Surgical volume, the frequency with which surgeons and surgery centers perform complex surgical procedures, is clearly understood as a key determinant of healthcare quality. The Agency for Healthcare Research and Quality (AHRQ) includes "how many times have you done this procedure" as one of the 10 questions patients should ask their doctor. Consumer Reports similarly recommends patients inquire about surgical volume when choosing a physician. Prior studies concluded that providers with higher surgical volume are expected to have fewer medical errors and defects, better acute outcomes overall, and other post-acute benefits following the surgical procedure. However, existing studies have only been able to leverage relatively small samples of data for specific surgical procedures. In this new paper, Clarify Health used a large, observational sample of national health insurance claims for patients undergoing hip and knee replacement surgeries performed in 2021. Hip and knee surgeries are the most common elective orthopedic surgical procedures where provider choice is possible for patients. It found that low provider surgical volume negatively impacts post-acute outcomes across inpatient and outpatient settings, even after it controlled for patient characteristics and other factors. And it found that treatment by higher-volume surgeons is particularly important for more clinically complex patients. Clarify Health analyzed two of the most common types of surgical episodes, total hip arthroplasty (THA), commonly known as hip replacements, and total knee arthroplasty (TKA), commonly known as knee replacements. For both hip and knee replacements, higher provider surgical volume is associated with better outcomes across multiple dimensions and multiple care settings, even after adjusting for differences in patient characteristics. Major findings included: - - Lower rates of post-acute inpatient readmission at both 7 and 60 days - - Lower rates of revision surgeries - - Lower rates of post-surgical stay orthopedic specialist visits, emergency department visits, and inpatient days - - Lower episode-level and orthopedic-specific standard dollar amounts When Clarify Health stratified hip and knee replacements by place of service (inpatient (IP), outpatient (OP), and ambulatory surgical center (ASC) settings), volume-outcome relationships largely remain. - - Post-surgical ED utilization rates are approximately 21% lower for high-volume surgeons in an IP setting compared to low-volume surgeons, 35% lower in an OP setting, and 34% lower in an ASC setting - - Readmission rates are approximately 32% lower for high-volume surgeons in an IP setting compared to low-volume surgeons, 47% lower in an OP setting, and 74% lower in an ASC setting - - Revision surgery rates are approximately 7% lower for high-volume surgeons in an IP setting compared to low-volume surgeons, 40% lower in an OP setting, and 5% higher in an ASC setting Its findings imply clinical benefits for patients who undergo hip and knee replacement surgeries with high-volume surgeons, even after adjusting for patient and other characteristics. Payers and health systems have begun to concentrate volume of surgeries and other procedures at specific sites within their networks, often referring to these locations as "centers of excellence" (COEs). For orthopedic surgeries, COEs are often implemented in OP or ASC settings. COEs have higher relative volume, are actively educating care teams about best practices and current medical research, often obtain special accreditations from national organizations and consistently generate improved outcomes versus lower-volume sites of care ...

In a landmark NLRB decision, the Board broadly expanded the monetary award that may be given to prevailing workers in unfair labor practice disputes. Prior to the new Thryv, Inc. and International Brotherhood of Electrical Workers, Local 1269 - (20-CA-251105) December 2022 decision, monetary damages had been limited to "back pay." This limit has been expanded by the NLRB to award monetary damages to include "make whole" relief. To make the employee "whole,"examples of additional forms of relief may include "consequential damages" such as increases in insurance premiums, co-pays, coinsurance, deductibles, and other out-of-pocket expenses, extra medical expenses, expenses incurred in connection with a search for other work, credit card debt interest and late fees on credit card debt, penalties suffered by employees who are forced to make early withdrawals from retirement accounts; and increased transportation or childcare costs. In this case the California employer, Thryv, Inc., operates a marketing agency engaged in the business of selling Yellow Pages advertising, as well its eponymous product "Thryv," an application for small businesses. While all parties agree that Yellow Pages advertising has increasingly declined since the advent of the Internet, Thryv still generates annual revenues in excess of $1.1 billion, with print and electronic advertising accounting for 88 percent of that amount. The Union represents a unit of employees that includes the Thryv outside sales force, which in turn consists of three subsets of "premise" representatives, so named because they go to customer premises to solicit advertising sales. Around mid-July of 2019, Thryv began implementing its proposal to lay off all of its New Business Advisors in the Northern California Region. The Assistant Vice President of Labor Relations emailed the Union stating that Thryv "will administer a force adjustment" and lay off the six New Business Advisors in the Northern California Region effective September 20. The email stated, "[i]f the Union desires to exercise its right to meet and discuss the Company’s plan within the 30-day period, please contact [Labor Relations Manager] Ralph Vitales to arrange such discussions." The Union and Thryv met several times to discuss the layoff of the New Business Advisors, but failed to arrive at an agreement. And Thryv then unilaterally implemented its layoff decision just nine days after the first bargaining session. While the trial judge did not find this to be unlawful, the NLRB reversed, and found that Thryv "violated Section 8(a)(5) and (1) by unilaterally laying off six New Business Advisors" without responding to the union request for additional documentation it needed to evaluate the offers made by Thryv. In concluding the appeal, the NLRB next turned to the issue of "the proper remedy." It went on to conclude "that it is necessary for the Board to revisit and clarify our existing practice of ordering relief that ensures affected employees are made whole for the consequences of a respondent’s unlawful conduct." Previously, the Board had issued a Notice and Invitation to File Briefs, which sought briefing on whether the Board should include, as part of its make-whole remedy, "relief for consequential damages." In it's amicus brief, the U.S. Chamber of Commerce pointed out that " By its terms, Section 10(c) identifies "back pay" as the only monetary relief that the Board can award to employees who suffer harm from an unfair labor practice. On finding that a person has committed an unfair labor practice, the Board "shall issue . . . an order requiring such person to cease and desist from such unfair labor practice, and to take such affirmative action including reinstatement of employees with or without back pay, as will effectuate the policies of [the Act]" 29 U.S.C. § 160(c). That language has been present e unchanged since the Wagner Act’s adoption in 1935." Despite arguments by amicus to the contrary, the Board concluded that "in all cases in which our standard remedy would include an order for make- whole relief, the Board will expressly order that the respondent compensate affected employees for all direct or foreseeable pecuniary harms suffered as a result of the respondent’s unfair labor practice." In rejecting the argument of the Chamber of Commerce (and several other amicus briefs) the Board supported their ruling by noting "The Supreme Court has held that our authority to fashion such a remedy "is a broad discretionary one." NLRB v. J. H. Rutter-Rex Manufacturing, 396 U.S. 258, 262-63 (1969), and several other case decisions. "Make-whole relief" is more fully realized when it consistently compensates affected employees for all direct or foreseeable pecuniary harms that result from a respondent’s unfair labor practice. Where, as here, employees have been laid off in violation of the Act or been the targets of other unfair labor practices, they may be forced to incur significant financial costs, such as out-of-pocket medical expenses, credit card debt, or other costs simply in order to make ends meet. We cannot fairly say that employees have been made whole until they are fully compensated for these kinds of pecuniary harms if the harms were direct or foreseeable consequences of the respondent’s unfair labor practice. The Board has a "statutory obligation to provide meaningful, make-whole relief for losses incurred by discriminatees . . . . " ...

Claims administrators are reminded that the Annual Report of Inventory (ARI) must be submitted in early 2023 for claims reported in calendar year 2022. 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 2022 can be found on the DWC website. Questions about submission of the ARI or the annual report of adjusting locations may be directed to the Audit Unit:: State of California Department of Industrial Relations Division of Workers’ Compensation - Audit Unit 160 Promenade Circle, Suite #340 Sacramento, CA 95834-2962 Email: DWCAuditUnit@dir.ca.gov, FAX 916.928.3183 or phone 916.928.3180 ...

