Two Minnesota workers' compensation cases have been elevated to the Supreme Court of the United States, that may determine the outcome of controversy over conflicting state and federal law on the use of medical cannabis in workers' compensation claims. The Minnesota Supreme Court ruled late last year that both workers comp claims were invalid because of marijuana’s Schedule I status under the federal Controlled Substances Act. In the first case, Susan Musta filed a petition with the U.S. Supreme Court in November after her state’s highest court determined that the CSA did, indeed, mean her employer did not need to provide reimbursement for medical cannabis after she was injured at her place of work, a dental center. Her case before SCOTUS is Susan K. Musta, Petitioner v.Mendota Heights Dental Center, et al. (No. 21-676). And the Minnesota Supreme Court made the same judgment in another case where Daniel Bierbach was injured at his job working for an all-terrain vehicle company and sought compensation for medical marijuana. His case is Daniel Bierbach, Petitioner v. Digger's Polaris, et al. (No. 21-998). The issue presented in both cases is whether the Controlled Substances Act preempts an order under a state workers’ compensation law requiring an employer to reimburse an injured employee for the cost of medical marijuana used to treat a work-related injury. Filings in both cases were distributed on February 2 for a Supreme Court conference that was scheduled on February 18. The justices are now seeking input on the issue from the Biden administration, as the February 22, 2022 entry on the both dockets reads "The Solicitor General is invited to file a brief in this case expressing the views of the United States." Congress recently has prohibited the U. S. Department of Justice from impeding state medical marijuana programs. Specifically, in appropriations bills since 2014, Congress consistently has barred DOJ from expending funds to "prevent" States "from implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana." E.g., Consolidated Appropriations Ac t, 2021, Pub. L. No. 116- 260, § 531, 134 Stat. 1182, 1282-83 (2020) (App. 109a). Minnesota authorized the use of marijuana for medical purposes in 2014 with the Medical Cannabis Therapeutic Research Act. Under the Cannabis Act, the Minnesota Department of Health administers a program that permits certain registered patients to possess marijuana for medical purposes. The Minnesota Supreme Court reasoned in both cases that the CSA preempted an order obligating an employer to reimburse an employee for the cost of medical cannabis because compliance with that order would expose the employer to criminal liability under federal law for aiding and abetting unlawful possession of cannabis. State supreme courts are divided on whether the CSA preempts an order under a state workers’ compensation law requiring an employer to reimburse an injured employee for the cost of medical marijuana used to treat a work-related injury. The supreme courts of Maine and Minnesota have held that the CSA preempts an order under their States’ workers’ compensation laws requiring reimbursement for medical marijuana. See Bourgoin v. Twin Rivers Paper Co. , 187 A.3d 10, 12 (Me. 2018); and Musta v. Mendota Heights Dental Ctr. , 965 N.W.2d 312, 327 (Minn. 2021); and Bierbach v. Digger’s Polaris, 965 N.W.2d 281, 282 (Minn. 2021) But the supreme courts of New Hampshire and New Jersey have reached the opposite conclusion with respect to their States’ medical marijuana laws. See Appeal of Panaggio, 260 A.3d 825, 835, 837 (N.H. 2021); and Hager v. M&K Constr., 247 A.3d 864, 887, 889 (N.J. 2021). These decisions manifest a mature split of authority that typically warrants review by the U.S. Supreme Court. U.S. Supreme Court Justice Clarence Thomas recently took issue with the government’s inconsistent stance on cannabis. In a statement issued in June, after the court declined to take up a tax case centered on cannabis, Thomas criticized the government’s approach as "contradictory" and "unstable.". "Once comprehensive, the Federal Government’s current approach is a half-in, half-out regime that simultaneously tolerates and forbids local use of marijuana," he wrote ...

Daryol Richmond, 31, a Kern Valley State Prison inmate pleaded guilty to conspiracy and aggravated identity theft charges for his role in a $25 million unemployment insurance fraud scheme during the COVID-19 pandemic, According to the plea agreement, Richmond obtained the personal identifying information for other individuals, including inmates and non-inmates, without their authorization. He then provided this information to his co-conspirators inside and outside of prison through emails and jail calls. The co-conspirators then filed applications for unemployment insurance with the California Employment Development Department (EDD) that falsely stated that the inmates, minor children, and others previously worked as clothing merchants, handymen, and other jobs, and recently became unemployed because of the COVID-19 pandemic. In the plea agreement, Richmond acknowledged that he was responsible for $1.4 million worth of the fraudulent claims. Richmond is scheduled to be sentenced by U.S. District Judge Dale A. Drozd on Sept. 19, 2022. He faces up to 20 years in prison and a $250,000 fine for the conspiracy charge. He also faces a mandatory, additional two years in prison for the aggravated identity theft charge. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account several variables. Charges are pending against the other defendants in this case: Telvin Breaux, 29, an inmate at the California Correctional Institution in Tehachapi; Holly White, 30, of Los Angeles; Cecelia Allen, 33, of Downey; Fantasia Brown, 33, of Los Angeles; Tonisha Brown, 28, of Los Angeles; Fantesia Davis, 32, of Victorville; and Shanice White, 28, of Hawthorne. This case is the product of an investigation by the Federal Bureau of Investigation, California Department of Corrections and Rehabilitation, EDD, and Department of Labor Office of Inspector General. Assistant U.S. Attorney Joseph Barton is prosecuting the case ...

