her dissent by claiming "Like a classic clown bop bag, no matter how many times California is smacked down for violating the Federal Arbitration Act (FAA), the state bounces back with even more creative methods to sidestep the FAA".

"And today the majority abets California’s attempt to evade the FAA and the Supreme Court’s caselaw by upholding this anti-arbitration law on the pretext that it bars only nonconsensual agreements. The majority’s ruling conflicts with the Supreme Court’s clear guidance in Kindred Nursing Centers Ltd. Partnership v. Clark, 137 S. Ct. 1421, 1428–29 (2017), and creates a circuit split with the First and Fourth Circuits. Because AB 51 is a blatant attack on arbitration agreements, contrary to both the FAA and longstanding Supreme Court precedent, I dissent. "

According to a report in Courthouse News, the Chamber of Commerce signaled it could appeal.

"The majority decision is clearly wrong, violates U.S. Supreme Court precedent and runs contrary to decisions of many other courts," said Daryl Joseffer, chief counsel for the chamber, in an email. "The U.S. Chamber will pursue further review of this flawed decision." ...

The Division of Workers’ Compensation announced that the 2022 minimum and maximum temporary total disability (TTD) rates will not change.

The minimum TTD will remain $203.44 and the maximum TTD rate will remain $1,356.31 per week.

Labor Code Section 4453(a) (10) requires the maximum and minimum weekly earnings upon which TTD is based be increased by an amount equal to percentage increase in the State Average Weekly Wage (SAWW) as compared to the prior year.

The SAWW is defined as the average weekly wage paid to employees covered by unemployment insurance as reported by the U.S. Department of Labor for California for the 12 months ending March 31 in the year preceding the injury.

In the 12 months ending March 31, 2021, the SAWW declined from $1,383 to $1,164. Therefore, the maximum average weekly wage considered for temporary disability rate will remain $2,034.47 (2/3 to produce a $1,356.31 weekly rate) and the minimum average weekly wage considered for temporary disability rate will remain $305.16 (2/3 to produce $203.44 weekly rate). The TTD minimum and maximum rates for 2022 are unchanged.

It is interesting that the Labor Code provides for an increase in rates if the SAWW increases, but no provision in the event of a decrease.

Under Labor Code Section 4659(c), workers with a date of injury on or after January 1, 2003 who are receiving life pension (LP) or permanent total disability (PTD) benefits are also entitled to have their weekly LP or PTD rate adjusted based on the SAWW. The decline in the SAWW dictates these rates also remain unchanged.

SAWW figures may be verified using the U.S. Department of Labor’s unemployment insurance database. ...

Earlier this summer, the California Supreme Court declined to add a third exception to the Privette rule, and thus reversed the Court of Appeal n the case of Gonzalez v Mathis. A month later, it reviewed the rule once again, and reversed a multi-million dollar jury verdict against Qualcomm.

In this new case, Qualcomm planned to upgrade its onsite turbine generators at its San Diego campus in 2013. In order to accommodate this upgrade, Qualcomm hired TransPower Testing, Inc., an electrical engineering service company, to inspect and verify the amperage capacity of Qualcomm’s existing switchgear equipment.

Frank Sharghi, TransPower’s president, is a licensed electrical engineer and had worked on that switchgear at least monthly for nearly 20 years, since before Qualcomm acquired the campus.

After Sharghi was unable to locate some of the busbars in the "main cogen: circuit during one inspection, Sharghi hired Jose M Sandoval - an electrical parts supply and repair specialist with ROS Electrical Supply & Equipment - to accompany him at a second inspection.

For this second inspection, Qualcomm approved a scope of work authorizing TransPower to inspect the main cogen circuit from the front and back.On the morning of the second inspection, the team attended a safety briefing led by Qualcomm plant operator, and the team was reminded that some circuits in the switchgear would remain live.

At some point during this inspection, Sandoval walked away from the rest of the TransPower team. Sandoval would later recall that he was having trouble judging the size of some of the main cogen busbars from the front side of the cabinet, and he thought he might be able to get a better view from the back.

Sandoval asked a fellow worker to hold a flashlight as they both approached the back side of the cabinets. Sandoval was holding a metal tape measure which triggered an arc flash from the live, exposed circuit. The 4,160-volt arc flash - thousands of degrees in temperature - had set him aflame, and he suffered serious injury.