KCRA-TV is a television station in Sacramento,affiliated with NBC. It is owned by Hearst Television. For months, KCRA 3 Investigates producer Dave Manoucheri and Photographer Victor Nieto traveled across California and interviewed people in other states as part of an unprecedented documentary project that revealed a wave of failures at California's Employment Development Department, or EDD. With nearly 15 hours of interviews from 17 people - and dozens of hours of news footage - the documentary tells the story of what is being called the worst fraud in California history. And the documentary seems to have triggered a federal investigation of the EDD. On Friday, James Comer, head of the Committee on Oversight and Accountability sent two letters, one to Nancy Farias, head of the EDD, and one to Martin Walsh, head of the U.S. Department of Labor. The letters both cite KCRA and the documentary "Easy Money: Fraud Fortune and Failures" in the need for an investigation of fraud against the California unemployment system. From 2020 onward, the department had seen massive numbers of fraudulent applications for unemployment and for the CARES Act era program "Pandemic Unemployment Assistance" (PUA). That program would allow freelancers and gig workers to apply for lost wages, something they had never been eligible for before. During the pandemic, EDD had a massive number of both legitimate and illegitimate applications for money. In an effort to get money out the door, the leadership at EDD and in the administration lifted fraud controls and allowed people to back-date their claims, assuming that they could catch fraud on the back end. However, EDD had no back-end fraud prevention mechanisms. The letter quotes the head of California Labor and Workforce at the time, Julie Su, as saying "there is no sugar coating the reality, California did not have sufficient security measures in place to prevent this level of fraud," something she said during a press call highlighted by Easy Money. Su would go on to become a deputy secretary of labor in the Biden administration. Comer, a Republican Congressman from Kentucky, took over the Committee on Oversight and Accountability with the changeover in the House of Representatives, now controlled by a Republican majority."Despite the unexpected and unprecedented nature of the coronavirus pandemic, California’s problems cannot be blamed on COVID alone," Comer wrote in the letter to Nancy Farias As part of their investigation, the committee is asking for: "1. All processes and procedures related to the disbursement of unemployment insurance benefits during the pandemic, including policies and procedures intended to ensure payments are made to the proper individual, and to ensure that the individual is a qualified recipient of unemployment insurance; 2. All documents and communications between employees of the California EDD and employees of the U.S. Department of Labor regarding the state’s UI benefit program; 3. All documents and communications related to efforts to prevent payment of fraudulent UI claims; 4. All documents and communications related to efforts to recoup UI claims paid improperly; and 5. All documents and communications related to identifying the total number of improperly paid UI benefits and documents sufficient to show whether those funds remain in the United States or were transferred to entities outside the United States." They are asking for similar information from the U.S. Department of Labor. The documents are requested no later than Jan. 27. The committee is holding its hearing into the matter on Feb. 1 ...

A fingertip pressed against a phone’s camera lens can measure a heart rate. The microphone, kept by the bedside, can screen for sleep apnea. Even the speaker is being tapped, to monitor breathing using sonar technology. In the best of this new world, the data is conveyed remotely to a medical professional for the convenience and comfort of the patient or, in some cases, to support a clinician without the need for costly hardware. But using smartphones as diagnostic tools is a work in progress, experts say. Although doctors and their patients have found some real-world success in deploying the phone as a medical device, the overall potential remains unfulfilled and uncertain. Smartphones come packed with sensors capable of monitoring a patient’s vital signs. They can help assess people for concussions, watch for atrial fibrillation, and conduct mental health wellness checks, to name the uses of a few nascent applications. Companies and researchers eager to find medical applications for smartphone technology are tapping into modern phones’ built-in cameras and light sensors; microphones; accelerometers, which detect body movements; gyroscopes; and even speakers. The apps then use artificial intelligence software to analyze the collected sights and sounds to create an easy connection between patients and physicians. Earning potential and marketability are evidenced by the more than 350,000 digital health products available in app stores, according to a Grand View Research report. "It’s very hard to put devices into the patient home or in the hospital, but everybody is just walking around with a cellphone that has a network connection," said Dr. Andrew Gostine, CEO of the sensor network company Artisight. Most Americans own a smartphone, including more than 60% of people 65 and over, an increase from just 13% a decade ago, according the Pew Research Center. The covid-19 pandemic has also pushed people to become more comfortable with virtual care. Some of these products have sought FDA clearance to be marketed as a medical device. That way, if patients must pay to use the software, health insurers are more likely to cover at least part of the cost. Other products are designated as exempt from this regulatory process, placed in the same clinical classification as a Band-Aid. But how the agency handles AI and machine learning-based medical devices is still being adjusted to reflect software’s adaptive nature. Ensuring accuracy and clinical validation is crucial to securing buy-in from health care providers. And many tools still need fine-tuning, said Dr. Eugene Yang, a professor of medicine at the University of Washington. Currently, Yang is testing contactless measurement of blood pressure, heart rate, and oxygen saturation gleaned remotely via Zoom camera footage of a patient’s face. Big tech companies like Google have heavily invested in researching this kind of technology, catering to clinicians and in-home caregivers, as well as consumers. Currently, in the Google Fit app, users can check their heart rate by placing their finger on the rear-facing camera lens or track their breathing rate using the front-facing camera. "If you took the sensor out of the phone and out of a clinical device, they are probably the same thing," said Shwetak Patel, director of health technologies at Google and a professor of electrical and computer engineering at the University of Washington. Google’s research uses machine learning and computer vision, a field within AI based on information from visual inputs like videos or images. So instead of using a blood pressure cuff, for example, the algorithm can interpret slight visual changes to the body that serve as proxies and biosignals for a patient’s blood pressure, Patel said. Google is also investigating the effectiveness of the built-in microphone for detecting heartbeats and murmurs and using the camera to preserve eyesight by screening for diabetic eye disease, according to information the company published last year. The tech giant recently purchased Sound Life Sciences, a Seattle startup with an FDA-cleared sonar technology app. It uses a smart device’s speaker to bounce inaudible pulses off a patient’s body to identify movement and monitor breathing. Binah.ai, based in Israel, is another company using the smartphone camera to calculate vital signs. Its software looks at the region around the eyes, where the skin is a bit thinner, and analyzes the light reflecting off blood vessels back to the lens. The company is wrapping up a U.S. clinical trial and marketing its wellness app directly to insurers and other health companies, said company spokesperson Mona Popilian-Yona ...