Delivery of healthcare services is a critical factor in the administration of workers' compensation claims. However, a recent poll shows that there might be trouble ahead, and staffing challenges to deliver quality care. New USA Today-Ipsos research finds that workers in the American healthcare sector are resilient in the face of two years of the pandemic. However, this survey also finds numerous warning signs of the ongoing strain these workers are experiencing, with half reporting they are burned out and almost a quarter thinking about leaving the field in the near future. Additionally, optimism among these workers has declined relative to Spring 2021 - as the vaccine was rolling out - as people in the healthcare field widely disapprove of how the rest of the country has handled the pandemic. The large majority of healthcare workers report being satisfied with their jobs, only slightly down from findings in a Spring 2021 KFF/WP poll. - - Four in five (80%) of healthcare workers report being somewhat or very satisfied with their current job, down slightly from the 89% saying the same in a Spring 2021 Kaiser Family Foundation/Washington Post poll. - - Three quarters (73%) agree with the statement "I love working in healthcare". - - A majority report feeling "hopeful" (59%), "motivated" (59%), or "optimistic" (56%) about going to work. However, the number saying hopeful (to 59% from 76%) or optimistic (to 56% from 67%) is down compared to last year. However, there are warning signs about the resiliency of workers in the healthcare sector after two years of the pandemic. - - About half (52%) report feeling "burned out", on par with the 2021 numbers (55%). - - Over a third (39%) report agreeing with the statement "the American healthcare system is on the verge of collapse". - - A third either disagree (16%) or don’t know how they feel (18%) regarding if they could pick a career over again, "I would still decide to go into health care". - - A quarter of healthcare workers (23%) say they are likely to leave the field in the near future. These are some of the findings of an Ipsos poll conducted between February 9-16, 2022 based on a nationally representative probability sample of 1,170 healthcare workers ages 18 or older. And the American Nurses Association reports that by 2022, there will be far more registered nurse jobs available than any other profession, at more than 100,000 per year. With more than 500,000 seasoned RNs anticipated to retire by 2022, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs for expansion and replacement of retirees, and to avoid a nursing shortage ...

One of the nation’s largest unions has taken aim at America’s largest hospital operator, HCA Healthcare, for practices that "maximize profits at the expense of patient care, working conditions, and responsible corporate behavior" including "apparent Medicare fraud," the union says. The basis for that last, most explosive claim: HCA’s unusually high emergency room admission rates. According to the story in Fortune, the allegations, leveled in a 45-page investigative report published last week by Service Employees International Union (SEIU), are based on the organization’s analysis of Medicare data and lawsuits filed by whistleblowers and health professionals against HCA. That analysis found the company has had an average emergency department admission rate that exceeded the national average by more than 5% between 2014 and 2019 (the most recent data available). In some states, including Texas and California, HCA’s average ER admission rate is 10% higher than the state average. Inpatient admissions receive higher Medicare reimbursement rates, and so the pattern raises concerns, says SEIU, that those higher admission volumes are driven by "corporate efforts to boost their profits" and "without respect to medical need." In a statement to Fortune, HCA rejected SEIU’s conclusions. SEIU’s accusations come at a time when American households continue to struggle with the world’s highest medical costs - with bills for unexpected hospital stays among the biggest pain points - and when unnecessary hospitalizations present a particular health danger. They also echo past allegations of wrongdoing by hospitals. Similar trends were observed at for-profit hospital operators Community Health Systems (CHS) and Health Management Associates (HMA) before drawing scrutiny and government investigations during the past decade. A 2012 investigation by 60 Minutes revealed that HMA (since acquired by CHS) gave its physicians admission targets to hit, for example. Both companies settled false claims charges with the government over those allegations of improper Medicare billing; neither company admitted wrongdoing. (HCA also has a history of settlements with the Department of Justice over alleged fraud.) While a 5%-higher-than-average admission rate may seem trivial, SEIU contends it enabled HCA to bring in "over $1 billion in excess Medicare payments" in five years. Given HCA’s presence in 20 states, and the consistency of the trend - state by state, the SEIU found HCA’s average admission rate exceeded the state average in all but one - the report’s authors argue the patterns can’t be coincidental ...

The Guardian reports that a sheriff's department in southern California is encouraging law enforcement officers who oppose vaccine mandates to "take back [their] freedom" and apply for jobs with the department. The Kern county sheriff’s office released a video last week inviting applications from deputies within Los Angeles county, where officials passed an order that could lead to the termination of thousands of county workers who haven’t received the Covid-19 vaccine or provided a religious or medical exemption. "Drive north, we have a place for you - Kern county is a community that backs the blue," the minute-long ad says as country singer George Strait sings The Weight of the Badge, a song paying tribute to police. Covid-19 vaccination rates inside the LA sheriff’s department have lagged far below that of the public with just 54% of workers fully vaccinated, despite a vaccination mandate for county employees. Last week the county board of supervisors moved to shift vaccine mandate enforcement power away from LA county Sheriff Alex Villanueva. Villanueva, who has criticized mask orders and said he will not fire workers who refuse the vaccine, said such an act could lead to more than 4,000 unvaccinated deputies losing their jobs. The sheriff’s office in Kern county, a deeply conservative expanse located immediately to the north of Los Angeles, responded with its video the next day. "So take back your freedom, and APPLY today to work at the Kern county sheriff’s office. You deserve a job that welcomes you and your values, with open arms." The battle over vaccine mandates for law enforcement in southern California highlights the divide over Covid health rules across the state. Vaccination rates continue to lag in more rural and conservative regions of California, where 70% of all residents are vaccinated. Kern county doesn’t require vaccinations for its workers. Its sheriff, Donny Youngblood, said in a press conference on Friday that he doesn’t know how many of his department’s deputies are vaccinated. Just 52% of Kern county residents are vaccinated, compared to 70% of LA county residents, according to the New York Times. "There’s a substantial number of deputies that already work here that aren’t vaccinated," he said. "I have no idea [how many] and don’t care," Youngblood said at the press conference. Though vaccination rates among law enforcement across the state have trailed behind the statewide rate, Youngblood said Kern county specifically wanted to target LA deputies. "The reason we reached out specifically to LA is there will be 4,000 deputy sheriffs if this were to happen that have real families have real children have real bills that could be unemployed because they refuse to take the vaccination." As Los Angeles County residents face rising crime and rising numbers of homelessness, Sheriff Alex Villanueva is speaking out against what he describes as a political push fueled by police activists to lay off 4,000 department employees of the sheriff who have not been vaccinated against the coronavirus. "This is nothing but a power grab by the board. And it’s shameful, and it’s going to harm public safety," ...