Sandoval filed suit against Qualcomm, TransPower, and ROS Electrical Supply, asserting claims for negligence and premises liability. Qualcomm moved for summary judgment on the basis that the presumption of delegation should shield it from liability here. Denying the motion, the trial court proceeded to trial, and a jury awarded Sandoval over $1 million in past and future medical expenses and $6 million in noneconomic damages. It apportioned the fault 46 percent to Qualcomm, 45 percent to TransPower, and 9 percent to Sandoval.

The Court of Appeal affirmed. However the California Supreme Court reversed in the case of Sandoval v Qualcomm.

"Strong public policy considerations readily acknowledged in our past decisions generally support a straightforward presumption about the responsibilities of hirers and contractors for worker injuries in situations like this: A person or entity hiring an independent contractor (a “hirer”) ordinarily delegates to that independent contractor all responsibility for the safety of the contractor’s workers."

"This presumption is rooted in hirers’ reasons for employing contractors in the first place, and society’s need for clear rules about who’s responsible for avoiding harms to workers when contractors are hired."

Thus the Supreme Court concluded "that defendant Qualcomm Incorporated, the hirer in this case, owed no tort duty to plaintiff Martin Sandoval, the parts specialist working for Qualcomm’s contractor, at the time of Sandoval’s injuries." ...

An advocacy group lacks standing to sue one of the largest restaurant chain companies in the United States for paying tipped workers less than minimum wage, a federal judge ruled Tuesday.

Courthouse News reports that One Fair Wage, a nonprofit focused on eliminating sub-minimum wages, sued Darden Restaurants, which operates national chains like the Olive Garden and Longhorn Steakhouse, this past April in the US. District Court for the Northern District of California. The group claims the company’s pay policies force workers to rely on tips for the bulk of their wages. This puts servers at the mercy of potentially biased, racist or sexist customers, according to the complaint.

It sought an injunction to stop Darden from paying sub-minimum wages to tipped workers in 43 states that allow the practice. According to the lawsuit, Darden pays waiters the lowest possible wage in the 43 states that allow tipped workers to make less than minimum wage. About 20% of Darden’s tipped workers make $2.13 an hour, and a majority of its tipped staff make less than the federal minimum wage of $7.25 an hour, according to the complaint. The federal minimum wage was last raised in 2009 from the prior rate of $6.55.

Seven states - including California, Oregon, Washington state, Nevada, Minnesota, Montana and Alaska - require tipped workers be paid full minimum wage. In California, employers with 26 or more employees must pay workers at least $14 an hour. That rate will increase on Jan. 1, 2022, to $15 per hour.

But U.S. District Judge Edward Chen found One Fair Wage is not entitled to sue someone else’s employer for workplace discrimination under Title VII of the Civil Rights Act of 1964.

"Simply put, OFW cites no case law establishing that a non-employee - here, an advocacy organization - has standing to challenge an employment practice, particularly where the alleged injury it contends renders it 'aggrieved' is either purely ideological or entirely derivative of the injury directly suffered by actual employees - Chen wrote in a 29-page ruling.

Chen wrote that prior rulings, including a 2020 decision in a District of Maryland case, Know Your IX v. DeVos, challenging U.S. Department of Education sexual harassment and assault policies, suggest "there has not been a sufficient showing of direct impairment of OFW’s ability to operate and function to confer standing."

But the judge did not dismiss the case on that basis. Rather, he found One Fair Wage’s lack of standing to sue under Title VII of the Civil Rights Act means the court didn't need to address the group’s other theory of liability.

Chen wrote that One Fair Wage’s position on standing would mean any outside group affected by an employer’s labor practices could file suit and seek relief that would affect the rights and compensation of a class of potentially thousands of employees.

"OFW’s broad standing approach would ignore the protection afforded to the class via Rule 23’s requirements of notice, objection rights, and judicial scrutiny of any class settlement," Chen wrote. "This is particularly pertinent here, as there may well be employees who object to the changes sought by OFW to eliminate unmediated tipping."

Chen dismissed the case with prejudice, finding any attempt to amend the lawsuit would be futile ...

The U.S. Food and Drug Administration’s announced that it had granted "full approval" to the Covid shots being offered by Pfizer. But to be clear, what was actually given full approval was a separate Pfizer-BioNtech vaccine product which goes by the name Comirnaty. But Comirnaty is not currently available in the U.S.