Wendy Johnson was injured while employed by the Santa Ynez Valley Journal, who was insured by SCIF. Her case proceeded to trial in 2019.The WCJ issued a Findings & Award, finding Johnson was permanently totally disabled and allowing an attorney fee of 20%. SCIF sought reconsideration and the Appeals Board granted the petition for further study and the matter was referred to mediation. As a result of the mediation, the parties entered into a Compromise and Release in the total amount of $685,000.00. Paragraph 7 of the C&R provides that "The parties agree to settle the above claim(s) on account of the injury(ies) by the payment of the SUM OF: $685,000.00 The following amounts are to be deducted from the settlement amount: $25,300.00 for permanent disability advances through [June 26, 2013[;] $121,058.93, payable to WENDY THOMPSON FOR NON-SUBMIT MSA[;][and] $137,000.00 request as applicant’s attorney’s fee." The $137,000.00 attorney fee amounts to 20% of the settlement. Applicant and applicant’s attorney signed the C&R on October 12, 2022 and the attorney for defendant State Compensation Insurance Fund (SCIF) signed it on October 14, 2022. The Appeals Board rescinded the August 14, 2019 Findings of Fact and Award and remanded this matter to the WCJ for consideration of the C&R. The WCJ issued an Order Approving Compromise and Release on October 24, 2022, approving the settlement terms agreed to by the parties, including the attorney fee of $137,000.00. SCIF again filed a Petition for Reconsideration, arguing that the WCJ’s finding that an attorney’s fee of $137,000.00 is unreasonable and not supported by evidence. The WCAB denied reconsideration of the attorney fee award in the panel decision of Thompson v Santa Ynex Valley Journal - ADJ8004567 (January 2023). In its Opinion Denying Reconsideration, the panel noted that a stipulation between the parties need not be supported by substantial evidence citing County of Sacramento v. Workers’ Comp. Appeals Bd. (Weatherall) (2000) 77 Cal.App.4th 1114, 1121 [65 Cal.Comp.Cases 1])," A stipulation is an agreement between opposing counsel ... ordinarily entered into for the purpose of avoiding delay, trouble, or expense in the conduct of the action, and serves ‘to obviate need for proof or to narrow range of litigable issues in a legal proceeding.(Weatherall, supra, 77 Cal.App.4th at p. 1119.) Stipulations are designed to expedite trials and hearings and their use in workers’ compensation cases should be encouraged. (Robinson v. Workers’ Comp. Appeals Bd. (Robinson) (1987) 194 Cal.App.3d 784, 791 [52 Cal.Comp.Cases 419].) Stipulations are binding on the parties unless, on a showing of good cause, the parties are given permission to withdraw from their agreements. (Weatherall, supra, at p. 1121.) While the Appeals Board has the authority to reject parties’ stipulations, this "discretion does not validate capricious decisionmaking." (Weatherall, supra, 77 Cal.App.4th at p. 1119.) The panel concluded by stating: "Permitting a party to subsequently withdraw from an agreement because they have changed their mind endangers the finality of approved settlements and undermines transactional stability in the workers’ compensation system and risks discouraging future settlements. Defendant here has not even alleged grounds in its petition that could constitute good cause to set aside the C&R." ...

A vial of insulin can cost as little as $2 to manufacture. Yet at the pharmacy counter, people with diabetes often end up paying hundreds for the life-saving medicine. In the U.S., insulin is so expensive that many diabetics struggle to afford it even when covered by health plans, and are forced to ration their use - sometimes with deadly consequences. More than 3 million adults in California - over 10% of the state’s adult population - have been diagnosed with diabetes. The California Attorney General filed a lawsuit against the nation's largest insulin makers and pharmacy benefit managers (PBMs) for driving up the cost of the lifesaving drug through what he alleges is unlawful, unfair, and deceptive business practices in violation of California's Unfair Competition Law. The lawsuit alleges manufacturers Eli Lilly, Novo Nordisk, and Sanofi, and pharmacy benefit managers CVS Caremark, Express Scripts, and OptumRx, have leveraged their market power to overcharge patients. A 2021 report found that insulin costs roughly ten times more within the United States than outside it. The three manufacturers named in the lawsuit produce over 90% of the global insulin supply and the three PBMs administer pharmacy benefits for roughly 80% of prescription claims managed. The lawsuit argues that because competition is highly limited in both their markets, these six companies are able to keep aggressively hiking the list price of insulin at the expense of many patients. The lawsuit alleges that manufacturers and PBMs are complicit in overcharging for insulin. Manufacturers set the drug’s list price and PBMs then negotiate for rebates on behalf of health plans. Because rebates are based on a percentage of list price, manufacturers raise their list prices to provide the largest rebates they can offer PBMs. PBMs are often paid for their services with a portion of the rebate they have negotiated. This creates an incentive to negotiate a drug with a higher rebate, not necessarily the lowest price for consumers. As a result, the drug becomes unaffordable for uninsured or underinsured patients, who have to pay the full price of insulin. High list prices also make insulin unaffordable for other patients as well, including those with high deductible health plans or coverage gaps. And the California Attorney general is not going it alone. The California lawsuit comes on the heels of a similar case filed in December by Illinois Attorney General Kwame Raoul. In a 125-page fraud lawsuit filed in Cook County Circuit Court, the office accused Eli Lilly, CVS Pharmacy, Novo Nordisk and several other pharmaceutical companies of artificially inflating the cost of insulin by over 1,000% since the late 1990s. "Today, insulin has become the poster child for skyrocketing and inflated drug prices," the suit states.The complaint singles out Eli Lilly in particular, noting the price for a dose of its analog insulin Humalog rose by 1,527% between 1997 and 2018 ...

AMTCR, Inc., AMTCR Nevada, Inc., and AMTCR California, LLC have been collectively operating as a single employer and/or integrated enterprise in Nevada, Arizona, and California, and have common management and ownership, centralized control of labor operations, and interrelation operations. These three entities Collectively own, manage, and operate approximately twenty-two McDonald’s fast food restaurants in this tri-state region, and are collectively doing business as "McDonald’s." The 22 restaurants operate under the common ownership and management of President/Owner Abelardo "Abe" Martinez III. And they share common managers, such as Director of Operations Theresa Hernandez and Area Supervisor Ruben Benitez, who both oversee employees throughout the tri-state region. They share a common corporate headquarters and/or main office and human resources department for the entire tri-state region located in Kingman, Arizona. And the EEOC just announced that this major McDonald's franchisee has agreed to pay nearly $2 million to settle an EEOC sexual harassment lawsuit. Prior to filing the civil action, the EEOC investigated a charge of discrimination that had been filed with the Commission. Following the investigation, the Commission issued Letters of Determination to the employer, finding reasonable cause to believe that Title VII was violated and inviting them to join with the Commission in informal methods of conciliation to endeavor to eliminate the discriminatory practices and provide appropriate relief. But the Commission was unable to secure from Defendants a conciliation agreement acceptable to the Commission. Therefore, in September 2021, the U.S. Equal Employment Opportunity Commission filed a civil lawsuit against the companies in the United States District Court District of Nevada, charging them with sexual harassment and constructive discharge in stores/restaurants in Nevada, Arizona, and California. The EEOC alleged in general that the "sexual harassment included, but was not limited to, constant groping, grabbing, and rubbing of the arms, shoulders, thighs, and buttocks; offensive comments and gestures regarding male genitalia; sexual advances; and sexual ridicule, intimidation, and insults." And that due to the employer's failure to remedy the ongoing sexual harassment, "the Charging Party and many other adversely affected employees could no longer tolerate the hostile and abusive work environment and were subjected to constructive discharge." One of the several specific instances of misconduct listed in the Complaint involved a twenty-six-year-old female Shift Manager, and another by a twenty-one-year-old male Cook. Both were employed at Defendants’ McDonald’s store in Blythe, California. Both claimed to be sexually harassed by the at Defendants’ McDonald’s store in Blythe, California, the by same General Manager, and who was also the hiring manager at this McDonald’s store. This Blythe General Manager was in charge of receiving and reviewing job applications, interviewing applicants, and making hiring decisions. He was allegedly particularly fond of the young male applicants. After conducting interviews, The General Manager would message young male applicants via Facebook and send them sexually inappropriate messages and requests for dates. The General Manager admitted to Claimant 5 that he informed these male applicants via Facebook that if they refused to sexually engage with him and/or date him, he would not hire them. During 2017 to mid-2019, many employees complained to "Claimant 5" about the General Manager’s sexual comments and conduct. Claimant 5 would relay these employee complaints to upper management, but Defendants did nothing to stop the harassment. In July 2019, Claimant 5 felt compelled to compile a list of all the sexual harassment complaints that she had received. Claimant 5 submitted the list of complaints to upper management with a request for an investigation and remedial action. Later in July 2019, an employee meeting was held at the store where Defendants required employees were required to sign an agreement regarding sexual harassment. However, allegedly no other remedial action was taken. After the July 2019 employee meeting, Claimant 5 continued to receive complaints from employees about being subjected to sexually offensive comments by male managers and co-workers. These comments often related to co-workers’ body parts such as breast size. The company has agreed to pay $1,997,500 to resolve the sexual harassment lawsuit. And it has agreed to provide significant, franchise-wide injunctive relief aimed at preventing discrimination and harassment in the workplace. AMTCR has also agreed to retain an outside third-party EEO monitor who will conduct internal audits of AMTCR’s practices in handling harassment and retaliation complaints; establish a centralized tracking system for discrimination, harassment, and retaliation complaints; and ensure accountability and appropriate disciplinary action occur ...