The Workers’ Compensation Insurance Rating Bureau of California, in collaboration with a number of other workers’ compensation rating bureaus, has released the COVID-19’s Impact on Workers' Compensation report. This benchmarking analysis included representation from the following WC bureaus: California, Delaware, Indiana, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Wisconsin and the National Council on Compensation Insurance (NCCI). This multi-bureau collaboration allowed for the creation of a COVID-19 claims database, which enabled the development of a more comprehensive view of COVID-19 claim characteristics and trends. Key findings in the report include: - - In California, COVID-19 claims represent 9 percent of total claim counts and 6 percent of total incurred losses. - - Indemnity-only claims emerged as a significant share of reported COVID-19 claims. - - In aggregate, COVID-19 claims that remained open have relatively higher case reserves due to the uncertainty of COVID-19 infections, later than average accident dates and the timing of the various waves of the pandemic. - - COVID-19 indemnity claims closed more quickly than non-COVID-19 indemnity claims, partly driven by the large share of indemnity-only claims. - - Despite the higher closure rate, the ratio of paid to paid plus case (incurred) severities on COVID-19 claims is lower when compared with that for non-COVID-19 claims. And a new COVID workers' compensation claim study has just been published in the February issue of the Journal of Occupational and Environmental Medicine. The objective of the study was to examine the attributes associated with long duration COVID-19 workers’ compensation claims. To meet this objective, a study was conducted on 13,153 COVID-19 WC claims accepted by a workers’ compensation insurance carrier between Jan 1, 2020 and November 30, 2021. The authors summarized their findings as follows: 1) Ninety five percent of accepted WC claims were closed within the study period; 2) Five percent of claims had 30-days or longer of lost time accounting for 65% of total paid WC costs; 3) Medical costs increased 8-fold once paid days lost crossed the threshold of 60 -days or greater; 4) Age was the strongest risk factor associated with increased WC costs and prolonged impairment. The authors concluded by saying "Age at the time of infection was the major factor associated with prolonged impairment and high costs of COVID-19 related WC claims." ...

Hogan Lovellls published a synopsis of federal enforcement activity that lead to their conclusion that "the implementation of electronic health records (EHR) and rapid expansion of telemedicine has caught the attention of the Department of Justice (DOJ) and the qui tam relators’ bar, prompting rigorous enforcement actions and increasing False Claims Act (FCA) cases." DOJ has traditionally been wary of telemedicine. Even before the COVID-19 pandemic and the accompanying rapid expansion of telehealth, enforcement in the telemedicine industry was on the rise. In 2019, DOJ pursued enforcement actions in the telehealth space that involved claims for durable medical equipment (DME) and for compound medicines. Through "Operation Brace Yourself," DOJ targeted an alleged fraud and kickback scheme through which DME companies paid illegal kickbacks and bribes to medical professionals working for fraudulent telemedicine companies. In exchange, the medical professionals referred Medicare beneficiaries to the conspiring DME companies for back, shoulder, wrist, and knee braces that were medically unnecessary. The DOJ investigation resulted in enforcement actions against 24 defendants associated with five telemedicine companies, as well as the owners of dozens of durable medical equipment companies and three licensed medical professionals. According to DOJ, the fraud schemes involved more than $1.2 billion in loss. Traditionally, Medicare’s coverage of telemedicine has been extremely limited. As a result of the pandemic, telehealth service providers were granted broad flexibility to provide telemedicine services and this flexibility remains today. The easing of restrictions stemming from the COVID-19 pandemic has prompted a dramatic increase in the use of telehealth. It seems unlikely that the federal government will reinstate pre-pandemic restrictions on telehealth services given the increased popularity and reliance on telehealth services. Indeed, Congress has introduced several bipartisan bills to address post-pandemic telehealth services, signaling that utilization of telehealth services will likely remain prevalent. In October of 2020, DOJ announced a telehealth enforcement action for a fraudulent DME billings scheme dubbed "Operation Rubber Stamp." The scheme involved allegedly paying medical professionals to order DME, genetic and other diagnostic testing, and pain medications without sufficient patient diagnostic interaction, resulting in $1.5 billion in fraudulent billings to government health care insurance programs. False Claims Act (FCA) violations have been alleged and resolved in an ongoing investigation dubbed Operation "Happy Clickers," which involves allegations that physicians "approved orders for medically unnecessary braces and cancer genetic testing despite many red flags that these items and services were illegitimate." In recent years, DOJ has pursued several FCA cases related to Electronic Health Records (EHR) that have led to large settlements and highlight various FCA risks. For example, in 2020, Practice Fusion Inc, a health information technology developer, paid $145 million to resolve criminal and civil investigations relating to its EHR software, including a $118.6 million FCA settlement. The resolution addressed allegations that Practice Fusion "extracted unlawful kickbacks from pharmaceutical companies in exchange for implementing clinical decision support (CDS) alerts in its EHR software designed to increase prescriptions for their drug products." FCA and other fraud investigations relating to telehealth fraud and EHR are expected to continue. Brian M. Boynton, Acting Assistant Attorney General for the Civil Division at the Department of Justice, recently stated that he expects "a continued focus on telehealth schemes, particularly given the expansion of telehealth during the pandemic." He also identified fraud relating to EHR as another area that is likely to be a focal point of future enforcement efforts. The Department of Health and Human Services Office of Inspector General (OIG) has also made clear that it is "conducting significant oversight work assessing telehealth services during the public health emergency." Telemedicine and EHR technologies have rapidly changed patient care, introducing opportunities for potential fraud and abuse and exposing gaps in oversight. Claims administrators should expect increased fraudulent activities in these areas going forward and take steps to minimize their risk ...