The 13-page "approval letter" is addressed to BioNTech Manufacturing GmbH and Pfizer Inc. in New York City, and approves a biologics license application (BLA) for BioNTech Manufacturing GmbH in Mainz, Germany, for COMIRNATY.

Then a letter to Pfizer Inc. on the same date states: "FDA is reissuing the August 12, 2021 letter of authorization in its entirety with revisions incorporated to clarify that the EUA will remain in place for the Pfizer-BioNTech COVID-19 vaccine for the previously-authorized indication and uses, and to authorize use of COMIRNATY (COVID-19 Vaccine, mRNA) under this EUA for certain uses that are not included in the approved BLA."

Footnote 8 reads: "The licensed vaccine has the same formulation as the EUA-authorized vaccine and the products can be used interchangeably to provide the vaccination series without presenting any safety or effectiveness concerns. The products are legally distinct with certain differences that do not impact safety or effectiveness."

The "certain differences"are not specified, but it is perfectly clear that the two products are legally distinct. An analysis by the Association of American Physicians and Surgeons notes these differences and concludes that "It appears that there are two legally distinct if otherwise mostly identical products. The remaining doses of the 'Pfizer-BioNTech COVID-19 vaccine' are still under an EUA and are not fully licensed."

As of this date, the FDA has not approved the non Cominaty branded vaccine such as the Pfizer BioNTech vaccines, nor any COVID vaccines for the 12- to 15-year age group, nor any booster doses for anyone.

The FDA acknowledges that while Pfizer has insufficient supplies of the newly licensed Comirnaty vaccine actually available, there is "a significant amount" of the Pfizer-BioNTech COVID vaccine - which has been produced under Emergency Use Authorization (EUA) and will continue to be offered under the same EUA status.

EUA-licensed vaccines have an extraordinary liability shield under the 2005 Public Readiness and Preparedness Act. Vaccine manufacturers, distributors, providers and government planners are immune from liability. The only way an injured party can sue is if he or she can prove willful misconduct, and if the U.S. government has also brought an enforcement action against the party for willful misconduct. No such lawsuit has ever succeeded.

Phizer's Cominaty vaccine likely does not have that liability protection for Pfizer. The abundant U.S. supply of EUA authorized Pfizer-BioNtech vaccine product does protect Pfizer. Instead, the government has created a comparatively stingy compensation program, the Countermeasures Injury Compensation Program, - compared to tort law - to redress injuries from all EUA products.

For purposes of an informed consent, those choosing to take either vaccine should be advised that an unprecedented number of lethal or serious adverse effects have been reported to the Vaccine Adverse Events Reporting System (VAERS).

The FDA-approved package insert for Comirnaty reads: "13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility. COMIRNATY has not been evaluated for the potential to cause carcinogenicity, genotoxicity, or impairment of male fertility." It mentions one study in female rats. The package inserts warns of myocarditis, but omits mention of Guillain-Barré syndrome, thrombotic complications, and other serious events.

Now the thorny issues. Can an employer mandate that employee's take a vaccine that is "legally distinct" from the approved Cominaty product made by Pfizer? And if they do, does that bring any potential side-effect related problem within the workers' compensation system?

Federal Regulations provide that no one can force a human being to take an EUA drug. Under 21 U.S. Code Sec.360bbb-3(e)(1)(A)(ii)(III), "authorization for medical products for use in emergencies," parties need to be informed of their "option to accept or refuse administration of the product." What is also not clear is if the employer's vaccine mandate under threat of termination interferes with this right ...

The Division of Workers’ Compensation (DWC) issued its Notice of Emergency Regulation Re-Adoption of regulations sections 46.2 and 36.7 for medical-legal evaluations and reporting.

The emergency regulations are set to expire on October 12, 2021, and re-adoption would extend the emergency regulations for an additional 90 days.

This is DWC’s second and final re-adoption in accordance with Government Code section 11346.1(h).

The re-adoption of the emergency regulations will continue to help injured workers and employers move their workers’ compensation claims toward a resolution and avoid undue delay. These regulations address how a medical-legal evaluation may proceed and provide alternatives for service of required forms for a medical-legal evaluation and report.

The re-adoption of the emergency regulations will be filed with the state’s Office of Administrative Law (OAL) on September 20, 2021. The regulations to be filed with OAL can be found on the DWC website.

