According to a new report - "The Future of Workplace Safety Technology Is Now" - just published by the National Council on Compensation Insurance (NCCI) technology, part 1 of a 3 part report, the workplace, and the role of workers are changing more dramatically today and at a faster pace than ever before. Along with shifting jobs and evolving workplaces come new and changing exposures to worker injuries. Questions continue to arise about the status and evolution of safety technologies. In fact, some insurers are testing or discussing these technologies, and in some cases, providing them to their customers/policyholders. Based on interviews with multiple workers compensation insurers, safety technology vendors/suppliers, and insureds, this series is a presentation of perspectives from various stakeholders. In this article, the first installment of NCCI’s series it explores carrier viewpoints on the latest trends in safety technology. The safety technology industry has evolved since NCCI published its first article on this topic in 2019. The four insurers that it interviewed for this article are currently using or exploring multiple types of safety technologies, including wearables, Artificial Intelligence (AI)/Computer Vision, the Internet of Things (IoT), software applications, and drones. Key insights include: - - Insurers are exploring multiple types of advanced safety technologies and are at various stages of implementation - - Back injury prevention is a common focus for new workplace safety technology; however, applications are available to address many other injury types - - Manufacturing, warehousing, and logistics industries are mentioned as principal target industries for modern safety solutions - - An employer culture of "safety and trust" is seen as critical to the adoption and sustainable use of advanced safety technologies - - Integrating workplace safety and operational efficiency may result in wider adoption of safety technologies - - More testing and analysis are needed to fully quantify the value of modern workplace safety technologies - - Safety technologies are deemed to be a "game-changer" by some industry experts; all interviewees see these technologies playing a major role in the future of worker injury prevention For example, the report said that Drones, also known as Unmanned Aircraft Systems (UAS), can evaluate certain exposures without putting workers at risk for injury. Drones can evaluate roofing conditions and cell phone towers, as well as monitor air quality in confined spaces. When asked if safety technology is a "game-changer," the responses varied, ranging from "It can be " - to "Absolutely." Safety technology was mentioned as a potential differentiator to offer higher service and value. It was also noted that "safety technology will point out problems but may not point out solutions. But pinpointing the problem could lead to a solution." Part 1 of The Future of Workplace Safety Technology Is Now is available at no charge on the NCCI website ...

Long COVID, also known as post-acute COVID-19 syndrome (PASC), is a condition where people experience symptoms of COVID-19 for weeks, months, or even years after their initial infection. The symptoms can be mild or severe, and can affect any part of the body. The World Health Organization (WHO) defines Long COVID as "the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation." Roughly 25 million people in the U.S. and over 17 million people in Europe have long COVID symptoms, with many more in other parts of the world. The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has released an updated COVID-19 report, Medical Treatments and Costs of COVID-19 Claims and "Long COVID" in the California Workers’ Compensation System - 2023 Update. The study provided an early assessment of the prevalence of "long COVID" (post-acute sequelae of SARS-CoV-2 infection, PASC) in the workers’ compensation system. The study estimated that approximately 11% of COVID-19 claims with an initial mild infection received medical treatment for long COVID symptoms over a 4-month post-acute care period. The rate of long COVID spiked to about 40% for those hospitalized for the initial infection. A recent study from the Workers Compensation Research Institute (WCRI) found that 7 percent of workers with COVID-19 claims received treatment for long COVID after the acute period of the infection. While long COVID prevalence was the highest among workers who were hospitalized during an acute stage of disease, even some workers with limited medical care early after the infection developed long COVID symptoms. For these Long COVID cases, the claim administrator will likely need to resolve the permanent disability component, and apportionment. Labor Code § 4663(a) provides that "(a) Apportionment of permanent disability shall be based on causation." That begs the question about causation of Long COVID under this standard. Perhaps a newly published study by the Genome-wide Association Study of Long COVID is a good start at an answer. The COVID-19 Host Genetics Initiative (COVID-19 HGI) ) was launched to investigate the role of host genetics in COVID-19 and its various clinical subtypes. It also conducted the first genome-wide association study (GWAS) specifically focused on Long COVID. This part of the study includes data from 24 studies conducted in 16 countries, totalling 6,450 individuals diagnosed with Long COVID and 1,093,995 controls. The new research, which was an international collaboration between dozens of scientists, describes how some people carry a version of a single gene, FOXP4, that is associated with developing long COVID. FOXP4 has been previously associated with COVID-19 severity, lung function, and cancers, suggesting a broader role for lung function in the pathophysiology of Long COVID. Conversely, scientists estimate that over 20% of people who get infected with COVID never have any symptoms - and a portion of them never even know they were infected. Now a new study published in Nature on July 19 says their genetics might be why the virus didn't make them sick. Some people have a version of a gene in their immune system called HLA-B that protects them from feeling the effects of the virus. The study found that people with this special HLA-B variant are 2 to 8 1/2 times more likely to be asymptomatic than those without the variant. Jill Hollenbach, an immunologist at the University of California, San Francisco, was one of the scientists who led the research on asymptomatic COVID. She says she was "surprised and excited" about the new long COVID findings. "The fact that the authors were able to detect this association [between the FOXP4 gene and long COVID], I think, is spectacular," Hollenbach says. Dr. Hollenbach would obviously be a local expert to consult for further information on possible apportionment in a claim for permanent disability in a Long COVID case ...

An influential bipartisan group of U.S. Senators sent letters to regulators within the U.S. Treasury for detailed information on nonprofit hospitals’ reported charity care and community investments. This is a sign of legislators' increasing scrutiny of tax-exempt hospitals' business practices Sens. Elizabeth Warren, D-Massachusetts, Raphael Warnock, D-Georgia, Bill Cassidy, M.D., R-Louisiana, and Chuck Grassley, R-Iowa, wrote they "are alarmed by reports that despite their tax-exempt status, certain nonprofit hospitals may be taking advantage of this overly broad definition of ‘community benefit’ and engaging in practices that are not in the best interest of the patient." Back in February 2018, Grassley and then-Chairman Orrin Hatch of Utah pressed the IRS for information on enforcement practices and compliance data on non-profit hospitals. In May 2018 he received a "Report to Congress on Private Tax-Exempt, Taxable, and Government-Owned Hospitals" which documented some decline in charity care provided to qualified patients in their geographical care. And now the newest round of letters to the IRS outlined studies from academic and policy groups highlighting that the tax-exempt status of the nation's nonprofit hospitals collectively was worth about $28 billion in 2020 and how this tally paled in comparison to the charity care most of those hospitals had provided during that same period. For example, Nonprofits like Allina Health System, which runs more than 100 hospitals and clinics in the Midwest and rakes in $4 billion in revenue annually, get tax breaks in exchange for providing care to the poor. In 2020, the health system avoided $266 million in taxes thanks to its nonprofit status, according to the Times reporting, citing data from the Lown Institute, a think tank that studies health care. The health system spent less than half of 1% of its expenses on charity care, whereas the national average is about 2%, according to an analysis of hospital financial filings published in Health Affairs. At the center of the tax debate is what counts as community care and charity to qualify for tax exemption under IRS guidelines. For instance, 82% of nonprofit hospital systems spent less on community programs than the value of their tax exemptions in 2019, according to a Lown Institute report. The American Hospital Association disputed that analysis claiming Lown ignored a range of community investment categories in its math. Lown research said that was intentional - because many of those categories should not count. Federal law does not say how much community benefit hospitals have to provide, but they do have to report their spending to the IRS each year, broken down by free and discounted care, unreimbursed care from government programs, and public health programming. And claims of abuse of the vagueness of the tax law have been quickly contested by the hospital lobby, which highlights that charity care is just one component of the broader activities that constitute a nonprofit hospital’s community benefit spending. However, that ambiguity was squarely in the crosshairs of the legislators authoring this newest round of inquiry, who said the long-standing community benefit standard "is arguably insufficient in its current form to guarantee protection and services to the communities hosting these hospitals." They said we "are alarmed by reports that despite their tax-exempt status, certain nonprofit hospitals may be taking advantage of this overly broad definition of "community benefit" and engaging in practices that are not in the best interest of the patient. These practices - along with lax federal oversight - have allowed some nonprofit hospitals to avoid providing essential care in the community for those who need it most." A 2020 report by the GAO found that the "lack of clarity" around what constitutes community benefits makes IRS’ oversight of nonprofit hospitals "challenging."In response, GAO made specific recommendations to the IRS to further increase transparency and ensure nonprofit hospitals are meeting their community obligations. Since the report’s publication in September 2020, the IRS has implemented several of GAO’s recommendations: creating a "well-documented process to identify hospitals at risk for noncompliance with the community benefit standard," adjusting the Form 990 Schedule H instructions to ensure more relevant responses, and establishing specific audit codes to better identify potentially noncompliant institutions. Yet the Senators complain in their letter that "more is required to ensure nonprofit hospitals’ community benefit information is standardized, consistent and easily identifiable." ...

