For more than 2,000 years Chinese healers have used herbal powders and tinctures, dust made from various animal parts and strategically placed needles to treat a host of human ailments. These are used in hundreds of nations globally, but the practice in China is perhaps the most extensive, documented and catalogued.

Over the past decade proponents of Traditional Chinese medicine (TCM) have worked hard to move it into the mainstream of global health care – and it appears those efforts are coming to fruition.

Western cultures have preferred what is called “allopathic” medicine, also called biomedicine, conventional medicine, mainstream medicine, orthodox medicine, and Western medicine. Generally the term applies to a system in which medical doctors and other healthcare professionals (such as nurses, pharmacists, and therapists) treat symptoms and diseases using drugs or surgery.

Labor Code 4600 specifically authorizes acupuncture treatment. As of June 15, 2007, California workers injured on the job got an easier path to receive acupuncture treatment as part of their workers’ compensation treatment as a result of amendments to the MTUS. Previously the ACOEM guidelines only made a brief mention of acupuncture for shoulder complaints.

Now, the latest (11th) version of the World Health Organization’s list known as the International Statistical Classification of Diseases and Related Health Problems (ICD-11) will include these remedies for the first time.  ICD-11 will be presented at the Seventy-second World Health Assembly for endorsement by Member States in May. Following endorsement, Member States will begin reporting health data using ICD-11 by January 2022.

According to its own mandate, the WHO sets the norms and standards for medical treatment around the globe and articulates “ethical and evidence-based policy options.”

It categorizes thousands of diseases and influences how doctors treat them; how insurers cover those treatments; and what kind of research is done on which ailments. More than 100 countries rely on the document to determine their medical agendas.

China has been pushing for wider global acceptance of traditional medicines, which brings in some $50 billion in annual revenue for the nation’s economy.

However there is much push back allopathic medicine providers.

An extensive assessment was done in 2009 by researchers at the University of Maryland: they looked at 70 review papers evaluating TCM, including acupuncture. None of the studies proved conclusive because the data were either too paltry or did not meet testing standards.

A 2018 study in the British Journal of Clinical Pharmacology tested 487 Chinese products taken by sick patients and discovered 1,234 hidden ingredients, including approved and banned Western drugs, drug analogues and animal thyroid tissue.

And in 2012 a team led by Megan Coghlan, then at Murdoch University of Australia, identified the DNA sequences in 15 samples of traditional medicines in the form of powders, tablets, capsules, bile flakes and herbal teas. The samples also contained plants that produce toxic chemicals and animal DNA from vulnerable or endangered species (the Asiatic black bear and saiga antelope, for example) and other creatures protected by international laws.

The consunsus of these researchers is that to include TCM in the ICD is an egregious lapse in evidence-based thinking and practice. Data supporting the effectiveness of most traditional remedies are scant, at best.

The Department of Industrial Relations and its Division of Workers’ Compensation posted a progress report on the department’s Independent Bill Review (IBR) program.

IBR is a process used to resolve billing disputes for medical treatment and medical-legal services provided to injured workers.

Prior to SB 863, a medical provider engaged in a billing dispute with a claims administrator was limited to filing a lien with the Workers’ Compensation Appeal Board in order to determine entitlement to the amount initially billed.

SB 863 established Second Bill Review (SBR) and IBR to decide billing disputes expediently, in which the only issue is the amount to be paid for the medical service provided. If the medical service is covered by a fee schedule, then SBR and IBR must be used to resolve the dispute.

The “2018 Independent Bill Review (IBR) Report: Analysis of 2013-2017” examines the IBR program activity from its implementation, capturing all applicant filings through December 31, 2017, thus providing an evaluation of the program during the first five years following its enactment.

During the first few months of the program, the IBRO received only a handful of applications. In the second quarter, filings increased and then accelerated throughout the remainder of 2013. In 2014, 2,009 applications were filed. The number of filings in 2015 and 2016 was nearly identical: 2,345 in 2015 and 2,385 in 2016. In 2017, filings decreased approximately 10 percent from the peaks in previous years, to 2,151.

In the first five years following IBR’s implementation, almost half the challenged billings (46.2%) related to Physician Services, including visits, consultations, and nonsurgical procedures. The second-highest number of review requests was for services at hospital outpatient departments and ambulatory surgical centers (17.9%). Disputes with contracts for reimbursement rates were the third highest (12.6%).

Among the filings that receive a review and a case determination, 71.1 percent are “overturned,” meaning the IBRO determined that additional reimbursement is warranted. The claims administrator’s determination is reversed, so the provider is due reimbursement for the review cost, along with the amount for review of the billing and fee schedule.

Overturned IBR case decisions for applications filed in 2013-2017 resulted in reimbursement to the providers totaling $12,277,568. This amount includes the repayment of filing fees for those cases. When IBR was introduced, the filing fee was $335. Effective April 1, 2014, this fee was reduced to $250 and then further decreased to $195 on January 1, 2015.

“We hope the findings of this report will encourage health care providers to consider using IBR for some of their payment disputes,” said DWC Administrative Director George Parisotto.

The progress report is posted on the DIR website.