Upon OAL approval and filing with the Secretary of State, the regulations are effective for an additional 90 days. For information on the OAL procedure, and to learn how you may comment on the emergency regulations, go to OAL’s website. A notice will be posted at the DWC website when the re-adoption is approved ...

The share of Americans who are required by their employer to get vaccinated against COVID-19 took a jump up in August to 19 percent, according to a Gallup poll reported on September 8. The percentage doubled in the last month. But not all employees are happy with this development.

A lawsuit, that was filed by LAPD Officers Saturday in U.S. District Court in Los Angeles, claims the mandate violates the employees’ constitutional rights to privacy and due process, and asks the court to provide immediate and permanent relief from the requirement.

The six LAPD employees suing include individuals "who could not assert a medical or religious exemption" to the vaccine requirement, as well as individuals who have "experienced and recovered from COVID-19" and have natural antibodies to fight the virus, the complaint states.

The lawsuit alleges the city’s mandate ignores the natural protections provided by such antibodies and claims the suing employees "can safely perform their job duties protecting themselves, fellow employees and the community they serve through non-pharmaceutical interventions such as daily health screenings, wearing masks, and quarantine."

The suit also claims the employees have been subjected to harassment and undue pressure to get vaccinated by LAPD leaders, including a captain who said during a roll call meeting that the city was willing to fire thousands of officers if they don’t get vaccinated.

It alleges that commanders have called unvaccinated officers "unfit for duty" and told them that they would be denied promotions and special assignments based on their unvaccinated status.

First responders nationwide have been among the more vociferous opponents of mandatory vaccination, though they are often exposed to more risks of infection. Los Angeles firefighter John Knox, who leads a group called Firefighters for Freedom, claims that the vaccine mandate violated members’ constitutional rights.

A coalition of Oregon police officers and firefighters have sued Gov. Kate Brown over a COVID-19 vaccine mandate for state employees.

The plaintiffs - including the Oregon Fraternal Order of Police and the Kingsley Firefighters Association - argued in a lawsuit filed this September in a Jefferson County court that Brown’s executive order violates a number of laws and want it blocked ...

Compared to other types of workers’ compensation claims (i.e., medical-only, temporary disability, permanent disability), job-related deaths are relative rare in California. DWC reports that in AY 2019, there were 748 work- related death claims out of 687,912 work injury claims recorded by the WCIS, so death claims comprised 0.109% of all California claims (one out of every 917 claims) in the year prior to the pandemic.

However, the number of California workers’ compensation death claims more than doubled last year as the pandemic resulted in 866 COVID death claims, bringing the total number of job-related death claims for the year to 1,563, up from 748 in 2019 according to a new California Workers’ Compensation Institute (CWCI) analysis. The analysis also found that despite a sharp drop in work-related COVID cases from January through June of this year, an additional 166 COVID death claims were reported for the first half of 2021, for a total of 1,032 COVID death claims in the first 18 months of the pandemic.

CWCI’s review of California workers’ compensation COVID-19 death claim trends and characteristics uses data on COVID-19 and non-COVID-19 claims with January 1, 2020 through June 30, 2021 dates of injury that were reported to the state Division of Workers’ Compensation (DWC) as of July 26. The study encompassed all 148,222 COVID-19 claims for the 18-month study period (including the 1,032 COVID death claims) and 899 non-COVID death claims reported for the same period. Among the findings:

- - COVID surpassed transportation incidents as the leading cause of job-related deaths claimed in California, as the 1,032 COVID death claims reported for the first 18 months of the pandemic represented 53% of all death claims reported in the state for that period.
- - Since the pandemic began, death claims have been more than 6 times as prevalent among COVID claims than non-COVID claims. For the 18-month period ending in June there were 6.96 death claims per 1,000 COVID claims compared to 1.12 death claims per 1,000 non-COVID claims.
- - A quarter of all COVID claims have involved workers over age 50, but this age group accounted for 72% of the COVID death claims. In contrast, workers between the ages of 30 and 49 accounted for 48% of all COVID claims, but only 20% of the COVID death claims.
- - Females accounted for 26% of the COVID death claims, which is well below their 46% share of the state’s work force and their 48% share of all COVID claims, but well above their 15% share of non-COVID death claims, likely due to the high concentration of females in the health care sector, especially in jobs requiring direct patient contact, which were especially hard hit by the coronavirus last year.
- - The health care sector has suffered the heaviest toll during the pandemic, accounting for 30% of all COVID claims and 21% of COVID death claims over the 18-month study period. A closer look, however, reveals that after vaccines became widely available, the health care sector’s share fell from one out of three COVID claims last year to one out of five COVID claims from February through June of this year.
- - Public safety/government workers share of the COVID claims increased from 17% last year to 22% for the 5-month period that began in February, the same month that this sector overtook health care in terms of monthly COVID claim volume. Since February, retail and transportation workers’ share of the COVID claims are each up by 3 percentage points while manufacturing workers’ share is up by 2 percentage points.
- - Regional data show Los Angeles County accounted for 26% of the state’s jobs, 28% of all COVID claims, and 25% of non-COVID death claims during the study period, but 38% of the COVID death claims.

