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Employers' arbitration rights in California have been eroding. In recent years, there have been a number of legal challenges to the use of mandatory arbitration agreements in employment disputes, and some of these challenges have been successful. For example, in 2019, California Governor Gavin Newsom signed Assembly Bill 51 (AB 51) into law, which prohibited employers from requiring employees to sign arbitration agreements as a condition of employment. However, this law was preempted by the Federal Arbitration Act (FAA) in the case of Chamber of Commerce v. Bonta. The Ninth Circuit Court of Appeals ruled in February 2023 that AB 51, which prohibited employers from requiring employees to sign arbitration agreements as a condition of employment, was preempted by the FAA. The court held that AB 51's deterrent effect on arbitration agreements conflicted with the FAA's policy of favoring arbitration. And yet another highly controversial new law has just been been passed in California that again seeks to limit employers rights to appeal disputes about a trial court decision to mandate arbitration of employer-employee disputes. Governor Newsom has singed SB 365 into law. Under existing law, Code of Civil Procedure Section 1294 identifies various orders or judgements which may be appealed by an aggrieved party, including an order dismissing or denying a petition to compel arbitration. Code of Civil Procedure Section 916 further provides that, subject to exceptions, the perfecting of such an appeal stays proceedings in trial court. That is to say, when a party is denied in their effort to compel arbitration, upon their appeal, the court proceedings to adjudicate the underlying conflict are postponed until the appeal is decided. SB 365 adds the sentence " Notwithstanding Section 916, the perfecting of such an appeal shall not automatically stay any proceedings in the trial court during the pendency of the appeal" to CCP Section 1294. Thus, as of January 1, 2024, in the event a trial court declines to compel an employer's motion to arbitrate a dispute with employees, and the employer appeals that denial, a stay of the proceeding in the trial court will no longer be an automatic protection of the employer's rights. The author of this law claimed that "SB 365 gives courts the discretion to prevent corporations from using a common delay tactic against workers and consumers - in both private and public enforcement actions - when a court has determined that a particular case cannot not be sent to arbitration. Current law allows corporate defendants to pause a consumer, government, or worker's case by simply filing an appeal of a trial court's denial of a motion to compel arbitration. Through this process, powerful corporations delay cases filed against them for typically one to three years." Earlier in this year, the California Chamber of Commerce added SB 365 to its 2023 Job Killer List and urged the legislature and the Governor to not allow it to become law. The Chamber's efforts were not successful. Nonetheless, this new law will likely be challenged for the same reasons as were successful in the Chamber of Commerce v Bonta litigation against AB 51 in February 2023. At the federal level, California is under the jurisdiction of the 9th Circuit Court of Appeals which followed its 1990 precedent, under which an appeal from the denial of a motion to compel arbitration does not automatically stay district court proceedings. See Britton v. Co-op Banking Group, 916By contrast, however, most other Courts of Appeals to address the question have held that a district court must stay its proceedings while the interlocutory appeal on the question of arbitrability is ongoing. E.g., Bradford-Scott Data Corp. v. Physician Computer Network, Inc., 128 F. 3d 504, 506 (CA7 1997). F. 2d 1405, 1412 (1990). To resolve that disagreement among the Courts of Appeals,last June the Supreme Court of the United States held that a district court must stay its proceedings while an interlocutory appeal on the question of arbitrability is ongoing in the case of Coinbase Inc., v Bielski - 22-105_5536 (June 2023). It concluded that "An appeal, including an interlocutory appeal, ‘divests the district court of its control over those aspects of the case involved in the appeal." This conclusion was supported by the Supreme Court's interpretation of the Congressional intent in creating the Federal Arbitration Act which preempts state law. This conclusion was supported by a 1982 Supreme Court case, Griggs v. Provident Consumer Discount Co., in which the justices explained that an appeal "divests" a federal trial court of control "over those aspects of the case involved in the appeal." SB 365 is therefore at odds with Section 16(a) of the Federal Arbitration Act which sets up a "one-way" right to an immediate ("interlocutory") appeal: The party seeking arbitration can appeal immediately if the trial court refuses to order arbitration, but the party opposing arbitration has no similar right if the trial court does order arbitration. And under the Coinbase decision, a stay of the trial court is automatic. It would seem that it is more likely than not that a challenge to SB 365 would be successful ...
/ 2023 News, Daily News
Consumer Watchdog reports that thirty-two members of California’s Democratic Congressional Delegation wrote a letter to Insurance Commissioner Ricardo Lara this week expressing concern that a plan he announced in September would diminish the Insurance Commissioner’s regulatory power and threaten the consumer protections established in insurance reform Proposition 103. The letter to Commissioner Lara, led by Representatives John Garamendi and Zoe Lofgren, said: 'Your recent announcements, including the proposed Sustainable Insurance Strategy, seem to suggest dramatic changes to the Commissioner’s regulatory power that may result in a diminution of the authority granted by California voters and your ability to create a stable insurance market in our state. Proposals such as using proprietary forward-predicting models, expediting rate reviews that limit public comment, allowing insurance companies to abandon certain regions of the state, and incorporating reinsurance costs into Californian rates could threaten the important consumer protections established in Proposition 103 and in place since 1988. We believe it is important to keep California consumer interests at the forefront of your decision-making process. 'We bring our concerns to your attention in anticipation of a comprehensive and transparent process of rulemaking, public hearings, and public comment on any proposed changes to the regulatory powers of the Commissioner and process for approving any rate increases for policyholders. Such a public process is necessary for the protection of consumers against unchecked corporate interests, and we strongly believe that any precipitous action should be subject to public scrutiny.' Prop 103 made the Insurance Commissioner’s office an elected post and Representative Garamendi was the first elected Commissioner in California. This month is the 35th anniversary of voters’ approval of Proposition 103, overcoming a record $63 million insurance industry campaign against it. Prop 103 implemented the strongest insurance consumer protections in the nation, according to the Consumer Federation of America, and has saved California homeowners, drivers and business owners hundreds of billions of dollars on their insurance. Consumer Watchdog’s challenges to excessive rate increases using Prop 103’s public participation process have saved consumers $4.6 billion since 2002. Read more about the law here or watch this 35th anniversary video. Consumer Watchdog warned last week that the deregulation deal cut by Insurance Commissioner Ricardo Lara with the insurance industry will not expand access to affordable insurance for California homeowners or small businesses. Documents uncovered by Consumer Watchdog through a public records request reveal - in their view - that the quid pro quo for allowing insurance companies to plunder California - the insurance industry’s "commitment" to resume the sale of insurance - is riddled with loopholes. The documents containing the Commissioner’s plan show: - - Insurers would be allowed to meet the deal’s only consumer benefit - their "commitment" to expand home insurance coverage in wildfire areas to 85% of their market share outside risky areas - by offering the same high cost, limited benefit coverage that homeowners are already guaranteed access to in the FAIR Plan today. - - The commissioner could waive the "85% commitment" entirely for any insurer that claims it cannot meet it. - - The bill’s other provisions to facilitate unjustified rate hikes mean consumers will be unable to afford the policies insurers are willing to sell. View the documents and read more about what they reveal about the Commissioner’s deregulation deal with the insurance industry ...