Dalila Tututi filed two Applications for Adjudication of Claim against Big Merryluck GG. On October 4, 2019, PCT Medical Services Gilbert filed a lien for medical treatment expenses incurred by or on behalf of applicant, pursuant to Labor Code section 4600. On December 9, 2019, the parties requested a lien trial on unresolved liens, including that of PCT Medical Services. On January 7, 2020, the parties proceeded to lien trial, at which time Ms. Airhana Hernandez ostensibly appeared on behalf of PCT Medical Services. However, Ms. Hernandez was unable to produce a Notice of Representation. The WCJ provided lien claimant’s representative additional time in which to produce the required notice, but the lien representative was unable to provide the notice by the end of the morning’s trial setting. The WCJ then issued a Notice of Intention to Dismiss Lien Claim or Lien Balance because "no compliant Notice of Representation per Title 8 CCR §10868, §10751 was filed at or before time of hearing." Lien claimant filed an objection to the Notice of Intention to Dismiss requesting discretionary relief pursuant to Code of Civ. Proc., § 473(b) for mistake, inadvertence, surprise or excusable neglect. However the WCJ issued an Order Dismissing Lien Claim or Lien Balance, stating "Even though a timely objection dated 1-17-2020 was filed on 1-17-2020, this objection does not show good cause for non-appearance by lien claimant or their representative at the Lien Trial on 1-7-20." The Lien Claimant's Petition for Reconsideration of the Dismissal was granted, and the Order Dismissing was reversed in the panel decision of Tututi v Big Merryluck GG -ADJ11296374; -ADJ11296239 (August 2023). Non-attorney representatives who appear on behalf of parties in workers’ compensation proceedings are required to file a valid notice of representation as required by WCAB Rule 10751, and WCAB Rule 10868, which specifies the requirements pertaining to a Notice of Representation involving lien claimants. Violation of the appropriate rules may give rise to monetary sanctions, attorney's fees and costs under Labor Code section 5813 and rule 10421. "Here, there is no dispute that Ms. Hernandez was unable to provide a valid Notice of Representation at the time of lien trial. Following the issuance of the court’s Notice of Intention, and review of lien claimant’s objection, the WCJ dismissed the lien with prejudice." Code of Civ. Proc., § 473(b) permits the trial court to relieve a party from a judgment, order or other proceeding taken against him through his mistake, inadvertence, surprise or excusable neglect. A motion seeking relief under section 473 is addressed to the sound discretion of the trial court; its decision will not be overturned on appeal absent a clear showing of abuse of discretion. (Shamblin v. Brattain (1988) 44 Cal.3d 474, 478 [243 Cal. Rptr. 902]; Elston v. City of Turlock (1985) 38 Cal. 3d 227, 233 [211 Cal. Rptr. 416].) The WCAB panel noted that discretion, "however is not a capricious or arbitrary discretion, but an impartial discretion, guided and controlled in its exercise by fixed legal principles. It is not a mental discretion, to be exercised ex gratia, but a legal discretion, to be exercised in conformity with the spirit of the law and in a manner to subserve and not to impede or defeat the ends of substantial justice." The court of appeal confirmed that the section 473(b) may afford relief to other parties to workers’ compensation proceedings in Fox v. Workers' Comp. Appeals Bd. (1992) 4 Cal.App.4th 1196 [57 Cal.Comp.Cases 149] (Fox). "We observe that while WCAB Rule 10751 requires the non-attorney representative making an appearance to provide a valid notice of representation, it does not specify a remedy for failure of compliance, and it does not mandate dismissal of the underlying lien claim." "We also observe that following notice of the failure to provide the required notice of representation on the day of trial, lien claimant attempted to remedy the deficiency by filing a Notice of Representation in EAMS later that same day." "In summary, we are persuaded that lien claimant has taken reasonable action to remedy the procedural deficiencies in its trial appearance, and that lien claimant promptly sought relief from its dismissal for failure to comply with our Rules, and that the public policy in favor of disposition on the merits warrants the rescission of the dismissal of the lien claim." ...

Ronald Hittle was an at-will employee of the City of Stockton and served as the City’s Fire Chief from 2005 through 2011. In May 2010, the City received an anonymous letter purporting to be from an employee of the Stockton Fire Department. The letter described Hittle as a "corrupt, racist, lying, religious fanatic who should not be allowed to continue as the Fire Chief of Stockton." The source of this information was not an anonymous individual, but later established as a high-ranking Fire Department manager. The City hired an outside independent investigator, Trudy Largent, to investigate various allegations of misconduct. In a 250-page report referencing over 50 exhibits, Largent sustained almost all of the allegations of misconduct against Hittle. This investigation ultimately led to his termination by the City. Largent’s Report specifically concluded that Hittle: (1) lacked effectiveness and judgment in his ongoing leadership of the Fire Department; (2) used City time and a City vehicle to attend a religious event, and approved on-duty attendance of other Fire Department managers to do the same; (3) failed to properly report his time off; (4) engaged in potential favoritism of certain Fire Department employees based on a financial conflict of interest not disclosed to the City; (5) endorsed a private consultant’s business in violation of City policy; and (6) had potentially conflicting loyalties in his management role and responsibilities, including Hittle’s relationship with the head of the local firefighters’ union. Hittle sued the City, former City Manager Robert Deis, and former Deputy City Manager Laurie Montes claiming that his termination was in fact the result of unlawful employment discrimination in violation of Title VII of the Civil Rights Act of 1964 and California’s Fair Employment and Housing Act. Hittle alleged that Deis and Montes terminated his employment as Fire Chief "based upon his religion." Defendants moved for summary judgment seeking dismissal of all of Hittle’s claims. Hittle subsequently cross-moved for partial summary judgment as to his federal and state religious discrimination claims on April 1, 2021. On March 1, 2022, the district court denied Hittle’s motion and granted Defendants’ motion as to all of Hittle’s claims. The 9th Circuit Court of Appeals affirmed in the published case of Hittle v City of Stockton -22-15485 (August 2023). The panel held that, in analyzing employment discrimination claims under Title VII and the California FEHA, the court may use the McDonnell Douglas Corp. v. Green burden-shifting framework - 411 U.S. 792 (1973) - under which the plaintiff must establish a prima facie case of discrimination. The burden then shifts to the defendant to articulate a legitimate, nondiscriminatory reason for the challenged actions. Finally, the burden returns to the plaintiff to show that the proffered nondiscriminatory reason is pretextual. Alternatively, the plaintiff may prevail on summary judgment by showing direct or circumstantial evidence of discrimination. Hittle was required to show that his religion was "a motivating factor" in defendants’ decision to fire him with respect to his federal claims, and that his religion was "a substantial motivating factor" with respect to his FEHA claims. The panel concluded that Hittle failed to present sufficient direct evidence of discriminatory animus in defendants’ statements and the City’s notice of intent to remove him from City service. And Hittle also failed to present sufficient specific and substantial circumstantial evidence of religious animus by defendants. On summary judgment, circumstantial evidence of discrimination "must be 'specific' and 'substantial'" "The district court’s grant of summary judgment in defendants' favor was appropriate where defendants' legitimate, non-discriminatory reasons for firing Hittle were sufficient to rebut his evidence of discrimination, and he failed to persuasively argue that these non-discriminatory reasons were pretextual." ...