CWCI’s review of California workers’ compensation death claims has been released as a Spotlight Report ...

A former California Employment Development Department employee has agreed to plead guilty to a federal criminal charge for causing nearly 200 fraudulent COVID-related unemployment relief claims to be filed in other people’s names, resulting in more than $1.6 million in ill-gotten gains.

Gabriela Llerenas, a.k.a. "Maria G. Sandoval," 49, of Perris, signed a plea agreement in which she has agreed to plead guilty to a single-count information charging her with mail fraud.

Court records show that Llerenas previously worked at EDD as a disability insurance program representative. She resigned in March 2002 after admitting to fraudulently authorizing and paying disability benefits administered by EDD. She was sentenced to 37 months in federal prison in connection with that scheme.

The new scheme that Llerenas has admitted running took advantage of the expanded eligibility for unemployment insurance benefits made possible by the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed by Congress and signed into law in March 2020.

From April to October 2020, Llerenas filed and caused the filing with EDD that falsely asserted the named claimants were self-employed independent contractors - often identifying them as cake decorators or event attendants - who were negatively affected by the COVID-19 pandemic. Llerenas obtained some of the names, Social Security numbers and other identifying information she used to submit the fraudulent claims through her prior work as a tax preparer.

In her plea agreement, Llerenas also admitted to falsely stating on some of the applications that the claimants were residents of California entitled to unemployment insurance benefits administered by EDD when in fact they lived elsewhere. She also admitted that, on some applications, she inflated the amounts of income she reported for the claimant to maximize the benefit amount. She also admitted to sometimes filing a dozen or more fraudulent EDD claims in a day.

As a result of the fraudulent unemployment benefits applications that Llerenas filed and caused to be filed, EDD authorized Bank of America to mail debit cards in the names of the claimants to addresses she provided, including her residence, her husband’s business location, her mother’s apartment and the addresses of friends and other family members.

Llerenas admitted that she charged the named claimants a fee for filling the applications, which was often paid out of the fraudulently obtained benefits. In at least one case, she told the named claimant that she was still employed at EDD and could control the distribution of the unemployment insurance benefits, and then demanded an additional payment for "releasing" the benefits.

In total, 197 debit cards were fraudulently issued because of this scheme, resulting in losses to EDD and the United States Treasury that Llerenas has admitted were at least $1,633,487.

Llerenas is scheduled to make her initial appearance on September 22. The criminal offense to which Llerenas has agreed to plead guilty carries a statutory maximum sentence of 20 years in federal prison ...

Most businesses in California are Single Enterprises, which means that all the normal and usual operations for the business are assigned to a single classification.

However, some businesses have two or more operations that cannot be easily described by a single classification. For these employers, the Multiple Enterprises rule provides direction in determining whether one or more classifications can be assigned.

Effective September 1, 2021, the Multiple Enterprises rule was amended to clarify the rule and definitions applicable to operations that constitute Multiple Enterprises to promote consistent and accurate data reporting as well as to make the rule simpler and easier to administer.

Under the revised Multiple Enterprises rule, the key to determining whether operations can be separately classified is physical separation of the operations. If the distinct operations of the business are physically separated, each operation can be separately classified; if they are not physically separated, the operations must be assigned to the highest-rated classification applicable to any of these operations conducted in a common workspace.

Visit the Multiple Enterprises page on wcirb.com to view the full text of the new rule.

Watch WCIRB Classification Education and Development Director Brian Gray explain the Multiple Enterprises rule changes in this six-minute video ...