Lyft drivers filed a a class action lawsuit in 2020, seeking an emergency ruling that requires the company to reclassify its drivers from "independent contractor" to "employee" status. They are represented by a lawyer who has been filing similar suits against Lyft and other "gig economy" companies for years. In the trial court, a motion to compel arbitration, the court stated in ruling on a motion to compel arbitration "While the status of Lyft drivers was previously uncertain, it is now clear that drivers for companies like Lyft must be classified as employees." ... "What makes this an emergency, in their view, is that if Lyft is finally forced to reclassify its drivers, those drivers will potentially qualify for sick pay under California law." And in ruling on the "emergency" the court stated "even if drivers were reclassified, the amount of sick pay involved would be small" and that "the plaintiffs insist that if they don’t get their zero to three days of paid sick leave immediately, they are willing to put their passengers at risk. One of the plaintiffs, for example, insists that (unless he is reclassified) he will continue to give rides even if he develops coronavirus symptoms and would expose his passengers to the disease." The Court obviously did not take this risk seriously. Thus the court moved on stating "In short, there are no heroes in the story of this case. But there are several complicated legal questions, to which this ruling now turns. The first question is whether the plaintiffs’ individual claims must be compelled to arbitration. " And the court concluded that issue by ruling "Lyft’s motion to compel arbitration is granted as to the plaintiffs’ claims for individualized relief." The Lyft drivers appealed the Order to the 9th Circuit Court of Appeals. At issue in this appeal is whether Lyft drivers are engaged in interstate commerce and therefore exempt from the Federal Arbitration Act ("FAA"). The Court of Appeals ruled that the drivers were properly ordered to arbitration in the unpublished case of Rogers v Lyft (Feb, 2022) No. 20-15689 D.C. No. 3:20-cv-01938-VC. At issue in this appeal is whether Lyft drivers are engaged in interstate commerce and therefore exempt from the Federal Arbitration Act ("FAA"). Section1 of the FAA exempts from the Act’s coverage all ‘contracts of employment of seamen, railroad employees, or any other class of workers engaged in foreign or interstate commerce. The 9th Circuit recently decided this question in Capriole v. Uber Techs., Inc., 7 F.4th 854 (9th Cir. 2021), holding that rideshare drivers "do not fall within the ‘interstate commerce’ exemption from the FAA." Id. at 861. In Capriole, the 9th Circuit concluded that Uber drivers, as a nationwide "class of workers," are not "engaged in foreign or interstate commerce" and are therefore not exempt from arbitration under the FAA. It based much of the reasoning on United States v. Yellow Cab Co., 332 U.S. 218, 228-29, (1947), an antitrust case in which the Supreme Court held that the transportation of interstate rail passengers and their luggage between rail stations in Chicago to facilitate their travel is part of "the stream of interstate commerce." "Because Capriole controls the outcome in this case, we affirm the judgment of this district court." ...

Two California Democratic lawmakers took separate aim Tuesday at pandemic disinformation they argue receives a broad audience and misplaced credibility through social media platforms - rejecting concerns that their legislation might carry free speech or business privacy considerations. Assemblyman Evan Low said his bill would label doctors’ promoting of misinformation or disinformation about COVID-19 to the public as unprofessional conduct that could draw disciplinary action from the California Medical Board. Disinformation is generally considered to be intentional or deliberate falsehoods, while misinformation can be inadvertent. The California Medical Association hasn’t taken a position on Low’s bill. But the association’s president, Dr. Robert E. Wailes, said in a statement that misinformation has prolonged the pandemic, "making the work of our frontline health care workers more difficult and dangerous while harming community health." The legislation differs from efforts in some other states like Florida and Tennessee, where Republican lawmakers have resisted doctor discipline proposals. Tennessee’s Board of Medical Examiners unanimously adopted in September a statement that said doctors spreading Covid misinformation - such as suggesting that vaccines contain microchips - could jeopardize their license to practice. But before any physicians could be reprimanded for spreading falsehoods about covid-19 vaccines or treatments, Republican lawmakers threatened to disband the medical board. The growing tension in Tennessee between conservative lawmakers and the state’s medical board may be the most prominent example in the country. But the Federation of State Medical Boards, which created language adopted by at least 15 state boards, is tracking legislation introduced by Republicans in at least 14 states that would restrict a medical board’s authority to discipline doctors for their advice on Covid. In Florida, a Republican-sponsored bill making its way through the state legislature proposes to ban medical boards from revoking or threatening to revoke doctors’ licenses for what they say unless "direct physical harm" of a patient occurred. If the publicized complaint can’t be proved, the board could owe a doctor up to $1.5 million in damages. Some medical boards have opted against taking a public stand against misinformation. The Alabama Board of Medical Examiners discussed signing on to the federation’s statement, according to the minutes from an October meeting. But after debating the potential legal ramifications in a private executive session, the board opted not to act. A few physician groups are resisting attempts to root out misinformation, including the Association of American Physicians and Surgeons, known for its stands against government regulation. And Sen. Richard Pan’s proposal, which still is being finalized, would require online platforms like Facebook to publicly disclose how their algorithms work and how they promote user content, including which data sets are used and how they rank the prominence of user posts. The platforms would also be required to confidentially share more detailed information with researchers, with the goal of creating more responsible algorithms. Congress is considering a Platform Transparency and Accountability Act with a similar goal at the federal level, Pan said, but he wants California to take the lead ...

For some counties and cities that share a public health agency with other local governments, differences over mask mandates, business restrictions, and other covid preventive measures have strained those partnerships. At least two have been pushed past the breaking point. California Healthline reports that a small city in Southern California and a county in Colorado are splitting from their longtime public health agencies to set up their own local departments. Both West Covina, California and Douglas County Colorado, plan to contract some of their health services to private entities. The West Covina City Council has voted to terminate its relationship with the Los Angeles County Department of Public Health over disagreements about covid shutdowns. West Covina officials have criticized the county health department’s covid restrictions as a one-size-fits-all approach that may work for the second-largest city in the U.S., but not their suburb of about 109,500 people. West Covina plans to join Long Beach, Pasadena, and Berkeley as one of a small number of California cities with its own health agency. A date for the separation has not been set. West Covina plans to contract some services to a private consultant, Transtech Engineers, that works mainly on city engineering projects and federal contracts, according to its website. West Covina Councilman Tony Wu and area family physician Dr. Basil Vassantachart are leading efforts to form the city’s own department. They hope L.A. County’s oversight of about 10 million people - "bigger than some states," as Vassantachart noted - can be broken up into regional departments. Amitabh Chandra, who directs health policy research at the Harvard Kennedy School of Government, said the private sector won’t necessarily have better answers to a public health problem. "It might be the case that they’re good at delivering on some parts of what needs to be done, but other parts still have to be done in-house," Chandra said. Jeffrey Levi, a professor of health policy and management at the George Washington University, suggests there are too many local health departments in the U.S. and there should be more regionalization, rather than splitting into smaller departments. "It’s very hard to effectively spend money and build the foundational capabilities that are associated with a meaningful public health department,” Levi said. “Doing this just because of anger at something like a mask ordinance is really unfortunate." "L.A. County Public Health Department is one of the most sophisticated, and one of the most robust health departments in the country," Levi said. "You are losing access to just a wide, wide range of both expertise and services that will never be replicable at the local level. Never." In Douglas County, Colorado many residents had opposed mask mandate guidance from the Tri-County Health Department, a partnership among Adams, Arapahoe, and Douglas counties. Tri-County issued a mask order for the counties’ school districts in September 2021 and, within days, conservative Douglas County announced its commissioners had voted unanimously to form its own health department. Douglas County, which in 1966 joined what was then called the Tri-County District Health Department, is phasing out of the partnership, with plans to exit entirely by the end of this year. It has already taken over many of its own covid relief efforts from Tri-County. It is contracting things like covid case investigation, contact tracing, and isolation and quarantine guidance to a private consultant, Jogan Health Solutions, founded in early 2021. The contract is reportedly worth $1.5 million. The most recent major private-sector takeover of public health was a flop. A private nonprofit, the Institute for Population Health, took over Detroit’s public health functions in 2012 as the city was approaching bankruptcy. The experiment failed, leaving a private entity unable to properly oversee public funding and public health concerns placed on the back burner amid the city’s economic woes. Residents also didn’t have a say in where the money went, and the staff on the city’s side was stripped down and couldn’t properly monitor the nonprofit’s use of the funds. By 2015, most services transferred back to the city as Detroit emerged from bankruptcy in 2014 ...