/ 2023 News, Daily News
Prema Thekkek, her Vacaville-based management company, Paksn Inc., and six skilled nursing facilities (SNFs) owned by Thekkek and/or operated by Paksn have agreed to enter into a $45.6 million consent judgment to resolve allegations that they submitted or caused the submission of false claims to Medicare by paying kickbacks to physicians to induce patient referrals. The six settling SNFs are Kayal Inc. (doing business as Bay Point Healthcare Center), Nadhi Inc. (doing business as Gateway Care & Rehabilitation Center), Oakrheem Inc. (doing business as Hayward Convalescent Hospital), Bayview Care Inc. (doing business as Hilltop Care and Rehabilitation Center), Aakash Inc. (doing business as Park Central Care & Rehabilitation Center) and Nasaky Inc. (doing business as Yuba Skilled Nursing Center) (collectively the SNF Defendants). The Anti-Kickback Statute prohibits offering or paying remuneration to induce the referral of items or services covered by Medicare, Medicaid and other federally funded health care programs. It is intended to ensure that medical decision-making is based on the best interests of patients and not compromised by improper financial incentives to providers. From 2009 to 2021, the SNF Defendants, under the direction and control of Thekkek and Paksn, systematically entered into medical directorship agreements with physicians that purported to provide compensation for administrative services, but in reality were vehicles for the payment of kickbacks to induce the physicians to refer patients to the six SNFs. Specifically, the defendants hired physicians who promised in advance to refer a large number of patients to the SNFs, paid physicians in proportion to the number of their expected referrals and terminated physicians who did not refer enough patients. On one occasion, a Paksn employee told Thekkek that two physicians were being hired because "they are promising at least 10 patients for $2000 per month," to which Thekkek responded, "good job. Make sure they give you patients everyday. [W]e can also expand to other buildings with them, if possible." On another occasion, an employee informed Thekkek that the defendants previously had paid a certain doctor "$1500 each month and he only send [sic] us 2 patients[,] so we didn’t pay him anything from Jan[uary] onwards." On a third occasion, Thekkek rejected a proposed stipend for a new medical director, explaining that the defendants had paid the previous medical director that amount because "we were getting admission[s] from him," whereas she did not expect the new medical director to refer many patients. More generally, Thekkek complained that if her employees did not pay medical directors promptly every month, "[t]hese doctors will not give us patients." Under the settlement, n addition to entering into a $45,645,327.25 consent judgment, the defendants will make scheduled payments to the United States of at least $385,000 over the next five years. That payment schedule was negotiated based on the defendants’ lack of ability to pay. The settlement stems from a whistleblower complaint filed in 2015 by Paksn’s former Vice President of Operations and Chief Operating Officer, Trilochan Singh, pursuant to the qui tam provisions of the False Claims Act, which permit private persons to bring a lawsuit on behalf of the government and to share in the proceeds of the suit. The Act also permits the government to intervene and take over the lawsuit, as it did in this case as to some of Singh’s allegations. In addition to resolving their False Claims Act liability, the defendants have entered into a five-year corporate integrity agreement with the HHS-OIG which requires, among other compliance obligations, an Independent Review Organization’s review of their physician relationships ...
/ 2023 News, Daily News
Bill Zachry is known throughout the risk management industry as a champion of workers’ compensation reform. He currently serves as Chair of the Audit Committee on the board of the State Compensation Insurance Fund. Prior to serving on SCIF Board Bill spent ten years as the Chair of the California Fraud Assessment Commission. He was the Group VP of Risk Management at Safeway / Albertsons for fifteen years. While there he was awarded Risk Manager of the year by RIMS, as well as workers’ compensation professional of the year from CCWC in 2016. He also spent three years as a Senior Fellow in the Sedgwick Institute where did research and writing on many risk management issues. He currently authors a number of articles for the Workers' Comp Thought Leadership Series. His recent article voiced his views on how "AI is Revolutionizing The Workers' Compensation Industry." He wrote that AI represents the future of workers’ compensation. However, like all new technologies, AI is not without its challenges and detractors. Here are a few considerations Mr. Zachary points out as we embark on this transformative journey. Data Privacy and Security: It is crucial to ensure the privacy and security of the sensitive data that AI systems use. Data privacy issues apply to both the products of the AI process and the data AI uses to produce those products. Privacy is particularly important when dealing with medical records and personal information. There are currently extensive state and federal privacy laws, rules, and regulations that require careful management. The federal government and others are also working on additional focused AI regulations and compliance issues that will complement current regulations, adding complexity to data access. Bias and Fairness: Historical data often contains potential bias due to a lack of standard definitions for much of the data held by claims, safety, and underwriting operations. This is especially true for risk assessment, safety programs and claims processing. It is important to ensure that new AI systems are trained with diverse and representative data to avoid discriminatory outcomes. Interoperability: Significant challenges will arise in integrating AI systems with existing software and databases in the workers’ compensation industry. A standardized data dictionary and glossary would facilitate the development and integration of AI into existing systems. While the Medicare Set Aside and the Rating Bureaus have created islands of consistent data, more work is needed. Regulatory Challenges: Many potential regulatory hurdles may slow down the adoption of AI in workers’ compensation. Aligning AI technologies with existing regulations and standards is difficult due to the overlap and lack of coordination among industrial and non-industrial disability programs, medical care programs, and the absence of accurate and consistent definitions throughout the entire system. One example of increased governmental oversight and additional regulations is the pending Presidential executive order concerning AI technology. Training and Education: Like the implementation of any new technology, it is essential to train and educate current workers’ compensation professionals about AI systems. Ensuring that adjusters and other stakeholders understand how to use AI tools effectively and interpret the outputs is crucial. Recognizing AI hallucinations is a specific skill that will need to be taught. Ethical Considerations: All new technology can be used for both good and bad. Significant ethical dilemmas may arise when AI systems are used in decision-making processes, such as determining claims eligibility or settlement amounts. This underscores the importance of transparent and accountable AI systems and responsible management of those systems. Human-AI Collaboration: AI can significantly complement the work of human claims adjusters rather than replace them. There are substantial benefits to adopting a collaborative approach where AI assists professionals in making informed decisions. However, if AI completely removes the human element, it may not optimize the potential results derived from the new technology. Legal and Liability Issues: As with all new technology, if misused or used ignorantly, significant potential legal and liability issues may arise if AI systems make incorrect predictions or decisions. These concerns are magnified by the potential for AI to occasionally have hallucinations, with the entire output being based on bad or non-existent data. One current example making the rounds is the legal brief that included citations of cases that do not exist. Ultimately, the responsibility rests with humans to ensure there are no unintended consequences or mischief. Misplaced Incentives: The workers’ compensation system is rife with misplaced incentives. AI does not eliminate these problems and may even exacerbate some of them driven by the misplaced incentives. Ongoing Monitoring and Maintenance: As with all new technology, it is important to continuously monitor and maintain AI systems to ensure they remain accurate and up-to-date. Strategies for handling system failures or errors should be in place. No system improves without constant feedback and the identification of problems and errors. This axiom is particularly true for AI. Stakeholder Acceptance: Without carefully gaining acceptance and trust from all stakeholders, including injured workers, employers, and insurance companies, AI will not succeed. Part of that acceptance is constant communication concerning what is being implemented, recognition of problems, and owning of mistakes. This should include transparent communication about AI's role in the process. Cost-Benefit Analysis: Most companies will not implement every idea all at once. The determination of which processes to implement should include an accurate cost-benefit analysis. This analysis should consider both the initial investment and the potential long-term savings and improvements in outcomes. Integration with Other Technologies: AI thrives on accurate and timely data. Emerging technologies, such as telemedicine or wearable devices, can enhance injury prevention, improve medical treatment recovery, and reduce the costs of claims management by providing accurate and timely data ...
