Dr. Roger A. Kasendorf, an osteopathic physician practicing in La Jolla, agreed to pay $125,000 to resolve allegations that he illegally prescribed opioids to his patients. The highly addictive and frequently abused opioids he prescribed included fentanyl, hydromorphone, oxymorphone, and oxycodone.

In response to the Justice Department’s focus on combatting the opioid epidemic, the Drug Enforcement Administration (DEA) and the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) investigated Dr. Kasendorf’s prescribing practices.

This investigation arose from data analytics tools which allow the Department of Justice to perform a variety of functions, including identifying statistical outliers, such as which doctors prescribe the highest opioid dosages and which doctors prescribe combinations of opioids and other drugs known to increase the risk of addiction, abuse, and overdose.

Based on the investigation, the United States contends that Dr. Kasendorf wrote prescriptions for opioids, including fentanyl, that were not issued for a legitimate medical purpose and while not acting in the usual course of his professional practice in violation the Controlled Substances Act and the False Claims Act.

The Centers for Disease Control and Prevention (CDC), the American Academy of Pain Medicine, the American Pain Society, state agencies and medical boards, and other medical literature provide guidance on appropriate practices when prescribing opioids.

One common tool is for health care providers to determine the Morphine Milligram Equivalent (MME, also commonly referred to as Morphine Equivalent Dose or MED) of prescribed opioids. MME is a uniform scale used to determine daily opioid dosage by using an equivalency factor to calculate a dose of morphine that is equivalent to the prescribed opioid.

The CDC recommends primary care clinicians who prescribe opioids for chronic pain outside of active cancer treatment, palliative care, or end-of-life care should avoid increasing opioid daily dosage over 90 MME or carefully justify a decision to titrate daily dosage to over 90 MME.

Prescribers should also seek to avoid prescribing opioid pain medication in combination with benzodiazepines (e.g., Xanax, Valium, Klonopin) when possible, and should consider whether the benefits outweigh the risks of combining opioids with other depressants (i.e., muscle relaxants and sleep medications).

The owner of a Campbell vocational training school has been charged with a kickback scheme where he illegally diverted more than $650,000 in workers’ compensation insurance money without training injured students trying to get back into the workplace.

Officials estimate that out of about 100 cases, two students of Rashad Said’s Advanced Vocational Institute (AVi) had taken some classes – and they were online with no live interaction.

Said, 62, of San Jose, who stands charged of 11 felony counts of workman’s comp fraud and kickbacks, is a former board member of the San Jose Regional Workforce Development Board. The Board’s duties include approval of local vocational schools eligible to receive government funding for job training to assist displaced workers, including workers’ comp claimants. Said, who faces incarceration if convicted, was arraigned on October 23, 2019. His plea hearing is scheduled for November 11, 2019 in Department 38 in the Hall of Justice in San Jose.

Under state rules, some workers whose injury makes them unqualified to continue with their present job can get re-trained for another kind of job. They receive vouchers which can be as high as $10,00 which can be used for tuition, books, tools/equipment, supplies and vocational counseling.

In this case, Said is accused of giving kickbacks to counselors who referred workers to his school. The state allows disabled workers to use up to 10 percent of their voucher for vocational counseling services. Said is accused of giving unwitting workers – many of them who spoke little English and didn’t understand the arrangement – cash amounts instead of any training. In fact, when an investigator searched the AVi offices on a weekday, it was closed and the computers were covered in dust.

The investigation began in the summer of 2018 after a student complained that another Santa Clara vocational school had refused to refund the remainder of her voucher after doctors advised her computer class was aggravating her wrist injury. The state launched an inquiry that lead to that school’s owner being charged. The inquiry also revealed transgressions by other schools leading to the discovery of AVi’s criminal offenses.

Other SJDB fraud cases have been reported recently.

Between 2015 and 2017, Salvador Franco, Jr., 42, of Downey and Mirella Flores, 45, of Paramount participated in an alleged Supplemental Job Displacement Voucher Fraud scheme involving the Technical School, Inc., doing business as Technical College, Inc., and Graduates Do Succeed Institute, doing business as GDS Institute, operating in Southern California.

Those two defendants entered no contest pleas to attempting to defraud multiple insurers of approximately $120,000 by having students sign over their Supplement Job Displacement vouchers and collecting the money without providing required vocational training.

Two Home Depot warehouse workers had an accident while driving vehicles called electric pallet jacks at Home Depot’s Mira Loma distribution warehouse.

After a workplace accident and inspection, the Division of Occupational Safety and Health cited Home Depot for several violations of workplace safety standards. The investigator found that the industrial truck operators wore tennis-type shoes while they were operating industrial trucks.

The Division determined Home Depot had violated regulations which requires “appropriate foot protection” for employees exposed to foot injuries, and which sets standards for the safe operation of industrial trucks and requires employers to make sure their employees comply. The Division said that in this case “appropriate” would be steel toed shoes.

Home Depot challenged the citations. Ultimately, the respondent, California Occupational Safety and Health Appeals Board, affirmed the footwear citation because Home Depot employees were exposed to foot injuries when they manually lift heavy loads and when they worked on foot or walked in close proximity to industrial trucks. They found Home Depot’s safety policies and prohibition on open-toed or open-heeled shoes didn’t adequately protect those employees.

The Board affirmed the truck-operation citation because Home Depot did not establish the employee caused the infraction despite knowing her conduct was contrary to the employer’s safety requirements.