The Mark Cuban Cost Plus Drug Company, a Public Benefit Corporation (PBC), aims to fundamentally change the way the pharmaceutical industry operates. As a public-benefit corporation, its social mission of improving public health is just as important as the bottom line. Cost Plus Drugs transparently charges a standard markup on every drug it sells. The costplusdrugs.com online pharmacy launched in January 2022 now carries over 1,000 prescription products, delivered by mail to thousands of happy customers every day. Cost Plus Drugs is working with health plans, managed-care organizations, pharmacy benefits managers (PBMs) and self-insured employers to bring these same savings to employer-sponsored benefit plans nationwide. RxPreferred Benefits claims it is transforming healthcare through transparent, pass-through Pharmacy Benefit Administration. In collaboration with self-funded employers and health plans, RxPreferred develops custom solutions that drive savings and promote healthcare accessibility for members with innovative strategies, technology, and data access. Headquartered in Nashville, TN, RxPreferred is privately-held and operates nationally, also offering a variety of pharmacy solutions including 340b Administration and PBM Services for Hospice, Long-Term Care, and Workers' Compensation. Cost Plus Drugs and RxPreferred have announced a new partnership, focused on improving healthcare access and lowering drug spend. With this venture, employers and their members utilizing RxPreferred for their pharmacy benefit will have access to all medications available through Cost Plus Drugs within their benefits package, with future plans to expand this offering along with local independent pharmacies. "Our partnership with RxPreferred is another step in the direction of bringing transparency to healthcare and lowering drug costs for individuals and families across the country.," said Mark Cuban. "We are excited to work with a like-minded company that aligns with our goals and puts improving access to affordable prescriptions first." Healthcare and prescription drug spend has continued to be a rising concern for both individuals and companies hosting their insurance benefits plan or plan sponsors. The pricing of drugs and schematics behind the industry are complex and traditionally been veiled from the end-consumer, leading to the need for transparency and control back in the hands of those ultimately paying for the drugs. "There is an education component for employers and employees needed to help people and their families access the appropriate medications at the best possible costs and live healthy lives.," says Jeff Malone, CEO of RxPreferred. "In an otherwise opaque industry, we're committed to bringing transparency to the prescription drug space, making this partnership with Mark Cuban Cost Plus Drug Company vital to our continued efforts in improving healthcare." With this partnership, RxPreferred and Mark Cuban Cost Plus Drug Company will bring together employer-sponsored benefits with the option to use Cost Plus Drugs as part of their plan, previously only offered to individuals outside of their insurance package. Cost Plus Drugs makes all drugs and pricing publicly available, giving everyone the opportunity to make informed decisions about their healthcare needs. RxPreferred started their efforts in transforming healthcare in 2011 with transparent custom pharmacy solutions and now work with employers nationwide to administer their pharmacy benefits plan. This partnership is the next iteration of strategic innovation it provides its' customers as part of an ever-evolving environment with the goals of sustainable prescription drug spend, improved member access, and transparency for employers and their members ...

The U.S. Bureau of Labor Statistics reported that there were 5,190 fatal work injuries recorded in the United States in 2021, an 8.9-percent increase from 4,764 in 2020. The fatal work injury rate was 3.6 fatalities per 100,000 full-time equivalent (FTE) workers, up from 3.4 per 100,000 FTE in 2020 and up from the 2019 pre-pandemic rate of 3.5. Key findings from the 2021 Census of Fatal Occupational Injuries - - The 3.6 fatal occupational injury rate in 2021 represents the highest annual rate since 2016. - - A worker died every 101 minutes from a work-related injury in 2021. - - The share of Black or African American workers fatally injured on the job reached an all time high in 2021, increasing from 11.4 percent of total fatalities in 2020 to 12.6 percent of total fatalities in 2021. Deaths for this group climbed to 653 in 2021 from 541 in 2020, a 20.7-percent increase. The fatality rate for this group increased from 3.5 in 2020 to 4.0 per 100,000 FTE workers in 2021. - - Suicides continued to trend down, decreasing to 236 in 2021 from 259 in 2020, an 8.9-percent decrease. - - Workers in transportation and material moving occupations experienced a series high of 1,523 fatal work injuries in 2021 and represent the occupational group with the highest number of fatalities. This is an increase of 18.8 percent from 2020. - - Transportation incidents remained the most frequent type of fatal event in 2021 with 1,982 fatal injuries, an increase of 11.5 percent from 2020. This major category accounted for 38.2 percent of all work related fatalities for 2021. Fatal event or exposure - - Despite experiencing an increase from 2020 to 2021, transportation incidents are still down 6.6 percent from 2019 when there were 2,122 fatalities. - - Fatalities due to violence and other injuries by persons or animals increased to 761 fatalities in 2021 from 705 fatalities in 2020 (7.9 percent). The largest subcategory, intentional injuries by person, increased 10.3 percent to 718 in 2021. - - Exposure to harmful substances or environments led to 798 worker fatalities in 2021, the highest figure since the series began in 2011. This major event category experienced the largest increase in fatalities in 2021, increasing 18.8 percent from 2020. Unintentional overdose from nonmedical use of drugs or alcohol accounted for 58.1 percent of these fatalities (464 deaths), up from 57.7 percent of this category’s total in 2020. - - Work related fatalities due to falls, slips, and trips increased 5.6 percent in 2021, from 805 fatalities in 2020 to 850 in 2021. Falls, slips, and trips in construction and extraction occupations accounted for 370 of these fatalities in 2021, and an increase of 7.2 percent from 2020 when there were 345 fatalities. Despite the increase this is still down 9.3 percent from 2019 when construction and extraction occupations experienced 408 fatalities due to this event. Occupation - - There was a 16.3-percent increase in deaths for driver/sales workers and truck drivers which went up to 1,032 deaths in 2021 from 887 deaths in 2020. This was the primary factor behind the increase in fatalities to workers in transportation and material moving occupations which reached a series high in 2021. - - Construction and extraction occupations had the second most occupational deaths (951) in 2021, despite experiencing a 2.6-percent decrease in fatalities from 2020. The fatality rate for this occupation also decreased from 13.5 deaths per 100,000 FTE workers in 2020 to 12.3 in 2021. - - Protective service occupations (such as firefighters, law enforcement workers, police and sheriff’s patrol officers, and transit and railroad police) had a 31.9-percent increase in fatalities in 2021, increasing to 302 from 229 in 2020. Almost half (45.4 percent) of these fatalities are due to homicides (116) and suicides (21). About one-third (33.4 percent) are due to transportation incidents, representing the highest count since 2016. - - Installation, maintenance, and repair occupations had 475 fatalities in 2021, an increase of 20.9 percent. Almost one-third of these deaths (152) were to vehicle and mobile equipment mechanics, installers, and repairers. - - The fatal injury rate for fishing and hunting workers decreased from 132.1 per 100,000 FTEs in 2020 to 75.2 in 2021 ...

