Labor Code Sections 62.5 and 62.6 authorize the Department of Industrial Relations to assess employers for the costs of the administration of the workers' compensation, health and safety and labor standards enforcement programs. These assessments provide a stable funding source to the support operations of the courts, to ensure safe and healthy working conditions on the job, to ensure the enforcement of labor standards and requirements for workers' compensation coverage. Labor Code Sections 62.5 and 62.6 require allocation of the six assessment types between insured and self- insured employers in proportion to payroll for the most recent year available. Enclosed with a letter is an invoice for the share of the following total assessments, and a document showing the methodology used to compute the assessment amounts and the resulting determination of the respective assessment/surcharge factors. The factors are applied to the premium amount are allocated across the following six categories: - - Workers' Compensation Administration Revolving Fund Assessment (WCARF) - - $ 698,761,939 - - Subsequent Injuries Benefits Trust Fund Assessment (SIBTF) - - $ 848,000,000 - - Uninsured Employers Benefits Trust Fund Assessment (UEBTF) - - $ 53,088,800 - - Occupational Safety and Health Fund Assessment (OSHF) - - $ 189,509,130 - - Labor Enforcement and Compliance Fund Assessment (LECF) - - $ 181,983,628 - - Workers' Compensation Fraud Account Assessment (FRAUD) - - $ 90,435,332 All workers' compensation insurance policies issued with an inception date during the calendar year 2025 must be assessed to recover amounts advanced on behalf of policyholders. Assessable Premium is the premium the insured is charged after all rating adjustments (experience rating, schedule rating, premium discounts, expense constants, etc.) except for adjustments resulting from the application of deductible plans, retrospective rating or the return of policyholder dividends. The assessment factors to be applied to the estimated annual assessable premium for 2025 policies are shown in the table on the notice. These are the same factors that were used to calculate the assessment. The total assessment is calculated based on the direct workers' compensation premiums reported to the Department of Insurance for Calendar Year 2023 by carriers. The first installment is due on or before January 1, 2025, with the balance due on or before April 1, 2025 ...

Laudio and the American Organization for Nursing Leadership (AONL) announced the release of their second joint report, Trends and Innovations in Nurse Manager Retention. The report provides new data on nurse manager retention trends, along with the downstream impacts of manager turnover, and couples it with actionable insights directly from managers on high-priority improvements to promote satisfaction, retention, and growth. The authors found the highest exit rates in the first few years of a nurse management role. In the first four years, between 10% and 12% of nurse managers step down and return to front-line work. In the first three, up to 12% leave the organization. Building on the spring report, Quantifying Nurse Manager Impact, the new report provides fresh insights from the Laudio Insights dataset - spanning over 200,000 frontline team members - and AONL-led interviews with nurse managers. The analysis shows that nurse manager turnover is highest during the first four years of leadership, revealing a critical window for leader support and investment. Furthermore, nurse manager transitions have a quantifiable impact on RN retention - they were associated with a two to four percentage point average rise in RN turnover in the year that followed. "Nurse managers are vital in maintaining the stability of frontline teams and ensuring optimal patient care," said Robyn Begley, CEO of AONL and chief nursing officer, SVP of workforce at the American Hospital Association. "This report underscores the importance of prioritizing nurse manager well-being and engagement in health systems’ workforce strategies. It also provides practical guidance to implement meaningful changes to support these crucial leaders." The report also highlights top areas for health system executives to prioritize based on nurse manager interviews.The national average exit rate for nurse managers is 8.8%, according to the report. At hospitals in California, Ohio and Louisiana, leaders shared with Becker's Hospital Reviewhow they have achieved turnover rates as low as 3%. In California Keck Hospital of USC, which has an annual nurse manager turnover rate of 3%, has "mastered" the skill of engaging these leaders and ensuring job satisfaction, according to Chief Nursing Officer Ceonne Houston-Raasikh, DNP, RN. The Los Angeles-based hospital hosts quarterly listening sessions for its 13 nurse managers to share their challenges and frustrations. Additionally, anonymous pulse surveys examine engagement levels. One issue that Keck Hospital of USC recently addressed was the timeline for performance evaluations. They were originally due Dec. 31, but after managers expressed the "crunch time" coupled with scheduled end-of-year time off, leaders postponed the deadline to Jan. 31. When Dr. Houston-Raasikh joined Keck, several nurse managers were fairly new to their roles. They were also relatively new to healthcare, as many had fewer than three years of experience. Nurses a few years into their career have less lived experience with conflict than those with 10-plus years into leadership, and thus need more support when navigating tense situations, Deana Sievert, DNP, RN, chief nursing officer of Columbus-based UH/Ross Heart Hospita said ...

U.S. Attorney Phillip A. Talbert announced that Ifeanyi Vincent Ntukogu, 49, of Fresno, was sentenced to seven years and three months in prison for illegally distributing oxycodone and hydrocodone. Ntukogu was a pharmacist in Madera who dispensed more than 450,000 oxycodone and hydrocodone pills based on fraudulent prescriptions, all in exchange for cash. "As a licensed pharmacist, Mr. Ntukogu was trusted to dispense medications safely, supporting positive health outcomes. He intentionally exploited his trusted role, dispensing hundreds of thousands of fraudulently prescribed oxycodone and hydrocodone pills, knowing his greed-fueled actions would put opioids in the hands of drug dealers and could cause grave harm to the public. Working closely with our state and federal law enforcement partners, we dismantled this operation and held those who chose profit over public safety accountable," said Special Agent in Charge Sid Patel, who leads the FBI Sacramento field office. "Ntukogo thought he could outsmart the system by rejecting red flag prescriptions all while conducting drug deals on the side for cash. His illicit scheme led to the distribution of nearly half a million highly addictive opioids in Tennessee, Texas and beyond; fueling the fire of prescription drug misuse and endangering American lives," said DEA Special Agent in Charge Bob P. Beris. "This lengthy sentence underscores the serious consequences for medical practitioners who place profits above people. DEA will continue to work with our counterparts to investigate, arrest and prosecute individuals who abuse their positions and threaten public safety." According to court records, from December 2014 through November 2018, Ntukogu dispensed more than 450,000 oxycodone and hydrocodone pills based on fraudulent prescriptions delivered to him by his co-conspirators and co-defendants in the case, Kelo White and Donald Pierre. The prescriptions were from more than 10 different physicians whose signatures were forged. Ntukogu reviewed each prescription and rejected the ones that he believed regulators may deem suspicious. For example, he rejected prescriptions that were supposedly written by certain doctors or that were written for individuals who were having prescriptions filled at other pharmacies because he believed those prescriptions may raise red flags. Ntukogu dispensed the pills through his New Life Pharmacy in Madera. Upon doing so, he required cash payments from White and Pierre and increased the price that he charged over time. White and Pierre then illegally sold the pills in Tennessee, Texas, and elsewhere. Ntukogu received hundreds of thousands of dollars for his participation in the scheme. His sentence was also enhanced because he used his special skills as a pharmacist to help commit the crime. This case was the product of an investigation by the Federal Bureau of Investigation, the Drug Enforcement Administration, and the California Department of Health Care Services. Assistant U.S. Attorneys Antonio Pataca and Joseph Barton prosecuted the case. The case was investigated under the DOJ’s Organized Crime Drug Enforcement Task Force (OCDETF). OCDETF identifies, disrupts, and dismantles the highest-level criminal organizations that threaten the United States using a prosecutor-led, intelligence-driven, multi-agency approach. For more information about OCDETF, please visit Justice.gov/OCDETF. This case was also part of the DOJ’s Operation Synthetic Opioid Surge (SOS), which is a program designed to reduce the supply of deadly synthetic opioids in high impact areas as well as identifying wholesale distribution networks and international and domestic suppliers. White is scheduled to be sentenced on Feb. 24, 2025. He faces a statutory maximum penalty of 20 years in prison and a $250,000 fine. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables. Pierre, the remaining defendant in the case, was previously convicted and sentenced to nine years and four months in prison. "This defendant displayed a blatant disregard for public safety and the law," U.S. Attorney Talbert said. "It took the effort of agents, investigators, undercover officers, and medical professionals to bring an end to this illicit prescription-writing racket. The U.S. Attorney’s Office will continue our pursuit of those who fuel the opioid epidemic for their own personal benefit." ...

