OxyContin maker Purdue Pharma LP won a court order on Friday briefly pausing the sprawling opioid litigation against the company so it can try to make headway on its proposed legal settlement that it says is worth $10 billion.

Privately-held Purdue filed for bankruptcy last month to help it implement the proposed deal, which will transfer Purdue’s ownership to a public trust owned by the plaintiffs. In addition, the family has also pledged to contribute at least $3 billion to the settlement.

The plaintiffs in the bulk of those cases support the proposed settlement, but at least 24 states oppose it.  U.S. Bankruptcy Judge Robert Drain on Friday approved a stay of all litigation until Nov. 6.

The company hopes over the coming weeks it can to convince the hold-out states to agree to extend the stay on litigation to six months, as the governments backing the settlement have agreed to.

Drain also hoped the brief stay would give the parties time to hammer out a protocol for sharing documents and financial information about Purdue and the Sackler family in a way that would win the trust of the hold-out states.

Just prior to Friday’s six-hour hearing, Purdue attorney Marshall Huebner said the company, the official committee of unsecured creditors and the Sacklers worked out an information sharing agreement.

The agreement would allow the committee to assess the settlement, and the Sacklers also agreed to provide information about their wealth and would agree to refrain from taking any material action with their property.

Drain said the public deserves an accounting of the company’s role in the crisis, which has led to some 400,000 deaths from 1999 to 2017, according to U.S. statistics. However, he said he feared a “trial becomes an autopsy” that destroys the value of Purdue, adding that most trials leave many unresolved questions.

“There are trials where people stand up and say ‘I did it.’ But that mostly happens on Perry Mason,” he said, referring to the popular TV show from the 1950s and ‘60s featuring a lawyer who won virtually every case. Drain also urged the parties to determine the best way to divvy up the settlement proceeds, echoing comments he had made on Thursday.

The California Insurance Guarantee Association provides funding when one of its member insurers becomes insolvent and unable to pay its insureds’ claims. California state law prohibited CIGA from reimbursing state and federal government agencies, including Medicare.

CIGA filed this declaratory action in federal court, after Medicare paid for and demanded reimbursement from CIGA for medical expenses of certain individuals whose workers’ compensation benefits CIGA was administering. The federal district court ruled in favor of Medicare, concluding that federal law preempted California law to the extent it prohibited CIGA from reimbursing Medicare.

The 9th Circuit Court of Appeal reversed in the published case of California Insurance Guarantee Association v Alex M. Azar, Secretary of HHS.

Medicare regulations define “primary plan” to mean, “in the context in which Medicare is the secondary payer, a group health plan or large group health plan, a workers’ compensation law or plan, an automobile or liability insurance policy or plan (including a self-insured plan), or no-fault insurance.” 42 C.F.R. § 411.21 (emphasis added); accord 42 U.S.C. § 1395y(b)(2)(A). CIGA does not fall within the plain meaning of this definition because it is not a workers’ compensation law or plan.

CIGA is “an insurer of last resort” and thus “assumes responsibility for claims only when no secondary insurer is available.”

The Court went on to say that “It makes little sense to interpret the statutory phrase ‘primary plan’ to refer to a payer of last resort. The Medicare statute describes Medicare only as ‘secondary.’ Under agency regulations, the term ‘secondary’ refers to benefits that ‘are payable only to the extent that payment has not been made and cannot reasonably be expected to be made under other coverage that is primary to Medicare.'”

Because CIGA is not a primary plan under the Medicare Act’s secondary payer provisions, it has no obligation to reimburse CMS for conditional payments made on behalf of workers’ compensation insureds. Therefore, the district court was reversed and the case remanded for further proceedings consistent with this opinion.

San Diego chiropractor, George Reese, with offices on El Cajon Boulevard, was indicted in 2015 for referring patients to a Los Angeles area medical service provider. Foremost Shockwave Solutions in return for bribes.