/ 2023 News, Daily News
KFF Health News reports that the Biden administration’s first major step toward imposing limits on the pharmacy benefit managers who act as the drug industry’s price negotiators is backfiring. Instead, it’s adding to the woes of the independent drugstores it was partly designed to help. PBMs have long clawed back a fee from pharmacies weeks or months after they dispense a drug. A new rule, which governs Medicare’s drug program, is set to take effect Jan. 1 and requires PBMs to take most of their "performance fees" at the time prescriptions are filled. The clawbacks have ballooned from about $9 million in 2010 to $12.6 billion in 2021, according to the Medicare Payment Advisory Commission, an agency created to advise Congress on the program for people who are 65 and older or have disabilities. Performance fees have also boosted Medicare patients’ prescription costs at the pharmacy counter by hundreds of millions of dollars, although insurers assert that the fees enable them to charge lower premiums. Pharmacist groups supported the Medicare rule change, but they didn’t anticipate the PBMs’ response, which has been to demand they accept new contracts with draconian cuts to their payments for dispensing medicines, said Ronna Hauser, vice president of the National Community Pharmacists Association, which represents independent drugstores. If pharmacies refuse the contracts, they risk losing Medicare customers - likely to the same giant PBM conglomerates, which have absorbed a growing share of the pharmacy business in recent years. PBMs sit at the center of the U.S. supply chain for drugs, where they say they negotiate lower prices for insurers - including Medicare - and for employers and their workers. But the organizations are loathed by independent drugstores, drugmakers, and patients alike, who accuse them of siphoning money from what is already the world’s most expensive health care system without providing additional value. PBM practices even put the squeeze on national chains like Rite Aid, Kroger, and Walgreens, which aren’t part of the conglomerates. Even CVS Health, which owns one of the three leading PBMs, has closed stores or trimmed staff as it pushes consumers to mail-order pharmacy services. In the early fall, PBM giant Express Scripts sent out confidential contracts announcing that in 2024 it will pay pharmacies roughly 10% below what they typically pay to buy wholesale brand-name drugs - meaning they could lose money on every prescription they fill, according to two independent pharmacists who received the documents. They declined to share the contracts because they are subject to nondisclosure agreements with Express Scripts. For the first months of 2024, pharmacies will face a double whammy. PBMs will pay them less for the drugs they dispense, while the pharmacies also face clawbacks on drugs dispensed in the last quarter of 2023. Some pharmacies are setting aside savings or taking out short-term loans to cover losses in the early months of next year. "I’m hoping we’ve made the right calculations and will get through this," said Marc Ost, co-owner of Eric’s Rx Shoppe in Horsham, Pennsylvania. Express Scripts has said it wants to help independent pharmacies survive, Doug Hoey, CEO of the National Community Pharmacists Association. said, but hasn’t responded to a June letter in which he asked the company to provide breathing space by imposing the 2023 clawbacks gradually over 12 months. CMS this month said it "strongly recommends" but does not require PBMs to come up with payment plans for pharmacies. In its statement, Express Scripts said it was "committed to reimbursing pharmacies fairly, ensuring Medicare beneficiaries have safe, quality pharmacies in their network, and giving beneficiaries all available discounts at the pharmacy counter." ...
/ 2023 News, Daily News
Nor-Cal Pharmacies Inc., doing business as Lockeford Drug located at 14090 E Highway 88 Lockeford CA 95237, and pharmacist/owner Lawrence Howen have agreed to pay $1 million in penalties to resolve allegations of violations of the Controlled Substances Act. The defendants agreed to the entry of a permanent injunction against them that permanently bars them from dispensing controlled substances, owning a company that dispenses controlled substances, or employing another person that dispenses controlled substances. The injunction, signed by U.S. District Judge Ana de Alba, includes findings that the defendants knew or deliberately ignored that they were dispensing controlled substances pursuant to prescriptions that were not for a legitimate medical purpose. Specifically, the injunction states that the defendants dispensed 116,330 pills, including more than 100,000 oxycodone and hydrocodone pills, based on invalid prescriptions presented by Joe Anthony Bernal, a defendant charged in the Northern District of California in a separate criminal case (4:19-cr-00585). They did so despite circumstances that were highly suggestive that Bernal was not presenting them with legitimate prescriptions. As also stated in the injunction, the defendants took no steps to determine the validity of Bernal’s purported prescriptions and were not concerned if those medications caused patient harm. Bernal is charged with conspiring with several others to illegally acquire and distribute oxycodone and hydrocodone. The charges against Bernal are pending and are only allegations; he is presumed innocent until and unless proven guilty beyond a reasonable doubt. "As a pharmacy that fills prescriptions for opioids and other dangerous drugs, the defendants had an obligation to fill only legitimate prescriptions," U.S. Attorney Talbert said. "The defendants failed to comply with that obligation, and thereby failed in their responsibility to prevent the opioids from being diverted into illicit channels." "The defendants went from pharmaceutical provider to drug dealer when they knowingly provided controlled substances without a legitimate medical purpose," said DEA Special Agent in Charge Brian M. Clark. "This egregious behavior by a trusted individual and entity not only fuels the fire of the opioid epidemic, but also wreaks havoc on the community they serve." This case was the product of an investigation by the Drug Enforcement Administration with assistance from the California Board of Pharmacy. Assistant U.S. Attorney Steven S. Tennyson handled the case ...
/ 2023 News, Daily News
Scott Shaw, a former San Jose State University (SJSU) Director of Sports Medicine, was sentenced to serve 24 months in prison for unlawfully touching female student-athletes under the guise of providing medical treatment. The sentence was handed down by the Honorable Beth Labson Freeman, United States District Judge for the Northern District of California. Shaw pleaded guilty to the charges on August 15, 2023. As part of the plea agreement, Shaw admitted that, between 2017 and 2020, he violated the civil rights of four students who played on women’s athletics teams by touching their breasts and buttocks without their consent and without a legitimate medical purpose. According to court documents, from 2008 until August 2020, Shaw served as the Director of Sports Medicine and head athletic trainer at SJSU, a public university that is part of the California State University system, and was an employee of the State of California. His duties included treating injuries sustained by student-athletes at SJSU. Shaw admitted that he engaged in all the conduct described above on SJSU’s campus, and in his capacity as an SJSU athletic trainer. Shaw admitted that female student-athletes allowed him to have physical contact with them only because of his status as an SJSU athletic trainer. Shaw further acknowledged that female student-athletes sought treatment from him because they were in pain, seeking relief, and wanted to continue participating in SJSU Athletics. Further, the student-athletes trusted him because he was an experienced athletic trainer. Shaw also admitted that he inappropriately touched each of the student-athletes as described above without any legitimate diagnostic or treatment purpose and without seeking or securing their consent in advance. Shaw further admitted that his conduct was not the result of mistake, carelessness, or accident. In sum, Shaw pleaded guilty to two counts of deprivation of rights under color of law, in violation of 18 U.S.C. 242. In addition to the prison term, Judge Freeman ordered Shaw to serve one year of supervised release, to begin after he has served his prison term, and to pay a $15,000 fine. Judge Freeman also scheduled a hearing to take place on February 6, 2024, to determine issues related to restitution. Judge Freeman ordered Shaw to surrender on or before March 6, 2024, to begin serving his prison term. "Today’s sentence sends a clear message that public school officials who exploit their positions of authority to sexually abuse and harass students will face serious consequences for their actions," said Assistant Attorney General Kristen Clarke of the Justice Department’s Civil Rights Division. "The Justice Department will not tolerate violations of civil rights committed under the guise of legitimate medical treatment by those in positions of power and trust." "Scott Shaw was entrusted to care for athletes in the California State University system. Instead, he used his power over female athletes to violate their civil rights by sexually groping them without their consent and without any medical justification," said First Assistant U.S. Attorney Patrick Robbins for the Northern District of California. "Such criminal assaults on college athletes will be investigated and prosecuted; anyone abusing their power over student athletes in this way should expect to spend time in prison for doing so." "A patient necessarily places enormous trust in a healthcare provider; that relationship is privileged and inviolable for good reason," said FBI Special Agent In Charge Robert Tripp. "Shaw’s violation of that relationship is reprehensible, as was reflected in his sentence. I commend the student athletes for their moral courage in coming forward to challenge Shaw. Their bravery prevented Shaw from committing further harm to others, and civil rights violations will continue to be a top priority for the FBI." Assistant U.S. Attorney Michael Pitman for the Northern District of California and Trial Attorney MarLa Duncan and Attorney Advisor Sarah Howard of the Civil Rights Division’s Criminal Section are prosecuting the case. This case was investigated by the FBI ...