The San Jose owner of a flooring company was sentenced to county jail last week to county jail and ordered to pay over $580,000 in restitution for fraud, after being caught under reporting his payroll to avoid paying thousands of dollars in insurance premiums. An investigation showed Martin Helda had under reported his All Bay Floor payroll avoiding $140,000 in insurance premiums and did not pay his employees about a $1 million in owed overtime. Helda, 35, pleaded guilty to three fraud counts, including Workers Compensation Premium Fraud, Employment Development Department fraud, and wage theft. In addition to paying restitution to victims, he was sentenced to four months in county jail and 200 hours of community service. The investigation began after an insurance audit revealed that Helda’s payroll did not match the number of people he had working for him. This case was investigated in conjunction with the newly formed Workers’ Exploitation Task Force (WE TF). DA Investigators utilized partnerships with the Department of Industrial Relations and the State Labor Commission to find justice for victims of wage theft. A DA investigation uncovered that Helda withheld time and a half overtime wages to at least 18 employees, including one employee who was owed approximately $60,000. However, there could be as much as $1.7 million owed to all employees including those not known to the DA’s Office. According to his biography posted on IdeaMensch.com Martin Helda "took the California State Contractors License Exam and was one of the youngest people ever in the state to pass the exam, and from there he launched All Bay Area Floors, a commercial flooring company." "He grew the business over the next 12 years to be one of the largest flooring companies in the Bay Area, with over 60 employees. Recently, Martin has launched his 2nd business, Bay Area Concrete Polishing, which he plans to be as successful has his first." However, at the time of his arrest in April 2021, media sources said he claimed he only had one employee. Victims who have yet to be identified in this matter may file a wage claim on the Labor Commissioner’s Office website or at any of their office locations. District Attorney Jeff Rosen said: "Whatever you think you might be saving in the short term will cost you a lot more than money in the long term. Fraud doesn’t pay." ...

Cal/OSHA and the Department of Industrial Relations (DIR) encourage California’s employers and workers to commit to workplace safety and health during Safe + Sound Week from August 7-13. Register your commitment to safety with Cal/OSHA for Safe + Sound Week. Those who register will join the thousands of businesses around the country showing their commitment to workplace safety and will have their workplace listed as a participant. This year’s program will provide resources for businesses on mental health and well-being. The benefits of participating in Safe + Sound Week include enhanced safety and health at work sites with effective safety programs to identify and address potential hazards before an injury or illness occurs; improved employee well-being and morale that increases business productivity; cost savings that proactive safety measures provide to reduce medical costs, workers’ compensation claims and potential losses associated with downtime and productivity disruptions; and increased awareness on best safety practices to help prevent work-related accidents, injuries and illnesses. Show that you and your group lead on safety as a core value by supporting Safe + Sound Week through the communication channels or social media platforms you use with the hashtag #SafeandSoundWeek. Cal/OSHA and DIR are participating in a West Coast Challenge again this year with Oregon and Washington. The three state leaders have posted a video issuing a challenge to each other in a friendly competition to see which of the three states has the highest ratio of businesses registered. Cal/OSHA helps protect workers in California from health and safety hazards on the job. Cal/OSHA’s jurisdiction to conduct workplace safety and health inspections extends to almost every workplace in California, with few exceptions for workplaces covered by federal agencies. Employers who have questions or need assistance with workplace health and safety programs can call Cal/OSHA’s Consultation Services Branch at 800-963-9424. Workers in California are protected regardless of immigration status. Workers who have questions about safety and health in the workplace can call 833-579-0927 to speak with a live bilingual Cal/OSHA representative between the hours of 9:00 a.m. and 7:00 p.m. Monday through Friday. Complaints about workplace safety and health hazards can be filed confidentially with Cal/OSHA district offices ...

On August 17, 2015, Evelyn Rivera went to see a doctor at Kaiser Permanente Hospital becaus.e she had injured her left shoulder. She told the doctor her shoulder had begun hurting after stretching it four or five days earlier. In February 2016, she had surgery on her shoulder to repair a torn rotator cuff. About a year after the initial appointment, Rivera submitted a workers’ compensation claim for an injury to the same shoulder. One doctor examined her on October 19, 2016, and another examined her in August .cling bin. The second doctor reviewed Rivera’s prior medical records and concluded he did not believe her injury was work related. Her workers’ compensation claim was later rejected, but the County of Riverside was billed for her visits to the two doctors. In July 2018, the Riverside County District Attorney’s Office filed a complaint charging Rivera with two felony counts of insurance fraud under Insurance Code section 1871.4, subdivision (a)(1) (count 1) and Penal Code section 550, subdivision (a)(1) (count 2). Rivera was arraigned in Riverside County Superior Court on September 21, 2018, pled not guilty, On March 15, 2019, at the Riverside County Superior Court preliminary hearing. Kurtis Lackman, a workers’ compensation investigator, testified about his investigation into Rivera’s case. Lackman said he began his investigation after the district attorney’s office received a referral from the county, which had already undertaken an investigation. He interviewed the doctors who examined Rivera after she made her workers’ compensation claim. He also interviewed Rivera. His testimony supported the facts set out above. After his testimony, the judge determined "it does appear that the offenses that are currently charged in Counts 1 and 2 have been committed. There’s sufficient cause to believe the defendant guilty of those particular offenses, so I will order that she be held to answer to same." The preliminary hearing resulted in a finding of probable cause, thus the People filed an information with the same charges now in Riverside County Superior Court., and Rivera pled not guilty at her arraignment. A settlement conference was held in October 2021, two and a half years later. Rivera asked the judge to reduce the charges to misdemeanors under section 17(b) and grant her misdemeanor diversion under Penal Code section 1001.95 (section 1001.95), avoiding the need for a trial. Later Rivera filed a formal motion to reduce the charges to misdemeanors and grant diversion, provided Rivera first paid restitution of approximately $20,000. The prosecutor objected, arguing the court did not have authority under section 17(b) to reduce the charges to misdemeanors until Rivera had pled guilty or been convicted. The judge agreed with the defense that under the "Williamson Rule" the prosecution could not charge Rivera under sectioAn 550(a)(1) because the more specific section 550(a)(6) governs. The court granted the motion and set aside count 2. On December 15, 2022, Rivera paid $20,000 in restitution and Riverside County Superior Court Judge Taylor reduced count 1 to a misdemeanor under section 17(b) and granted diversion under section 1001.95, with conditions that she perform 20 hours of community service and attend a life skills class. The People filed a petition for a writ of mandate seeking to vacate the order setting aside the section 550(a)(1) count and the order reducing the Insurance Code count to a misdemeanor.overturn the order reducing count 1 to a misdemeanor and the order setting aside count 2. The Court of Appeal agreed with Rivera and the trial court that the People were required to prosecute this workers’ compensation fraud case under the more specific section 550(a)(6). It therefore denied the People’s petition for a writ of mandate as to that order in the unpublished case of People v Superior Court (Rivera) -E080532 (August 2023) The People charged Rivera under section 550(a)(1), which states it is unlawful to "[k]nowingly present or cause to be presented any false or fraudulent claim for the payment of a loss or injury, including payment of a loss or injury under a contract of insurance." (Italics added.) The gravamen of the complaint and information was that Rivera knowingly presented a false claim for the payment of benefits available under the workers’ compensation law. Rivera argues, and the Court of Appeal agreed, that the allegation against her also falls under section 550(a)(6), which makes it unlawful to "[k]nowingly make or cause to be made any false or fraudulent claim for payment of a health care benefit." (Italics added.) Workers’ compensation benefits like funds paid to cover medical expenses are "health care benefits," which means section 550(a)(6) applies specifically to her case. The only differences between the two statutory provisions is that 550(a)(1) applies to payments for any losses or injuries and section 550(a)(6) applies to payments for health care benefits, a subset of the general category. Rivera argued that the well established 1954 California "Williamson Rule" (In re Williamson, 43 Cal. 2d 651, 276 P.2d 593) justified the ruling of the trial court. The Williamson Rule is a legal doctrine in California criminal law that states that if a general statute includes the same conduct as a special statute, and thus conflicts with it, the special act will be considered as an exception to the general statute whether it was passed before or after such general enactment. The Court of Appeal concluded that "It follows that the Williamson rule applies, and we should infer the Legislature intended that conduct like Rivera’s be prosecuted exclusively under section 550(a)(6)." ... "The trial judge was correct to set aside the section 550(a)(1) count, and we will therefore deny the People’s petition for a writ of mandate as to that order." ...