The bribes were set by the conspirators at $100 per patient and paid through an intermediary. After taking a cut amounting to $25 per patient, the intermediary would pay the remaining $75 per patient to Reese.

Foremost Shockwave Solutions was allegedly controlled by attorney Lee Mathis and Fernando Valdes its president. Both were also indicted. Although disguised as “office rent” payments, the illegal bribes were allegedly paid in cash during clandestine exchanges in restaurants and parking lots.

The indictment alleged that defendant Foremost Shockwave Solutions and others engaged in a $22 million kickback and bribery scheme through which co-conspirators paid bribes and kickbacks to physicians to refer California Workers’ Compensation patients to Foremost.

For example, $6,000 in cash was delivered to Reese in the parking lot of the Jolly Roger in Oceanside, hidden in a gift bag. Other times, it was passed in envelopes or stashed inside newspapers.

According to the indictment, Reese and his codefendants generated and submitted bills to insurers totaling in the tens of millions of dollars. Most of these treatments involved the providing of “Shockwave therapy,” which uses low energy sound waves to initiate tissue repair. Proceeds from the insurance claims generated through this scheme were paid to Mathis and Valdes.

Reese pleaded guilty in June 2016. and began serving a one year one day sentence. Valdez entered into a plea agreement in July 2017.

Foremost Shockwave Solutions has just entered into an agreement with prosecutors that provided the following. Foremost agrees that “it will not, directly or indirectly, attempt to collect or collect on any bills, claims, or liens filed by FOREMOST SHOCKWAVE SOLUTIONS or on its behalf.”

In exchange, the United States will dismiss, without prejudice, the pending charges against Foremost.

A Southern California-based ophthalmology group, its former CEO and several of its physicians have paid the United States and California $6.65 million to settle False Claims Act allegations that they defrauded public health care programs by billing for unnecessary eye exams, improperly waiving Medicare co-payments, and violating other regulations, the Justice Department announced today.

Retina Institute of California Medical Group (RIC), is a medical partnership of ophthalmologists who specialize in the treatment of retinal diseases. RIC operates in multiple locations in Los Angeles, Orange and Riverside counties. On October 2, the RIC and several other defendants paid the United States $6,353,410 and paid California $296,590 pursuant to a settlement agreement.

The other defendants who participated in the settlement are:

— Dr. Tom S. Chang, of Pasadena;
— Tom S. Chang, M.D., Inc., a Pasadena-based company;
— Dr. Michael A. Samuel, of Arcadia;
— Dr. Michael J. Davis, also of Arcadia;
— Brett Braun, former CEO of Retina Institute of California Medical Group;
— California Eye and Ear Specialists, a Pasadena-based subsidiary of Trilogy Eye Medical Group Inc., a company for whom Chang and Samuel serve as senior executives; and
— San Gabriel Ambulatory Surgery Center LP, a San Gabriel-based company.

Between January 2006 and August 2017, the defendants allegedly violated the False Claims Act by submitting bogus claims to Medicare and Medicaid/Medi-Cal, according to a settlement agreement signed in this case. Medicare reimburses physicians for examining patients, paying more money as the medical exams performed increase in complexity. RIC personnel allegedly improperly billed public health programs by misclassifying simpler exams as being more complex, using billing codes normally used for patients with severe or emergency conditions.

RIC and the other defendants also allegedly waived Medicare co-payments and deductibles without proper documentation of patients’ financial hardship, which was intended to induce referrals. The defendants allegedly also billed Medicare and Medicaid for medical services that weren’t performed, were unnecessary, not documented in the medical record or were not in compliance with applicable rules and regulations.

The allegations were made in a whistleblower lawsuit filed in United States District Court by Bobbette A. Smith and Susan C. Rogers, who formerly worked for RIC as administrators, under the qui tam – or whistleblower – provisions of the False Claims Act. These provisions permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The United States may intervene in the lawsuit, or, as in this case, the whistleblower may pursue the action. Smith and Rogers will receive a share of the settlement, but that amount has not yet been determined.