/ 2023 News, Daily News
Existing state law establishes the California Retail Food Code (Health and Safety Code Part 7) to provide for the regulation of retail food facilities. Health and sanitation standards are established at the state level through the California Retail Food Code, while enforcement is charged to local agencies, carried out by the 58 county environmental health departments, and four city environmental health departments (Berkeley, Long Beach, Pasadena, and Vernon). [HSC §113700, et seq.] A "food facility" is defined as an operation that stores, prepares, packages, serves, vends, or otherwise provides food for human consumption at the retail level. Excludes various entities from the definition of a "food facility," including a cottage food operation, and a church, private club, or other nonprofit association that gives or sells food to its members and guests, and not to the general public, at an event that occurs no more than three days in any 90 day period. [HSC §113789] Existing law defines a "food handler" as an individual who is involved in the preparation, storage, or service of food in a food facility. [HSC §113790] The California Retail Food Code, provides for the regulation of health and sanitation standards for retail food facilities by the State Department of Public Health. Existing law, with specified exceptions, requires a food handler to obtain a food handler card within 30 days of their date of hire and to maintain a valid food handler card for the duration of their employment as a food handler. A recent New York Times article published on January 17, 2023, entitled, "How Restaurant Workers Help Pay for Lobbying to Keep Their Wages Low." According to the article, when new restaurant workers pay $15 to take the ServSafe online class in food safety, they are also helping to fund a nationwide lobbying campaign to keep their own wages from increasing. The article claims that ServSafe doubles as a fund-raising arm of the National Restaurant Association (NRA), which has spent decades fighting increases to the minimum wage at the state and federal levels. ServSafe is the dominate food handling training company in the country controlling an estimated 70% of the market. They make money by charging workers for food handling trainings in all 50 states. Generally speaking, if an employer requires employees to obtain training, the employer is required to pay for that training, which is both a federal requirement under the Fair Labor Standards Act, as well as a state requirement under Labor Code Section 2802. However, if a certification is required by the state in order to be employed in a given employment category, there is generally no requirement that an employer pay for training leading to licensure or certification. According to an opinion issued by the Division of Labor Standards Enforcement (DLSE) of the Department of Industrial Relations concerning whether an employer must pay for t cost of a class that an employee had to take in order to retain their job selling life insurance, DLSE stated that "While the license may be a requirement of the employment, it is not the type of cost encompassed by Labor Code §2802. The most important aspect of licensure is that it is required by the state or locality as a result of public policy. It is the employee who must be licensed and unless there is a specific statute which requires the employer to assume part of the cost, the cost of licensing must be borne by the employee." However, there are numerous examples of laws or regulations where the state requires the employer to provide training, and it is clear that the employer is required to pay for the cost of this training. One example is the requirement that employers with five or more employees provide sexual harassment training. Additionally, there is a long list of various training requirements under California’s Division of Occupational Health and Safety, specific to different types of industries. As a result of this New York Times article, a California legislator introduced SB 476, which was approved by the legislature, and signed by Governor Newsom, which amends Section 113948 of the Health and Safety Code effective January 1, 2024. This new law requires employers to consider the time it takes for the employee to complete the training and examination as compensable "hours worked," for which the employer is required to pay, and to also pay the employee for any necessary expenditures or losses associated with the employee obtaining a food handler card. It also requires an employer to relieve an employee of all other work duties while the employee is taking the training course and examination. And it also prohibits employers from conditioning employment on an applicant or employee having an existing food handler card ...
/ 2023 News, Daily News
The life expectancy of men in the U.S. is nearly six years shorter than that of women, according to new research published on Monday in JAMA Internal Medicine. As life expectancy at birth in the US decreased for the second consecutive year, from 78.8 years (2019) to 77.0 years (2020) and 76.1 years (2021), the gap between women and men widened to 5.8 years, its largest since 1996 and an increase from a low of 4.8 years in 2010. For more than a century, US women have outlived US men, attributable to lower cardiovascular and lung cancer death rates related largely to differences in smoking behavior.This study systematically examines the contributions of COVID-19 and other underlying causes of death to the widened gender life expectancy gap from 2010 to 2021. "Across the world, women tend to live longer than men," said Brandon Yan, a resident physician at the UCSF School of Medicine and a research collaborator at the Harvard T.H. Chan School of Public Health, who is the lead author of the study according to a review published by Stat News. (Both institutions collaborated in the research.) But the widening gap should concern the U.S., Yan said, because it shows that baseline factors accounting for men’s lower longevity - genetics, men’s higher vulnerability to chronic disease - aren’t the sole reason for the difference in life expectancies. "The opioid epidemic, mental health, and chronic metabolic disease are certainly front and center in the data that we see here, explaining why there’s this widening life expectancy gap by gender, as well as the overall drop in life expectancy," said Yan. Men have higher mortality rates from all three conditions compared to women. In addition, Yan notes, "a lot of these drivers of worsening life expectancy in particular for men are preventable causes of death." Even Covid-19 could be considered a preventable cause of death in the time since vaccines have become available, he said. The decline in life expectancy in the U.S. suggests that advancements in medical treatment are no longer sufficient to counter ongoing public health crises, Yan said. "We have a health care system that is very advanced in treating illnesses and advanced disease. But for the most part - it is not very good when it comes to preventative care." In the years leading to 2010, it was public health improvements - such as aggressive anti-smoking campaigns and the consequent reduction of deaths from respiratory illnesses and cancer - that led to the increased longevity and a reduced male-female gap in life expectancy. The reasons that issues such as suicide or opioid overdose affect men more than women are complex. "There’s a substantial socio-cultural norms component to this data as well in terms of the ways that society views masculinity and the way that men ought to behave," said Yan. "That has profound effects on care-seeking behaviors," he said. Whether a man seeks care for mental health issues, for instance, or even goes to routine primary care visits and takes medications, may be impacted by ideas about masculinity ...