42 year old Liana Karapetyan, who lives in El Dorado Hills, was sentenced to 18 months in prison for one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive health care kickbacks. According to court documents, Karapetyan and her husband, Akop Atoyan, owned and controlled home health care and hospice agencies in the greater Sacramento area: ANG Health Care Inc., Excel Home Healthcare Inc., and Excel Hospice Inc. On behalf of the agencies, Karapetyan and Atoyan certified to Medicare that they would not pay kickbacks in exchange for Medicare beneficiary referrals to the agencies. Despite their certifications, from at least July 2015 through April 2019, Karapetyan and Atoyan paid and directed others to pay kickbacks to multiple individuals for beneficiary referrals, including employees of health care facilities, as well as employees’ spouses. The kickback recipients included John Eby, a registered nurse who worked for a hospital in Sacramento; Anita Vijay, the director of social services at a skilled nursing and assisted living facility in Sacramento; Jai Vijay, Anita Vijay’s husband; and Mariela Panganiban, the director of social services at a skilled nursing facility in Roseville. In total, Karapetyan, Atoyan, and others caused the agencies to submit over 8,000 claims to Medicare for the cost of home health care and hospice services. Based on those claims, Medicare paid the agencies approximately $31 million. Of that amount, Medicare paid the agencies at least $2 million for services purportedly provided to beneficiaries referred in exchange for kickbacks paid to, among others, Eby, Anita Vijay, Jai Vijay, and Panganiban. Because the agencies obtained the beneficiary referrals by paying kickbacks, the agencies should not have received any Medicare reimbursement. This case was the product of an investigation by the Federal Bureau of Investigation and the Department of Health and Human Services’ Office of Inspector General. Assistant U.S. Attorney Matthew Thuesen prosecuted the case. In separate cases, Atoyan, Eby, Jai Vijay, Anita Vijay, and Panganiban pleaded guilty for their roles in the kickback scheme. They await sentencing ...

Courthouse News reports that the former chief financial officer of the defunct Girardi & Keese California personal injury law firm lost his bid to be released from jail while fighting charges he stole $10 million from the firm in a "side fraud" scheme separate from the estimated $100 million disgraced attorney Thomas Girardi is accused to have siphoned off from his clients' trust funds. Tom Girardi, a titan of the California plaintiffs bar, is believed to have used his client settlement funds as his own personal piggy bank for years. The 83-year-old lawyer is suffering from Alzheimer's and his firm went bankrupt two years ago as reports of his malfeasance came out. Last year, a Chicago law firm accused singer and "Real Housewives of Beverly Hills" star Erika Jayne of acting as a "frontwoman" for her then-husband, Girardi. The court filing called Girardi's now-shuttered law firm "the largest criminal racketeering enterprise in the history of plaintiffs’ law." U.S. District Judge Dale Fischer on Monday rejected the arguments by a lawyer for Christopher Kamon that his client wanted a "fresh start" and that there are perfectly innocent explanations why he liquidated his assets in the U.S., transferred millions of dollars to overseas bank accounts, and bought a $2.4 million home in the Bahamas. "The government has proven that he's a flight risk," Fischer said at the hearing in LA federal court. "The transfer of funds is extremely suspicious in my view." Kamon, 49, has been in jail since his arrest Nov. 5 at the airport in Baltimore when he returned from the Bahamas. Prosecutors with the U.S. Attorney's Office in LA say that Kamon planned to leave the county, change his name and hide, citing an unidentified witness who they say was an unwitting co-schemer who believed the accountant had authority to use the law firm's funds for his private pursuits. Prosecutors say Kamon, who worked at the Girardi Keese accounting department for almost two decades, used falsified invoices, fraudulent transfers and cash kickbacks from the firm's accounts to steal millions of dollars. They also claim he improperly used the firm's funds for his personal expenses, including home renovations, travel around the world on private planes and and tens of thousands a month for "female companionship." It was highly doubtful that he was authorized to provide a $20,000 monthly allowance to an escort, Assistant U.S. Attorney Ali Moghaddas said at the hearing. If convicted, the accountant could face 11 to 14 years in prison just for his "side fraud," according to the government. That doesn't take into account Kamon possible culpability in the broader fraud scheme perpetrated by Girardi and others, which involved an estimated $100 million stolen from client settlement funds, the government said. In addition, prosecutors said, the $1 million secured bond Kamon proposes to post as bail is far from sufficient to secure his return to court because he still has millions of dollars in foreign bank accounts. The judge agreed Kamon could easily reimburse his family members and friends who have agreed to put up equity in their homes as part of his bond should he decide to flee rather than risk a possible 15 years in prison. Jack DiCani, one of Kamon's attorneys, told Fischer everybody knew where his client was going and that he travelled to the Bahamas and sought residency there under his own name. According to DiCani, he had repeatedly reached out to federal prosecutors in Chicago, where there's a criminal investigation into the purported fraud by Girardi, and there hadn't been any indication that Kamon was a target in that probe, which could have prompted him to flee. "Mr. Kamon wanted a fresh start at life," DiCani told the judge. "They've taken objective facts and read into them a nefarious explanation - that he was trying to hide from law enforcement." Kamon doesn't have a criminal record, is charged with only one nonviolent crime, and nothing in his past or present conduct suggests that he is a flight risk, DiCani previously said in his request for pretrial release. The government, however, said Kamon has been trying to avoid being served with lawsuits in civil litigation stemming from his role at Girardi Keese and that even his own lawyers didn't know where he was. They also scoffed at the argument that there was nothing unusual about the fact that he had four mobile phones on him when he was arrested, saying that for some busy professionals it might be normal to have more than one phone, but not for someone who's unemployed ...

A Tarzana man pleaded guilty to federal criminal charges for running a nearly $6 million scheme in which he knowingly sold used skin-tightening medical devices that were deliberately misbranded as new, as well as counterfeit devices that he claimed were to be used with fat-reducing laser machines. Kambiz Youabian, 49, pleaded guilty to a two-count information charging him with mail fraud and introducing a misbranded medical device into interstate commerce. According to his plea agreement, Youabian owned and operated MSY Technologies Inc., a West Los Angeles-based company that did business under the names "Thermagen" and "Global Electronic Supplies" (GES). From March 2016 to June 2022, Youabian purchased used transducers, which are medical devices used to tighten the skin of dermatology patients by delivering ultrasound energy to a patient’s skin. Used properly, transducers are designed to provide no more than 2,400 treatments. After this number is reached, the devices are considered depleted and should be disposed of in accordance with health code regulations. Through GES, Youabian purchased depleted transducers for nominal sums, typically $50. Youabian then remanufactured the depleted transducers and added fabricated serial numbers to make the transducers appear to be new. Then, through his Thermagen company, Youabian fraudulently marketed and sold - for many times more than he paid for them - the remanufactured transducers to health care providers and customers as "new" transducers with 2,400 remaining treatments. To conceal his connection to Thermagen, Youabian used names of fabricated Thermagen employees on correspondences with victim providers and used out-of-state commercial mailboxes for Thermagen’s return of address on shipments, which he sent through the U.S mail. For example, in February 2020, Youabian, through Thermagen’s website, sold a device falsely advertised as "new" and "containing 2,400 lines" - and with a retail price of $1,695 - to a buyer. Youabian then shipped the device - which contained a fake serial number - from Los Angeles to Florida via the United States Postal Service. Youabian also shipped counterfeit PAC keys, medical devices used to operate laser machines designed to reduce fat on patients, through the mail. He then transferred his ill-gotten gains to bank account his controlled, including accounts he opened in the names of MSY Technologies, himself, and his au pair. In June 2022, law enforcement executed search warrants at Youabian’s home and the GES-Thermagen office in West Los Angeles. In the GES-Thermagen office, law enforcement seized 75 transducers in various states of refurbishment, a manufacturing workstation containing tools and transducer parts, and detailed records of GES and Thermagen’s expenses. Youabian admitted in his plea agreement to unlawfully selling thousands of medical devices, including transducers and PAC keys, and receiving at least $5,821,474 in fraudulent proceeds that should have been paid to the companies that are the sole U.S. distributors for these devices. Youabian also admitted to causing reputational harm to the device manufacturers and distributors of these medical devices. United States District Judge Dale S. Fischer scheduled a June 26 sentencing hearing, at which time Youabian will face a statutory maximum sentence of 23 years in federal prison. The U.S. Food and Drug Administration Office of Criminal Investigations and the United States Postal Inspection Service investigated this matter. Assistant United States Attorney Gregory D. Bernstein of the Major Frauds Section is prosecuting this case ...

