Charles Ruben (DOB 9/13/1951), formerly of Simi Valley,  pleaded guilty to a felony violation of Insurance Code section 1871.4(a)(l} – making a fraudulent statement of a material fact for the purpose of obtaining workers’ compensation benefits. Previously he was President of Cr’s Gate Service, Inc.

Cr’s Gate Service, Inc. is a California Domestic Corporation filed on March 9, 2006. The company’s filing status is listed as Suspended and its File Number is C2869102. The Registered Agent on file for this company is Charles Ronald Ruben and was located at 1596 Kane Ave, Simi Valley, CA 93065-3625.

Between May 11, 2016, and November 23, 2016, Ruben was placed off work for an injury sustained while employed at his electric gate company in Simi Valley.

During that time, he collected disability payments that totaled $34,981.33 and systematically failed to report that he earned $48,686.20 while working as a self-employed contractor.

Sentencing for Ruben is scheduled June 7, 2019, at 9:00 a.m. in courtroom 12 of the Ventura Superior Court, County of Ventura.

He faces a maximum of five years in jail.

At the time he entered his plea, Ruben provided a check to the victim, State Compensation Insurance Fund, for the full amount of restitution due in this case for $41,326.45.

Telemedicine is the use of electronic communication technologies to provide clinical services to patients without an in-person visit, with the goal of improving the patient’s health status. The electronic communications or monitoring may be used for follow-up visits, management of chronic conditions, medication management, consultation with specialists, or other clinical services that can be provided remotely via secure video and audio connections.

According to a representative from Kaiser Permanente, a leader in telemedicine services, the number of telemedicine customers is expected to increase to roughly 7 million by 2018 (up from 350,000 in 2013). In 2015, of KP’s 110 million interactions between physicians and members, 56% were virtual, surpassing physical visits for the first time.

The Department of Veterans Affairs, which operates the nation’s largest healthcare system and is recognized as a world leader in the development and use of telehealth services, has achieved better results through telemedicine. According to the VA, telemedicine has increased access to high-quality healthcare services and has proven to be an effective and convenient way for patients to receive—and medical providers to provide—medical care.

A 2014 report by Towers Watson estimated that US businesses could save more than $6 billion a year by using telemedicine

When it comes to legislation and rule changes to advance the use of telemedicine, some states are moving more quickly than others.

In 2017 Harbor Health Systems, a One Call Care Management company, announced that it is one of the first companies to receive approval from the California Department of Workers’ Compensation to offer telemedicine through its medical provider networks. Harbor’s MPN networks cover approximately 2 million employees in the state of California.

In early 2018, Texas proposed a rule that would expand injured workers’ access to telemedicine services by lifting a restriction in the Medicare-based reimbursement policy that limits the use of telemedicine to underserved areas—typically rural regions with few healthcare providers.In April 2018, the Texas Department of Insurance, Division of Workers’ Compensation, announced a new fee schedule applicable to telemedicine and telehealth services provided on or after September 1, 2018.

Also in 2018, legislators in Florida proposed two telehealth-related bills, House Bill 793 and Senate Bill 280. Among other provisions, these bills attempted to establish a standard of care for telehealth providers and authorize them to use telehealth to perform patient evaluations and prescribe certain controlled substances. However, neither bill advanced.

Now in 2019, a bill submitted in New York, SB 1042, proposes creating a task force to study how telehealth and telemedicine might help employees in workers comp, as well as the providers treating them and the businesses employing them.

Since 2013, the annual Workers’ Compensation Benchmarking Study has taken a broad look at the drivers of workers’ comp claims outcomes. The 2018 edition features a notable shift in focus, taking a deep dive into the most critical claims outcome driver identified in past years: medical performance management.

Through think-tank sessions and focus group research, study researchers distilled the input of a diverse group of industry executives to compile their ideas on the most promising and realistic medical management strategies of interest for employers, insurers, TPAs and government entities, as well as brokers and consultants.

According to the summary published in Risk and Insurance, leaders surveyed suggest that organizations must align their goals around quality and outcomes in order to move what has proved to be a tough-to-budge needle. Researchers identified three core goals shared by industry respondents:

    Investing in health outcomes
    Encouraging employee engagement and empowerment, and
    Promoting population health and injury prevention

The organizations surveyed are actively employing or evaluating a spectrum of strategies for meeting these goals, from the familiar to what once might have been seen as fringe.

The ‘N Factor’: Executives surveyed ranked the use of nurse case management as the #1 most critical medical management program for impacting claims outcomes. (Followed by return-to-work services and nurse triage.)

Study after study backs up the ranking. A 2016 Helmsman report used a set of 4,000 claims normalized for injury, patient and biopsychosocial factors, with half having nurse involvement. The nurse-involved claims had 16 percent lower future medical costs, 15 percent lower overall costs and 12 percent faster claims resolutions. A similar Helmsman study done for a single employer showed nurse-involved claims having 57 percent fewer disability days.

In the past, the “Us vs. Them” employer-employee paradigm put the focus on fighting tooth and nail to avoid paying for any comorbidities. It also fostered a belief that worker health is of no concern to workers’ comp programs unless a workplace condition was the cause of a specific health problem.

Times have changed, largely with the growing body of research showing a substantive connection between conditions like diabetes and obesity and claim cost/duration. A growing number of employers are recognizing how healthier employees are less likely to be injured, and recover faster and with less complications if they do get injured.