/ 2023 News, Daily News
Behind the scenes at the state Capitol, California is launching an unprecedented $1.2 billion overhaul of its battered job safety net. Its Employment Development Department - better known as the EDD - is attempting to rebuild its unemployment and disability systems as it recovers from a pandemic that left millions of workers waiting for payments and tens of billions of dollars missing to suspected fraud. A year-long CalMatters investigation finds that the state was primed for disaster by years of missed red flags and failed reforms. Once COVID hit, public records and interviews reveal that California’s system was initially friendlier to scammers than to many real workers - and then the state got so aggressive that many workers struggled to prove their own identities. New financial reports requested by CalMatters show that amid the chaos, the EDD and its unemployment payment contractor Bank of America split a half a billion dollars in revenue, though the bank says it ultimately spent more to cover fraud losses. Another large EDD contractor, Deloitte, made more than a quarter of a billion dollars on tech contracts and emergency contracts to build systems that state reports say buckled during the pandemic. Five years, $1.2 billion. And a new model for government contracting in the tech-challenged home state of Silicon Valley. That is what California officials say it will take to overhaul an employment safety net pushed to the brink by record pandemic job losses, widespread fraud and the political panic that followed. The biggest-ever attempt to reform California’s Employment Development Department, known as "EDDNext," officially started late last year. A roughly 100-person team is leading the rebuild, and is already signing multi-million-dollar contracts for Salesforce and Amazon technology, according to interviews and records requested by CalMatters. At the same time, the EDD is quietly making plans to move on from its turbulent relationship with longtime unemployment payment contractor Bank of America. Between now and 2025, the EDD will begin rolling out new benefit debit cards, and eventually, a direct deposit payment option from a different, yet-to-be-named contractor, the agency said in a statement. The question for the EDD now: Will history repeat itself, or can California finally lead a nationwide quest to reinvent unemployment? After the Great Recession, the state paid Deloitte to upgrade several facets of its operation, including part of its claim management systems, in a series of contracts that ballooned to more than $152 million from 2010 to 2018, copies provided to CalMatters show. That system was one of several that state reports later found buckled during COVID, but Deloitte was awarded another $118 million as the state doled out emergency pandemic funds, according to contracts provided to CalMatters. The irony, as Jennifer Pahlka wrote in her book "Recoding America" is that the money went to the very vendor "which built the ineffectual systems in the first place." U.S. Rep. Katie Porter, a Democrat from Orange County who sits on a U.S. House Oversight Committee that has investigated pandemic unemployment fraud, sighed heavily when asked about the past Deloitte "unemployment modernization" project " a response, she said, to both the contractor in question and a broader lack of oversight on big-budget projects. "Deloitte has an unfortunate track record of not getting it done here," Porter said. "If we’re going to contract this and spend our dollars with a private company to do this, we have to hold them accountable for delivering." Deloitte defended its work for the EDD in a statement, noting that "many technology constraints highlighted by California elected officials during the pandemic related to functions in EDD systems that Deloitte was not contracted to maintain." "California’s vast unemployment insurance system has been under enormous strain since 2020, and employers are paying the price," the California Chamber of Commerce argued in an August report. According to the Chamber of Commerce Study "California has among the most generous and "claimant-friendly" laws regarding eligibility and claims processing, and that the state's unemployment insurance (UI) program has among the most forgiving exceptions for misconduct or fraud in the nation." ...
/ 2023 News, Daily News
The Centers for Disease Control and Prevention’s (CDC) National Institute for Occupational Safety and Health (NIOSH) announced the launch of Impact Wellbeing. This new campaign provides hospital leaders with evidence-informed resources to improve workplace policies and practices that reduce burnout, normalize help-seeking, and strengthen professional wellbeing. "Even before the pandemic, healthcare workers faced challenging working conditions that lead to burnout. This includes long work hours, risk for hazardous exposures, stressful work, and high administrative burdens," said John Howard, MD, Director of NIOSH. "Hospital leaders need support to implement organizational changes. Practical adjustments can reduce burnout and strengthen professional wellbeing within their hospitals." Impact Wellbeing supports hospital leaders, and in turn their healthcare workforce, by providing actionable steps to fine-tune quality improvements, establish new workflows, and help staff feel safe seeking help. To get started in operational-level solutions, practices, and policies for incremental, sustained impact, hospital leaders can access the following campaign resources: - - NIOSH Worker Well-Being Questionnaire (WellBQ): Understand how your workforce is doing and identify ways to improve healthcare worker wellbeing. - - Leadership Storytelling Guide: Help hospital leaders talk publicly about getting help for their own mental health concerns and encourage staff to do the same, using this guide from the Health Action Alliance. - - Total Worker Health® Strategies: Train front-line supervisors to help their staff balance their work and home responsibilities using supportive supervision. Additionally, hospital leaders can remove one of the most substantial system barriers to healthcare worker wellbeing - intrusive mental health questions on hospital credentialing applications. Auditing and changing hospital credentialing application questions removes barriers to care and sends a clear message to healthcare workers that their hospital supports their wellbeing and mental health. The Dr. Lorna Breen Heroes’ Foundation developed three simple steps hospital leaders can follow to make it safe for their healthcare workers to seek care. "Like everyone, healthcare workers deserve the right to pursue mental health care without fear of losing their job because of stigmatizing and discriminatory questions," said J. Corey Feist, JD, MBA, Co-Founder and President of the Dr. Lorna Breen Heroes’ Foundation. "My sister-in-law, Dr. Lorna Breen, experienced this barrier firsthand, confiding in our family that she was fearful of being ostracized at work if she acknowledged that she needed help. Shortly after, she died by suicide. Sadly, I have heard from numerous families who lost healthcare worker loved ones to suicide who expressed the same concerns as Lorna." For more than 50 years, NIOSH has empowered workers and employers, including hospital leaders, with strategies and resources to create sustainable, safe workplaces. Impact Wellbeing builds upon these efforts and speaks directly to hospital leaders to address the operational factors within hospitals that contribute to burnout. "Although some causes of burnout may take time to address, there are many feasible ways to champion a healthy workforce and hospital system," said Casey Chosewood, MD, MPH, Director of the Office for Total Worker Health at NIOSH. "By identifying and implementing practical operational adjustments, hospital leaders can help healthcare workers continue doing what they do best—delivering the highest quality patient care." Explore Impact Wellbeing resources at www.cdc.gov/impactwellbeing. Impact Wellbeing is made possible by the COVID-19 American Rescue Plan of 2021. It builds on momentum from the passage of the Dr. Lorna Breen Health Care Provider Protection Act. Established under the Occupational Safety and Health Act of 1970, NIOSH is the federal research institute focused on the study of worker safety and health, and empowering employers and workers to create safe and healthy workplaces. For more information about NIOSH, visit www.cdc.gov/niosh/ ...
/ 2023 News, Daily News
A third superseding indictment was just unsealed in federal court in Brooklyn charging Brian Michael Sutton, Brycen Kay Millett, Anthony Santamaria, Joshua Manuel Alegria, Hershel Tsikman and Hafizullah Ebady with conspiracy to commit health care fraud, health care fraud and money laundering conspiracy. As alleged, the defendants participated in an international scheme to acquire pharmacies across the United States with pre-existing relationships with private health insurance companies. Using those pharmacies, in conjunction with call centers to induce individuals to accept unnecessary medications and a network of recruited physicians, the defendants generated more than $500 million in fraudulent prescriptions purportedly filled by the scheme pharmacies. Santamaria, Alegria and Tsikman were arrested today in California and will be arraigned this afternoon in federal court in Los Angeles. Millett and Ebady were previously indicted and arrested on health care fraud charges, and will be arraigned at a later date. Sutton remains at large and is believed to reside in Moscow. Breon Peace, United States Attorney for the Eastern District of New York and James Smith, Assistant Director-in-Charge, Federal Bureau of Investigation, New York Field Office (FBI) announced the arrests and charges. As alleged, between 2017 and 2022, Sutton, a U.S. citizen residing in Russia, led his co-defendants in carrying out an international scheme to bill private insurers for hundreds of millions of dollars’ worth of fraudulent prescriptions. At Sutton’s direction, the conspirators oversaw call centers initially based in Utah, but later operated from Russia and other foreign nations. Call center employees telephoned beneficiaries enrolled in private insurers’ health care plans and offered prescription medications at little to no cost to the beneficiaries and without any medical exam to determine the medical necessity for those medications. The defendants also recruited doctors purportedly to review prescriptions by nurse practitioners and physician’s assistants after telemedicine visits. Contrary to what the recruited doctors were told, in many cases there were no telemedicine visits between the beneficiaries and any medical professionals. The conspirators generated fraudulent prescriptions under the physicians’ names and National Provider Identifier (NPI) numbers. Despite the prescriptions, many beneficiaries never received the medications. To conceal their involvement, the defendants operated under multiple aliases, funneled millions of dollars through pass-through shell companies and straw owners, used end-to-end encrypted communications and moved operations overseas. Specifically, the defendants purchased and operated dozens of existing brick-and-mortar pharmacies through straw owners including in Brooklyn, Staten Island, Manhattan, Long Island, New Jersey, Pennsylvania, Texas, Michigan and Alabama. The conspirators also laundered millions of dollars in fraudulent proceeds from overseas through pass-through shell companies that they used to purchase the scheme pharmacies and conceal the defendants’ involvement. After acquiring the brick-and-mortar pharmacies, the conspirators oversaw the installation of pharmacy management software that allowed for the remote submission of reimbursement requests by the scheme pharmacies to private insurers; they also trained and supervised a team of "billers" that remotely submitted hundreds of thousands of reimbursement requests totaling over $500 million for over 50 pharmacies. Ultimately, private insurers paid over $280 million as a result of the fraudulent billing. Co-conspirators Dela Saidazim pleaded guilty in February 2023 and David Gary Bishoff pleaded guilty in March 2023 to health care fraud conspiracy and are awaiting sentencing. The government’s case is being handled by the Office’s Business and Securities Fraud Section. Assistant United States Attorneys John Vagelatos, Jessica Weigel and Jonathan P. Lax are in charge of the prosecution with assistance from Paralegal Specialist William Daniels. Claire S. Kedeshian of the Office’s Asset Recovery Section is handling forfeiture matters ...
