The Division of Workers’ Compensation has posted an order adopting regulations to update the evidence-based treatment guidelines of the Medical Treatment Utilization Schedule (MTUS).

The updates, effective for medical treatment services rendered on or after November 23, 2021, incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent treatment guidelines to the Clinical Topics section of the MTUS.

The ACOEM guidelines that are incorporated by reference into the MTUS are:

– – Low Back Disorders Guideline  268 pages, (ACOEM February 13, 2020)

The administrative order consists of the order and two addenda:

– – Addendum one shows the regulatory amendments directly related to the evidence-based update to the MTUS.
– – Addendum two contains a hyperlink to the ACOEM guideline adopted and incorporated into the MTUS by reference.

A few of the more notable recommendations of the new guideline which are illustrative of new approaches are:”

– –  “Patients should be encouraged to return to work as soon as possible as evidence suggests this leads to the best outcomes. This process may be facilitated with temporary modified (or alternative) duty particularly if job demands exceed patient capabilities. Full-duty work is a reasonable option for patients with low physical job demands and/or the ability to control such demands (e.g., alternate their posture) as well as for those with less severe presentations”

– –  “Among the modes of exercise, aerobic exercise has the best evidence of efficacy, whether for acute, subacute, or chronic LBP patients.”

– –  “Many invasive and noninvasive therapies are intended to cure or manage LBP, but no quality evidence exists that they accomplish this as successfully as therapies that focus on restoring functional ability without focusing on pain. In those cases, the traditional medical model of “curing” the patient does not work well. Instead, patients should be aware that returning to normal activities most often aids functional recovery.

– – “Patients should be encouraged to accept responsibility for managing their recovery rather than expecting the provider to provide an easy “cure.” This process promotes the use of activity and function rather than pain as a guide, making the treatment goal of return to occupational and non- occupational activities more obvious.”

Health care providers treating, evaluating (QME), or reviewing (UR or IMR) in the California workers’ compensation system may access the MTUS (ACOEM) Guidelines and MTUS Drug List at no cost by registering for an account.

The San Francisco District Attorney’s Office has charged Russell A. Robinson, a now-disbarred San Francisco-based attorney, with multiple felony counts for defrauding a client, two courts, and two insurance companies – all while illegally practicing law after he was suspended from doing so.

According to public documents, Mr. Robinson had been placed on involuntary inactive status by the California State Bar in June 2019, and was not authorized to practice law after that time. Nonetheless, according to witnesses and records obtained, Mr. Robinson continued to practice as an attorney. He also is alleged to have made false statements to induce a client to retain his services and even filed a lawsuit on the client’s behalf in a California Superior Court. As a part of that lawsuit, Mr. Robinson filed with the Court numerous false documents bearing the forged signatures of a licensed attorney and a legal assistant.

Other records show that Mr. Robinson also impersonated his client, the licensed attorney, and others in his communications with two different insurance companies, and he is alleged to have forged his client’s signature on documents he submitted to those insurance companies. These fraudulent communications and documents resulted in the insurance companies providing approximately $265,000 in settlement proceeds to Mr. Robinson for his client, most of which he allegedly embezzled.

In addition, other records show that Mr. Robinson also forged the signature of a legal assistant on twelve documents he filed with the Review Department of the State Bar Court, which recommended that he be disbarred. The California Supreme Court accepted that recommendation and disbarred Robinson in June 2021.

For his acts, Mr. Robinson has been charged with multiple felony counts, including Unauthorized Practice of Law in violation of Business and Professions Code section 6126(b); False Personation in violation of Penal Code section 529(a)(2); Identity Theft in violation of Penal Code section 530.5; Embezzlement in violation of Penal Code section 503; and Forgery in violation of Penal Code sections 470(a) and 470(c); and Filing a False Instrument in violation of Penal Code section 115(a).

“Our legal system depends on lawyers to be truthful and act with integrity,” said the San Francisco District Attorney. “Breaching that trust hurts not only the individuals who have been defrauded, but damages the confidence the public places in the legal system. Those who practice law are not above it.”

This case was investigated by SFDA Inspector Jonathan Collum, who was assisted by the State Bar of California, Office of Chief Trial Counsel. The SFDA’s investigation into Mr. Robinson’s conduct remains ongoing.

Mercury News reports that a former volunteer reserve captain for the Orange County Sheriff’s Department has been charged with defrauding the state workers’ compensation program of $17 million.

54 year old Simon Semaan, who lives in Los Angeles County,  faces a maximum 16 years in state prison if convicted of seven felony counts of fraud and seven enhancements of committing a white collar crime of more than $500,000.  He has pleaded not guilty and is free on $4 million bail. He was let go by the Sheriff’s Department this September

According to authorities, Semaan ran Pacwest Security Services, but did not have workers’ compensation insurance for his employees as required by law. He did have insurance with two different companies for a firm called PSSM Inc. The Costa Mesa company that provides licensed, unarmed security guards,

Semaan had been a sheriff’s reserve officer since 1993 and was a noted supporter of former Sheriff Michael S. Carona. Carona ultimately was found guilty of a federal charge of witness tampering and served 52 months in prison. Semaan, a Los Angeles resident, was let go by the Sheriff’s Department in September.

In 2008, he was appointed by then Gov. Arnold Schwarzegger to a state private security disciplinary review committee.

The alleged $17 million theft represents the largest insurance premium fraud case ever filed in Orange County and the second largest in California, authorities said.

“The Orange County District Attorney’s Office is committed to prosecuting these dishonest business owners as a way of protecting legitimate business owners who follow the law and play by the rules,” said Kimberly Edds, a spokeswoman for District Attorney Todd Spitzer. “Everyone deserves a level playing field, and Orange County is continuing to ensure that no one is gaining an unfair advantage to undercut the competition.”