As the world gets closer to the eventual end of the virus pandemic, more than ever, white-collar workers worldwide are working remotely, and last year most said they want to keep that arrangement with employers. Just 3% of white collar workers wanted to return to the office five days a week, according to a poll by Accenture Research last year. But this year, the love affair with hybrid work may be fading. A full 86% of employees wanted to work from home at least two days a week, the report said after surveying nearly 10,000 people around the world last year, across areas including finance, technology and energy. All age groups felt the same way, they added. Workers reported a preference for commuting into cities on Tuesdays, Wednesdays and Thursdays, raising the prospect of empty offices for the rest of the week. Many banks geared up for flexible working after two years of COVID lockdowns, with the likes of Citigroup Inc., HSBC Holdings Plc and NatWest Group Plc allowing hybrid working for many staff. Some fintech companies like Revolut Ltd. and Eigen Technologies Ltd. are even allowing staff to work entirely remotely. NatWest expects around 87% of its 60,000 staff to split work between home and the office in the longer term. For now about 10,000 of its staff, including traders and employees in branches and data centers, still work entirely in the office, Sam Bowerman, one of the bank’s human resources directors, said in an interview earlier this month. "We’re keen to avoid mandating X number of days per week. It’s customer led," Bowerman said. "So far we’ve seen no detriment to productivity and the flexibility has produced a lot of goodwill." In theory, hybrid offers the best deal for both employer and employee. It combines pre-Covid-19 patterns of office-based working with remote days, in a working schedule that would allow both in-person collaboration and team building, as well as greater flexibility and the opportunity for focused work at home. But in reviewing the phenomena, the BBC claims in a story reported in January, that emerging data is beginning to back up anecdotal evidence: many workers report, that hybrid work is emotionally draining. In a recent global study by Seattle based employee engagement platform Tinypulse, more than 80% of people leaders reported that such a set-up was exhausting for employees. Workers, too, reported hybrid was more emotionally taxing than fully remote arrangements - and, even full-time office-based work. "There was a feeling that hybrid would be the best of both worlds," says Elora Voyles, an industrial organizational psychologist and people scientist at Tinypulse, based in California. "For bosses, it means they retain a sense of control and that they can see their workers in person. For employees, it offers more flexibility than full-time in the office and means they can work safely during the pandemic." However, as the novelty of hybrid working has faded, so too has workers’ enthusiasm. "We found that people were less positive about hybrid through 2021 as the year went on," explains Voyles. Optimism among workers soon gave way to fatigue. In Tinypulse’s survey of 100 global workers, 72% reported exhaustion from working hybrid - nearly double the figures for fully remote employees and also greater than those based fully in the office. Voyles says the small sample size reflects a wider trend; she believes it’s the disruption to employees’ daily routines - and the staccato nature of hybrid - that workers find so tiring. Physically carrying work back-and-forth between home and the office may also come with a psychological impact for some. A recent study found 20% of UK workers reported difficulties switching off from work and feeling ‘always on’; struggling to adapt to hybrid, and the permeable boundaries between home and work, was cited as a major factor ...

Carmen Hall Soruco, 70, and her husband Antonio Soruco, 75, both of Novato, were sentenced last week after pleading guilty to workers’ compensation fraud charges. Carmen Hall Soruco was sentenced on multiple felony counts to two years of probation with full search and seizure, 120 days in jail, and ordered to pay over $925,000 in restitution to State Compensation Insurance Fund and Employment Development Department. Antonio Soruco was sentenced to one year of probation with full search and seizure, 120 days in jail, and was also ordered to pay over $925,000 in restitution to SCIF and EDD after pleading guilty to multiple misdemeanor charges. The Department of Insurance began an investigation into Soruco Structures, a general contractor company, after a worker filed a Workers’ Compensation claim alleging to be injured on a job site while working. The business had not reported employees or payroll on their Workers’ Compensation policy until the claim was filed. Although Soruco Structures was licensed as a sole proprietorship under Carmen Hall Soruco, Antonio Soruco, Hall’s husband, also operated the business. The investigation revealed Hall and Soruco committed Workers’ Compensation insurance premium fraud by failing to report employees and payroll to SCIF from October 15, 2013 through December 8, 2016. The investigation further revealed unreported payroll to SCIF, leading to a premium loss of approximately $585,666. Investigators also discovered Hall and Soruco committed payroll tax evasion by failing to report employees and payroll to California’s EDD from October 15, 2013 through February 6, 2019 which resulted in a payroll tax loss to EDD of approximately $342,405. This case was prosecuted by the Marin County District Attorney’s Office ...