/ 2023 News, Daily News
The Division of Workers’ Compensation (DWC) has posted the 2022 DWC Audit and Enforcement Unit annual report on its web page. The Audit Unit annual report provides information on how claims administrators audited by the DWC performed and includes the Administrative Director’s ranking report for audits conducted in calendar year 2022. The 2022 Audit Unit annual report details the results of audits conducted in 2022 and provides the name and location of each insurer, self-insured employer, and third-party administrator audited during that time. This report to the Legislature summarizes audits conducted in accordance with Labor Code sections 129 and 129.5 to assure that injured workers, and their dependents in the event of their death, are provided with all benefits due them in an expeditious manner. The audit findings, by law, must detail the number of files audited, the number and type of violations cited, and the amount of an undisputed compensation found due and unpaid to the injured worker. The audit findings presented in this report are statistical and do not identify any individual injured worker. The Labor Code provides that contents of the claim files and the Audit Unit working papers are confidential. Performance of insurers, self-insured employers, and third-party administrators subject to profile audit review and full compliance audit is rated in accordance with the performance standards set annually by the Administrative Director. The DWC Administrative Director’s 2022 Audit Ranking Report lists, in ascending order by performance rating, the administrators audited in calendar year 2022. The DWC Audit & Enforcement Unit completed 48 audits. Forty-six audit subjects (96%) met or exceeded the PAR 2022 performance standard and therefore had no penalty citations assessed in accordance with Labor Code section 129.5(c) and CCR, Title 8, section 10107.1(c)(4). However, these audit subjects were ordered to pay all unpaid compensation. Congratulations to the top 10 ranking carriers or third party administrators as follows: 1. Sutter Health / Sacramento 2. Workers' Compensation Administrators, LLC / Santa Maria 3. Tristar Risk Management / Fresno 4. Loma Linda University Health / San Bernardino 5. Sedgwick Claims Management Services / Rancho Cordova 6. Insurance Company of the West / Woodland Hills, CA 7. County of Kern / Bakersfield 8. Tokio Marine America Insurance Company / Pasadena 9. Self Insured Schools of CA / Bakersfield 10. State Compensation Insurance Fund - State Contract Claims / Riverside Two audit subjects (4%) failed to meet or exceed the PAR standard, and their audits expanded into full compliance audits of indemnity claims (FCA stage 1). One of the two audit subjects met or exceeded the FCA 2022 performance standard and therefore had penalty citations assessed for unpaid and late payment of indemnity pursuant to Labor Code section 129.5(c)(2) and CCR, Title 8, section 10107.1(d). The other one audit subject failed to meet or exceed the FCA 2022 performance standard, and their audit expanded into full compliance audits of indemnity claims (FCA stage 2), and samples of denied claims to be audited were added. This audit subject was assessed administrative penalties for all penalty citations in accordance with Labor Code section 129.5(c) and CCR, Title 8, sections 10107.1(d) and (e). The Annual Audit Unit report is posted to the DWC Audit and Enforcement Unit web page ...
/ 2023 News, Daily News
A farm owner has been charged with involuntary manslaughter after his worker was killed servicing an unsafe 16,000-pound spinach harvester. The Santa Clara County Grand Jury returned an indictment against a Watsonville-based company, Willoughby Farms, and its owner, for causing the death of Carlos Jimenez Cruz. At approximately 4:30 a.m. on October 15, 2020, the 32-year-old victim was strangled to death when the hood on his clothing was caught in a spinning shaft on the machine. David Willoughby, 50, the president of Willoughby Farms, Inc. was arraigned this week on felony charges. The corporation, along with an affiliated LLC, will be also be arraigned on the felony charges. The allegations include failing to provide adequate training to employees and failing to cover the dangerous parts of the machine, causing the death of Mr. Cruz. The maximum sentence for involuntary manslaughter is four years in prison. Willoughby Farms faces millions of dollars in fines for three related Labor Code violations. According to Cal/OSHA records, at 5:30 a.m. on October 15, 2020, Cruz was greasing the spinach harvesting machine with a grease gun for routine maintenance. There were no direct witnesses to the accident however the employee was last observed on the ground greasing the machine by a coworker who left the area to retrieve a water tank. When the coworker returned to the area, he found the employee on the platform, not moving, with his hoodie caught around the shaft of the machine. The coworker climbed up the ladder and pulled the cord to stop machine. Emergency services were called, and the employee pronounced dead at the scene. Cal/OSHA issued 7 citations, 5 of which were deemed "Serious." Records reflect the employer contested all seven. Case status remains open. "Employers have a basic responsibility to make sure their workers are safe," District Attorney Jeff Rosen said. "It is a tragedy and a crime when a person doing their job is injured or killed because an employer fails to pay attention to safety." Willoughby Farms has been around for generations growing spinach and other crops. This is the second time that a Santa Clara County Grand Jury has indicted an employer for a workplace death. In 2015, a jury convicted US Sino Investment owner Richard Liu and Project Manager Dan Luo of involuntary manslaughter when an unsupported 12-foot trench collapsed and crushed a worker 36 year old day laborer, Raul Zapata. The defendants were sentenced to two years in prison. In total, US Sino Investment, was penalized $168,175 in citations. Their convictions and sentencing capped an extremely rare jury trial in such workplace deaths, which are typically settled either through administrative fines. "This is certainly the first instance of its kind I’ve ever heard of," said Dave Cogbill, executive director of the California Building Industry Association ...