Home Depot filed a petition for writ of mandate, asking the trial court to relieve them of the footwear citation on the ground the findings weren’t supported. The trial court declined, and Home Depot asked the court of appeal to make the same determination. However, the court of appeal affirmed in the unpublished case of Home Depot USA v California Occupational Safety and Health Appeals Board.

Home Depot did not require their employees to wear protective shoes when they worked in the warehouse. Their policy required only that they wear “closed-toed and closed-heeled shoes.” Home Depot’s policy said “Flip-Flops, sandals, open-toed shoes, or open heeled shoes” are unacceptable.

Home Depot says they don’t require their warehouse employees to wear steel-toed boots or similar footwear because such footwear can cause ergonomic problems, tripping hazards, and fatigue, and they can be “cumbersome,” “uncomfortable” and “bulky.”

Amicus curiae, Retail Litigation Center, Inc. and National Federation of Independent Business, who support Home Depot, object that the Board’s opinion articulates an “uncertain standard [that] will have far-reaching consequences for employees in a wide range of businesses, including large retailers and small independent businesses that may have industrial trucks or pallet jacks in the facility even though the majority of employees encounter them only rarely.”

However, the court of appeal concluded that there was substantial evidence supporting the Board’s determination that Home Depot employees were both actually exposed and realistically likely to be exposed to foot injuries. A violation of the safety order is not based on previous history of accidents or injuries resulting from the exposure but rather on the existence of the danger which may cause injury.

The court did however “agree the language in the Board’s opinion can be read to sweep too broadly, so we emphasize our holding is limited to the facts and evidence of the case.”

United Parcel Service Inc’s  new Flight Forward drone unit will soon start home prescription delivery from CVS Health Corp.

The service, which will debut in one or two U.S. cities in the coming weeks, shows how the parcel delivery company plans to expand its upstart drone business beyond hospital campuses.

“Flight Forward will work with new customers in other industries to design additional solutions for a wide array of last-mile and urgent delivery challenges,” UPS Chief Strategy and Transformation Officer Scott Price said.

The Atlanta-based company this month won the U.S. government’s first approval to operate a drone airline, leapfrogging rivals like Amazon.com Inc and Alphabet Inc’s Wing and clearing the way for the expansion of Flight Forward.

UPS, which owns 251 jet aircraft and charters nearly 300 more, is building its Flight Forward business at a time when U.S. drone delivery is in its infancy. Regulations for operating those unmanned vehicles in U.S. airspace are not expected until 2021.

On Monday, Flight Forward and partner Matternet also announced a deal to deliver biological samples and other cargo on University of Utah Health hospital campuses. That will be similar to the service at North Carolina’s WakeMed Hospital, where Flight Forward operates about 10 flights per day, said Bala Ganesh, vice president of the advanced technology group at UPS.

Flight Forward has also signed a hospital campus deal with healthcare provider Kaiser Permanente, UPS said.

In addition, the company said pharmaceutical distributor AmerisourceBergen Corp will use Flight Forward drones to move pharmaceuticals, supplies and records to select U.S. medical campuses it serves.

UPS rival FedEx Corp  last week delivered a residential package to a home in Christiansburg, Virginia, as part of a trial service with Alphabet’s Wing Aviation.

Dan Gagnon, vice president of global healthcare strategy at UPS, said Flight Forward “is not a one and done business model. We’re looking for scale and repetition.”

Dr. Venkat Aachi is a physiatrist in San Jose, California and is affiliated with multiple hospitals in the area, including El Camino Hospital and Good Samaritan Hospital-San Jose.

Aachi was just sentenced to 24 months in prison for health care fraud and for distributing hydrocodone outside the scope of his professional practice. Aachi, 52, of Saratoga, pleaded guilty to the charges on March 25, 2019.

Over the course of just one year, Aachi wrote 5,992 prescriptions for controlled substances, the majority of which were for narcotics. Further, from September 2017, to July 2018, four undercover law enforcement agents posed as new patients. They visited Aachi about four times each, and after each visit, they received a prescription for a schedule II controlled substance with little to no physical examination.

A federal grand jury indicted Aachi on October 9, 2018, charging him with six counts of distributing drugs outside the scope of professional practice, in violation of 21 U.S.C. § 841(a)(1) and (b)(1)(C), and one count of health care fraud, in violation of 18 U.S.C. § 1347. Aachi pleaded guilty to one count under each statute.

According to the plea agreement, Aachi was a licensed physician who operated a pain clinic in San Jose and maintained a DEA registration number authorizing him to prescribe controlled substances. Aachi admitted that from September 18, 2017, through July 2, 2018, he wrote hydrocodone-acetaminophen prescriptions that were outside the scope of his professional practice and not for a legitimate medical purpose.

For example, in November of 2017, he wrote a prescription enabling a patient to receive 90 hydrocodone-acetaminophen pills. Aachi did not conduct a physical examination of the patient nor discuss the patient’s pain or response to prior medication. Aachi acknowledged that he knew the prescriptions were not for a legitimate medical purpose and that he did not write the prescriptions in the usual course of his professional practice.

Aachi also admitted that on July 2, 2018, he falsely submitted to an insurance company a false and fraudulent claim for payment for healthcare benefits, items, and services. Aachi admitted he acted with the intend to defraud the insurance company.

In addition to the prison term, Aachi was ordered to serve 3 years of supervised release and ordered him to pay $82,616.85 in restitution. Aachi will begin serving his sentence on January 22, 2020.