The California Legislature passed a law requiring the California State Auditor’s Office to conduct an audit of the State Bar’s attorney complaint and discipline process. The Legislature included this requirement in the law because the State Bar did not take action against Los Angeles lawyer Tomas Girardi, husband of "Real Housewives of Beverly Hills" star Erika Jayne, for misconduct until recently, despite repeated allegations of this attorney’s misconduct over decades. A Los Angeles Times investigation documented how the now-disgraced attorney Tom Girardi cultivated close relationships with the agency and kept an unblemished law license despite over 100 lawsuits against him or his firm - with many alleging misappropriation of client money. Along with his family and employees, Girardi contributed more than $7.3 million to political candidates. The Auditor of the State of California 2021 audit report is entitled "The State Bar of California: It Is Not Effectively Managing Its System for Investigating and Disciplining Attorneys Who Abuse the Public Trust" and was released on April 29, 2021. The Auditor noted that "the State Bar’s backlog grew by 87 percent from the end of December 2015, to the end of June 2020." As pointed out by the Auditor, this "growing backlog allows attorneys who are under investigation more time to continue practicing law while their cases are pending, increasing the risk for potential harm to the public." The Auditor’s "analysis indicates that both higher- and lower-priority cases are taking significantly longer to resolve." Additionally, as the Auditor highlights, the "State Bar is also disciplining attorneys at a drastically lower rate for reasons it cannot adequately explain. From 2015 through 2019, the total number of cases that resulted in discipline - including reprovals, suspensions, and disbarments - declined by 54 percent." The public outcry over Girardi’s long history of complaints prompted the State Bar to conduct its own special disciplinary audit, which it published in June 2021. The audit, commissioned by Interim Chief Trial Counsel Melanie Lawrence, revealed mistakes made in some investigations over the many decades of Mr. Girardi’s career going back some 40 years and spanning the tenure of many Chief Trial Counsels. The State Bar subsequently prepared a proposal to streamline it's disciplinary process. On October 28, 2022, the State Bar provided the Legislative Analyst's Office (LAO) with its proposed (1) caseload processing standards for resolving attorney discipline cases within its Office of Chief Trial Counsel (OCTC), (2) establishment of a backlog goal and metrics to measure such a goal, and (3) staffing requirements needed to achieve the new standards. As required by Chapter 723 of 2021 (SB 211, Umberg), The LAO presented its assessment of the State Bar’s proposal. which raised concerns with some of the assumption the state bar made in developing the new standards. - - Overarching Comments - Consider Whether Changes for Additional Oversight Are Warranted. The State Bar’s proposal assumes that the existing disciplinary process is generally reasonable. However, the Legislature will want to consider whether it believes changes are warranted. Additionally, we note that the lack of legislative approval of the State Bar budget can make oversight difficult. Accordingly, the Legislature will want to consider what level of oversight it wants to exercise over State Bar processes and funding. - - New Case Processing Standards - Partially Reasonable, but Raises Several Concerns. We found it reasonable to include both risk and complexity when prioritizing cases. However, we identified several concerns related to the proposed standards. For example, we find it unclear whether the aggressive time lines reflected in the standards are reasonable. In light of these concerns, we raised five key questions for legislative consideration. For example, the Legislature will want to consider how aggressive they believe case processing standards should be. - - Establishment of Backlog Goal and Metrics - Partially Reasonable, but Also Raises Several Concerns. We found that alternative definitions of backlog could also be reasonable and identified several concerns with the State Bar’s proposal. For example, the State Bar’s proposed backlog metrics measure closed, rather than pending, workload. Based on our review, we identified three key questions for legislative consideration. For example, the Legislature will want to consider how backlog should be defined and calculated. - - Staffing Analysis - Makes Sense to Delay Analysis. We found that it was reasonable that the State Bar report only provides a preliminary estimate of staffing and resource needs. However, we are concerned with the State Bar’s plan to conduct a staffing analysis in 2023 given that the full impact of various operational changes will likely not be known at that time. Based on our review, we identified two key questions for legislative consideration. For example, the Legislature will want to consider when would be the most appropriate time for the State Bar to conduct the staffing analysis. The bar's chief mission officer Yun Xiang said in reply that ."The state bar is pleased to learn that the Legislative Analyst's Office found the proposed disciplinary case processing standards ‘reasonable’ in many key aspects," He indicated that the state bar will continue to collaborate with the LAO and the Legislature to provide further clarifications and address the proposal-specific issues." ...

Tracy Dominguez, Ruben Xavier DeLeon claimed that Mercy Hospital of Bakersfield, Arthur Park, M.D., and Hans C. Yu, D.O.provided negligent medical care to Demi Ruben Dominguez and Malakhi Ruben DeLeon resulting in their deaths. They claimed to be the wrongful death heirs to the decedents, The heirs sought to retain the legal services of the firm of Carpenter, Zuckerman & Rowley (CZR) to represent them in the medical malpractice action against the healthcare defendants. However, CZR claimed it was not economically feasible for it to represent heirs on a contingency basis given the limitations on recovery in malpractice cases for noneconomic losses to $250,000 under Civil Code section 3333.2 and the limitations on contingency fee arrangements under Business and Professions Code section 6146. CZR said however that it is ready, willing, and able to represent the heirs if it is permitted to charge the contingency fee it ordinarily charges in personal injury matters and if the $250,000 cap on noneconomic damages is lifted. On May 26, 2020, plaintiffs filed a complaint for declaratory and injunctive relief against the California Attorney General, and the healthcare defendants and challenge the constitutionality of two California statutes - Civil Code section 3333.2, which caps the amount of damages a plaintiff may recoup for noneconomic losses at $250,000 (Civ. Code, § 3333.2, subd. (b)); and Business and Professions Code section 6146, which sets limits on the amount of contingency fees a law firm may charge in representing a plaintiff in a professional negligence action against a health care provider. Plaintiffs allege Civil Code section 3333.2’s cap on noneconomic damages was "enacted in 1975 and has not been adjusted - for inflation or otherwise - in the intervening nearly 45 years." Plaintiffs allege "CZR will spend at least $200,000 in costs to prosecute" heirs’ claims against healthcare defendants; and because "the limit on contingent fees applies to [a] client’s net recovery," CZR would only recover "a mere $20,000 in fees" on a maximum award of $250,000 for noneconomic damages. The Attorney General demurred to plaintiffs’ complaint and each cause of action therein on the grounds that plaintiffs "do not have standing to assert" any of the alleged causes of action, and each cause of action "fails to state facts sufficient to constitute a cause of action." The trial court sustained the demurrer, without leave to amend, finding that plaintiffs are without standing to pursue the claims alleged and have failed to adequately allege facts to support the claims they purport to allege. The Court of Appeal affirmed in the published case of Dominguez v Bonta - F082053 (January 2023). The challenged statutes were enacted in 1975 as part of The Medical Injury Compensation Reform Act (MICRA). In enacting MICRA, the Legislature found that ‘there was a major health care crisis in the State of California attributable to skyrocketing malpractice premium costs." Plaintiffs alleged that one or both of the challenged statutes, separately or in tandem, (1) impair heirs’ "right to petition the government for redress of grievances" under the First Amendment and Fourteenth Amendment of the United States Constitution and article I, section 3 of the California Constitution; (2) constitute "a government taking [of] private property without just compensation" in violation of the Fifth Amendment and Fourteenth Amendment of the United States Constitution and article I, section 19 of the California Constitution; (3) "violate the equal protection provisions" provided by the Fourteenth Amendment to the United States Constitution and article I, section 7 and article IV, section 16 of the California Constitution (as stated in two separate claims by plaintiffs); (4) "violate the due process provisions" (as stated in two separate claims by plaintiffs) and the "right to petition the government for redress of grievances" under the Fourteenth Amendment to the United States Constitution and article I, section 7, subdivision (a) of the California Constitution; ; and (5) deprive heirs of their "right to a jury trial as protected by" article I, section 16 of the California Constitution. The Court reviewed a select number of prior decisions addressing the constitutionality of the challenged statutes, including one of the earliest MICRA-related cases decided by the California Supreme Court, American Bank & Trust Co. v. Community Hospital (1984) 36 Cal.3d 359. However because it concluded "that plaintiffs lack standing to pursue the claims they have alleged, we need not determine whether their allegations are sufficient to state one or more valid causes of action." Plaintiffs’ cause of action for declaratory relief is derivative of plaintiffs’ other claims.for medical malpractice in another action. The "actual controversy" language in Code of Civil Procedure section 1060, which is required to establish standing, does not embrace controversies that are ‘conjectural, anticipated to occur in the future, or an attempt to obtain an advisory opinion from the court. Here plaintiffs’ alleged injuries are neither concrete nor actual, and that they are, at the present time, conjectural and hypothetical. Thus the court concluded that plaintiffs lack standing to challenge Civil Code section 3333.2 and Business and Professions Code section 6146 ...