A San Fernando Valley woman pleaded guilty to federal criminal charges for conspiring to defraud health insurance companies by causing millions of dollars in fraudulent claims to be submitted to provide patients with "free" cosmetic procedures, including Botox injections. The indictment included several co-conspirators, including an insurance company SIU investigator who helped her avoid detection. Roshanak Khadem, 54, a.k.a. "Roxanne Khadem" and "Roxy Khadem," of Sherman Oaks, pleaded guilty to one count of conspiracy to commit health care fraud and one count of subscribing to a false income tax return. She was the last of the group to plead guilty. According to her plea agreement, she owned and operated facilities that provided aesthetic services to clients, including R&R Med Spa in Valley Village and Nu-Me Aesthetic and Anti-Aging Center in Woodland Hills. Khadem caused patients to visit her clinics to receive cosmetic procedures, including Botox injections, facials and laser hair removal. Khadem knew these procedures were not covered by the patients’ health insurers. Khadem also knew that her employees informed some patients that, if they turned over their health insurance information to the Khadem-owned clinics, the patients could receive free or discounted cosmetic procedures pursuant to a “credit” they would earn. Health insurance information from these patients was provided to the insurance biller for the clinics, knowing and intending that the information would be used to submit false and fraudulent claims to the health insurers for medical procedures that Khadem knew were either not actually provided to the patients or were not medically necessary. Then, based on the amount that the health insurers paid on those false and fraudulent claims, Khadem and others would calculate an amount, which the co-conspirators referred to as a "credit," that the patients could use to receive free or discounted cosmetic procedures from the clinics. Those patients would then come into the clinics to receive the free or discounted cosmetic procedures. Khadem and her co-conspirators submitted claims, which included false and fraudulent claims for which those companies paid out at least $1,361,200. Prosecutors estimate the amounts paid based on false and fraudulent claims submitted as part of the health care fraud conspiracy in which Khadem participated could be as much as $7,991,406. Khadem failed to report this income on her income tax returns for 2013, 2014 and 2015. Khadem’s underreporting of her income for these three years caused a total tax loss of $453,451. A June 27 sentencing hearing hearing has been scheduled, at which time she will face a statutory maximum sentence of 13 years in federal prison. 44 year old Gary Jizmejian, who lives in Santa Clarita, and who was a former senior investigator at the Anthem Special Investigations Unit, the anti-fraud unit within Anthem, previously pleaded guilty to using his cell phone to send text messages to co-defendants as part of a this commercial bribery scheme was also sentenced to 18 months in federal prison. The indictment alleged that, in return for cash payments, Jizmejian assisted Khadem and others by providing them with confidential Anthem information that helped them submit fraudulent bills to Anthem. In September 2012, Jizmejian gave Khadem insurance billing codes - CPT Codes - that Jizmejian knew could be used to submit fraudulent claims to Anthem without Anthem detecting the fraudulent claims. Jizmejian gave Khadem the billing code for an allergy-related lab test and instructed her to submit to Anthem large numbers of bills with this CPT code. Khadem and other members of the conspiracy used this billing code to submit approximately $1 million in fraudulent claims to Anthem, according to the indictment. The indictment further alleged that Jizmejian worked to prevent the insurance companies from detecting the fraud at the clinics, which included helping Khadem to avoid responding to inquiries from fraud investigators, diverting attention of other Anthem SIU investigators away from the clinics, and closing Anthem investigations into fraud that was being committed at the clinics. In September 2015, based on confidential information obtained from Anthem, Jizmejian tipped Khadem off about a federal criminal investigation into the clinics, according to the indictment. The remaining three defendants in this case each have pleaded guilty. Lucine Ilangezyan, 42, of North Hills, pleaded guilty to one count of conspiracy to commit health fraud, and was sentenced to 18 months in federal prison. Dr. Roberto Mariano, 63, of Rancho Cucamonga, a physician who helped operate the clinics, and Marina Sarkisyan, 52, of Panorama City, who was the office manager at the clinics, await sentencing ...

Claims administrators are reminded that the Annual Report of Inventory (ARI) must be submitted in early 2022 for claims reported in calendar year 2021. The California Code of Regulations, title 8, Section 10104 requires claims administrators to file, by April 1 of each year, an ARI with the Division of Workers’ Compensation (DWC) indicating the number of claims reported at each adjusting location for the preceding calendar year. Even if no claims were reported in the prior year, the report must be completed and submitted to the DWC Audit Unit. Each adjusting location is required to submit an ARI unless its requirement has been waived by DWC. When ARI requirements are waived, claims administrators must file an annual report of adjusting locations. This report is to be filed annually on April 1 of each calendar year for the adjusting location operations as of December 31 of the prior year. Claims administrators are required to report any change in the information reported in the ARI or annual report of adjusting location within 45 days of the effective date of the change. Penalties of up to $500 per location for failure to timely file this Report of Inventory may be assessed under Title 8, California Code of Regulations, Section 10111.1(b)(11) or 10111.2(b)(26). The form for 2021 is located on the DWC website under the Audit and Enforcement Unit page. Questions about submission of the ARI or the annual report of adjusting locations may be directed to the Audit Unit: ...

Juan Suarez sustained a cumulative injury to his low back and neck through September 8, 1993 (ADJ365717) while employed by Haley Brothers insured by Unicare Insurance and a specific injury to his low back and neck on July 27, 1986 (ADJ3469175) while employed at T.M. Cobb Company insured by Liberty Mutual. In a 1997 Stipulations with Request for Award, Liberty Mutual paid Unicare $25,000.00 in full satisfaction of its contribution issue to resolve any and all future claims for contribution. Unicare agreed to assume full and sole responsibility for all future payment of benefits Unicare is now insolvent and its claims are administered by the California Insurance Guarantee Association (CIGA). CIGA took the position that Liberty Mutual was "other insurance" despite the wording of the Stipulation. Thus the issue submitted at a January 2020 trial was: "Is Liberty Mutual liable for the administration of this claim and possible reimbursement and contribution to the California Insurance Guarantee Association." The WCJ agreed with CIGA and found that Liberty Mutual is available "other insurance" and ordered that Liberty Mutual take over administration of applicant’s medical care and resolve reimbursement and contribution issues with CIGA. But Liberty Mutual's Petition for Reconsideration of this order was granted in the panel decision of Suarez v Haley Bros/TM Cobb et.al. (ADJ365717 - ADJ3469175) (Feb 2022) In order to obtain reimbursement or a change of administrators, CIGA must show that Liberty Mutual is jointly and severally liable for medical treatment. The panel discussed the Court of Appeal decision in California Ins. Guarantee Assn. v. Workers’ Comp. Appeals Bd. (Lopez) (2016) 245 Cal.App.4th 1021 (81 Cal.Comp.Cases 317), where a final award apportioning liability between insurers did not change the joint and several nature of defendants’ liability. In Lopez, the insurers agreed, in a compromise and release agreement, that the insurers would apportion liability for the remaining liens according to proof and with rights to contribution and reimbursement between the two being reserved. The Lopez Court noted that the carriers understood their liability remained joint and several even after settlement and apportionment However in this case, Unicare Insurance settled its contribution rights as part of the Stipulated Award, and, significantly, the award issued solely against Unicare. Applicant was a signatory to these stipulations, including the stipulation that only Unicare would be liable for benefits. Therefore, after the settlement, Liberty Mutual no longer had any liability for benefits to Mr. Lopez and he could only obtain medical treatment benefits from Unicare. There cannot be joint and several liability where one party has no liability. Accordingly, the panel granted reconsideration and found that Liberty Mutual is not liable for applicant’s medical treatment and CIGA is not entitled to reimbursement from them ...