The former president and CEO of a Whittier medical clinic pleaded guilty to submitting fraudulent billings to a Medi-Cal health care program that provides family planning services to low-income Californians without health insurance. Vincenzo Rubino, 58, of Valencia, pleaded guilty to nine counts of health care fraud and two counts of aggravated identity theft in the middle of his federal criminal trial, in which the prosecution had nearly concluded its case. According to evidence presented at trial, Rubino founded, owned and operated Santa Maria’s Children and Family Center, a Whittier-based medical clinic registered as a non-profit public benefit corporation and enrolled as a Family Planning, Access, Care and Treatment (Family PACT) provider run through Medi-Cal. From November 2014 to August 2017, Santa Maria’s submitted fraudulent claims totaling nearly $5 million to the Family PACT program for family planning services that were never provided, often using the information of patients who were recruited at off-site locations with offers of free diabetes testing, but who in fact never received the examinations and other services. To submit many of these claims, Rubino used the names of two medical providers whom the patients did not see and who did not even work for Santa Maria’s at the time -- a physician’s assistant and an elderly doctor who was himself a patient in a skilled nursing facility during much of the scheme. The Medi-Cal program paid more than $2.3 million dollars on the fraudulent claims, as well as an additional approximately $1.5 million to a pharmacy and laboratory stemming from referrals based on the same services that were never delivered. United States District Judge Otis D. Wright II scheduled a sentencing hearing for January 22, 2024, at which time Rubino will face up to 10 years in federal prison for each health care fraud count, and a mandatory sentence of two years in federal prison consecutive to the other sentences for each aggravated identity theft count. The United States Department of Health and Human Services Office of Inspector General and the California Department of Justice investigated this matter ...

After a two-month trial, this week a jury awarded former UC San Diego oncologist Dr. Kevin Murphy more than $39 million in his whistleblower claim against the University of San Diego. According to the report by the San Diego Union-Tribune, the dispute between Murphy and UCSD began in the fall of 2015, when philanthropist Charles Kreutzkamp died of cancer and left $10 million to the university "for cancer research." The university planned to use it as a general gift for its Moores Cancer Center. Murphy said the donor had intended to fund Murphy’s experimental brain stimulation treatment, known as PrTMS. He complained the school was attempting to divert the funds. Eventually, the school steered the money to Murphy’s research. But he said school officials thwarted his attempts to set up clinical trials and ignored his official complaints about it. The school said Murphy violated policies, wrongly used donated funds to set up a research clinic off campus and enriched himself and his companies. According to investigative reporting by non-profit Inewsource.com, the UC system launched the litigation battle in 2020 when it sued Murphy, alleging he committed fraud and enriched himself using the $10 million donation to the university meant for research. It claimed at least $6.9 million of that donation was gone but no research was ever performed. Murphy countersued, claiming UCSD led a campaign against him when he spoke up about the university funds being directed away from their intended purpose. Those two lawsuits were combined into a massive trial that ended this week with a $39 million verdict in favor of Dr. Murphy. The jury deliberated for fewer than eight hours before returning a verdict Wednesday afternoon. In addition to ruling in favor of Murphy, the jury also found that the doctor had breached his duty of loyalty to UCSD and acted against its interests. The jury awarded about $67,000 in favor of the UC system, which covered money Murphy had earned outside the university that he had failed to turn over as required. The UC system asked for more than $8 million in damages, including civil penalties for violations of the False Claims Act and years of Murphy’s salary paid to him while he was disloyal to the public institution. UCSD had also sued for damages against Murphy’s private medical clinic and medical software company, but the jury found that the companies did not owe any damages. Murphy said he would use the funds to run the trials he had always intended to conduct using the $10 million donation to UCSD. The ruling is the latest of several whistleblower cases his laywer, Mark T. Quigley at Greene Broillet & Wheeler, has won against the University of California. According to the firms website, . In another high-profile whistleblower retaliation trial, Mr. Quigley says that he attained a $2 million verdict against the UC Regents and the former Dean of the UC Irvine School of Medicine. The plaintiff in that case, Mark Linskey, M.D., is a tenured full professor at the UC Irvine School of Medicine and the former Chair of the Department of Neurological Surgery. Mr. Quigley said he resolved the case for a total of $3 million in damages and also obtained a Court Order reinstating Dr. Linskey to the Department of Neurological Surgery and residency program. In another case, Scheer vs UC Regents, (2022) 76 Cal App. 5th 904, a California State Appeals Court recently reinstated one of Mr. Quigley's whistleblower retaliation cases which involves a top UCLA pathology doctor's claims that he was fired in retaliation after raising concerns about workplace mismanagement. The plaintiff, Dr. Arnold Scheer, alleged in his 2017 lawsuit that the University of California Regents and two former supervisors fired him after he identified numerous issues and violations concerning patient safety, mismanagement, fraudulent conduct, sub-standard facility conditions, lost specimen samples, and more. A Los Angeles County Superior Court judge dismissed all of Dr. Scheer's claims at the summary judgment stage, but the three-judge panel unanimously revived the case that asserts three causes of action: violations of a state whistleblower protection law, Labor Code section 1102.5, a whistleblower law specifically protecting University of California employees, Government Code section 8547.10; and a health care worker whistleblower protection law, Health, and Safety Code section 1278.5. An in another case, attorney Quigley achieved a $10 million settlement in Pedowitz v. UC Regents, a whistleblower-retaliation case. The Los Angeles Times reports that Robert Pedowitz, originally recruited to UCLA in 2009 to run the orthopedic surgery department, sued UCLA, the UC Regents, fellow surgeons, and senior university officials because they failed to act on his complaints about conflicts of interest. Pedowitz alleged that they later retaliated against him for speaking out. According to the LA Times story, Pedowitz stated he became "concerned about colleagues who had financial ties to medical-device makers or other companies that could unduly influence their care of patients or taint important medical research." Pedowitz raised concerns about the financial dealings of several doctors, including an orthopedic surgeon that testified at trial about receiving $250,000 in consulting fees in 2008 from device maker Medtronic. Pedowitz also took issue with physicians who included UCLA logos on personal websites without getting official permission. After raising his concerns, however, Pedowitz said he was pressured to step down as department chairman in 2010. He accused the university of retaliation, stating he was denied patient referrals and prevented from participating in grants and other activities, LA Times reports ...

