51 year old Jason Vertz, of Fresno, and 45 year old Alana Powers, an inmate at the Central California Women’s Facility (CCWF) in Chowchilla, were each sentenced to five years and one month in prison for conspiracy to commit mail fraud and aggravated identity theft.

According to court documents, Vertz and Powers submitted several fraudulent unemployment insurance claims in Powers’ and other CCWF inmates’ names to the California Employment Development Department (EDD). Recorded jail calls and emails show that Powers and other inmates provided names, dates of birth, and social security numbers for inmates at CCWF to Vertz to submit the fraudulent claims. Shortly thereafter, the benefits were loaded onto debit cards that were mailed to the addresses the defendants provided.

The underlying applications for the claims stated that the inmates had worked within the prescribed period as maids, cleaners, fabrication welders, and other occupations, and that they were available to work, which was not true because they were incarcerated. The claims would have been denied if accurate answers had been given. EDD and the United States have suffered an actual loss of over $74,000 as a result of the fraud.

This case was the product of an investigation by the FBI, the California Department of Corrections and Rehabilitation Investigative Services Unit, and the California EDD. Assistant U.S. Attorneys Alexandre Dempsey and Joseph Barton are prosecuting the case.

On May 17, 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Department of Justice in partnership with agencies across government to enhance efforts to combat and prevent pandemic-related fraud. The Task Force bolsters efforts to investigate and prosecute the most culpable domestic and international criminal actors and assists agencies tasked with administering relief programs to prevent fraud by, among other methods, augmenting and incorporating existing coordination mechanisms, identifying resources and techniques to uncover fraudulent actors and their schemes, and sharing and harnessing information and insights gained from prior enforcement efforts.

Anyone with information about allegations of attempted fraud involving COVID-19 can report it by calling the Department of Justice’s National Center for Disaster Fraud (NCDF) Hotline at 866-720-5721 or via the NCDF Web Complaint Form at: https://www.justice.gov/disaster-fraud/ncdf-disaster-complaint-form.

An Orange County man is expected to be arraigned in federal court on an indictment charging him with defrauding victims who paid for COVID-related medical protective equipment that was never delivered, causing nearly $3 million in losses.

60 year old Christopher John Badsey, who lives Lake Forest, was arrested by FBI agents on July 8 without incident. He is charged with four counts of wire fraud and two counts of money laundering. He was arraigned in United States District Court in downtown Los Angeles.

According to an indictment returned by a federal grand jury on July 7, Badsey falsely represented that he had access to millions of boxes of medical-grade nitrile gloves through his Irvine-based company, First Defense International Security Services Corp. (FDI)

This type of personal protective equipment was in high demand and short supply during the COVID-19 pandemic.

Badsey allegedly entered into contractual agreements with victims, whom he required to provide a money deposit to inspect the gloves before delivery.

After receiving the deposits, Badsey allegedly instructed victims to travel to the Los Angeles area, where he claimed the gloves were stored in a warehouse. But when victims attempted to visit the warehouse, Badsey and other FDI employees allegedly provided excuses as to why the gloves could neither be inspected, nor delivered, to the victims.

Nitrile gloves were never provided to the victims, and Badsey is alleged to have absconded with the deposit money totaling nearly $3 million. After obtaining the victims’ wire deposits, Badsey and others are believed to have used those funds to make lavish purchases for their personal benefit.

If convicted of all charges in the six-count indictment, Badsey would face a statutory maximum sentence of 100 years in federal prison.

Fifteen states that led the effort to block a controversial bankruptcy plan for OxyContin-maker Purdue Pharma have abandoned the fight.

That’s according to court documents reviewed by NPR and filed by a mediator late Wednesday as part of a federal bankruptcy proceeding in White Plains, N.Y.

Among the states that have agreed to sign on to the bankruptcy deal are Massachusetts and New York, whose attorneys general had mounted fierce legal opposition to the agreement.

The other states now abandoning their opposition to the deal are: Colorado, Hawaii, Idaho, Illinois, Iowa, Maine, Minnesota, Nevada, New Jersey, North Carolina, Pennsylvania, Virginia and Wisconsin.

According to the mediator, nine states have yet to agree to the Purdue Pharma bankruptcy plan. They include Connecticut, where the company is headquartered, as well as California, Delaware, Maryland, New Hampshire, Oregon, Rhode Island, Vermont and Washington. The District of Columbia also hasn’t agreed to the deal.

“The negotiations were difficult and hard-fought, with the outcome uncertain,” said federal bankruptcy Judge Shelley C. Chapman in the legal filing.

The settlement plan, which is now all but certain to be finalized next month, would shelter members of the Sackler family, who own Purdue Pharma, and many of their associates from future opioid lawsuits.

In return, the Sacklers have agreed to give up ownership of the bankrupt drug company. They will also pay out roughly $4.2 billion from their private fortunes in installments spread over the next decade.

According to the mediator’s report, the Sacklers have now agreed to boost their settlement payment by a relatively modest amount – roughly $50 million.

The deal also includes a “material expansion” of the public document repository already created under the settlement plan that aims to provide some transparency about Purdue Pharma’s role in the opioid epidemic.