A San Francisco psychiatrist was sentenced in federal court Wednesday to serve 120 days in prison and pay $1.4 million restitution after he pleaded guilty to a scheme to submit false reports for non-disabled clients to receive federal benefits to which they were not entitled. According to the U.S. Attorney's Office, 76 year old George Demetrius Karalis pleaded guilty Aug. 11 and was sentenced Wednesday by U.S. District Judge Charles Breyer. The government's sentencing memorandum describes meetings between Karalis and undercover agents where the defendant instructed his clients on how to obtain federal and state government benefits to which they were not entitled. According to his plea agreement, Karalis admitted that between August 2015 and June 30, 2020, he treated U.S. Postal Service employees who were receiving Federal Employees' Compensation Act (FECA) workers' compensation benefits for alleged stress and psychological disorders. Karalis counseled his non-disabled clients on how to continue receiving benefits to which they were not entitled. Karalis also admitted that he submitted false reports and certifications about his clients so that they could continue receiving FECA benefits. Karalis admitted that the total loss attributable to his conduct and is between $550,000 and $1,500,000. He also agreed to pay $1,400,000 in restitution, $920,000 of which will be paid to the U.S. Postal Service and $480,00 of which will be paid to the California Employment Development Department. This is however, not the first public record of allegations of worker's compensation insurance fraud and also grand theft against him. Records (131 pages) from the Medical Board of California in its disciplinary case D1-90-3188, show a 1996 stipulated resolution of allegations of fraudulent billing pertaining to liens filed in several pending workers' compensation cases. The attached liens were against multiple carriers including SCIF, Travelers, Industrial Indemnity, Atlantic Mutual and perhaps others. However he specifically denied "any allegations of fraud, dishonesty, corruption, gross negligence, or incompetence." Nonetheless his probation was continued for three years from June 9, 1995. His license was restored to "cleared" status following completion of probation on July 31, 1998. Records from a 1990 disciplinary action against him in disciplinary case D-3800 he was accused of unprofessional conduct claiming that "on or about August 24, 1987, respondent was convicted by a guilty plea in the Superior Court, of County of Alameda, Case No. 89328, on one count of violation of Penal Code section 487(1) [grand theft]. The Accusation said this involved property of Computer Sciences Corporation and the State of California (Medi-Cal Program). He was placed on three years probation, and did not serve any jail time. He admitted these allegations in his Stipulation and was placed on probation by the Medical Board for 5 years. He was admitted to practice medicine in California on September 1, 1971 after graduation from the University of California, Irvine College of Medicine in 1970. He is currently still licensed with no current disciplinary charges pending against him. A six-month CBS News investigation reported in 2021 raised new questions about how effectively state medical boards hold bad doctors accountable and protect patients. It reported from an insider who sits on California's medical board, which is responsible for licensing and disciplining more than 150,000 doctors. This is one of many similar media stories over the years on the same issue ...

New research from The Hartford found that 43% of U.S. workers have delayed routine health care appointments since the COVID-19 pandemic began. The delay in care comes as many also report declines in their mental health (42%), social well-being (41%), financial security (32%) and physical health (29%). A national omnibus online survey was conducted in the U.S. among approximately 2,000 adults aged 18+, including 1001 full-time and part-time employed respondents. The research was conducted Jan. 5-7, 2022. The margin of error is +/- 3% at a 95% confidence level. The Hartford, which has been tracking workplace burnout levels among U.S. workers throughout the pandemic, found that the burnout rate has remained high at 61% in January - the same level reported in February and July of 2021. This burnout rate and declining health is manifesting in the way many U.S. workers feel about their jobs. Most respondents (63%) said their overall health/wellness impacts their productivity at work. Thirty percent noted they’re less engaged with their work and 25% said they have trouble concentrating or focusing. "It is difficult to overcome the fear and fatigue we’re all experiencing amid the COVID-19 pandemic; however, it is important that people get back to prioritizing routine health visits and screenings to stay physically and mentally healthy," said The Hartford’s Chief Medical Officer Dr. Adam Seidner. "Many health conditions, such as high blood pressure or diabetes, may not be noticeable or detected without routine screenings. These types of conditions, when they continue to develop undetected, can lead to more serious health problems." According to the January 2022 Future of Benefits Pulse Survey, the top five reasons workers are putting off appointments include: - - Fear of contracting COVID-19 (47%); - - Difficulty getting an appointment (29%); - - The need to cancel appointments due to COVID-19 restrictions/requirements (25%); - - Fear of other illnesses (24%); and - - Not a current priority (21%) "Employers play a key role in helping to remove some of the barriers to health care, which is important in helping people live active and productive lives," Seidner said. "I encourage employers to continue to offer the flexibility needed to ensure their employees can take key steps to improve their mental and physical health - and avoid the dangers of delayed care." According to an analysis of The Hartford’s 2021 short-term disability claims data, the top five injuries and illnesses are: - - Musculoskeletal injuries, such as neck or back pain - - COVID-19 - - Digestive disorders, such as hernias or appendicitis - - Mental health conditions - - Rheumatologic disorders, such as osteoarthritis and rheumatoid arthritis Seidner notes that these types of illnesses and injuries can be treated before becoming a disabling condition that prevents people from working or can be managed well following a disability claim by keeping up with routine care. To help get back on track with appointments, Seidner recommends U.S. workers: - - Talk to their doctor’s offices about the precautions they are taking in the office to keep patients safe; - - Stay current on prescription medications and continue to follow the medical guidance related to an existing condition; - - Consider a telehealth visit, if available; - - Ask to be placed on a call-back list to be made aware of openings due to cancellations if appointments aren’t readily available; and - - Take advantage of the online health portals available to communicate directly with your doctor. To better engage with workers and promote their overall wellness, Seidner recommends employers: - - Offer benefits and resources that address the overall well-being of their workforce - encompassing physical health, mental health, as well as financial resilience; - - Communicate more often to employees to remind them of the benefits and services that are available; - - Lead by example by making your own appointments a priority; and - - Offer the flexibility employees need to make their appointments a priority. The Hartford Financial Services Group, Inc., operates through its subsidiaries under the brand name, The Hartford, and is headquartered in Hartford, Connecticut ...