The economic outlook for hospitals remains bleak, according to the July 2023 data on hospital financial performance from Kaufman Hall. Kaufman Hall’s newest Physician Flash Report, with data through the second quarter of 2023, found that provider productivity for medical groups continues to increase, with net patient revenue per provider FTE up 10% from a year ago. However, this productivity was not enough to offset rising expenses as the median investment/subsidy per provider still rose 5% year-over-year to $224,243. The total direct expense per provider full-time equivalent (FTE) reached $611,519, a 4% increase compared to Q2 2022. They report that most hospitals underperformed in June as high expenses and economic pressures persist. As margins continue to stabilize on the surface, the gap between high-performing hospitals and those struggling in this new "new normal" is widening. Key takaways from the July 2023 National Hospital Flash Report are: - - Hospital margins underperformed in June, compared to the previous month. Despite an overall trend of continued improvement, most hospitals underperformed slightly compared to May. Fiscal year-end accounting adjustments may have also contributed to the performance bump in June. - - Average lengths of stay continue to decrease, and emergency department visits are down. Patient volumes continue to stabilize, and increases in outpatient revenue indicate people are continuing to shift away from inpatient settings. - - Bad debt and charity care are increasing. Hospitals are being affected as states step up efforts to redetermine Medicaid eligibility and more people are disenrolled. - - Inflation continues to challenge hospitals’ performance. Supplies and purchased service expenses remain high. Decreases in labor expenses may indicate higher staff turnover and even reductions in workforce. "This ‘new normal’ is an incredibly challenging environment for hospitals," Erik Swanson, senior vice president of Data and Analytics with Kaufman Hall, said in a statement. "It’s time for hospital and health system leaders to begin developing and implementing a strategy for long-term sustainability, including expanding their outpatient footprint and re-evaluating where finite resources are being utilized." "As labor continues to be the largest share of expenses, health systems need to think strategically about provider employment models," said Matthew Bates, managing director and Physician Enterprise service line lead with Kaufman Hall. "Organizations that want to see performance improvement must figure out how best to effectively integrate advanced practice providers into the care team model." ...

Michele Earley, Ashraf Gorgi, Hyun Sook Lee, Roman Hernandez Aguilar, and Jose Flores Campos were each applicants in a workers’ compensation proceeding. In each case one of the parties had filed a Petition for Reconsideration of a ruling issued in their case. By statute, the WCAB must act upon such petitions within 60 days. To satisfy this requirement, the Board often grants petitions for purposes of further study without first deciding whether reconsideration is actually warranted. Later - sometimes many months after the petition for reconsideration was filed - the Board issues a decision on the merits affirming, reversing, or modifying the ruling at issue. In each of these five cases, the Board issued a grant-for-study order. The Petitioners’ grant-for-study orders arose in different situations with different timelines. The cases are different but the Board’s orders were exactly the same. The uniform language of these orders reveals a standard form and not particularized analyses. The Board explained its grant-for-study procedure. It generally tries to identify significant cases or those requiring en banc review, and cases involving complicated or novel issues. It was able to trace the history of this practice to the 1950’s; an earlier origin existed but is lost in time. The Board surmised the grant-for-study procedure "evolved naturally" from 1913 statutes that allowed the Industrial Accident Commission (a precursor to the Board) either to grant or to deny rehearing and thereafter to issue a decision after rehearing. According to the results of a public records request that Petitioners served on the Board, as of November 2, 2021, there were 543 workers’ compensation cases awaiting a final decision in which the Board had issued a grant-for-study order between October 1, 2018 and October 1, 2021. The time between the filing of the grant-for-study orders and the Board’s final decisions ranged from five to 21 months. The Court of Appeal issue a writ of mandate requiring the Board to cease its grant-for-study procedure and to comply with the statute when granting reconsideration in the published case of Earley v. Workers' Comp. Appeals Bd. B318842 (August 2023). Labor Code section 5908.5 requires the Board to explain its reasons for granting reconsideration and to identify the evidence supporting its decision. The Court simply said that the "statute is clear. The Board must obey it." At oral argument, the Board assured the Court of Appeal that it carefully reviews the cases in which it decides to issue a grant-for-study order. A careful review is not enough. Section 5908.5 requires the Board to go a step further and to explain in its order granting reconsideration why it made the decision to grant reconsideration based upon the evidence in the particular case. However the Court of Appeal noted that "The Board’s grant-for-study orders in these cases fell short. These orders gave no reason for granting reconsideration other than a boilerplate statement that further study is necessary 'based upon our initial review of the record.' A rubber stamp could have authored these statements." "The Board does not claim that its standard grant-for-study order complies with section 5908.5. Rather, its defense of the grant-for-study procedure focuses on the long tenure of the procedure and the claimed impossibility of issuing a reasoned order in all cases. But a long-standing and incorrect procedure remains incorrect." "The Board must comply with section 5908.5 when it orders reconsideration. That is, the Board must state in detail the reasons for its decision and the evidence supporting it. Those reasons must be based on the grounds identified in section 5903. The Board need not, however, issue a final order within 60 days. The review necessary to support a decision to grant a petition for reconsideration within 60 days does not involve the same burden as the preparation of a final ruling. The Board must engage in the analysis necessary to permit a reasoned decision as to whether reconsideration is warranted based upon the factors identified in section 5903 and the evidence in the particular case. The Board then can decide whether to affirm, to modify, or to vacate the order at issue after further consideration and a more thorough review of the record." Petitioners met the statutory requirements for an award of attorney fees under Code of Civil Procedure section 1021.5. However the Court of Appeal reduced the requested $221,554.50 in fees by one half because Petitioners’ success was only partial. "Petitioners successfully challenged the lawfulness of the Board’s current grant-for-study practice, resulting in an order that will require the Board to comply with section 5908.5 when it grants reconsideration. They did not achieve their aim of requiring the Board to issue final rulings on petitions for reconsideration within 60 days." The Court of Appeal also awarded Petitioners their out-of-pocket appellate costs, which they identify as $7,891.63 ...