The case, which was filed in May 2013 and unsealed in July 2016, was monitored by the United States Attorney’s Office, as well as the U.S. Department of Health and Human Services – Office of Inspector General.

The lawsuit is captioned United States, et al., ex rel. Smith and Rogers v. Tom S. Chang, M.D., et al., No. 13-CV-3772-DMG (C.D.Cal.).

Maria Leon sustained an injury arising out of and occurring in the course of her employment resulting in her death on November 20, 2012, while she was employed as a caregiver by the Department of Social Services (DSS), and as a kitchen helper by Meals on Wheels.

Ms. Leon was survived by two sons, Juan Manuel Vasquez and Julian Vasquez. An Application for Adjudication of Claim was filed and both were claiming a death benefit as dependents of Ms. Leon.

They also filed a civil action for negligence in LA County Superior Court against the operators of Golden West Towers, the senior living center where Ms. Leon was murdered by a tenant of the center.

Julian Vasquez filed a petition dismissing his claim with prejudice on February 29, 2016. On the same date, the attorney for Juan Manuel Vasquez filed a petition to withdraw as attorney, citing Juan Manuel Vasquez’s failure to cooperate with his counsel in the prosecution of the claim.

An order was issued on March 24, 2016, dismissing with prejudice the “potential dependent Julian Vasquez.” The WCJ also issued an order relieving counsel representing Juan Manuel Vasquez.

On March 25, 2016, a settlement check in the sum of $559,311.17, was issued to Juan Manuel Vasquez as a result of third party tort litigation.

In light of the dismissal of the claims of Julian Vasquez and Juan Manuel Vasquez, The Death Without Dependents unit of the Department of Industrial Relations (DWD), sought to proceed as an applicant to claim the statutory death benefit under Labor Code section 4706.5.

The WCJ found that the DWD failed to meet its burden of proof to establish Ms. Leon had no surviving dependents, and that the defendants provided sufficient evidence to prove that at least Juan Vasquez and his three children were the dependents of Ms. Leon prior to her death. The WCJ further held that a credit of $599,31 1.17 for Mr. Vasquez’ civil recovery is applicable and would negate a claim for death benefits. The WCJ denied DWD’s application for death benefits. The DWD petition for reconsideration affirmed the take nothing the panel decision of Mary Leon v DSS.

Dependency is determined as of the time of injury, and may be found to be total or partial, depending on the facts established. “Dependency may be defined as reliance upon another person for support. Total dependents are those who at the time of injury are solely supported by the decedent, or who have a legal right to look to him for their entire support . . . . Partial dependents are those who at the time of injury have means of support other than the deceased’s contributions . . . . ” (Mendoza v. Workers’ Comp. Appeals Bd. (1976) 54 Cal.App.3d 820 [41 Cal.Comp.Cases 71]. )

However, if the employee dies and leaves no dependents, the death benefit escheats to the State of California and is to be paid to the Death Without Dependents unit of the Department of lndustrial Relations, pursuant to Labor Code section 4706.5(a). This provision has been held to require the DWD to affirmatively establish the absence of any dependents, either total or partial, of the deceased.

DWD argues that because Juan Manuel Vasquez and Julian Vasquez chose not to pursue their claims for death benefits, they must be found not to be entitled to the benefit and therefore DWD should be found to be entitled to receive the benefit.

This, however, is not what the law requires. The law does not provide that the death benefit escheats to DWD if a dependent, either partial or total, has not received the benefit. Rather, the law requires DWD to establish that no “person entitled to a dependency death benefit” exists. DWD has not established that Juan Manuel Vasquez or Julian Vasquez were not dependent upon their mother and had no claim to a death benefit as partial dependents. Since Juan Manuel Vasquez and Julian Vasquez chose to receive a civil settlement in an amount greater than the amount of the death benefit, and withdrew their claims for workers’ compensation death benefits, the WCJ properly found DWD did not meet its burden to establish that “such employee does not leave surviving any person entitled to a dependency death benefit.”