The Division of Workers’ Compensation has posted proposed amendments to the QME regulations to its online forum where members of the public may review and comment on the proposals. The changes are being proposed to help the Qualified Medical Evaluator program better service the community. The draft regulations include the following: - - Extends the time frame to schedule a medical-legal evaluation by an additional 30 days. - - Clarifies that the time frame for scheduling of an evaluation is for both initial and subsequent evaluations. - - Updates to allow for electronic service of documents. - - Provides flexibility if parties agree an initial evaluation can occur at any office listed with the medical director. - - Deletes reference to Agreed Panel QME to be consistent with Labor Code section 4062.2(c) - - Provides for a QME or AME to reschedule an evaluation within 60 days of the date of the cancellation unless the parties agree beyond the 60 days. - - Provides a mechanism for Remote Health Medical-Legal evaluations if specific criteria are met. - - Provides a definition of remote health evaluations and identification of office location when a remote health evaluation is conducted. The forum can be found on the DWC forums webpage under "current forums." Comments will be accepted on the forum until 5 p.m. on Friday, February 25, 2022 ...

The bipartisan Commission on Combating Synthetic Opioid Trafficking was charged with examining aspects of the synthetic opioid threat to the United States, and with developing a consensus on a strategic approach to combating the illegal flow of synthetic opioids into the United States. It just published it's final report. The Commission was composed of representatives of seven executive branch departments and agencies, four sitting members of both the Senate and the House of Representatives, and four subject-matter experts from the private sector chosen for their deep experience and expertise on this topic. Sadly, the report begins by saying the "overdose crisis in the United States claims more lives each year than firearms, suicide, homicide, or motor vehicle crashes." And goes on to report that some two-thirds of these deaths - about 170 fatalities each day, primarily among those ages 18 to 45 - involved synthetic opioids. The primary driver of the opioid epidemic today is illicit fentanyl, a synthetic opioid that is up to 50 times more potent than heroin. The report found that Mexico is the principal source of this illicit fentanyl and its analogues today. In Mexico, cartels manufacture these poisons in clandestine laboratories with ingredients - precursor chemicals - sourced largely from the People’s Republic of China (PRC). The opioid crisis in the United States first gained public attention in the 2000s. Decades of an oversupply of prescription opioid pain medications beginning in the mid-1990s seeded its origins. Starting around 2014, potent synthetic opioids - mostly, illegally manufactured fentanyl - began their sharp rise in U.S. drug markets. Although they increasingly displaced prescription opioids and heroin in some places, these new drugs rapidly worsened an already-alarming public health problem. The emergence of counterfeit tablets that contain minute quantities of synthetic opioids is particularly troubling. Drug traffickers in Mexico produce most of these tablets, but illegal pill pressing does occur to a lesser extent in the United States and Canada. The Commission developed 21 key actions supported by 78 enabling actions that address the most-salient and -actionable challenges that the United States faces today in combating the flow and use of illegally manufactured synthetic opioids. And as the federal government mulls over these findings and recommendations, recent studies show that San Francisco overdose deaths far exceed COVID deaths. Over the past two years, the city has seen more than 1,360 drug overdose fatalities - more than double the total COVID-19 death toll there. The majority of those deaths were in the Tenderloin and neighboring SOMA district. San Francisco Mayor London Breed announced an "emergency declaration" for the area last month saying drug deaths, open-air drug dealing, street chaos and violence there had gotten "totally out of control." She vowed "tough love" for those who break the law and expanded access to help for those with alcohol and substance use disorders. However, concurrently with this new report, the Biden administration is being heavily criticized for announcing a $30M grant to fund free crack pipes, in what might appear to some as a mixed message to addicts. On Tuesday, US Senator Marsha Blackburn of Tennessee wrote to the department of Health and Human Services, expressing "grave concerns" that a $30 million grant program from the Substance Abuse and Mental Health Services Administration (SAMHSA) could include subsidizing drug paraphernalia. "Government-funded drug paraphernalia is a slap in the face to the communities and first responders fighting against drugs flowing into our country from a wide-open southern border," Ms Blackburn wrote in her letter. "If this is the president’s plan to address drug abuse, our nation is in serious trouble." ...

Unlicensed insurance agent Karyl Lynn Reed, 58, formerly of Costa Mesa, was convicted last week on multiple felony counts of embezzlement and white-collar fraud enhancements after defrauding three victims of over $1.4 million. Reed was sentenced to four years in prison and ordered to pay more than $1.4 million in restitution. Reed was arrested last year in Seabrook, Texas, and was arraigned on October 27, 2021, in Orange County after she was extradited. An investigation by the Department of Insurance found that between 2012 and 2019, Reed acted as an insurance agent without a license and collected premiums for workers’ compensation insurance through her businesses, Envoy Business Partners and Allenn Specialty Group. She would provide her victims with fraudulent Certificates of Insurance, causing her victims to believe they had valid coverage when there was actually none. The investigation discovered Reed also operated a staffing company without valid workers’ compensation coverage and personally adjusted and administered employee injury claims. She collected workers’ compensation premiums and payroll, employer and employee taxes from victims, and provided them with falsified Certificates of Insurance as well leading them to believe they were covered when they were not. The Department’s investigation revealed that one victim did not have workers’ compensation coverage for an employee who became injured. Another victim had requested an updated Certificate of Insurance from their insurance company and were told no policy or coverage was in place and found out the policy number Reed had provided them belonged to a policy for another business. The investigation further revealed another victim who discovered the money they were paying Reed to her staffing service was not being remitted to the insurance company. Consumers can check the license status of their agent or contact the Department of Insurance at 800-927-4357 if they suspect they are victims of insurance fraud. This case was prosecuted by the Major Fraud Unit of the Orange County District Attorney’s Office ...