Domino’s sells ingredients used to make pizzas to its franchisees. As relevant to this case, Domino’s buys those ingredients from suppliers outside of California, and they are then delivered to Domino’s Southern California Supply Chain Center. At the Supply Center, Domino’s employees reapportion, weigh, and package the relevant ingredients for delivery to local franchisees but do not otherwise alter them. The plaintiff drivers ("D&S drivers"), employees of Domino’s, then deliver the ingredients in response to orders from Domino’s California franchisees. Edmond Carmona and two other "D&S drivers filed a putative class action against their employer, Domino’s Pizza in 2020, alleging various violations of California labor law. Each plaintiff’s agreement with Domino’s requires arbitration of "any claim, dispute, and/or controversy" between them. But the federal district court denied Domino’s motion to compel arbitration. The 9th Circuit Court of Appeals previously affirmed the district court’s denial of Domino’s motion to compel arbitration, holding that because the drivers were a "class of workers engaged in foreign or interstate commerce," their claims were exempt from the Federal Arbitration Act by 9 U.S.C. § 1. But the U.S. Supreme Court granted Domino's Petition for Certiorari, vacated the 9th Circuit decision, and remanded the case for reconsideration in light of Southwest Airlines Co. v. Saxon, 142 S. Ct. 1783 (2022). After remand from the Supreme Court, the 9th Circuit Court of Appeals again reaffirmed the trial court's denial of Domino's arbitration petition, and distinguished the application of the Southwest decision from the Domino case in its published decision of Carmona v Domino's Pizza - 21-55009 (July 2023). In Saxon the Supreme Court used a fact-specific test to determine if a worker is exempt from the FAA under 9 U.S.C. § 1. This test should be focused on "the actual work that the members of the class . . . typically carry out" in that business rather than simply the employer’s business. In Saxon the Supreme Court held that an employee who "frequently loads and unloads cargo on and off airplanes that travel in interstate commerce" was engaged in interstate commerce. Id. at 1793. The critical question is whether the workers are actively "engaged in transportation" of goods in interstate commerce and play a "direct and necessary role in the free flow of goods across borders." In finding that the cargo workers met this description, the Court specifically rejected Southwest’s argument that the cargo workers must themselves cross state lines to be engaged in interstate commerce. However the 9th Circuit pointed out that the Saxon decision did not address the question in the Domino's case. Rather, the Saxon Court expressly pretermitted whether "last leg" drivers like the D&S drivers in this case qualified for the exemption. The decision after remand in the Domino's case squarely rested upon the 9th Circuit reading of Rittmann v. Amazon.com, Inc., 971 F.3d 904 (9th Cir. 2020), "a case whose continued validity Saxon expressly declined to address." Rittmann confronted whether delivery drivers who transported goods from Amazon warehouses to in-state consumers were exempt from the FAA under § 1, and concluded that, because the Amazon goods shipped in interstate commerce were not transformed or altered at the warehouses, the entire journey represented one continuous stream of commerce. Here in the Domino's case the issue is whether the D&S drivers operate in a single, unbroken stream of interstate commerce that renders interstate commerce a central part of their job description. The pause in the journey of the goods at the warehouse alone does not remove them from the stream of interstate commerce. "Because the goods in this case were inevitably destined from the outset of the interstate journey for Domino’s franchisees, it matters not that they briefly paused that journey at the Supply Center." ...

A new California Workers’ Compensation Institute (CWCI) review of the Independent Medical Review (IMR) process shows that after hitting an all-time low high in 2022, the number of IMR decision letters rose 4.1% in the first six months of 2023 compared to the first half of 2022. However the number of letters and individual decisions remained below pre-pandemic levels. CWCI’s review encompassed more than 1.3 million IMR decision letters issued from 2015 through June 2023 in response to applications submitted to the state after a Utilization Review (UR) physician modified or denied a workers’ comp medical service request. As in prior reviews, Institute analysts tallied the number of letters issued each quarter based on the letter date; determined the distribution and uphold rates by medical service category for the disputed treatment requests, as well as the distribution and outcomes of pharmaceutical IMRs by major therapeutic drug group; and calculated the percentage of IMRs associated with high-volume medical providers. The data show that total IMR volume trended down for four consecutive years (2019 through 2022), as the number of work injury claims fell during the pandemic and pharmaceutical disputes declined after the state adopted the evidence-based Medical Treatment Utilization Schedule (MTUS) Prescription Drug Formulary and Pain Management and Opioid Guidelines. After climbing to a record 184,735 letters in 2018, IMR letter volume declined 31.1% over the next four years, falling to 127,215 letters in 2022. While IMR decisions were down across all medical service categories, the addition of the Pain Management and Opioid Guidelines into the MTUS in late 2017 and the implementation of the MTUS Formulary in January 2018 had a huge effect as prescription drug disputes fell from 47.3% of all IMRs in 2017 to 33.3% in 2022, while the initial data from 2023 show prescription drug disputes fell to 32.6% of the IMRs in of the first half of this year. From 2018 through June of this year, opioids’ share of the pharmaceutical IMRs has dropped from nearly a third to less than a quarter of all prescription drug IMRs. With prescription drugs representing a smaller share of the IMR disputes, there has been a shift in the distribution of services submitted for IMR since 2018, with the biggest percentage increases noted in physical therapy, which jumped from 10.3% to 13.4% of the IMRs; injections, which increased from 9.0% to 12.1%; and durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), which rose from 7.1% to 8.9% of the IMRs over the past 5-1/2 years. As in previous reviews, the latest data show that a small number of physicians continue to drive much of the IMR activity, with the top 1% of requesting physicians (80 doctors) accounting for 40.3% of the disputed service requests that underwent IMR in the 12 months ending on June 30 of this year. The top 10 individual physicians alone accounted for 11.6% of the disputed requests, and notably, 9 of the 10 individual providers with the highest number of IMR requests a year earlier were still on the top 10 list in the latest review. IMR outcomes remained fairly stable, with IMR physicians upholding UR doctors’ modifications or denials 89.2% of the time in the first half of 2023 versus 91.1% of the time in 2022. The 2023 uphold rates by type of service request ranged from 75.7% for evaluation/management services to 92.9% for acupuncture. CWCI members and subscribers will find a more detailed summary of IMR experience through June 2023 in Bulletin 23-11 at www.cwci.org, and Institute members can also access updated IMR slides under the Research tab ...

U.S. Senators Susan Collins (R-ME), Amy Klobuchar (D-MN), Jacky Rosen (D-NV), and Thom Tillis (R-NC) introduced bipartisan legislation to build the healthcare workforce in rural and medically underserved areas. The Conrad State 30 and Physician Access Reauthorization Act, cosponsored by Senator Angus King (I-ME), would allow international doctors to remain in the U.S. upon completing their residency under the condition that they practice in areas experiencing doctor shortages. The legislation is endorsed by the American Medical Association, the American Hospital Association, the Federation of American Hospitals, the National Rural Health Association, the Niskanen Center, the American Academy of Neurology, and the Public Affairs Alliance of Iranian Americans. The Conrad State 30 and Physician Access Reauthorization Act extends the Conrad 30 program for three years, improves the process for obtaining a visa, and allows for the program to be expanded beyond 30 slots if certain thresholds are met. The bill also provides worker protections to prevent doctors from being mistreated. A version of the bill was included as an amendment to the comprehensive immigration bill that passed the Senate in 2013. The Conrad 30 Waiver program allows states to waive the two-year home residency requirement for J-1 visa holders who agree to practice medicine in an underserved area for at least three years. Under the bill, the number of waivers that a state can obtain each year would be increased from 30 to 35, and the program would be extended for three years. "As we work to address medical workforce shortages, it’s critical that we make sure talented doctors trained and educated here in the U.S. can remain in our country," said Senator Klobuchar. "The Conrad 30 program has brought nearly 20,000 physicians to underserved areas, filling a critical need for quality health care in our rural communities. Our bipartisan bill to reauthorize this program would encourage doctors to use their talents and training in underserved communities, improving health care for families across the nation and boosting our rural medical workforce." The bill would also make a number of other changes to the Conrad 30 Waiver program, including: - - Allowing alien physicians to be employed at an academic medical center to meet the program's employment requirements if the alien's work is in the public interest, even if the medical center is not in an underserved area. - - Requiring employment contracts for alien physicians under the Conrad program to contain certain information, such as the maximum number of on-call hours per week the physician shall have to work. - - Allowing states to use waivers to recruit and retain physicians who have already practiced in underserved areas for at least three years. The bill has not yet been passed by the Senate, but it is expected to be considered in the coming months ...