The California Attorney General announced the filing of 31 criminal charges and two enhancements against US Framing West and two employees,Thomas Gregory English and Amelia Frazier Krebs, for multiple violations of state labor laws. The announcement follows their surrender and arraignment in Los Angeles Superior Court earlier this month. Between 2018 and 2022, US Framing West provided framing construction for multiple projects across California allegedly using crews of unlicensed subcontractors. While working these projects, US Framing West allegedly committed grand theft, payroll tax evasion, prevailing wage theft, and filed false documents with the State. In the complaint, the Attorney General alleges that US Framing West failed to pay more than $2.5 million in state payroll taxes during this period and underpaid its workers by approximately $40,000 at a public works project in Cathedral City. US Framing West is a construction company that specializes in framing contracting. DOJ’s investigation revealed that US Framing West had secured a number of high-paying framing jobs on large construction projects in California and then subcontracted out the physical labor to unlicensed subcontractors. Starting in 2018 and through to 2022, US Framing West is alleged to have hired numerous unlicensed contractors for projects throughout the State and failed to file and submit taxes to the California Employment Development Department (EDD) for these employees. DOJ’s investigation into US Framing West began after the Northern California Carpenters Regional Council alerted DOJ to potential wage theft violations occurring at an Oakland construction project. DOJ, with support from the California Department of Insurance, California Department of Industrial Relations (DIR), and EDD, subsequently conducted a joint investigation into US Framing West for allegations relating to violations of state labor laws and tax evasion on construction projects spanning Alameda, Los Angeles, Contra Costa, Orange, Riverside, San Diego, San Francisco, and Santa Clara counties. Additionally, DOJ alleges that US Framing West engaged in prevailing wage theft and filing false documents with DIR in connection with a public works project in Cathedral City. Public works projects - projects that use more than $1,000 of public funds - require all workers on the project to be paid the "prevailing wage." ...

Jesus "Jesse" Fonseca worked at Walmart's Apple Valley distribution center in San Bernardino County for 14 years, During that time he claimed he competently executed all tasks and was commended for his hard work and dedication. His yearly performance reviews were always satisfactory and he received quarterly bonuses throughout the entirety of his employment. In addition, he received numerous awards, including model safety trucks, safety jackets, certificates and annual safety belt buckles. Also, he was a leader in his department, and was involved in a hiring committee, a safety committee, and a set run committee. Additionally, he rained drivers and was a mentor for approximately 12 drivers. Fonseca was injured on the job when his semi-truck was rear-ended on June 19, 2017. He filed a workers' compensation claim and his work restrictions varied from time to time, but for the most part they included no pushing, pulling and lifting over 5-10 pounds and no commercial driving. Fonseca claimed his doctors said that he should not be driving the 18-wheeler for 10-14 hours per day as was typical for his employment with Walmart. He also claimed that Walmart failed to accommodate each and every request for accommodations he made. On January 31, 2018, Fonseca said he received a call from Walmart who said it .was informed that there was a report of fraud and questioned him for approximately 20 to 30 minutes. Walmart told him that they were informed that he was driving a vehicle and his restrictions provided that he could not drive. He informed Walmart that his restriction not to drive was as to commercial vehicles for commercial purposes, and did not understand those restrictions to include personal driving, especially because he drove to his doctor’s appointments and was not informed that he could not drive himself to his appointments. So he maintained that he did not do anything wrong. On February 3, 2018, he claimed Walmart denied his last request for modified duty before he was terminated from employment. His workers’ compensation claim continued without incident and he claims he did not receive any further information or communications from Walmart as to the alleged fraud until March 27, 2018, when Tisha Snyder allegedly called him and accused him of fraud and told him that his employment was going to be terminated because of gross misconduct and integrity. Snyder allegedly called him in the presence of a third party, his supervisor, Lou Lacroix. The next day March 28, Fonseca allegedly attempted to discuss his termination with Walmart’s VP of transportation, Jeff Hammonds. However, Mr. Hammonds initially said he would get back to him by end of day, then he refused to speak with him since he was represented by workers’ compensation counsel. On March 29, 2018, while Fonseca was on lave for his work-related injuries, Walmart terminated his employment with the stated reason of gross misconduct and integrity. His attorney claimed Walmart's third-party workers' compensation administrators investigated Fonseca, and videotaped him driving an RV, and determined no further action was warranted. Fonseca alleges that on November 18, 2018, he applied for two jobs and alleges he was allegedly "forced" to disclose he was fired for "gross misconduct and integrity" and as a result he was "not considered for either job." On July 7, 2019 he filed a First Amended Complaint in the United States District Court, Central District of California (case 5:19-cv-00821-JGB-KK which was later transferred to state court) and he alleged 11 causes of action, for Disability Discrimination, Failure to Accommodate, Failure to Engage in an Interactive Process, Retaliation under FEHA, Failure to Prevent Discrimination, Interference under CFRA, Retaliation under CFRA, Hostile Work Environment, Wrongful Termination in Violation of Public Policy; Intentional Infliction of Emotional Distress and Defamation. The case ultimately proceed to a two phase trial in the San Bernardino Superior Court (CIVDS1909501). On November 19, 2024 the jury issued its Special Verdict for Defamation Per Quod (a legal term that describes a defamatory statement that requires additional evidence to prove its harmful effect on a plaintiff's reputation). The Special Verdict found past economic losses of $522,323, future economic loss of $677,926, past non-economic loss of $3.5 million, Future non-economic loss of $5 million, (which totals $9.7M in actual damages) and additionally a phase II award of $25 million in punitive damages. Lead attorney David M. deRubertis s reportedly said the evidence in the trial "showed that Walmart's defamation of Jesse was part of a broader scheme to use false accusations to force injured truckers back to work prematurely or, if not, terminate them so that Walmart can cut down workers' compensation costs," In a statement to Newsweek,Walmart spokesperson Kelly Hellbusch said, "This outrageous verdict simply does not reflect the straightforward and uncontested facts of this case. Accordingly, we will pursue all available remedies." The deRubertis Law Firm APC and Eldessouky Law APC represent Fonseca. Constangy Brooks Smith & Prophete LLP represents Wal-Mart ...