Aaron Brown became an inmate at Los Angeles County jail on approximately February 16, 2018. On March 8, 2018 he transferred to "wayside" facility. One week later, he signed an agreement to participate in the conservation work program, which provided "work time" credits of 1 ½ days for every one day of work in the program. On March 22, 2018, Brown slipped and fell while walking to the coffee pot at the print shop where he participated in the conservation work program. He reported the injury immediately and was examined at urgent care. He returned to urgent care the next evening due to hip pain. Hours later, he was released on the early release program. Los Angeles County denied his claim for workers' compensation benefits claiming there was a lack of and employment relationship. After conclusion of a trial, the WCJ found that Brown was not an employee for purposes of workers’ compensation benefits. The WCJ relied upon an ordinance passed in 1970 that states that county inmates may be forced to labor and that such county inmates shall not be considered an employee for the purposes of workmen’s compensation insurance. Also submitted into the record is the Inmate Worker Agreement. Brown's petition for reconsideration was granted, and the WCAB panel concluded that he was an employee at the time in the case of Brown v County of Los Angeles/Sheriff's Department - ADJ11278318 (December 2022). Labor Code section 3351 defines "employee," and section 3357 provides that "Any person rendering service for another, other than as an independent contractor, or unless expressly excluded herein, is presumed to be an employee." This is a rebuttable presumption. Penal Code section 4017 provides that county inmates working in the suppression of fire are considered employees of the county. It does not speak as to the employee status of county inmates who do not work in fire suppression. The employee status of county inmates are thus left to the courts to decide. In making this determination, courts have looked at whether the work that the inmate performed was "voluntary" or "compulsory" as an incident to incarceration and whether there was consideration for the work performed. If an inmate was performing compulsory work as an incident to penal servitude, he is not an employee and has no rights to workers’ compensation benefits. (Parsons v. Workers’ Comp. Appeals Bd. (1981) 126 Cal.App.3d 629 [46 Cal.Comp.Cases 1304].) In deciding whether an inmate was performing compulsory or voluntary work, trial courts may ask the following questions (the Rowland factors): (1) Did the county require the worker to work as a condition of incarceration? (2) Did the inmate worker volunteer for the assignment? and (3) What consideration were received, if any; for example, monetary compensation, work-time credits, freedom from incarceration, etc. (Rowland v. County of Sonoma (1990) 220 Cal.App.3d 331, 333-334.). There is a difference in determining employee status between persons incarcerated in state prison and person incarcerated in county jail. State inmates are statutorily included in the definition of "employee" while county inmates are subjected to a compulsory test to determine their employee status. In more recent laws, employer control is a major factor in determining employment status (the more employer control, the more likely employment status is found, whereas here, the opposite effect results when applying the compulsory test, in that the more control the county exercises, the more likely the inmate’s work is found to be compulsory without the protections of an employment relationship. The language in a local ordinance with respect to assigning work to inmates is not determinative, although it may be considered in determining whether the inmate’s work is compulsory or voluntary. In applying the compulsory test above using the Rowland factors, the WCAB panel concluded that applicant’s work at the time was voluntary. Accordingly, it concluded that applicant is an employee of the county and entitled to workers’ compensation benefits ...

Prior to the COVID-19 pandemic, telemedicine adoption was far from widespread. Despite obvious benefits of improving access, the technology wasn't in place, consumers weren't ready, and providers resisted the shift to virtual care. Then came the pandemic - and the need for social distancing. Suddenly, telemedicine was in high demand. As the pandemic surged across the U.S., the use of telemedicine also spiked. In June 2020, approximately 40% of healthcare encounters were conducted virtually. As restrictions lifted, use of telemedicine dropped from the highs of the 2020 lockdowns to a more stable 10-15%. And telemedine is taking incremental steps toward mainstream adoption with initiatives launched at the federal level this week. The National Institutes of Health, in collaboration with the Administration for Strategic Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services, has has just launched the Home Test to Treat program, an entirely virtual community health intervention. Telehealth services provider eMed will implement the Home Test to Treat program. Their services are provided under a contract award by NIBIB contractor, VentureWell. Having administered millions of verified at-home telehealth sessions during the pandemic, eMed will host the user-friendly Home Test to Treat website, where participants can sign up for the program, report symptoms, receive telehealth and antiviral treatment delivery, and coordinate telehealth enabled test kits. NIBIB also has issued a contract with UMass Chan Medical School, whose researchers, in collaboration with eMed, will analyze data collected from each participating community, including the impacts of a home-based process for testing and treatment, individual attitudes about the Home Test to Treat program, and clinical outcomes from treatments. Later this month, local and state officials in Berks County, Pennsylvania, will be the first to pilot the Home Test to Treat program. Up to 8,000 eligible residents are anticipated to participate in the program. Program organizers will gather information from participants to identify best practices and make improvements to the Home Test to Treat model that can be used to implement the program on a larger scale. Additional communities across the country will be selected to participate based on level of community need, access to healthcare treatment, expected COVID-19 infection rates and socio-economic factors. Through collaborations with local health departments, Home Test to Treat aims to offer services to approximately 100,000 people across the United States in the coming year. Major pharmacy chains including CVS and Walgreens already offer telehealth services that can help facilitate treatments for COVID-19, and some primary care physicians also provide this option for their patients. Walgreens partnered with companies including DoorDash and Uber to offer free deliveries of COVID-19 antivirals last year ...

Hospital overcrowding and healthcare access challenges have prompted two counties in Central California to issue emergency declarations in less than a week. Meanwhile, the largest health system in the region has gone out of network with several commercial insurance plans. According to the story in Becker's Hospital Review. the emergency declarations over healthcare access largely stem from the recent closure of Madera (Calif.) Community Hospital, the city's only hospital for about 150,000 residents. It officially shut its doors at midnight on Dec. 30, after Trinity Health's plan to buy the hospital fell through because the health system didn't accept the conditions set forth by California Attorney General Rob Bonta, The Fresno Bee reported Jan. 3. The Madera County Sheriff's Office declared a local state of emergency on Dec. 29, citing the "significant impact" the closure will have on the community. "The lack of hospital services in Madera County is expected to strain local resources deployed within Madera County, thereby depleting ambulance and response resources such as law enforcement and fire," the sheriff's office wrote in a Facebook post. "By proclaiming a local state of emergency we are formally requesting help from state and federal officials." The closure means residents in Madera will have to travel at least a half hour to other hospitals, many of which are in neighboring Fresno County and already overcrowded, Madera County officials said during their Dec. 29 meeting. In response, Fresno County proclaimed its own emergency declaration on Jan. 3, citing the additional strain the Madera hospital's closure has put on other area hospitals amid a surge in respiratory viruses. The Fresno County Board of Supervisors also said local emergency services were operating under an "assess and refer" policy, which diverts non-emergency patients from hospitals to other sources of care, and that it adopted the emergency resolution to emphasize the need for assistance at the state and federal level, according to the Fresno Bee. Fresno County's largest health system, Clovis, Calif.-based Community Health System, operates four hospitals, a cancer institute and other outpatient facilities in the area. On Dec. 31, in-network contracts expired between Community and several commercial payers, including UnitedHealthcare, Cigna and Anthem Blue Cross. A system spokesperson told Becker's Jan. 4 the involved parties are still actively negotiating to reach agreements. "As Community negotiates in good faith we must ask commercial health plans to acknowledge the unprecedented cost challenges of delivering care to the residents of the Central Valley and join us in reaching a fair and reasonable agreement," the system wrote on its website. A spokesperson for UnitedHealthcare told The Fresno Bee Dec. 19 that the system asked for an "egregious and unreasonable" rate increase. "This is not affordable or sustainable," the spokesperson said. "We've offered [Community Health System] market-competitive rate increases that will ensure its hospitals and facilities continue to be fairly compensated for the care they provide to our members." The affected facilities include Community Regional Medical Center, Fresno Heart & Surgical Hospital, Community Behavioral Health Center, Community Subacute & Transitional Care Center, Community Home Health and Community Health Partners, and Clovis Community Medical Center. On Jan. 2, Centene's Health Net and Community signed an in-network agreement covering commercial, Medicare and Medi-Cal plans ...