/ 2023 News, Daily News
David Leung, a former Bay Area restaurant owner, pled guilty to eight felony counts for cheating his employees and defrauding the State of California through tax evasion. Leung owned Kome Japanese Seafood Buffet Inc. in Daly City, Tomi Japanese Seafood and Grill Inc. in San Jose, and Tomi Japanese Seafood Buffet in Concord. Leung pleaded guilty to eight felonies including six counts of wage theft, tax evasion, and filing a false tax return. Sentencing will occur on April 23, 2024. The California Department of Justice’s (DOJ) Tax Recovery in the Underground Economy (TRUE) Task Force prosecuted the case in partnership with multiple state agencies. The guilty plea was the result of an investigation by DOJ, CDTFA, EDD, and DIR. DOJ, CDTFA, and EDD are a part of the (TRUE) Task Force. TRUE began investigating suspected wage theft, sales and employment tax evasion, and suppression of sales by Leung in 2017. Leung was charged with stealing more than $893,000 in wages from employees and evaded $287,697 in sales tax to CDTFA and $171,820.55 in employment taxes to EDD. Assembly Bill 1296 established the Tax Recovery in the Underground Economy Criminal Enforcement Program (TRUE) on January 1, 2020. Formerly known as Tax Recovery and Criminal Enforcement (TRaCE), TRUE is an important measure to support the state’s efforts to combat and deter underground economic crimes in California. The case will proceed against two other defendants. It is important to note that every defendant is presumed innocent until proven guilty. "Tax evasion and wage theft harm hardworking Californians trying to make ends meet and seriously impact our state’s ability to provide critical services for Californians," said Attorney General Bonta. "David Leung purposefully evaded his obligations as a taxpayer and exploited his employees for his own gain. I want to thank the California Department of Tax and Fee Administration, the Employment Development Department, and the Department of Industrial Relations whose critical efforts were key to stopping his unlawful behavior. Today’s announcement should serve as a reminder: If you break the law and engage in fraud or theft, my office will hold you accountable." "Tax evasion is not a victimless crime; Californians rely on that revenue to support vital services and programs," said California Department of Tax and Fee Administration Director Nick Maduros. "Together with law enforcement and our fellow state departments, we are committed to taking aggressive action against those who try to defraud the system." "Together with workers and community organizations that represented or assisted the primarily Chinese speaking workers who were cheated out of their earned wages, my office was able to secure $2.6 million in compensation for these workers in 2020," said Labor Commissioner Lilia García-Brower. "Wage theft is a crime that has profound impacts on families, and ripple effects throughout our communities and the economy. We appreciate the Attorney General’s office’s partnership on this case." ...
/ 2023 News, Daily News
A disbarred New York City lawyer, who simultaneously represented the Los Angeles Department of Water and Power (LADWP) and a ratepayer suing the City of Los Angeles in the wake of an LADWP billing debacle, was sentenced to 33 months in federal prison for accepting a kickback of nearly $2.2 million for causing another lawyer to purportedly represent his ratepayer client in a collusive lawsuit against the city, which enabled the city to settle the case on favorable terms. Paul O. Paradis, 60, of Scottsdale, Arizona, who once ran the Manhattan-based Paradis Law Group, was sentenced by United States District Judge Stanley Blumenfeld Jr. At the sentencing hearing, Judge Blumenfeld said Paradis intentionally placed himself "at the center of sophisticated and greedy schemes of corruption that wreaked havoc on individuals and institutions alike." Judge Blumenfeld further explained that Paradis was motivated by "pure greed" and said the level of corruption in the case was "mind-boggling." Paradis pleaded guilty in January 2022 to one count of bribery. In 2013, LADWP implemented a new billing system that it had procured from an outside vendor, PricewaterhouseCoopers (PwC). After LADWP rolled out the new system, hundreds of thousands of LADWP ratepayers received massively inflated and otherwise inaccurate utility bills. Soon afterward, the city and LADWP faced multiple class-action lawsuits filed by ratepayers alleging harm resulting from the faulty billing system. In December 2014, the Los Angeles City Attorney’s Office retained Paradis as special counsel to represent the city in a lawsuit against PwC. When Paradis began representing the city as special counsel in the PwC litigation, the Los Angeles City Attorney’s Office was aware that he was simultaneously representing Antwon Jones, a ratepayer who had a claim against LADWP arising from billing overcharges. Jones was unaware that his lawyer, Paradis, also represented his intended adversary. At a February 2015 meeting with at least one senior member of the City Attorney’s Office, Paradis was authorized and directed to find counsel that would be friendly to the city to supposedly represent Jones in a class-action lawsuit against the city. Under this so-called "white knight" strategy, the forthcoming Jones v. City of Los Angeles lawsuit would be used as a vehicle to settle all existing LADWP-billing-related claims against the city on the city’s desired terms. Soon thereafter, Paradis recruited an Ohio lawyer to nominally represent Jones in the white knight lawsuit with the understanding that Paradis would do virtually all the work. In exchange, and unbeknownst to the city, Paradis and the Ohio lawyer agreed that Paradis would receive 20% of the Ohio lawyer’s fees in the Jones v. City case as a secret kickback. In July 2017, a Los Angeles Superior Court judge issued a final approval of the $67 million settlement agreed to by the parties in Jones v. City, including approximately $19 million in plaintiffs’ attorney fees, of which the Ohio lawyer and his law firm obtained approximately $10.3 million. The Ohio lawyer then secretly paid $2,175,000 to Paradis, disguising the kickback as a real estate investment, and funneling it through shell companies that Paradis and the Ohio lawyer had set up exclusively for the purpose of transmitting and concealing the illicit payment. Paradis also admitted bribing LADWP’s general manager, David H. Wright, to obtain a lucrative $30 million no-bid contract in June 2017 to remediate LADWP’s billing system. In another secret deal, Wright lobbied the LADWP Board to approve the contract for Aventador Utility Solutions, a downtown Los Angeles-based cyber services company formed by Paradis, in exchange for Paradis’ promise to make Wright Aventador’s future CEO and give him a $1 million annual salary and luxury car. At the time it approved the no-bid contract, the LADWP Board was not informed that Paradis had ghostwritten a May 2017 independent monitor report on the Jones v. City settlement on which LADWP based its decision. The Paradis-written report claimed that LADWP could not meet its obligations under the Jones v. City settlement agreement unless it contracted with Aventador. The LADWP Board also was unaware that Wright was advocating for the award of the $30 million no-bid contract to Paradis’s company because he had been bribed. Paradis pled guilty to a cooperation plea agreement that requires Paradis to provide information to federal investigators as well as to the State Bar of California, which is conducting its own disciplinary investigation related to the collusive litigation scheme, in exchange for potential sentencing consideration. Federal prosecutors said Paradis’ cooperation helped to secure the guilty pleas of Wright, who also pleaded guilty to bribery, Thomas H. Peters, the former litigation chief of the City Attorney’s Office, who pleaded guilty to extortion in connection with covering up the collusive litigation, and David F. Alexander, LADWP’s former Chief Information Security Officer, who pleaded guilty to lying to the FBI about bribery-related conversations with Paradis. In court papers and at the sentencing hearing this month, federal prosecutors recommended a sentence of 18 months’ imprisonment based on Paradis’ cooperation with the federal and State Bar of California investigations. Judge Blumenfeld acknowledged the basis for the government’s recommendation but stated a higher sentence was necessary to account for Paradis’ conduct, which Judge Blumenfeld said, "shattered public confidence in the government and legal profession." Wright and Alexander are serving federal prison sentences of six years and four years, respectively, after pleading guilty to felony offenses in this case. Peters was sentenced to probation ...
/ 2023 News, Daily News
The National Council on Compensation Insurance (NCCI) Annual Insights Symposium (AIS) 2023 presentation titled Under the Microscope: Medical Trends in Comp Guide described changes in the utilization of physician services over time, from 2012 to 2022. During that period, average utilization per claim over studied states increased modestly. A decrease in utilization due to less severe diagnoses and fewer major surgeries was more than offset by increased physical therapy. NCCI’s Physician Service Utilization - A Multistate Review extends the AIS research to consider variations in the utilization of physician services across states in a given year. NCCI’s Physician Service Utilization - A Multistate Review webinar examines an analytic method to deconstruct differences in physician service utilization between states into contributions from differences in injury mix and medical treatment. The Physician Service Utilization - A Multistate Review Guide provides a slide-by-slide examination of the key insights, data sources, and background underlying the presentation. - - Physician service utilization differs across states. They range from a low of $800 to around $3,000, with the all-state average right about $1,800. - - Patterns of interstate variation have been stable over the past decade. - - Utilization variations reflect state differences in injury mix, likelihood of major surgery, and service intensity. - - Interstate variations bigger than +/ 10% are mainly driven by differences in the intensity of nonsurgical medical services. - - Differences in injury mix and likelihood of major surgery are lesser drivers of utilization variation, though significant in some states. - - For most states, the change in utilization between 2012 and 2022 was modest. - - Interstate physician utilization variations have remained stable over the past decade - the order of state differences has remained consistent between 2012 and 2022. - - Service intensity emerges as the primary factor behind interstate variations in physician utilization for many states. - - While differences in injury mix and the likelihood of major surgery do play a role, their impact on utilization variation is comparatively smaller, although notable in specific states. - - In many states, physical therapy (PT) drives physician service intensity - especially for claims without surgery. - - Three major body systems - back/neck, shoulder, and leg/foot (includes leg, knee, ankle, and foot) account for nearly 60% of injuries in 2022 for the all-state category. - - The mix in individual body systems does not have a particular correlation with the differences in utilization. Instead, they uniformly contribute, to some extent, to the percentage difference in physician service utilization. NCCI has looked to see if common features of state medical regulation correlate with or explain these variations. Examples are features such as workers compensation treatment guidelines, the use of fee schedules, network penetration, and the like. That investigation led it to understand that there was not any single feature that can explain these variations. For additional insights, check out the Physician Service Utilization - A Multistate Review Guide. This comprehensive resource is a companion to the webinarand offers a slide-by-slide examination of the key insights, data sources, and background underlying the presentation ...