A Santa Clarita man has been arraigned on an indictment alleging he distributed protonitazene - a novel synthetic opioid that is up to three times more powerful than fentanyl (which itself is 50 times stronger than heroin) - resulting in a victim’s fatal overdose this spring. The coroner’s office has identified the young man as Bryce Jacquet (DOB November 10, 2001). Out of over 160,000 death records made public by the county’s medical examiner since 1999, this appears to be the very first to explicitly mention protonitazene as a cause of death. Benjamin Anthony Collins, 21, is charged with one count of distribution of protonitazene resulting in death. This is believed to be the nation’s first death-resulting criminal case involving this narcotic. Protonitazene is a benzimidazole derivative with potent opioid effects which has been sold over the internet as a designer drug since 2019, and has been identified in various European countries, as well as Canada, the US and Australia. It has been linked to numerous cases of drug overdose, and is a Schedule I drug in the US. It was developed by a Swiss pharmaceutical company in the 1950s as an alternative to morphine, but was never adopted due to severe side effects. Collins was arrested on November 18, and pleaded not guilty to the charge at his arraignment. A trial date of January 14, 2025, was scheduled. A federal magistrate judge ordered Collins jailed without bond. According to the indictment, during the early morning hours of April 19, 2024, Collins knowingly and intentionally distributed protonitazene, which resulted in the death of 22 year old Bryce Jacquet. In recent years, protonitazene has been sold over the internet. Collins allegedly sold the 22-year-old victim pills containing protonitazene and arranged to sell the victim a bulk supply of these pills in the future. The victim, a resident of Stevenson Ranch, consumed the pills soon afterward in the front seat of his car and quickly died. His mother later found him dead in the front seat parked outside her home and called 911. An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed to be innocent until and unless proven guilty in court. If convicted, Collins would face a mandatory minimum sentence of 20 years in federal prison and a statutory maximum sentence of life imprisonment. The Drug Enforcement Administration and Los Angeles County Sherriff’s Department are investigating this matter. Assistant United States Attorney Lisa J. Lindhorst of the General Crimes Section is prosecuting this case ...

The Oceanside Unified School District filed a lawsuit in U.S. District Court for the District of New Jersey against pharmaceutical and pharmacy benefit companies. The lawsuit alleges that three pharmaceutical manufacturers - Eli Lily, Novo Nordisk, and Sanofi - and three pharmacy benefit managers - Express Scripts, CVS Caremark, and Optum RX - colluded to inflate the price of insulin paid by the district's self-funded health plan. The lawsuit describes a scheme in which pharmacy benefit managers (PBMs) secure billions of dollars in rebates from pharmaceutical manufacturers in exchange for including their insulin products on the PBMs' list of approved drugs, known as formularies. Manufacturers then artificially raise their prices to pay for those rebates, shadowing each other in lockstep rather than competing to offer lower consumer prices. The lawsuit points out that insulin is a century-old medication, and while its production costs have decreased with little need for new investments in innovation, research, or development, its price has surged by more than 1000 percent since 2003. This dramatic increase is attributed to a pricing strategy involving pharmaceutical manufacturers and pharmacy benefit managers. One of the attorneys representing the School District said in a press release that "like many organizations with self-funded health plans, the Oceanside Unified School District should not be forced to pay inflated and unreasonable insulin prices created by a scheme between big pharma and benefits managers to engage in unfair and deceptive trade practices. This lawsuit aims to address these practices under state unfair business laws and federal Racketeer Influenced and Corrupt Organization (RICO) laws." According to the story published by NBCSandiego.com, Oceanside Unified School District is one of more than 200 school districts joining in the lawsuits nationwide. The attorney representing it says they’re anticipating more districts from San Diego County to come forward. However, some employers with self-insured pharmacy benefits plans may become targets of litigation themselves. A study published by The American Journal of Managed Care last July conducted a national survey of 110 employer drug benefit decision makers for organizations with self-insured pharmacy benefits. The study found that nearly two-thirds of employers reported having rebate agreements with a rebate guarantee for specialty drugs.The person or entity most influential to rebate strategy decisions was often a benefits consultant (37.3%), a human resources/benefits leader (29.1%), or a benefits broker (21.8%). Employers with rebate guarantees ascribed a higher level of importance to guarantees when selecting a PBM than employers receiving rebates without a guarantee and those who do not receive rebates. The study concluded by saying "As the public discourse on PBMs and drug rebates continues, it is important to recognize the role employer benefits consultants may play in perpetuating employer reliance on guaranteed rebate arrangements." Responding to this study, the Mahoney Group warned "the reliance on drug rebate guarantees poses an elevated fiduciary risk for employers, especially in light of the Consolidated Appropriations Act (CAA) of 2021, which imposes tighter fiduciary duties on sponsors of group health plans." Large, self-insured employers are also beginning to face lawsuits from their workers over claims of mismanaging health and pharmaceutical benefits and violating their fiduciary duties under the Employee Retirement Income Security Act. Employees at Johnson & Johnson earlier this year filed a federal class-action lawsuit against their New Jersey-based employer alleging that over the years they have paid millions of dollars more for drugs than they should have. Wells Fargo was also sued by employees in a July class action for allegedly paying inflated prices to its contracted pharmacy benefits manager, Express Scripts. In a statement to NBC 7, Eli Lily said, in part: "These allegations are baseless. It is the school district and other health plans - not Lilly - who negotiate the terms of their rebate arrangements, including whether to pass those rebates on to people who take insulin." CVS Caremark also responded, saying, in part, "Pharmaceutical companies alone are responsible for the prices they set in the marketplace for the products they manufacture ... we intend to vigorously defend against this baseless suit." ...

Pharmaceutical company QOL Medical, LLC (QOL) and its CEO, Frederick E. Cooper, have agreed to pay $47 million to resolve allegations that they caused the submission of false claims to federal health care programs, in violation of the False Claims Act, by offering kickbacks, in the form of free Carbon-13 breath testing services, to induce claims for QOL’s drug Sucraid. Sucraid is an FDA-approved therapy for the rare genetic condition, Congenital Sucrase-Isomaltase Deficiency (CSID). CSID patients have difficulty digesting sucrose (table sugar) and suffer from chronic gastrointestinal symptoms such as diarrhea, abdominal pain, bloating and gas. As part of the settlement, QOL and Mr. Cooper admitted and accepted responsibility for certain facts providing the basis of the settlement. Beginning in 2018, QOL, with Mr. Cooper’s approval, distributed free Carbon-13 breath test kits to health care providers and asked providers to give the kits to patients with common gastrointestinal symptoms. QOL claimed that the test could "rule in or rule out" CSID. In fact, the test does not specifically diagnose CSID. Conditions other than CSID can cause a patient to test "positive" for low sucrase activity on a Carbon-13 breath test. Approximately 30% of the Carbon-13 breath tests from QOL were positive for low sucrase activity. QOL paid a laboratory to analyze the breath tests, report the results to health care providers, and provide the results to QOL. The results QOL received from the laboratory did not contain patient names, but did contain the name of the health care provider who ordered the test, along with the patient’s age, gender, symptoms and test result. Between 2018 and 2022, QOL disseminated this information to its sales force with instructions to make sales calls for Sucraid to health care providers whose patients had positive Carbon-13 breath test results. QOL tracked whether sales representatives converted "positive" Carbon-13 breath tests into Sucraid prescriptions. As QOL’s CEO, Mr. Cooper was aware of and approved the implementation and continuation of this marketing program. Some QOL sales representatives also made claims regarding the Carbon-13 test’s ability to definitively diagnose CSID that were not supported by published scientific literature. For example, in slides at a 2019 national sales training, which Mr. Cooper reviewed, QOL suggested that sales representatives tell health care providers, "If you have a positive breath test, the patient will not improve unless you treat with Sucraid." The allegations resolved by the settlement agreement were, in part, originally bought in a case filed under the qui tam or whistleblower provisions of the False Claims Act by former QOL Medical employees. The case is captioned United States ex rel. John Doe 1, et al. v. QOL Medical, LLC, et al., No. 1:20-cv-11243 (D. Mass.). Of the total $47 million recovery, approximately $43.6 million constitutes the federal portion of the recovery and approximately $3.4 million constitutes a recovery for State Medicaid programs. The whistleblowers will receive approximately $8 million as their share of the recovery. This matter was handled by Assistant U.S. Attorneys Brian LaMacchia and Lindsey Ross for the District of Massachusetts and Trial Attorneys Emily Bussigel and Paige Ammons of the Justice Department’s Civil Division. The case was investigated by HHS-OIG, FBI, DCIS and the Office of Inspector General for the Department of Veterans Affairs ...