Embrace Technology: Executives surveyed report they are leveraging technology to improve communication with both providers and workers. One large employer surveyed is using FaceTime to meet with injured workers and providers and to speed recovery by approving treatment decisions on the spot.

The availability of things such as app-based physical therapy and health coaching allows more flexibility for both employers and employees, putting the necessary tools for a positive outcome literally in the hands of the injured worker.

Trusting Employees: Once a rare practice, employee self-reporting is gaining traction among employers, with large employers such as Starbucks embracing it as an extension of its employee advocacy philosophy. Those employing such programs report decreased litigation and increased employee engagement. But another strong argument in favor of self-reporting is the ability to decrease lag time and reporting errors made by supervisors, and speed time to triage and treatment.

To read the rest: The Workers’ Compensation Benchmarking Study is a national research program designed to advance claims management. As in prior years, the 2018 Report will be available to all without cost or obligation as a contribution to the workers’ compensation industry. The 2018 Report as well as prior reports may be requested here.

A 44-year-old San Mateo County sheriff’s correctional officer pleaded no contest Wednesday to misdemeanor worker’s compensation fraud and was sentenced to 10 days in county jail, District Attorney Steve Wagstaffe said.

According to the report in SFGate, Edmundo Rocha reported an injury in October 2016 that he said resulted from defensive tactics training the previous month, San Mateo County prosecutors said.

Rocha was diagnosed with a left shoulder sprain and was offered workers’ compensation benefits. His doctor ordered him to be on modified duty, but the sheriff’s office eventually had him stay out of work on total temporary disability, prosecutors said.

However, while on disability, he ran in a Spartan Race and a GoPro camera worn by a fellow sheriff’s employee captured Rocha navigating obstacles in the course. When he went to see a specialist weeks later, he did not disclose that he was able to participate in the race.

Wagstaffe said the sheriff’s office eventually reported the case to the district attorney’s office, and investigators learned from interviewing employees that there was the video from the race.

Rocha’s attorney Josh Bentley entered the no contest plea on his behalf Wednesday morning, according to Wagstaffe.

Along with the 10-day jail sentence, which can be served in Sacramento County where Rocha lives, he was also sentenced to two years of probation and ordered to pay $5,000 in restitution, Wagstaffe said.

Bentley, who was not immediately available for comment, presented a check for $5,000 in restitution to the court, the district attorney said.

Rocha will surrender to authorities on March 23 to serve the jail sentence, Wagstaffe said.

He said Rocha was on administrative leave from the sheriff’s office as of last week. A sheriff’s spokesperson was not immediately available to comment on Rocha’s current employment status.

A new study published in the JAMA Network and summarized by Reuters Health says that spending on health care advertising in the U.S. has almost doubled over the past two decades as companies compete for their share of the world’s biggest health care market.

Annual health care marketing surged from $17.7 billion in 1997 to at least $29.9 billion in 2016, driven by a rapid spike in spending on direct-to-consumer (DTC) advertisements for prescription drugs, the study found. Over this period, DTC spending climbed from $2.1 billion to $9.6 billion.

Pharmaceutical marketing to health professionals accounted for the biggest outlay, and climbed from $15.6 billion to $20.3 billion despite new policies at hospitals and medical schools designed to limit industry influence over prescribing.

“While marketing may have positive effects like destigmatizing diseases (e.g., HIV) or embarrassing symptoms (e.g., impotence) it can also expand or even create disease or raise false hopes by exaggerating treatment effects – for example marketing of marginally effective Alzheimer’s drugs,” said study coauthor Dr. Steven Woloshin of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire.

“This can lead to overdiagnosis, overtreatment (with associated harms) and wasted resources,” Woloshin said by email.

To compete for market share, just about every player in the industry from drugmakers to insurers to hospitals to diagnostic test makers invest in marketing to insiders who make prescribing and purchasing decisions as well as to consumers.

Health spending in the U.S. is the highest in the world, totaling $3.3 trillion in 2016, or 17.8 percent of the gross domestic product, researchers report in JAMA.

The industry marketing outlays in the current study match the roughly $30 billion budget of the National Institutes of Health and far outstrip the budget of about $5 billion for the agency in charge of policing the industry, the U.S. Food and Drug Administration (FDA), Woloshin noted.

The study focused on marketing of prescription drugs, disease awareness campaigns, health services, and laboratory tests to consumers and professionals. It underestimates total spending because researchers lacked data on so-called detailing, or sales calls to clinicians, coupons or rebates, online promotions, and spending on medical meetings and other events, the authors note.

Industry marketing budgets also include numerous other outlays that weren’t counted in the study, like the cost of training and salaries for sales reps, marketing research, fees paid to advertising agencies and lobbying campaigns, the authors also point out.

Still, it is the most comprehensive analysis of medical marketing in the U.S. that has ever been done, said Dr. Howard Bauchner, editor-in-chief of JAMA.

“For clinicians, policy makers, and patients it is important for them to be aware of the extent of medical marketing,” Bauchner said by email.

And marketing can be a mixed bag for patients.

“DTC for health services might also encourage consumers to get services they don’t need – tests in particular, and these can have negative consequences (false positives, worry about small risks),” Rosenthal added. “On the benefit side, some DTC advertisements help de-stigmatize conditions like sexually transmitted infections or depression and encourage people to seek care.”