Nursing turnover continues to be a substantial challenge for healthcare organizations as the nursing shortage remains high nationwide, and in California, with no particular solution on the horizon. A study from Nursing Solutions Inc. (NSI) showed that actual reported hospital and staff RN turnover increased from 18 percent in fiscal year 2020 to 27 percent in fiscal year 2021; the same March 2022 study reported that the workforce lost about 2.5 percent of RNs in 2021. In the latest NSI report (March 2023), turnover reduced to 23 percent in fiscal year 2022 but still remains elevated compared with prepandemic levels. A Health Affairs study published in April 2022 found that the RN workforce fell by about 100,000 by the end of 2021, which is a "far greater drop than ever observed over the past four decades." This decline was particularly pronounced among midtenure nurses (aged 35 to 49). Career satisfaction, intention to leave jobs, and mental health and wellbeing issues among registered nurses have gotten significantly worse since the midst of the COVID-19 pandemic, according to the AMN Healthcare 2023 Survey of Registered Nurses. The AMN Healthcare 2023 Survey of Registered Nurses, based on responses from more than 18,000 nurses in January 2023, found that career satisfaction dropped by 10 percentage points since the middle of the pandemic in 2021. In addition, the likelihood of encouraging others to become a nurse declined 14 points since 2021. So this data begs the question about possible solutions. In 2022, the US Department of Labor budgeted $80 million to encourage not-for-profit organizations, educational institutions, and tribal organizations to apply for grants of up to $6 million each to train current and former nurses to become nursing educators and frontline healthcare workers to train for nursing careers. At the local level, CalMatters reports that the California Legislature is looking at several ideas to address the nursing shortage by bringing more early-career nurses into the field. But so far, the groups with most to gain - or lose - are at odds over how to solve the staffing problems afflicting California’s health care workforce. Labor organizations and hospitals want nursing schools to prioritize certain applicants for admission, such as people who already have experience in the industry. But the schools say that won’t help them graduate more nurses. They need more faculty and more hands-on training opportunities to increase class sizes. Hospitals and unions say they don’t have much time to waste. Estimates show California faces a shortage of about 36,000 licensed nurses, according to the UC San Francisco Health Workforce Research Center on Long-Term Care. Labor advocates say the nursing shortage creates a vicious cycle. The nurses on shift wind up doing more work. They get burned out and flee the industry, worsening the problem. Service Employees International Union (SEIU) and the United Nurses Associations of California/Union of Health Care Professionals turned their attention to the state’s community college system, where graduates can earn degrees to become nursing assistants, licensed vocational nurses or registered nurses. Both groups say community colleges offer the most affordable and efficient way to earn a nursing degree. But community college and some university nursing school leaders contend they cannot boost the number of graduates. Nursing programs are full, they say, and the proposals do nothing to expand the number of admission slots. About 14,000 new students enrolled in nursing programs during the 2020-21 school year, according to the Board of Registered Nursing’s annual school report. That’s about 1,000 fewer students than the previous two years due to smaller class sizes, but schools across the state received more than 55,000 applications, a 10-year record. United Nurses Associations of California/United Health Care Professionals lobbied for a $300 million investment over five years to double the state’s nursing school capacity. It was included in the state budget Gov. Gavin Newsom signed earlier this summer. The details of how the money will be spent have not been decided ...

Jimmy and Ashley Collins, the husband-and-wife owners of a Tennessee medical practice have pleaded guilty to charges that they used Marines and sailors in San Diego County as pawns in a nearly $66 million medical insurance scheme. They are the last members of the major conspiracy to plead guilty. The married couple living in Birchwood, admitting that they worked with others to recruit TRICARE beneficiaries who were willing to sign up to receive expensive compounded medications, even though the beneficiaries did not really need the medications. The beneficiaries’ information was sent to Choice MD, a Tennessee medical clinic co-owned and operated by the Collinses. Doctors and medical professionals employed by the Collinses at Choice MD, including Dr. Susan Vergot, Dr. Carl Lindblad, and nurse practitioner Candace Craven, then wrote prescriptions for the TRICARE beneficiaries, despite never conducting a medical review or examination of the patients in person. Once signed by the doctors, these prescriptions were not given to the straw beneficiaries, but sent directly to The Medicine Shoppe, a pharmacy in Bountiful, Utah, which filled the prescriptions and received massive reimbursement from TRICARE. Between December 2014 and May 9, 2015 - the day that TRICARE stopped reimbursing for compounded medications - the doctors working for the Collinses at Choice MD authorized 4,442 prescriptions and billed TRICARE $65,679,512 for these prescriptions. The owners of The Medicine Shoppe then paid kickbacks to the Collinses based on a percentage of the TRICARE reimbursement paid for the prescriptions referred by the Collinses’ recruiter network. Between February and July 2015, these kickback payments to the Collinses totaled at least $45.7 million dollars. The Collinses, in turn, paid kickbacks to the recruiters working as part of their network, including defendants Josh Morgan, Kyle Adams, and Daniel Castro, among others. The United States has seized property and items purchased by the Collinses and others with the proceeds of the scheme. Included among these items is an 82-foot yacht; multiple luxury vehicles, including two Aston-Martins; a multimillion-dollar investment annuity; dozens of pieces of farm equipment and tractor-trailer trucks; and three pieces of Tennessee real estate. The Collinses are the last members of the conspiracy to plead guilty. The doctors and nurse practitioner who prescribed these unnecessary prescriptions, the corporate owner of the pharmacy that filled these unneeded prescriptions, and the patient recruiters have all pleaded guilty for their roles in the conspiracy to commit healthcare fraud and admitted their roles in this fraudulent scheme. Jimmy and Ashley Collins are scheduled to be sentenced on October 27 at 9 a.m. before U.S. District Judge Janis L. Sammartino. The two doctors, Susan Vergot and Carl Lindblad, were previously sentenced to 24 and 28 months in custody, respectively. in a San Diego federal court for participating in the health care fraud scheme ...