The Leapfrog Group, an independent nonprofit focused on patient safety, released its fall 2024 Hospital Safety Grade, evaluating nearly 3,000 hospitals on their ability to prevent medical errors, accidents and infections. The Hospital Safety Grade uses up to 30 performance measures to assign an A, B, C, D or F to individual hospitals and uses a public, peer-reviewed methodology, calculated by top patient safety experts under the guidance of a National Expert Panel. It is transparent and free to the public. Leapfrog analysts use the data to observe national performance trends and state rankings. For fall 2024, Utah ranks number one with the highest percentage of "A" hospitals for the third cycle in a row, followed by Virginia and Connecticut in second and third. The latest Grades also show hospitals are making progress in patient safety across several performance measures including notable improvements in healthcare-associated infections, hand hygiene and medication safety. Healthcare-Associated Infections (HAIs). Since Leapfrog reported Hospital Safety Grades in fall 2022, when HAI rates were at their highest peak since 2016, average HAI scores have declined dramatically: - - Central line-associated bloodstream infections (CLABSI) decreased by 38%. - - Catheter-associated urinary tract infections (CAUTI) decreased by 36% - - Methicillin-resistant Staphylococcus aureus (MRSA) decreased by 34% Hand Hygiene As Leapfrog detailed in its 2024 Hand Hygiene Report, since Leapfrog began public reporting a tough new standard for hand hygiene in 2020, the percentage of hospitals achieving the standard has soared from 11% to 78%. Medication Safety Medication errors are the most common type of error that occur in hospitals and the new Hospital Safety Grade suggests improvements in how hospitals prevent them. Two of the measures in the Leapfrog Hospital Safety Grade show this progress: Computerized Physician Order Entry (CPOE): Leapfrog tracks how well hospitals use CPOE systems to catch common errors in prescribing, such as prescribing the wrong dose or prescribing a medication with a dangerous interaction with other medications the patient takes. Studies have shown CPOE systems can reduce harm from prescriber errors by as much as 55%. In 2018, only 65.6% of hospitals met Leapfrog’s Standard, while this year, that number rose to 88.1%. Bar Code Medication Administration (BCMA): Leapfrog scores hospitals on deployment of BCMA systems, which use barcodes at the bedside to ensure the right patient gets the right medication at the right time. In 2018, 47.3% of graded hospitals met the standard, while this year, 86.9% did. Trends in Safety Grades by State Key findings on state performance on the fall 2024 Leapfrog Hospital Safety Grade include: - - The states with the highest percentages of "A" hospitals are Utah, Virginia, Connecticut, North Carolina, New Jersey, California, Rhode Island, Idaho, Pennsylvania, Colorado and South Carolina - - Utah ranks #1 in percentage of "A" hospitals for the third Safety Grade cycle in a row. - - California ranks in the top 10 for the first time since fall 2014. - - There were no "A" hospitals in Iowa, North Dakota, South Dakota or Vermont. The Leapfrog Hospital Safety Grade is the only hospital ratings program focused exclusively on preventing medical errors and patient harm. It is fully transparent, free to the public and updated biannually in the fall and spring. Detailed hospital performance information, including patient experience and safety measures, as well as grades for individual hospitals searchable by states and localities is available ...

The U.S. Postal Service announced its financial results for the 2024 fiscal year ended September 30. Controllable loss, which excludes certain expenses that are not controllable by management, was $1.8 billion for the year, compared to over $2.2 billion for the prior year. The net loss for the year under generally accepted accounting principles (GAAP) totaled $9.5 billion, compared to a net loss of $6.5 billion for the prior year, an increase of $3.0 billion primarily attributed to the year-over-year increase in non-cash workers’ compensation expense. Over 80% of our current year net loss is attributed to factors that are outside of management's control, specifically, the amortization of unfunded retiree pension liabilities and non-cash workers' compensation adjustments. September 30, 2024 saw the release of Delivering for America 2.0 - Fulfilling the Promise, which revisits and reexamines our original 10-year transformation and modernization plan issued in March 2021, describes the significant progress made over the past three years, and summarizes the evolution of our major strategies that are now driving the organization forward to financial stability and sustained service excellence.. "Our pricing and product strategies are continuing to improve our revenue picture and fuel market share gains in our package business, demonstrating the increasing competitiveness of the Postal Service," said Postmaster General Louis DeJoy. "While we continue to reduce our costs, there remain many economic, legislative and regulatory obstacles for us to overcome. We look forward to continuing our focus on transforming and modernizing the Postal Service, driving revenue, reducing the cost to deliver, improving operational performance, and positioning the organization for long-term financial sustainability." Total operating revenue was $79.5 billion for the year, an increase of $1.4 billion, or 1.7 percent, compared to the prior year. Revenue from Shipping and Packages, First-Class Mail and Marketing Mail all increased for the year. Shipping and Packages revenue increased $625 million, or 2.0 percent, compared to the prior year. First-Class Mail revenue increased $830 million, or 3.4 percent, compared to the prior year. Marketing Mail revenue increased $292 million, or 1.9 percent, compared to the prior year. Total GAAP operating expenses were $89.5 billion for the year, an increase of $4.1 billion, or 4.8 percent, compared to the prior year. The overall increase in operating expenses was due to non-cash workers' compensation adjustments and inflationary impacts on compensation costs, retirement costs and other operating costs, partially offset by lower transportation costs. "The financial results for the year and the ongoing trend of declining mail volume and increasing package volume reinforce our commitment to the full implementation of the Delivering for America plan," said Chief Financial Officer Joseph Corbett. "Adherence to the tenets of the plan, for example, has allowed us to reduce work hours for the third consecutive year, cumulatively reducing 45 million hours that will result in $2.3 billion in annual savings prospectively, and to save $1.3 billion in transportation costs in fiscal year 2024. The plan delivers the framework for us to better innovate to grow revenue, work more efficiently, and achieve financial sustainability to fulfill our universal service mission over an integrated network to deliver both mail and packages." ...