County and sheriff’s office authorities nabbed 540 pounds of processed pot and $140,095 overall from five sites in Santa Cruz and Monterey counties while investigating allegations of unlawful distribution and cultivation of cannabis. The businesses also are suspected of tax evasion, money laundering and operating without workers’ compensation insurance.  Five sites were searched April 3 by deputies assigned to the Santa Cruz County Licensing Office:

— Redwood Skyline at the 2700 block South Rodeo Gulch in Santa Cruz.
— Rooted Republic at the 100 block of Manfre Road in Watsonville.
— Newton Enterprises at the 7000 block of Highway 1 in Moss Landing.
— Monterey Botanicals at the 22000 block of Fuji Lane in Salinas.
— Boutique Unlimited at the 100 block of Airport Road in King City.

The business owners are accused of not complying with state and local regulations regarding cannabis cultivation, according to the press release.

In one suspected scheme, authorities claim there is evidence of at least one business using money orders “in a sophisticated effort to launder large amounts of currency” to avoid paying the Santa Cruz County cannabis business tax, according to the release.

All of the searched businesses were controlled by the same corporate group of people, “who are suspected of directing specific financial transactions to avoid financial reporting and tax obligations,” according to the release.

Recent regulations have spurred an uptick in investigations of a once-illicit market.

Multiple residential properties in Santa Cruz County are linked with the corporate officials being investigated. Those properties also have been the focus of recent investigations linked with unregulated, unlawful commercial cannabis. “Investigators are determining whether unregulated cannabis from those properties was introduced into the lawful, regulated market through the five businesses searched,” according to the release.

No one was arrested during the investigation Officials will consult with the District Attorney’s Office to determine whether criminal charges are suitable. Civil assessments also will be considered. “The total amount of unpaid cannabis tax to the County of Santa Cruz will be determined once business records and banking records have been examined,” according to the release.

The WCIRB Governing Committee met this month to review the WCIRB Actuarial Committee’s analysis of December 31, 2018, California workers’ compensation loss and loss adjustment expense experience.

Following review and discussion of the latest data and analysis, the Committee conferred on whether to direct the WCIRB to submit a mid-year 2019 advisory pure premium rate filing to the California Department of Insurance (CDI).

Pure premium rates by definition reflect indemnity and medical losses and loss adjustment expenses only, are advisory and are not required to be adopted by insurance companies. In California’s open rated workers’ compensation insurance market, insurers are largely free to file their own rates and rating plans directly with the CDI.

Recognizing that mid-year filings and adjustments to advisory pure premium rates can be disruptive to employers, agents and brokers as well as insurers, the Committee established a guideline in 2011 stating that mid-year filings would generally not be made by the WCIRB unless there was highly unusual volatility in experience or major legislative, regulatory or judicial action.

Based on the December 31, 2018, experience and analysis, the Committee determined that the overall improvement in experience since the January 1, 2019, approved pure premium rates was more moderate, approximately $0.06 per $100 of payroll or less than 4 percent, than in recent prior years and did not warrant a mid-year 2019 pure premium rate filing.

The Committee also noted in its determination that there are concerns relating to indicated increases in average 2018 claim severities as well as potential distortions in loss development arising from the recent dramatic reductions in pharmaceutical costs.

The Committee instructed the WCIRB to further analyze these areas in preparation for the January 1, 2020, annual pure premium rate filing to be presented to the Committee in August for submission to the CDI.

The Actuarial Committee’s analysis of December 31, 2018, experience is publicly available to all stakeholders as are the documents from today’s Committee meeting, including the agenda and materials presented at the meeting, on the Committee Documents page of the WCIRB website.

Oklahoma’s attorney general dropped all but a single claim against Johnson & Johnson and Teva Pharmaceutical Industries Ltd in a closely watched lawsuit alleging the drugmakers helped fuel the U.S. opioid epidemic.

The move by Oklahoma Attorney General Mike Hunter came ahead of an upcoming May 28 trial, the first in the United States to result from roughly 2,000 lawsuits seeking to hold manufacturers of painkillers responsible for contributing to the epidemic.

Hunter dropped the claims after announcing last week that OxyContin maker Purdue Pharma LP had along with the wealthy Sackler family who own it reached a $270 million settlement.

The 2017 lawsuit accused the three companies of engaging in deceptive marketing that downplayed the addiction risk from opioids while overstating their benefits. The Sacklers were not defendants in the case. The companies deny wrongdoing.

Hunter said he would continue to bring a public nuisance claim against J&J and Teva but was dropping five other claims, including that they violated the Oklahoma Medicaid False Claims Act. Hunter said dropping those claims would not impact the amount of damages the state is seeking. Hunter had been asking for more than $20 billion before Purdue’s settlement.

J&J in a statement said the state’s decision to drop most of its claims “underscores their lack of merit.”  It said the evidence at trial will show that the company appropriately marketed its pain medications.

Teva did not respond to a request for comment.

Hunter said the decision to refocus the case around the single claim that the companies caused a public nuisance that needs remediated will obviate efforts by the companies to delay the upcoming trial.

It will also transform what was to be a televised jury trial into a non-jury one in which a state court judge will decide the case, Hunter said.

More than 1,600 other opioid-related lawsuits are consolidated before a federal judge in Ohio, who has pushed for a settlement ahead of the trial before him in October. Other cases, including Oklahoma’s, are pending in state courts.