Purdue Pharma has pleaded guilty twice to federal criminal charges related to its opioid marketing practices, first in 2007 and again last year.

The Sacklers have never faced charges. Under this deal, they will admit no wrongdoing and will remain one of the wealthiest families in the U.S.

The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP).

Overtreatment and low-value care cost the U.S. healthcare system between $75.7 and $101.2 billion annually. Despite the associated high cost, unnecessary or ineffective care appear to be on the rise.

A search of peer-reviewed and “gray” literature from January 2012 to May 2019 focused on the 6 waste domains previously identified by the Institute of Medicine and Berwick and Hackbarth: failure of care delivery.

Computations yielded the following estimated ranges of total annual cost of waste: failure of care delivery, $102.4 billion to $165.7 billion; failure of care coordination, $27.2 billion to $78.2 billion; overtreatment or low-value care, $75.7 billion to $101.2 billion; pricing failure, $230.7 billion to $240.5 billion; fraud and abuse, $58.5 billion to $83.9 billion; and administrative complexity, $265.6 billion.

One strategy to promote quality, value-based care is applying evidence-based medicine (EBM) to help guide treatment decisions. EBM integrates medical research with clinical expertise and patient values to support decision making based on the best available evidence.

How well does that work? Researchers attempted to answer that question in a study recently published in the journal PLOS, “Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system.”

In the U.S., state workers’ compensation (WC) systems have developed or adopted treatment guidelines to promote evidence-based care for occupational injuries. The most common occupational injury is back strain, and occupational stressors are thought to contribute to low back pain (LBP). The point of this new study was to quantify the influence of adherence to guideline-recommended interventions in the first week of treatment for an initial low back pain (LBP) injury on lost workdays.

In a retrospective cohort of California’s workers’ compensation claims data from May 2009 to May 2018, 41 diagnostic and treatment interventions were abstracted from the medical claims for workers with acute LBP injuries and compared with guideline recommendations. Lost workdays within 1-year post-injury were compared by guideline adherence. 59,656 workers met the study inclusion criteria.

The reviewers concluded that when workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.

With that being said, the study disclosed in its Conflict of Interest Statement that authors Gaspar and Wizner are employed by MDGuidelines, which is the sole proprietor of ACOEM guidelines. Hegmann is Editor-in-Chief of the ACOEM guidelines.

Luis Beltran Witron claimed an injury to the bilateral shoulders, neck, back and chest on May 5, 2019 while employed as a laborer by Polymeric Technology Corporation.

On August 13, 2019, defendant sent a letter to applicant acknowledging his claim. Enclosed with the letter was a copy of the Complete MPN Notification in English and Spanish.

Defendant subsequently sent applicant a Notice of Acceptance of Claim on August 26, 2019. An MPN Notification in English and Spanish was enclosed again. The parties stipulated that the claim was accepted for the left shoulder and that Witron initially treated at Concentra in the MPN.

Applicant’s attorney filed an Application for Adjudication of Claim on September 21, 2020. On the same date, applicant’s attorney sent a letter requesting a change of PTP and nominated NMCI Medical Clinic.

On February 10, 2021, applicant’s attorney sent a letter to defendant stating “the applicant will commence treatment with NMCI as the carrier failed to provide the applicant with an MPN PTP per the previous demand.”

On the same date, defendant sent an email to applicant’s attorney stating: “The claim is accepted for the left shoulder. If your client is interested in receiving medical treatment for the left shoulder on an industrial basis, he can access the BHHC MPN and designate a treating physician.”

At an expedited hearing the applicant contends that he has the right to treat outside the MPN because defendant failed to comply with applicant’s demand letter for a change of treating doctor and a request to schedule the initial appointment per CCR Section 9767.5(g).

The WCJ found that there was a delay by defendant in responding to applicant’s request for a change of treating physician, but the delay did not constitute a neglect or refusal of medical treatment. Reconsideration of this finding was denied in the WCAB panel decision of Witron v Polymeric Technology Corporation (ADJ13620994 – June 2021)

The issue was whether defendant’s delay in responding to applicant’s September 21, 2020 request to treat with NMCI constituted a neglect or refusal to provide care.

Applicant was treating regularly in the MPN from August 2019 until January 2020. There is no evidence in the record of any treatment after January 2020. Applicant sent his request to treat with NMCI in September 2020. As acknowledged by the WCJ in her Report, there was a delay by defendant in responding to this request until February 2021. However, applicant did not provide evidence at trial of any treatment (or even efforts to obtain treatment) following his September 2020 request.

The 20-day time limit for a Medical Access Assistant (MAA) to schedule an appointment per AD Rule 9767.5(g) only applies where the MAA is scheduling an appointment with a specialist based on a referral, not to the scheduling of an initial appointment with a primary treating physician.

The record does not indicate that applicant was seeking an appointment with a specialist based on a referral; rather, it shows that he was requesting treatment generally. Moreover, as noted above, applicant did not request assistance from the MAA. Therefore,AD Rule 9767.5(g) does not apply to the facts in this case.

“Defendant’s delay in responding to applicant’s single September 21, 2020 letter asking to treat with NMCI is not substantial evidence of a neglect or refusal to provide treatment such that applicant may treat outside the MPN.”