On June 16, 2009, fire destroyed the building in which defendant Cory Michael Hoehn and his roommate, Forest Kroll, had leased an apartment. An investigator for the building’s insurer, plaintiff California Capital Insurance Company determined that "careless smoking" on the patio caused the fire. Although the investigator reached no conclusion about who started the fire or who was present when it began, California Capital sued Hoehn and Kroll in March 2010 for "general negligence," alleging that they caused the fire due to "improperly discarded smoking materials." The company asked for $472,326 in damages. In March 2010, the company attempted to serve Hoehn with a complaint and summons in the lawsuit. The affidavit supporting the return of service stated that the summons and complaint were left with Shannon Smith and identified Smith as "Girlfriend," "Co-Occupant," and "a competent member of the household." A copy of the summons and complaint was also mailed to Hoehn’s address. California Capital was unable to serve Kroll and dismissed him from the lawsuit. In April 2011, approximately a year after attempting to serve Hoehn, California Capital requested and obtained a default judgment against Hoehn for $486,528, based on an investigator’s declaration that careless smoking habits caused the fire. In March 2018, California Capital assigned its rights to the default judgment to Sequoia Concepts, Inc. Based on a May 2018 writ of execution, the sheriff of Placer County, in January 2020, served on Hoehn’s employer an earnings withholding order, placing a lien on Hoehn’s wages in order to begin payment of the default judgment. In March 2020, Hoehn filed a motion to set aside the default judgment. In a supporting declaration, he stated as follows: He did "not recall receiving or seeing the Summons or Complaint at any time." Shannon Smith "did not live with" him at the apartment and he "never received a summons or complaint or any legal paperwork from [her] at any time. He "did not receive any request for judgment or notice of a default judgment hearing" in the case. He learned that there had been a default judgment against him in January 2020, when his employer informed him that a lien had been placed on his wages. He promptly contacted an attorney who filed the motion to set aside the default judgment. Hoehn’s motion sought relief on two theories: (1) the court should exercise its power under section 473(d) to vacate the judgment; and (2) the judgment was obtained by extrinsic fraud or mistake. The trial court, following a long line of appellate court opinions, held that relief under section 473(d) was not available because Hoehn made the motion more than two years after entry of the default judgment. Regarding Hoehn’s second asserted ground for relief, the court concluded that "the fact that the proof of service of summons misidentifies Shannon Smith as a co-occupant" did not "demonstrate that the statement constitutes extrinsic fraud." The Court of Appeal affirmed. Relying on Trackman v. Kenney (2010) 187 Cal.App.4th 175 (Trackman) and Rogers v. Silverman (1989) 216 Cal.App.3d 1114 (Rogers) - and rejecting Hoehn’s criticisms of those decisions - the court concluded that relief under section 473(d) was time-barred. It further concluded, like the trial court, that the mistake in service was insufficient to make out a claim of extrinsic fraud that would support equitable relief from a default judgment. The California Supreme Court reversed in the case of California Capital Insurance Co. v. Hoehn -S277510 (November 2024) Code of Civil Procedure section 473, subdivision (d) provides in relevant part that a court "may . . . on motion of either party after notice to the other party, set aside any void judgment or order." Under this provision, a party may move to vacate a judgment on the ground of improper service of process. A line of decisions, followed by the Court of Appeal has held that such motions must be made within a "reasonable time" if the challenged judgment is not void on its face and its invalidity must be established by extrinsic evidence. To set the outer limit for what constitutes a reasonable time, courts have borrowed the two-year time limit of section 473.5, which applies where proper constructive service was given but the defendant did not receive actual notice. The California Supreme Court granted review in this case to decide whether these decisions are correct. It held that they are not, and said that this judicially created rule finds no footing in the statute’s text, has not been adopted by the Legislature, and lacks any sound justification. The Supreme Court therefore reversed the Court of Appeal’s judgment ...

A new California Workers’ Compensation Institute (CWCI) analysis that examines how medical inflation impacts allowable fees under the California workers’ compensation Official Medical Fee Schedule (OMFS) finds that physician and non-physician practitioner service fees represent more than half of treatment payments in the system and that differences in inflationary factors used between OMFS and Medicare explain the growing differential between California workers’ compensation and Medicare rates for professional services. The new analysis focuses on the price indices used to adjust various OMFS payment rates. Maximum fees for different types of medical services provided to injured workers in California are regulated by the OMFS, but each OMFS section uses distinct rules for payment calculation and different inflation factors to update payment rates. For example, the Inpatient, Outpatient Facility, Ambulatory Surgical Center, Ambulance Service, and the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) sections of the fee schedule use Medicare’s inflationary factors, and the cumulative percentage increase in the OMFS inflationary factors for these fee schedules has been lower than economy-wide inflation. But over the past decade, inflationary adjustments for the OMFS conversion factor used to calculate fees in the Professional Services section of the schedule, which account for 53 percent of California workers’ compensation medical care payments, have not aligned with Medicare, as in 2015 Medicare suspended use of the Medicare Economic Index (MEI), a measure of inflation faced by physicians with respect to their practice costs and wage levels, and shifted to statutory changes set by the U.S. Congress. In contrast, in California workers’ compensation, use of the MEI remains mandated by statute. From 2015 to 2019, statutory annual adjustments to the Medicare conversion factor were minimal (0.5 percent), and the state Division of Workers’ Compensation did not adopt them, but from 2021 to 2024, Congress mandated increases ranging between 1.25 percent and 3.75 percent per year for Medicare, which the state incorporated into the OMFS along with the MEI adjustments. As a result, the OMFS conversion factor as a percentage of Medicare for professional services rose from 124.4 percent in 2017 to 145.7 percent in 2024. In addition to the inflation adjustments, each year fee schedule rates (e.g., price levels) are affected by changes in other factors including: - - the Relative Value Units used in the Resource-Based Relative Value Scale system to quantify the complexity and resources required for medical services; - - the weights assigned to Diagnosis-Related Groups which are used to classify patients based on their principal diagnosis, surgical procedure, age, presence of comorbidities, complications and other factors; - - the weights assigned to the Ambulatory Payment Classification for hospital outpatient services; and - - geographic adjustment variables (like Geographic Practice Cost Indices and wage indexes). CWCI notes that while fee schedule rates set the maximum reimbursable fee for each service, average payments for physician services are also influenced by changes in utilization, service mix, and discounting practices. CWCI has published its analysis of the impact of inflation on OMFS fees in a Report to the Industry which is available for free under the Research tab on the Institute’s website at www.cwci.org ...

The Lown Institute is an independent think tank advocating bold ideas for a just and caring system for health. The Lown Hospitals Index, a signature project of the Institute, is the first ranking to assess the social responsibility of U.S. hospitals by applying measures never used before like racial inclusivity, avoidance of overuse, and pay equity. As many as 30 million people receive medical care for a spine problem each year. While surgery is an appropriate treatment option for some, many procedures are performed despite little to no evidence of benefit, and they come with risks. Possible complications include infection, blood clots, stroke, heart and lung problems, paralysis, and even death. In this current study, hospital overuse was measured using Medicare fee-for-service and Medicare Advantage claims data for three years of the most recently available data (2020-2022 for fee-for-service and 2019-2021 for Medicare Advantage). Spinal fusion and/or laminectomy was defined as overuse for patients with low-back pain if they did not have radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis. Spinal fusion-only cases were not considered overuse for patients with stenosis with neural claudication and spondylolisthesis. Laminectomy-only cases were not considered overuse for patients with stenosis who had neural claudication. Vertebroplasty was defined as overuse for patients with spinal fractures caused by osteoporosis, excluding patients with bone cancer, m- yeloma, or hemangioma. Researchers examined hospital data for common back surgeries, including spinal fusion, laminectomy, and vertebroplasty, for which clinical trials have repeatedly shown lack of benefit for certain patients. Patients with low-back pain caused by aging (excluding cases with neurologic symptoms, trauma, or structural abnormalities) receive little to no benefit from spinal fusion or laminectomy. Patients with spinal fractures caused by osteoporosis (excluding cases with bone cancer, myeloma, or hemangioma) receive little to no benefit from vertebroplasty. Key Takeaways Include: - - More than 200,000 procedures met criteria for overuse and are estimated to have cost Medicare around $2 billion over a three-year period. - - On average, 14% of spinal fusions/laminectomies met criteria for overuse, with individual hospital overuse rates ranging from less than 1% to more than 50%. - - On average, 11% of patient visits for osteoporotic fracture resulted in an unnecessary vertebroplasty, with individual hospital rates of overuse ranging from zero to 50%. - - New Hampshire, Iowa, Massachusetts, and Pennsylvania had the highest overuse rates of spinal fusion/laminectomy with rates over 18%. Arkansas, Kansas, Oklahoma, and Nevada had the highest overuse rates of vertebroplasty, with rates over 16%. - - California overuse rate for Vetebrosplasty was 7.3% and was 13.4% for Spinal Fusion/Laminectomy. - - U.S. News Honor Roll hospitals had varied performance. At Cleveland Clinic fewer than 1% of patient visits with osteoporotic fracture resulted in an unnecessary vertebroplasty, compared to nearly 20% at Mayo Clinic Phoenix. - - A total of 3,454 physicians performed a measurable number of low-value back surgeries. Over three years, these physicians received a total of $64 million from device and drug companies for consulting, speaking fees, meals, and travel, according to Open Payments data analyzed by Conflixis. Mount Nittany Medical Center in Pennsylvania has the highest rate of unnecessary spinal fusion/laminectomy in the nation at 62.8%. The hospital performed 535 procedures with 336 of them meeting criteria for overuse. Lown’s research also found that a single physician is responsible for 92% (308) of those overuse procedures. Notable variation in spinal fusion/laminectomy overuse rates are present even among the nation’s most prestigious hospitals, including those on the U.S. News & World Report Honor Roll for America’s Best Hospitals. At UC San Diego (1.2% overuse rate), the hospital performed 783 procedures with only 15 meeting criteria for overuse. While at the Hospital of the University of Pennsylvania (32.6% overuse rate), 641 procedures were performed with 209 meeting overuse criteria. According to a study published by Journal of Family Medicine and Primary Care, the side effects and risks associated with the medical intervention are called iatrogenesis. Iatrogenesis is composed of two Greek words, "iatros," which means physicians and "genesis," which means origin. Hence, iatrogenic ailments are those where doctors, drugs, diagnostics, hospitals, and other medical institutions act as "pathogens" or "sickening agents." ...