Sampson Parker worked as a bus driver for AC Transit in December 2016 when he injured his his left leg, left ankle, left foot, and right wrist.Following his injury, he underwent multiple surgeries.

The last surgery occurred on October 15, 2019, when he underwent the placement of a revision intramedullary tibial nail placed in a locking fashion along with an open reduction, internal fixation (ORIF) utilizing two plates and screws for fixation along with the implantation of bone morphogenic protein and that the surgery caused a shortening of his left lower leg.

On February 8, 2021, his primary treating physician, Scott Petersen, M.D., issued a report stating that he was maximally medically improved. Dr. Peterson’s physical examination revealed that his left leg was six centimeters shorter than the right. Dr. Petersen described the last surgical procedure as a "limb shortening surgery."

On May 18, 2021, the matter proceeded to trial on the issues of whether he qualified for the amputation exception to the 104 week cap on temporary total disability indemnity and if so, whether his entitlement to receive temporary disability indemnity would run continuously or whether it would stop after 104 weeks had been paid and resume on the date of the last surgery.

A Findings and Award issued concluding that the surgical removal of bone from Parker’s left lower extremity combined with a shortening of the limb constituted an amputation pursuant to Labor Code section 4565(c)(3)(C), and that he was entitled to receive temporary disability indemnity for the period beginning on December 17, 2018 and continuing through February 7, 2021.

Reconsideration of this finding was denied in the panel case of Parker v AC Transit (ADJ10741808).

The Labor Code provides that for an employee who suffers from the certain injuries or conditions (in this case an amputation), aggregate disability payments for a single injury occurring on or after April 19, 2004, causing temporary disability shall not extend for more than 240 compensable weeks within a period of five years from the date of the injury. Otherwise the limit is 104 weeks.

In Cruz v. Mercedes-Benz of San Francisco, (2007) 72 Cal. Comp. Cases 1281, 1283 (Appeals Board en banc), the Appeals Board defined "amputation" as "the severance or removal of a limb, part of a limb, or other body appendage."

It is undisputed that as a result of a "limb shortening surgery," Parker lost approximately two inches from his left lower extremity, a protruding external body part. The amputation exception does not require the severance of an entire body part ...

A new federal plan has been announced - that is aimed at lowering prescription drug prices - endorses giving the government sweeping power to directly negotiate the cost of medicines, calling it one of the key steps Congress could take to make drugs "more affordable and equitable" for all Americans.

The plan, which was developed by the Department of Health and Human Services and released on Thursday, mirrors a range of legislative options that both House and Senate lawmakers have floated in recent years.

Those include capping out-of-pocket costs in Medicare Part D, limiting how quickly pharmaceutical companies can hike prices on existing drugs and banning so-called pay-for-delay agreements aimed at blocking generic competition to brand-name drugs.

Under the HHS plan, the government would directly negotiate prices for drugs in Medicare parts B and D, with those prices also being available to private insurance plans and any employers who want to participate.

House Democrats passed a similar provision as part of a major drug pricing bill in 2019. But it never made it into law, and some in the party’s centrist wing have since vowed to oppose drug price negotiation.

The HHS plan also lays out a series of administration actions that the department could take to fulfill what it identified as three "guiding principles," making drugs more affordable, improving competition within the industry and encouraging innovation.

Those options included testing value-based payment models and boosting cost-sharing support to certain low-income Medicare beneficiaries. It also suggests that improved data collection from insurers and pharmacy benefit managers could give the government better insight into drug pricing, as well as rebates and out-of-pocket spending on prescription medications.

HHS developed the report in response to an executive order that President Joe Biden issued earlier this year aimed at improving competition across a range of industries, including the drug sector. Executive Order 14036, "Promoting Competition in the American Economy" identifies a lack of competition as a key driver for problems across economic sectors.

The report states that "Americans spend more than $1,500 per person on prescription drugs and pay prices that are far higher than any comparable nation. Prices for brand name drugs are rising faster than inflation." ...

Three former National Football League players have pleaded guilty for their roles in a nationwide scheme to defraud a health care benefit program for retired NFL players. A total of 15 defendants have pleaded guilty in connection with this scheme.