A new California Workers’ Compensation Institute (CWCI) study finds that after across-the-board declines in California inpatient hospitalizations during the COVID-19 health care crisis of 2020, the number of inpatient stays paid under Medicare, Medi-Cal, and private coverage all began to rebound in 2021, but the number of workers’ compensation hospitalizations fell an additional 5.7%. The latest results come from a CWCI study that measures and compares the use of inpatient services and procedures in different systems using data compiled by the state on more than 35.3 million hospital stays with 2012 through 2021 discharge dates. The 2021 decline in workers’ compensation hospitalizations brought the total decline over the past decade to 48.1%, more than triple the 10-year decline of 15.0% noted for hospital stays paid under private coverage, while hospitalizations paid under Medicare were only down 5.2% and those paid by Medi-Cal increased by 11.7%. Workers’ compensation is by far the smallest program analyzed, representing just 163,249 (<0.5 %) of the California inpatient stays over the 10-year study period, and just 0.3 % in 2021. Most workers’ compensation hospital stays are for the treatment of musculoskeletal and connective tissue disorders (between 58.1% and 66.0% of the stays since 2012), but COVID’s impact is evident in the recent data, as the percentage of injured worker inpatient stays for the treatment of diseases and disorders of the respiratory system nearly tripled from 2.6% in 2019 to 7.4% in 2020 and remained at an elevated level (7.0%) in 2021. A review of the hospital stays for diseases and disorders of the respiratory system found that half were for respiratory infections and inflammation, though injured worker hospitalizations in this diagnostic category included a larger share of collapsed lungs or major chest traumas. Surgical stays are far more prevalent in workers’ compensation than in other systems, with the data showing they accounted for more than 2/3 of injured workers’ inpatient hospitalizations in 2021, versus 24.7% for Medicare, 21.1% for Medi-Cal, and 31.5% for private coverage. Workers’ compensation inpatient surgeries continue to be led by spinal fusions (17.6% of the 2021 surgeries) and major joint replacements (10.7%). Despite a sharp decline in workers’ compensation spinal fusions (-59.1% since 2012), they are still far more prevalent among the injured worker inpatient population than among inpatients covered by Medi-Cal (0.6%), Medicare (1.3%); or private coverage (1.8%). As for workers’ compensation joint replacement surgeries, the Institute found that 87.9% of all injured workers who underwent knee or hip replacements in 2021 were diagnosed with primary osteoarthritis, which tends to develop from mechanical wear and tear, structural degeneration, and joint inflammation, rather than from an acute, direct trauma to the joint associated with a specific injury. Furthermore, the decline in workers’ compensation inpatient surgeries has been somewhat offset by an increase in the number of injured worker spinal fusions and total joint replacements performed on an outpatient basis.. More detailed findings from the CWCI study have been released in a Research Update Report, "Trends in the Utilization of Inpatient Care in California Workers’ Compensation." ...

Employers - and their vendors - need to be aware of the significant changes that are now in effect as the California Privacy Rights Act (CPRA) became operative on January 1, 2023. The implementation of privacy rights in California began In 1972, when California voters amended the California Constitution to include the right of privacy among the "inalienable" rights of all people. Since California voters approved the constitutional right of privacy, the California Legislature has adopted specific mechanisms to safeguard Californians’ privacy, including the Online Privacy Protection Act, the Privacy Rights for California Minors in the Digital World Act, and Shine the Light, but consumers had no right to learn what personal information a business had collected about them and how they used it or to direct businesses not to sell the consumer’s personal information. San Francisco real estate developer Alastair Mactaggart began advocating for consumer privacy a few years ago, after a Google engineer he met at a dinner party told him Americans would be shocked by how much the company knows about us. Mactaggart successfully pushed the Legislature to pass a landmark data privacy law in 2018, the California Consumer Privacy Act of 2018 (CCPA). into law. The CCPA gave California consumers the right to learn what information a business has collected about them, to delete their personal information, to stop businesses from selling their personal information, including using it to target them with ads that follow them as they browse the internet from one website to another, and to hold businesses accountable if they do not take reasonable steps to safeguard their personal information. Mactaggart soon discovered that this law passed by the California legislature needed some changes, so he drove the effort to put Prop. 24 on the 2020 ballot. And voters seemed to have agreed with him. The California Privacy Rights Act of 2020 (CPRA), also known as Proposition 24, was a California ballot proposition that was approved by a majority of voters after appearing on the ballot for the general election on November 3, 2020. This proposition expands California's consumer privacy law and builds upon the California Consumer Privacy Act (CCPA) of 2018, which established a foundation for consumer privacy regulations, with an array of consumer privacy rights and business obligations with regard to the collection and sale of personal information. The new CPRA took effect on Dec. 16, 2020, but most of the provisions revising the CCPA did not become "operative" until Jan. 1, 2023, applying to personal data collected on or after January 1, 2022. The CCPA is codified at Cal. Civ. Code § 1798.100 et seq., and the regulations are found at 11 CCR §§ 999.300 et seq. CPRA did not replace the CCPA. The CPRA is more accurately described as an amendment of the CCPA. The California Privacy Protection Agency is a new agency, created by the CPRA, which is vested with "full administrative power, authority, and jurisdiction to implement and enforce" the CCPA. CPRA eliminated the California Consumer Privacy Act's (CCPA) exemption for employee personal information. Workers now have the same rights as any consumer. This includes requirements that are currently in effect under the CCPA as well as the new requirements added under the CPRA. CPRA applies only to employees that are California residents, based on the definition of consumer. Businesses with a presence in multiple jurisdictions in the United States can consider applying a uniform approach, but should keep in mind employment laws in those other jurisdictions and any applicable data privacy laws in other jurisdictions. Notably, recent comprehensive data privacy laws passed in Virginia, Colorado, Utah and Connecticut exempt personal data collected in the context of employment. Employers must provide notice of employees' rights under the CPRA and give employees a way to tell the employer about their exercise of these rights. The employer has limited time to respond to a request and must properly document all responses. Business-to-business transactions are now subject to the CPRA. It is not clear how this will apply to worker's compensation claims administrators who receive information from an employer. In actions by the California Attorney General, businesses can face penalties of up to $7,500 per intentional violation or $2,500 per unintentional violation (but there is an opportunity to cure any alleged violation within 30 days after receiving notice of the alleged violation). In actions brought by consumers for security breach violations, consumers may recover statutory damages not less than $100 and not greater than $750 per consumer per incident or actual damages, whichever is greater. In actions for statutory damages, consumers must first provide businesses with written notice and an opportunity to cure. Consumers may also seek injunctive or declaratory relief, as well as any other relief the court deems proper. Businesses may also be subject to an injunction in actions brought by the Attorney General ...