The decline in opioid use in California workers’ compensation has outpaced the decline among the state’s overall population according to a new California Workers’ Compensation Institute (CWCI) analysis of 2017-2023 opioid prescription data from the California Department of Justice’s Controlled Substance Utilization Review and Evaluation System (CURES) database. The analysis builds on prior CWCI studies by tracking multiple opioid utilization metrics, noting the percentage change in the number of opioid patients over the study period, changes in the average strength of the daily dose of morphine equivalents (the "morphine equivalent dose" or MED), and the average duration of opioid use for workers’ comp opioid patients. Duration of use and MED level are highly correlated with addiction and harmful side effects of opioids, including overdose and overdose-related death. The study also compares these metrics to opioid treatment guidelines to identify the proportion of patients whose opioid use exceeded guideline recommendations and how these proportions changed over time. Key findings include: - - Nearly 22.3 million Californians were prescribed opioids between 2017 and 2023, with workers’ comp patients accounting for 1.1% of that total. The number of Californians who were prescribed opioids each year fell 34% from 6.8 million in 2017 (17.3% of the population) to 4.5 million in 2023 (11.5% of the population), while the number of workers’ comp patients prescribed opioids fell 62% from 91,620 in 2017 to 34,744 in 2023. - - Breaking the opioid utilization results out by level of patient acuity showed that: - - - - The number of acute opioid workers’ comp patients (<30 days of opioid use) declined an average of 9.2% per year vs. 4.9% for all acute California opioid patients. - - - - The number of subacute opioid workers’ comp patients (30-89 days of opioid use) declined an average of 12.6% per year vs. 9.8% for all subacute California opioid patients. - - - - The number of chronic opioid workers’ comp patients (90 or more days) declined an average of 10.6% per year vs. 6.3% for all chronic California opioid patients. - - Over the study period the average daily morphine equivalent dose for workers’ comp patients declined across the board, falling 26% for chronic patients, 23.6% for acute patients, and 17.6% for subacute patients. The proportion of new acute workers’ comp patients that exceeded the recommended 50 MED per day threshold fell by 9.9 percentage points and the proportion that was within the 20-50 MED range rose by 13.3 percentage points. - - The proportion of new acute workers’ comp patients receiving opioid prescriptions that exceeded the recommended 5-day supply decreased by 8.2 percentage points during the study period, with 2/3 of that decrease occurring in 2018, immediately after the state incorporated Pain Management and Opioid Treatment Guidelines into the Medical Treatment Utilization Schedule (MTUS) and implemented the MTUS Formulary. - - Among chronic workers’ comp patients, the share of total days’ supply with an MED over 50 dropped from 27.1% in 2017 to 21.3% in 2023. - - During each calendar year in the study period, most workers’ comp chronic opioid patients also received opioid prescriptions from other payer systems, but the percentage of those patients who received opioids from both workers’ compensation and other systems declined from 72.1% in 2017 to 68.7% in 2023. - - From 2017-2023, the total daily morphine equivalent dose (from all payers) for workers’ compensation patients declined by 17.1 MED. The portion of the MED covered by workers’ comp declined by 8.4 MED or 24.1%, the portion covered by other payers declined by 8.6 MED or 32.6%. - - A declining share of workers’ compensation opioid patients had prescriptions in which their days’ supply of opioids from other payers overlapped with their workers’ comp prescriptions. The proportion of days’ supply that overlapped multiple systems declined from 8.0% in 2017 to 3.7% in 2023, so it appears that the declines in opioid utilization in workers’ comp did not lead to increased opioid use in other systems. While opioid use nationwide has declined across different health care systems, the steep decline in California workers’ compensation, which the CWCI study shows exceeded the decline noted for the general population, reflects the success of reforms enacted over the past two decades. These included a mandate that medical care provided to injured workers conform to evidence-based treatment standards; the addition of Chronic Pain and Opioid Guidelines into the MTUS; implementation of the MTUS Formulary; a requirement that opioid dispensers enter prescription and patient information into CURES within one day of dispensing the drug; and a requirement that doctors check CURES before prescribing a controlled substance to a patient for the first time, and at least once every four months when continuing to prescribe the drugs to the patient ...

Four Los Angeles area residents were arrested after a Department of Insurance investigation found the suspects allegedly committed insurance fraud by claiming a bear had caused damage to their vehicles, but it was actually a person in a bear costume. Ruben Tamrazian, 26, of Glendale, Ararat Chirkinian, 39, of Glendale, Vahe Muradkhanyan, 32, of Glendale, and Alfiya Zuckerman, 39, of Valley Village, have all been charged with insurance fraud and conspiracy. The Department’s investigation began after an insurance company suspected fraud. The suspects claimed on January 28, 2024 in Lake Arrowhead a bear entered their 2010 Rolls Royce Ghost and caused interior damage to the vehicle. They provided video footage to their insurance company, which showed the alleged bear in the vehicle. Upon further scrutiny of the video, the investigation determined the bear was actually a person in a bear costume. Detectives found two additional insurance claims with two different insurance companies, for the suspects with the same date of loss and at the same location. Each of those claims involved two different vehicles, a 2015 Mercedes G63 AMG and a 2022 Mercedes E350, and the suspects again appeared to use a bear costume to make it appear that a bear also entered and damaged those vehicles. They provided the video footage to the other insurance companies as well to substantiate their claims. To further ensure it was not actually a bear in the video, the Department had a biologist from the California Department of Fish and Wildlife review the three alleged bear videos and they also opined it was clearly a human in a bear suit. After executing a search warrant, detectives found the bear costume in the suspects’ home. The insurance companies were defrauded of $141,839, because of the alleged fraud committed by the suspects. Department detectives were assisted by the Glendale Police Department and the California Highway Patrol. The San Bernardino County District Attorney’s Office is prosecuting this case ...

U.S. Attorney Phillip A. Talbert announced that a federal grand jury returned an eight-count indictment against Leonel Hernandez, 51, of Parlier, charging him with mail fraud. According to court documents, Hernandez was employed as a supervisor for a farm labor contractor in Sanger. Between March 2017 and October 2020, Hernandez submitted falsified disability insurance claims using identities of individuals known to him, including some who were already deceased and some who were farm laborers in Sanger or Fresno. Hernandez forged physician signatures on the disability insurance claim forms, falsely certifying that the physicians had examined the claimants and falsely certifying other medical information that was allegedly obtained through such examinations. Hernandez used the U.S. mail to submit at least 20 claims and caused losses exceeding $300,000. If convicted, Hernandez faces a maximum statutory penalty of 20 years in prison and a $250,000 fine. Any sentence, however, would be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables. The charges are only allegations; the defendant is presumed innocent until and unless proven guilty beyond a reasonable doubt. This case is the product of an investigation by the Federal Bureau of Investigation and the California Employment Development Department. Assistant U.S. Attorneys Chan Hee Chu and Joseph Barton are prosecuting the case ...