Clinton Portis, 40, of Fort Mill, South Carolina, and Tamarick Vanover, 47, of Tallahassee, Florida, pleaded guilty on Friday, Sept. 3. Robert McCune, 40, of Riverdale, Georgia, pleaded guilty on Aug. 24. The former players admitted to participating in a scheme to defraud the Gene Upshaw NFL Player Health Reimbursement Account Plan. The Plan was established pursuant to the NFL’s 2006 collective bargaining agreement and provided for tax-free reimbursement of out-of-pocket medical care expenses that were not covered by insurance, and that were incurred by former players, their spouses, and their dependents - up to a maximum of $350,000 per player.

According to court documents, Portis caused the submission of false and fraudulent claims to the Plan on his behalf over a two-month period, obtaining $99,264 in benefits for expensive medical equipment that was not actually provided. Vanover recruited three other former NFL players into the fraudulent scheme and assisted them in causing false and fraudulent claims to be submitted to the Plan, obtaining $159,510 for expensive medical equipment that was not actually provided. McCune orchestrated the nationwide fraud, which resulted in approximately $2.9 million in false and fraudulent claims being submitted to the Plan and the Plan paying out approximately $2.5 million on those claims between June 2017 and April 2018.

Portis and Vanover pleaded guilty two days after a trial against them resulted in a hung jury and a mistrial on certain counts against Vanover. McCune, the third defendant in that trial, pleaded guilty to all charges against him on the second day of trial. A retrial on the charges against Portis and Vanover had been scheduled.

Portis and Vanover were originally indicted, along with McCune and seven other defendants, in the Eastern District of Kentucky in December 2019 for their roles in the fraud. Since the initial charges were announced, five additional retired NFL players were charged in the scheme. All 12 of the other defendants charged have pleaded guilty to conspiracy to commit health care fraud: Joseph Horn, Correll Buckhalter, Carlos Rogers, James Butler, Etric Pruitt, Ceandris Brown, John Eubanks, Antwan Odom, Darrell Reid, Anthony Montgomery, Fredrick Bennett, and Donald "Reche" Caldwell, who passed away in June 2020.

Portis and Vanover pleaded guilty to conspiracy to commit health care fraud and agreed to pay full restitution to the Plan. Portis is scheduled to be sentenced on Jan. 6, 2022, and Vanover is scheduled to be sentenced on Jan. 22, 2022. They each face a maximum penalty of 10 years in prison.

McCune pleaded guilty to conspiracy to commit wire fraud and health care fraud, 13 counts of health care fraud, 11 counts of wire fraud, and three counts of aggravated identity theft. McCune is scheduled to be sentenced on Nov. 19. He faces a maximum penalty of 20 years in prison for conspiracy to commit wire fraud and health care fraud, 10 years for each count of health care fraud, 20 years for each count of wire fraud, and two years for each count of aggravated identity theft.

A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

This case was investigated by the FBI and included efforts by various FBI Field Offices and Resident Agencies, including Los Angeles, San Diego, Sacramento, and Newport Beach, California ...

WHO officials said on Tuesday that Covid-19 is likely "here to stay with us" as the virus continues to mutate in unvaccinated countries across the world and previous hopes of eradicating it diminish.

According to the report by CNBC,"I think this virus is here to stay with us and it will evolve like influenza pandemic viruses, it will evolve to become one of the other viruses that affects us," Dr. Mike Ryan, executive director of the World Health Organization’s Health Emergencies Program, said at a press briefing in Geneva Switzerland.

Officials at the global health agency have previously said vaccines do not guarantee the world would eradicate Covid-19 like it has other viruses. Several leading health experts, including White House chief medical advisor Dr. Anthony Fauci and Stephane Bancel, CEO of Covid vaccine maker Moderna, have warned that the world will have to live with Covid forever, much like influenza.

"People have said we’re going to eliminate or eradicate the virus," Ryan said. "No we’re not, very, very unlikely."

If the world had taken early steps to stop the spread of the virus, the situation today could have been very different, WHO officials said.

"We had a chance in the beginning of this pandemic," Maria Van Kerkhove, the WHO’s technical lead on Covid-19, said Tuesday. "This pandemic did not need to be this bad."

In January, Nature asked more than 100 immunologists, infectious-disease researchers and virologists working on the coronavirus whether it could be eradicated. Almost 90% of respondents think that the coronavirus will become endemic - meaning that it will continue to circulate in pockets of the global population for years to come.

"Eradicating this virus right now from the world is a lot like trying to plan the construction of a stepping-stone pathway to the Moon. It’s unrealistic," says Michael Osterholm, an epidemiologist at the University of Minnesota in Minneapolis.