/ 2023 News, Daily News
The Leapfrog Group, an independent national nonprofit driving a movement for patient safety founded in 2000 by large employers and other purchasers, just released its fall 2023 Hospital Safety Grades, assigning a letter grade to nearly 3,000 general hospitals on how well they prevent medical errors, accidents and infections. The Leapfrog Hospital Safety Grade is the only hospital ratings program based exclusively on hospital prevention of medical errors and harms to patients. It is fully transparent and free to the public, and grades are updated biannually in the fall and in the spring. The latest grades show hospitals reducing health care-acquired infections (HAIs) post-pandemic, after significant increases in infection rates during the COVID-19 pandemic. This cycle, nearly 30% of hospitals earned an "A," 24% earned a "B," 39% earned a "C," 7% earned a "D," and less than 1% earned an "F." Out of 3000 hospitals surveyed, 11 of them were given a score of "F." Four of those 11 are in California. - - Memorial Hospital of Gardena - - Mission Community Hospital (Panorama City) - - Pacifica Hospital of the Valley (Sun Valley) - - Providence St. Mary Medical Center (Apple Valley) New York is the state with the second most on the "F" list with two hospitals receiving an "F" grade. Utah is the state with the highest percentage of "A" hospitals in the country this fall. After Utah, the top ten states for "A" hospitals are: Virginia, North Carolina, Pennsylvania, South Carolina, Connecticut, Montana, Tennessee, Florida and Texas. "Now that we have pre- and post-pandemic data for patient safety measures, we are encouraged by the improvement in infections and applaud hospitals for reversing the disturbing infection spike we saw during the pandemic," said Leah Binder, president and CEO of The Leapfrog Group. "However, there’s still more work to be done. It’s deeply concerning that patient reports about their health care experience continues to decline." ...
/ 2023 News, Daily News
Jeremy Gober, 42, of Hanford, pleaded guilty on November 6 to health care fraud and aggravated identity theft charges for submitting more than $1.5 million in fraudulent claims to Medicare and Medi-Cal for sleep studies, U.S. Attorney Phillip A. Talbert announced. Jeremy Gober co-owned and co-operated Got Sleep Inc., which operated sleep clinics in Fresno and Orange Counties in California. Sleep clinics perform diagnostic sleep studies to identify disorders like sleep apnea and narcolepsy. According to court documents, between August 2016 and July 2020, Gober caused Got Sleep to submit thousands of claims to Medicare and Medi-Cal for sleep studies that were not actually performed on patients. The claims also stated falsely that the patients had been referred for the sleep studies by physicians with whom Gober had previously worked. This was done because Medicare and Medi-Cal will not pay for a sleep study unless the patient was referred by a physician. This case is the product of an investigation by the U.S. Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and the California Department of Health Care Services. Assistant U.S. Attorney Joseph Barton is prosecuting the case. U.S. District Judge Ana de Alba is scheduled to sentence Jeremy Gober on March 4, 2024. He faces a maximum statutory penalty of 10 years in prison for the health care fraud conviction and an additional, mandatory two years in prison for the identity theft conviction. In September 2023, Jeremy Gober’s brother, Travis Gober, pleaded guilty to similar health care fraud and aggravated identity theft charges related to other sleep clinics in the Central Valley. He is scheduled to be sentenced on Jan. 16, 2024. Travis Gober faces a maximum statutory penalty of 10 years in prison for the health care fraud conviction, and an additional, mandatory two years in prison for the identity theft conviction ...
/ 2023 News, Daily News
Late last month, President Biden issued an Executive Order to establish new standards for artificial intelligence (AI) safety and security with the goal of ensuring the U.S. leads the way in seizing the promise and managing the risks of AI. The Executive Order also aims to protect privacy, advance equity and civil rights, stand up for consumers and workers, promote innovation and competition, as well as advance U.S. leadership around the world. The Order is more than 100 pages in length and is a directive across the "whole of government" to begin regulating this new technology. The order directs or makes requests of countless federal agencies, from the Departments of Energy and Homeland Security to the Consumer Financial Protection Bureau and the Federal Housing Financing Agency, and more. These agencies, in turn, have the authority to issue regulations that carry the force of law. The order also mandates the creation of new AI Governance Boards and Chief AI Officer positions across federal agencies, laying a possible groundwork for a new centralized AI agency. And the reaction to this Order across America is not all good. Forbes responded with the article "Biden’s New AI Executive Order Is Regulation Run Amok." and the author believes that this "may prove one of the most dangerous government policies in years" citing several scenarios of potential unintended negative consequences in various industries. Some industry groups have expressed concern that the order's regulatory requirements will stifle innovation in the AI sector. For example, the NetChoice trade group has warned that the order could "put any investment in AI at risk of being shut down at the whims of government bureaucrats." Other critics have argued that the order is too vague and lacks specific details about how the government plans to implement and enforce its provisions. For example, the Algorithmic Justice League, a civil rights group, has said that the order "does not go far enough" to protect people from the harms of AI. Some experts have also criticized the Biden administration for failing to consult more broadly with the public and stakeholders before issuing the order. For example, the Brookings Institution think tank has said that the order "reflects the administration's own priorities, but not necessarily the priorities of the broader AI community." The American Civil Liberties Union (ACLU) has warned that the order's focus on national security could lead to the government using AI for mass surveillance and other purposes that could violate civil liberties. Citing the announcement of this Executive Order, the National Safety Council issued a responsive statement. saying that it believes data and AI can be used to gain insights into workplace safety programs and that employers can apply those same insights and technology to reduce the risk of serious injuries and fatalities for workers. The National Safety Council is America’s leading nonprofit safety advocate - and has been for 110 years. As a mission-based organization, we work to eliminate the leading causes of preventable death and injury, focusing our efforts on the workplace and roadways. Over the past five years, NSC has focused specifically on how technology, including AI, can improve health and safety outcomes on the job through its Work to Zero initiative, which continues to reveal how technology works well and can be improved to save lives. Some of the prevailing AI technologies include machine learning, computer vision, natural language processing, as well as predictive and prescriptive analytics engines. All these technologies serve as powerful tools to identify risk factors for musculoskeletal disorders and other injuries, reduce employee incidents and streamline manual tasks. The NSC said it urges the White House, Congress and other policymakers to examine these findings as it continues to incorporate learnings into this effort. The Biden Executive Order on AI is just the beginning of the process of regulating AI in the United States. It remains to be seen how the order will be implemented and enforced, and whether it will be effective in addressing the risks and challenges posed by AI ...
/ 2023 News, Daily News