UnitedHealth Group Incorporated is an American multinational health insurance and services company based in Minnetonka, Minnesota. Selling insurance products under UnitedHealthcare, and health care services under the Optum brand, it is the world's eleventh-largest company by revenue and the largest health care company by revenue. It was founded in 1977, UnitedHealth Group has grown significantly through strategic acquisitions and organic growth. Its focus on innovation, data-driven insights, and integrated care delivery models has positioned it as a major player in the healthcare industry. In 1988, United HealthCare started its first pharmacy benefit management, through its Diversified Pharmaceutical Services subsidiary. It managed pharmacy benefits delivered both through retail pharmacies and mail. The subsidiary was sold to SmithKline Beecham in 1994 for $2.3 billion.[ In 1994, United HealthCare acquired Ramsey-HMO, a Florida insurer. In 1995, the company acquired The MetraHealth Companies Inc. for $1.65 billion. MetraHealth was a privately held company formed by combining the group healthcare operations of The Travelers Companies and MetLife. In 1996, United HealthCare acquired HealthWise of America, which operated HMOs in Arkansas, Maryland, Kentucky and Tennessee. In 1998, the company was reorganized as the holding of independent companies UnitedHealthcare, Ovations, Uniprise, Specialized Care Services and Ingenix, and rebranded as "UnitedHealth Group". Also in 1998, United Health Group acquired HealthPartners of Arizona, operator of Arizona's largest AHCCCS provider Over the following 25 years UnitedHealth continued these aggressive acquisition and merger strategies. More recently, in February 2022, UnitedHealth announced the acquisition of Change Healthcare, the largest health payments platform in the US, which the US Justice Department tried to block on antitrust grounds; the sale went through by September. But inn February 2024, the subsidiary was brought completely down by the 2024 Change Healthcare ransomware attack, and the Justice Department announced that it was opening a new antitrust and Medicare overcharging probe. The company is ranked 8th on the 2024 Fortune Global 500.and had a market capitalization of $474.3 billion as of July 15, 2024. The company has a substantial impact on the U.S. healthcare system. Its scale and influence allow it to negotiate favorable contracts with healthcare providers, pharmaceutical companies, and medical device manufacturers. The company has also been at the forefront of initiatives to improve healthcare quality, reduce costs, and enhance patient outcomes. In recent years, UnitedHealth Group has been actively expanding its global footprint and investing in emerging technologies like artificial intelligence and telemedicine. And it has recently proposed a $3.3 billion acquisition of Amedisys, a leading home health and hospice care provider. This deal aims to expand UnitedHealth's presence in the home care market and integrate it with its existing healthcare services. Founded in 1982, Amedisys has grown steadily over the years through organic growth and acquisitions. The company has a significant presence in the U.S., with operations in 37 states and the District of Columbia. Amedisys employs over 21,000 individuals and serves millions of patients annually. However, Amedisys has been involved in legal disputes and regulatory scrutiny, including allegations of fraud and improper billing practices. The company has also faced challenges related to reimbursement rates and staffing shortages. In 2023, Amedisys agreed to be acquired by Optum, a subsidiary of UnitedHealth Group, in a deal valued at $3.3 billion. And the U.S. Department of Justice (DOJ) and several states have filed a lawsuit this month in the United States District Court for the District of Maryland to block the deal, arguing that it would reduce competition and harm consumers. O "We are challenging this merger because home health and hospice patients and their families experiencing some of the most difficult moments of their lives deserve affordable, high quality care options," said Attorney General Merrick Garland in a statement following the complaint’s filing in Maryland federal court. To address some of the overlaps between UnitedHealth and Amedisys, UnitedHealth has proposed to divest certain facilities to VitalCaring Group (VitalCaring). But as the complaint alleges, the proposed divestiture does not alleviate harm in over 100 home health, hospice, and labor markets, which generate at least a billion dollars in revenue annually, serve at least 200,000 patients, and employ at least 4,000 nurses ...

The National Council on Compensation Insurance (NCCI) recently conducted a comprehensive survey of more than 100 workers compensation executives addressing key issues for 2025.The financial health of the workers compensation system, medical inflation, economic uncertainty, and the shifting workplace and workforce continue to be top concerns for industry executives, a recent survey reveals. "Each year, our Carrier Executive Survey captures the pulse of the industry and helps us pinpoint key issues facing workers compensation stakeholders," remarked Bill Donnell, President and CEO of NCCI. NNCCI said it is dedicated to staying ahead of emerging trends and equipping stakeholders with data and insights to make informed decisions for the future. The survey report highlights two key concerns that appear more than any others: First: Financial Health of the System - Will There Be a Turn? This and other related questions are common from inquiring stakeholders. All metrics point to a healthy and strong system, as evidenced by nearly a decade of combined ratios below 90%. Preliminary results for 2024, based on National Association of Insurance Commissioners data through midyear, suggest another strong year with a combined ratio of 90% or below. Improvements in safety and automation have contributed to nearly 20 years of frequency decline in states where NCCI provides ratemaking services. NCCI expects this trend to continue. Secondly: Medical Inflation. "Industry stakeholders consistently name medical inflation as a top concern, and this year, it is more prevalent than ever. Currently, medical inflation and its impact on workers comp is moderate and in the range of 2.5-3.5%. Medical inflation behaves differently in workers compensation compared to the broader economy. There are two main considerations when evaluating medical inflation and its impact on workers compensation. - - Fee schedules are a major factor in keeping workers compensation (WC) medical costs in control. These state-mandated cost containment mechanisms put limits on WC payments to healthcare providers and how much those payments can change from one year to the next. - - Medical inflation in WC is different than medical inflation in the broader economy. Consider the different types of injuries and treatment in WC - the differentiation matters. The categories of treatment are also weighted differently. It’s important to look behind the numbers, as NCCI has identified in the Workers Compensation Weighted Medical Price Index. NCCI’s annual Carrier Executive Survey is part of its ongoing communication efforts that identify key issues facing workers compensation stakeholders. This year’s survey highlights familiar top concerns and other emerging issues like legalization of medical marijuana, how climate impacts workers, and the evolving regulatory and legal landscape. For more information, view NCCI’s Focus on Top Industry Concerns. These and other important issues will be addressed at NCCI’s Annual Insights Symposium 2025 ...