An attorney for Semaan did not return Mercury News phone calls seeking comment.

The Sheriff’s Department declined to comment, other than to say he was no longer with the agency.

Three members of a San Fernando Valley family have been sentenced – two of them in absentia after they fled justice following their convictions at trial – to years in federal prison for scheming to fraudulently obtain more than $20 million in Paycheck Protection Program (PPP) and Economic Injury Disaster Loan (EIDL) COVID-19 relief funds.

On Monday, United States District Judge Stephen V. Wilson handed down prison sentences to the Encino residents:

– – Richard Ayvazyan, 43, who was ordered to serve 17 years;
– – Marietta Terabelian, 37, Richard Ayvazyan’s wife, who was sentenced to six years; and
– – Artur Ayvazyan, 41, Richard Ayvazyan’s brother, who was ordered to serve five years in federal prison.

At Monday’s sentencing hearing, Judge Wilson said he could not recall a fraud case conducted in such a “callous, intentional way without any regard for the law.” Judge Wilson further described Richard Ayvazyan as “an endemic, cold-hearted fraudster with no regard for the law” and someone who “views fraud as an achievement.”

The FBI is offering a reward of up to $20,000 for information leading to the arrest of Richard Ayvazyan and Terabelian, who allegedly cut their tracking bracelets on August 29 and went on the run while awaiting sentencing in this case. Judge Wilson sentenced them in absentia, and they remain fugitives from justice.

At the end of an eight-day trial, a federal jury on June 25 found Richard Ayvazyan, Terabelian, and Artur Ayvazyan guilty of one count of conspiracy to commit bank fraud and wire fraud, 11 counts of wire fraud, eight counts of bank fraud and one count of conspiracy to commit money laundering. Richard Ayvazyan and his brother were also convicted of aggravated identity theft.

On June 28, the jury further found that Richard Ayvazyan and Terabelian must forfeit bank accounts, jewelry, watches, gold coins, three residential properties and approximately $450,000 in cash.

Judge Wilson previously sentenced four defendants in this case:

– – Manuk Grigoryan, 28, of Sun Valley, was sentenced on October 25 to six years in prison;
– – Edvard Paronyan, 41, of Granada Hills, was sentenced on September 27 to 30 months in prison;
– – Vahe Dadyan, 42, of Glendale, was sentenced on October 18 to 12 months and one day in prison; and
– – Arman Hayrapetyan, 39, of Glendale, was ordered on October 18 to serve 10 months of probation.

Tamara Dadyan, 42, of Encino, is scheduled to be sentenced on December 6, but Judge Wilson has not yet ruled on a motion to withdraw her guilty plea.

The defendants used dozens of fake, stolen or synthetic identities – including names belonging to elderly or deceased people and foreign exchange students who briefly visited the United States years ago and never returned – to submit fraudulent applications for approximately 150 PPP and EIDL loans. In support of the fraudulent loan applications, the defendants also submitted false and fictitious documents to lenders and the Small Business Administration (SBA), including fake identity documents, tax documents and payroll records.

The defendants then used the fraudulently obtained funds as down payments on luxury homes in Tarzana, Glendale and Palm Desert. They also used the funds to buy gold coins, diamonds, jewelry, luxury watches, fine imported furnishings, designer handbags, clothing and a Harley-Davidson motorcycle. The conspirators sought to fraudulently obtain more than $20 million in COVID-19 relief funds.

The FBI, IRS Criminal Investigation, the Small Business Administration’s Office of Inspector General, and the Federal Housing Finance Agency Office of Inspector General investigated this matter.

6th Circuit Court ‘wins’ lottery to hear lawsuits against Biden’s vaccine rule

Under federal law, when multiple lawsuits involving “one or more common questions of fact” are filed in separate courts, the petitions are consolidated and heard by one court chosen at random. The procedure is often used to handle product liability and antitrust cases, when thousands of lawsuits may be consolidated and heard by a single court.

The 6th Circuit Court of Appeals has won the lottery to hear legal challenges to the Biden administration’s vaccine rule that affects some 84 million workers.

The Biden administration rule was formally issued on Nov. 5 by the Occupational Safety and Health Administration. Lawsuits challenging the rule came in quick succession. Within 10 days, 34 lawsuits were filed, covering all 12 regional circuit courts and giving each of those courts one entry into the lottery.

A report by NPR claims the 6th Circuit Court of Appeals, based in Cincinnati, Ohio, is known to lean conservative, with most of its judges appointed by Republican presidents. Six were appointed by President Donald Trump and five were appointed by President George W. Bush, while a total of five were appointed by Democratic Presidents Bill Clinton and Barack Obama.

It will now be up to the 6th Circuit to decide whether to lift the stay issued by the 5th Circuit. A three-judge panel temporarily blocked the OSHA rule one day after it took effect and reaffirmed that decision last Friday, calling the rule “a one-size-fits-all sledgehammer that makes hardly any attempt to account for differences in workplaces (and workers).”

While a majority of the lawsuits seek to overturn the OSHA rule, several labor unions went the other way. They sued saying the rule does not go far enough to protect workers from COVID-19. The rule does not apply to employers with fewer than 100 workers.

The union lawsuits were mostly filed in courts that either have a majority of judges appointed by Democratic presidents or are evenly split.

But an article in Politico speculates that that the legal challenges are likely to end up in front of the Supreme Court, where a conservative majority seems ripe to limit the federal government’s ability to police workplaces in emergencies more broadly.

Some of the arguments made in the cases could “have serious implications on the constitutionality” of other OSHA rules and regulations, said Benjamin Noren, associate chair of the Labor and Employment group at the law firm Davidoff Hutcher & Citron.