But failure to eradicate the virus does not mean that death, illness or social isolation will continue on the scales seen so far. The future will depend heavily on the type of immunity people acquire through infection or vaccination and how the virus evolves.

Influenza and the four human coronaviruses that cause common colds are also endemic: but a combination of annual vaccines and acquired immunity means that societies tolerate the seasonal deaths and illnesses they bring without requiring lockdowns, masks and social distancing ...

San Diego area pain clinic doctor Brenton Wynn, M.D., has paid $200,000 to resolve allegations that he illegally prescribed opioids and other dangerous drugs to his patients. Wynn has an office at 502 Euclid Ave., Suite 200, in National City. He was a graduate of Howard University College of Medicine in 1998.

The Controlled Substances Act provides that doctors may write prescriptions for opioids only for a legitimate medical purpose while acting in the usual course of their professional practice. The United States alleged that Dr. Wynn wrote opioid prescriptions to patients without a legitimate medical purpose and/or outside the usual course of his professional practice for more than five years. Dr. Wynn wrote prescriptions for fentanyl, oxycodone, hydromorphone, methadone, oxymorphone, and morphine.

The United States further alleged that Dr. Wynn prescribed at the same time a dangerous combination of opioids and benzodiazepines such as Xanax and Valium. Of even more concern, Dr. Wynn allegedly prescribed to some patients a combination of at least one opioid, one benzodiazepine and one muscle relaxant such as Soma. Drug abusers colloquially refer to the opioid, benzodiazepine, and muscle relaxant combination as the "Trinity" or "Holy Trinity" because of its rapid euphoric effects. These drug combinations are known to significantly increase the risk of addiction, abuse, and overdose.

Based on its investigation, the United States alleged that Dr. Wynn prescribed large quantities of opioids to his patients that reached high daily MME levels, often even exceeding 120 MME. The United States further alleged that Dr. Wynn sometimes continued to prescribe dangerous opioids even when his patients’ urine drug test results showed that they were not taking the drugs Dr. Wynn prescribed.

The DEA has a pending administrative action against Dr. Wynn (Docket No. 20-10) to revoke his ability to prescribe opioids and other controlled substances.

"While the vast amount of medical professionals prescribe opioids legitimately and are meeting their patients’ standard of care, DEA will vigorously pursue information from the public about the doctors who are not," said DEA Special Agent in Charge John W. Callery. "DEA will always protect the public from doctors who put their patients in harm’s way."

Assistant U.S. Attorney Dylan M. Aste of the U.S. Attorney’s Office for the Southern District of California handled this matter along with DEA investigators ...

The Mu coronavirus variant has been recorded in 49 US states, with Florida and California reporting the highest numbers of Mu infections. California has recorded 384 Mu variant cases, with 167 cases contained in Los Angeles County area. Until recently, Alaska had the highest number of Mu cases, with 146 people testing positive for the variant. With its relatively small population, of 730,000 people, Mu made up four per cent of the state’s sample size.

Nebraska is the only state in the United States to have not detected a case of the Mu variant of COVID-19, which may render vaccines less effective.

Since being first identified in Colombia in January, the Mu variant has spread to 41 countries, including the United States. Mu is not an "immediate threat", said Dr Anthony Fauci, in a news conference. But scientists will be "keeping a very close eye on it".

"This variant has a constellation of mutations that suggests that it would evade certain antibodies, not only monoclonal antibodies, but vaccine- and convalescent serum-induced antibodies," he said.

At least one case of the Mu variant has been detected in the District of Columbia and every state in the U.S. aside from Nebraska, according to Outbreak.info, a website that provides open source data on COVID-19 variants.

LA County Public Health issued a statement explaining more work is needed to tell what we are dealing with: "More studies are needed to determine whether Mu variant is more contagious, more deadly or more resistant to vaccine and treatments than other Covid-19 strains," it said.

Maine, Connecticut and Florida round out the list of states with the highest prevalence of Mu cases. Florida's had the second-highest number of samples, at 384 of the 60,475 samples that were sequenced being of the Mu variant.

The World Health Organization labeled Mu a variant of interest on August 30 because its characteristics could make it more transmissible or resistant to vaccines. However, the Centers for Disease Control and Prevention (CDC) has yet to make the same classification ...