In February 2013, Jose de Jesus Ortiz was admitted to Elmcrest Care Center, LLC, a skilled nursing facility. He suffered from Parkinson’s disease, dysphagia, and dementia; he had a history of falling; and he was on an advanced dysphagia diet. On August 4, 2017, staff at Elmcrest found the Ortiz on the floor and nonresponsive. They administered CPR and called 911. Paramedics later transported him to a hospital, where he passed away four days later. He was 63 years old. Plaintiff Ericka Ortiz, as personal representative and administrator of the Estate of Jose de Jesus filed a civil action against Elmcrest and the individual staff members, asserting causes of action for elder abuse and neglect; negligence/willful misconduct; and fraud. The operative pleading alleged that, as result of Respondents’ failure to provide basic and necessary care to the decedent, he suffered a fall from his bed that led to suffocation, deprivation of oxygen to his brain, and respiratory arrest. The trial court granted Elmcrest's motion to compel the Estate to arbitrate its claims based on an agreement the decedent executed upon his admission to Elmcrest. On March 30, 2022, after a 15-day arbitration hearing, the arbitrator served the parties with a 90-page document entitled "Interim Award" (the First Interim Award) The First Interim Award concluded with the arbitrator’s liability determinations on all causes of action and set forth conditions for further proceedings before the award would become final. The Award stated that the Estate "did not sustain her burden of proof as to the first cause of action for Elder Abuse and Neglect, the third cause of action for Negligence/Willful Misconduct[,] and the sixth cause of action for Fraud." And it provided "This Interim Award will become final twenty days after service unless either side (a) points out in writing an omission to decide a submitted issue or (b) moves for further relief authorized by the law and the parties’ Arbitration Agreement." On May 26, 2022, the arbitrator served the parties with "Interim Award No. 2" (the Second Interim Award). The Second Interim Award reaffirmed that the Estate "did not sustain its burden of proof as to the third cause of action for Negligence/ Willful Misconduct" and "did not sustain its burden of proof as to the sixth cause of action for Fraud." However, as to the "first cause of action for Elder Abuse/Neglect," the Second Interim Award found the Estate had "sustained its burden On July 6, 2022, the Estate petitioned the trial court to vacate the First Interim Award. Among other things, the Estate argued the First Interim Award was not final and had been superseded by the Second Interim Award. On September 7, 2022, the Arbitrator issued a "Final Award," awarding the Estate $100,000 in damages on the elder abuse claim, $208,035 in attorney fees, and $92,921.77 in costs. Unlike the First Interim Award, this award placed no conditions on finality. It stated: "This Award is binding and is intended to address all issues in dispute even if not expressly discussed herein. The Arbitrator is not empowered to redetermine the merits of any claim already decided. [¶] This Award may be presented to the Court pursuant to CCP §1285 et seq." On September 30, 2022, the Arbitrator issued a "Final Award (Corrected)," again awarding $100,000 in damages and $92,921.77 in costs (the Final Award). The Final Award corrected a miscalculation related to the lodestar and multiplier to award the Estate $207,000 in attorney fees. On December 14, 2022, Elmhurst filed a petition to vacate the Final Award. The same day, the Estate filed a petition to confirm the Final Award. the trial court entered an order (1) denying the Estate’s petition to confirm the Final Award and (2) granting Respondents’ petitions to vacate the Final Award and to confirm the First Interim Award. On May 2, 2023, the trial court entered its order vacating the Final Award and confirming the First Interim Award. The Estate filed a timely appeal. The Court of Appeal reversed and vacated the order with directions to enter a new order confirming the final arbitration award served on September 30, 2022 in the published case Ortiz v. Elmcrest Care Center, LLC -B330337 (November 2024). The California Arbitration Act (§§ 1280-1294.4; the Arbitration Act) represents a comprehensive statutory scheme regulating private arbitration in this state. Section 1283.4 specifies the requisite "form and contents" of an arbitration award. The statute provides the "award shall be in writing," "signed by the arbitrators concurring therein," and it "shall include a determination of all the questions submitted to the arbitrators the decision of which is necessary in order to determine the controversy." (§ 1283.4.) The issuance of an 'award' - meeting the requirements of section 1283.4 "is what passes the torch of jurisdiction from the arbitrator to the trial court." (Lonky v. Patel (2020) 51 Cal.App.5th 831, 843- 844. Thus, it is incumbent on the trial court, before confirming or vacating what has been deemed an award, ‘to ensure that the "award" is an "award" within the meaning of [section 1283.4]. Two points of law were critical to the resolution of the issues on appeal: (1) a ruling is an "award" under the Arbitration Act only if it determines all questions submitted to the arbitrator that are "necessary in order to determine the controversy" and (2) it "is for the arbitrators to determine which issues were actually necessary to the ultimate decision in deciding whether a ruling constitutes an award under the statute. Here, as in Lonky, the arbitrator could have made a final determination that she had addressed all necessary issues when she served the parties with the First Interim Award. She did not. Instead, she expressly deferred final disposition of the matter until 20 days had lapsed or, in the event either party identified an omitted issue or moved for further relief, until she issued a later ruling after additional briefing. "By its terms, the First Interim Award was not a final 'award' as defined in section 1283.4 because, in issuing the ruling, the arbitrator expressly reserved for further proceedings her ultimate decision on whether all questions necessary to a determination of the controversy had been resolved and whether either party was entitled to further relief." ...

The National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and behavioral research. Its mission is to seek fundamental knowledge about the nature and behavior of living systems and 3 the application of that knowledge to enhance health, lengthen life, and reduce illness and disability. The NIH funds a wide range of research projects, from basic science to clinical trials, conducted by scientists at universities, medical schools, and other research institutions around the country.It funds more biomedical research than any other public institution in the world, dedicating 91 percent of its $49 billion budget to research both inside and outside the agency. However, Congress has not thoroughly reviewed NIH operations and practices since the 21st Century Cures Act passed in 2016, nearly a decade ago. An now after the presidential election, there is an abundance of media speculation that the NIH is under the cross hairs of the upcoming Donald Trump presidency. The agency has historically enjoyed bipartisan support, Trump proposed cutting its budget during his first term. "I do think you probably will see changes in NIH, as well as other public health agencies like CDC and maybe even FDA," says Dr. Joel Zinberg, a senior fellow at the Competitive Enterprise Institute and director of the Public Health and American Wellbeing Initiative at the Paragon Health Institute, both conservative think tanks. "And that's primarily I think because there was a real erosion in trust in those agencies during the pandemic," he says. And shaking up the NIH has fans. Robert F. Kennedy Jr., a vocal critic of mainstream medicine, has President-elect Donald Trump's ear. According to a report by NPR, over the weekend, Kennedy said he'd like to immediately replace 600 NIH employees. "We need to act fast, and we want to have those people in place on Jan. 20 so that on Jan. 21, 600 people are going to walk into offices at NIH, and 600 people are going to leave," Kennedy said while speaking at the Genius Network Annual Event in Scottsdale, Ariz." As of September 30, 2021, the NIH had 18,718 employees, according to its website. Kennedy previously proposed in a Wall Street Journal op-ed that half of NIH's research budget should be spent on "preventative, alternative and holistic" medicines. He has also said he will clear out "entire departments" of the U.S. Food and Drug Administration (FDA) if given a place in Trump's administration, as the former president has repeatedly promised. Earlier this year, U.S. Senator Bill Cassidy, M.D. (R-LA), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released a white paper detailing proposals to improve the National Institutes of Health (NIH). Last year, Cassidy requested feedback from stakeholders on policies Congress could consider to modernize NIH. The report also examined how the United States can sustain its advantage in biomedical research to ensure Americans receive the most innovative treatments as quickly as possible. Cassidy laid out several proposals to address this, including streamlining peer review of research, and addressing challenges in recruiting and maintaining our biomedical workforce. He also highlighted the importance of robust collaboration between NIH, public health and health care institutions, and the private sector in identifying how NIH policies can be adapted to most effectively support potentially transformative research. Additionally, many stakeholders noted that NIH has failed to convene the Scientific Management Review Board (SMRB), an advisory board required by Congress to provide feedback on agency structure and operations. This lack of transparency combined with declining public trust in the agency during the COVID-19 pandemic underscores the need for greater accountability. In the report, Cassidy emphasized the need for NIH to enhance transparency, including reestablishing SMRB and creating an apparatus allowing public input on agency practices. Nonpartisan watchdogs, such as the Department of Health and Human Services Office of the Inspector General (HHS OIG), have also found deficiencies in NIH oversight of its extramural grants. Cassidy recommends holding NIH accountable to carry out its grants management responsibilities while balancing more effective oversight with reducing unnecessary burden on researchers. And conservative think tanks like the Heritage Foundation have been floating long to-do lists for changing the NIH ...