The new 93 page working paper - Temperature, Workplace Safety, and Labor Market Inequality - by researchers from the University of California, Los Angeles and Stanford University documents, for the first time, the growing safety risks of excessive heat for U.S. workers in occupations not just where the work is mostly outside but also indoors. The researchers examined 11,146,912 confidential records of workplace injuries in California from the Department of Workers’ Compensation (DWC) over the period 2001 to 2018 combined with zip code level information on daily temperature from the same period. The data also included the medically determined cause (e.g. fall), type (e.g. strain), and body parts affected (e.g. knee) by the incident, as well as some limited demographic information including age and gender for each claim. They found that hotter temperature significantly increases the likelihood of injury on the job. A day with high temperatures between 85 and 90 leads to a 5 to 7 percent increase in same-day injury risk, relative to a day in the 60’s. A day above 100 leads to a 10 to 15 percent increase. Causal identification relies on the premise that idiosyncratic variation in daily temperature within a given zip code-month is plausibly exogenous, and that the resulting effect on injuries is not driven by potential endogenous changes in labor inputs. Higher temperatures also increase injuries in some industries where work typically occurs indoors. In manufacturing, for instance, a day with highs above 95 increases injury risk by approximately 7 percent relative to a day in the low 60’s. In wholesale, the effect is nearly 10 percent. They also found that claims for many injuries not typically considered heat-related rise on hotter days. These include injuries caused by falling from heights, being struck by a moving vehicle, or mishandling dangerous machinery. The increase in injuries affects a wide range of body parts, suggesting that the mechanisms may not be limited to heat-illnesses such as heat stroke or heat syncope. The risks are "substantially larger for men versus women; for younger versus older workers; and for workers at the lower end of the income distribution." "These are previously undocumented facts with possibly significant policy implications, given the nearly exclusive attention to date on outdoor workers and heat illnesses: i.e. incidents that are medically coded as due to heat exposure." The researcher estimated that hotter temperature has caused approximately 360,000 additional injuries in California over the period 2001-2018, or roughly 20,000 per year relative to a hypothetical benchmark in which all workers experience only optimal temperatures. "For perspective, this is roughly eleven times the number of workplace concussions, and at least nineteen times the annual number of workplace injuries the worker compensation microdata records as caused by extreme temperature." They estimate the socioeconomic costs of these injuries are on the order of $525 million to $875 million per year, given the costs of healthcare, lost wages and productivity, and other knock-on costs such as work disruptions and potential permanent disability. However researchers also found evidence of significant adaptation potential, as they noted that the effect of temperature on injuries falls significantly during the study period. For instance, the effect of a day above 90 falls by roughly a third between 2000 and 2018, and the effect of days above 100 is statistically indistinguishable from zero after 2005. The temporal profile of heat’s effects on injuries coincides with the introduction of what was at the time the nation’s first heat safety mandate, the California Heat Illness Prevention Standard (Q3 2005), which applied only to outdoor workplaces. "While we remain agnostic to the source of the decline in heat-related injuries, our findings are consistent more broadly with the possibility of adaptation using existing technologies." A new AB 1643 - California Heat Study: Advisory Committee is set to use this data as part of a roadmap to tackle hot workplace issues. The group of state agency staffers and scholars will examine persistent problems with underreported heat-related illness and injuries, as well as gaps in data collection and the financial toll on workers and businesses when temperatures rise and production falls ...

U.S. workers compensation insurers were able to underwrite profitably between 2019 and 2022 even as significant changes occurred in the nation’s workforce due to the pandemic, according to a new report by the Insurance Information Institute. "Overall, we see a healthy and strong workers compensation system," said NCCI’s chief actuary, Donna Glenn, FCAS, MAAA. "Premiums written have returned to pre-pandemic levels, and claims frequency has resumed a long-term average decline." Workers comp net written premiums improved in 2022, with an 11.2 percent increase, compared with 8.4 percent for the overall industry. Since 2014, workers compensation insurers cumulatively saw a net combined ratio of below 100 and, since 2017, that figure has consistently stayed below 90, with a 2022 net combined ratio of 87.4 for workers compensation insurers (when including state funds, in comparison to 84.0 for private carriers only). U.S. auto, home, and business insurers, across all insurance lines, had a net combined ratio last year of 102.4, according to Triple-I’s Issues Brief. "Commercial lines achieved lower net combined ratios than personal lines in both 2021 and 2022, and we forecast that to continue through at least 2025," said Dale Porfilio, FCAS, MAAA, chief insurance officer, Triple-I. "Workers comp had the lowest combined ratio among major product lines in 2021 and 2022, resulting from many years of deliberate efforts by insurance carriers and their policyholders to improve workplace safety." Claim frequency is the main cost driver in workers comp. Due to improved workplace safety and increased use of automation, frequency has been low - averaging 3 percent declines annually over the past 20 years. After an 8.3 percent decline in 2020, frequency rebounded by exactly the same amount in 2021, reflecting the impact of the pandemic and the subsequent recovery. From 2019 to 2021, claim frequency fell slightly (0.7 percent), reflecting rises in the Manufacturing (5.2 percent) and Miscellaneous (6.7 percent) industry groups, offset by a 12.1 percent drop in the Office and Clerical group. Manufacturing and Miscellaneous - which includes package delivery, warehousing, and transportation - are groups that have seen a great deal of new hiring, so it’s possible these increases reflect accidents related to employee inexperience and insufficient training during the pandemic. The drop in Office and Clerical claim frequency almost certainly is due to the pandemicdriven rise in remote work. NCCI estimates that claim frequency for 2022 is consistent with the long-term downward trend. Unlike claim frequency, medical and indemnity severity have increased about 60 percent over the past two decades. In 2022, indemnity severity rose 6 percent, and medical severity was up 5 percent. Workers compensation has benefited from a generally strong economy in recent years, most notably due to the growth in payrolls, the Issues Brief states. Private employment surpassed its pre-pandemic level in 2022 and employment growth remains faster than pre-pandemic norms, according to the U.S. Department of Labor’s Bureau of Labor Statistics. Improved workplace safety, coupled with more employers allowing remote work arrangements, have combined to drive down the number of workers compensation insurance claims filed annually since 2021, Triple-I found. Moreover, many states have medical fee schedules, reducing medical inflation as insurers and medical providers set fixed prices for the services and products needed by injured workers ...

Brian Hill, 64, and Leslie Hill, 68, a husband and wife from Bakersfield, have been charged with multiple felony counts of insurance fraud and conspiracy after a Department of Insurance investigation found the couple under-reported over $4 million in employee payroll for the construction company they owned. The Department began an investigation into Brian Hill Construction, Inc., owned by the Hills, after receiving information that the company paid an employee with a combination of check and cash, and that the cash pay was not reported to the company’s workers’ compensation carrier. Between July 2017 and October 2019 Brian Hill Construction Inc. held a workers’ compensation insurance policy through State Compensation Insurance Fund and between October 2019 and October 2020 held a workers’ compensation insurance policy through Benchmark Insurance. An investigation into Brian Hill Construction, Inc., revealed the company reported approximately $135,667 in employee payroll between July 2017 and October 2019 to State Compensation Insurance Fund. However, an audit by the Department revealed the business actually had over $3.6 million in employee payroll for the same time period. The investigation also revealed Brian Hill Construction, Inc. reported approximately $9,140 in employee payroll between October 2019 and June 2020 to Benchmark Insurance, but an additional Department audit revealed the company actually had over $500,000 in employee payroll for the same time period. Over the course of three years, Brian and Leslie Hill failed to report over $4,025,250 in employee payroll to their insurance carriers. The hiding of employee payroll resulted in the illegal reduction of workers’ compensation insurance premiums paid and $2,542,365 in premium owed to the insurance companies. The investigation also discovered one employee of Brian Hill Construction Inc. was injured on the job and sent to a local hospital where they received minimal medical treatment. By law the employer was required to file a workers’ compensation claim, but the Hills circumvented the workers’ compensation process by paying the medical facility directly and eliminating benefits the injured worker may have been entitled to. Brian Hill was arraigned yesterday and Leslie Hill is scheduled to be arraigned on Thursday, July 27, 2023. The Kern County District Attorney’s Office is prosecuting this case ...