An artificial intelligence (AI) system scored 2:0 against elite human physicians in two rounds of competitions in diagnosing brain tumors and predicting hematoma expansion.

The BioMind AI system, developed by the Artificial Intelligence Research Centre for Neurological Disorders at the Beijing Tiantan Hospital and a research team from the Capital Medical University, made correct diagnoses in 87 percent of 225 cases in about 15 minutes, while a team of 15 senior doctors only achieved 66-percent accuracy.

The AI also gave correct predictions in 83 percent of brain hematoma expansion cases, outperforming the 63-percent accuracy among a group of physicians from renowned hospitals across the country.

The outcomes for human physicians were quite normal and even better than the average accuracy in ordinary hospitals, said Gao Peiyi, head of the radiology department at Tiantan Hospital, a leading institution on neurology and neurosurgery.

To train the AI, developers fed it tens of thousands of images of nervous system-related diseases that the Tiantan Hospital has archived over the past 10 years, making it capable of diagnosing common neurological diseases such as meningioma and glioma with an accuracy rate of over 90 percent, comparable to that of a senior doctor.

All the cases were real and contributed by the hospital, but never used as training material for the AI, according to the organizer.

AI will not only reduce the workload but also push doctors to keep learning and improve their skills, said Lin.

Bian Xiuwu, an academician with the Chinese Academy of Science and a member of the competition’s jury, said there has never been an absolute standard correct answer in diagnosing developing diseases, and the AI would only serve as an assistant to doctors in giving preliminary results.

Dr. Paul Parizel, former president of the European Society of Radiology and another member of the jury, also agreed that AI will not replace doctors, but will instead function similar to how GPS does for drivers.

Dr. Gauden Galea, representative of the World Health Organization in China, said AI is an exciting tool for healthcare but still in the primitive stages.

China has introduced a series of plans in developing AI applications in recent years.

In 2017, the State Council issued a development plan on the new generation of Artificial Intelligence and the Ministry of Industry and Information Technology also issued the “Three-Year Action Plan for Promoting the Development of a New Generation of Artificial Intelligence (2018-2020).”

The Action Plan proposed developing medical image-assisted diagnostic systems to support medicine in various fields.

The Labor Commissioner’s Office has issued wage theft citations to a large farm labor contracting operation for failing to timely provide 1,374 seasonal farm workers their final pay.

Vista Santa Rosa Inc. did not pay discharged workers on the last day of work as required by law, and the company consistently issued final paychecks at least 72 hours late. Both client employers and their labor suppliers are accountable for workplace labor law violations in California.

An investigation was launched in August 2016 after workers reported violations of late pay to California Rural Legal Assistance, a nonprofit that provides free legal services. The investigation identified $646,875 in waiting time penalties, of which $323,729 is due to 867 affected workers in 2016, and $323,145 is due to 864 workers in 2017.

Vista Santa Rosa Inc. hires and provides farm workers to growers in the Coachella Valley region. In 2016, Vista was a sole-proprietorship owned and operated by Jose Luis Gomez Jr. In 2017 Gomez began doing business as Vista Santa Rosa Inc. Both Gomez and his successor company Vista share joint and several liability for the $646,875 in waiting time penalties.

California Labor Code section 2810.3 holds client employers – those that obtain or are provided workers from a subcontractor – responsible for their subcontractor’s workplace violations. Client employers also liable for Vista’s violations include:

— Brighton Distributing, Inc.
— Alexandra Dates, Inc.
— Coachella Valley Ranch Development, Inc.
— MICA, LLC
— The Wildwood Group, Inc.
— East-West Unlimited, LLC
— Anthony Vineyards, Inc.
— Sun World International, LLC

If a worker quits, final wages are due within 72 hours of the notice. Waiting time penalties are imposed when the employer intentionally fails to pay all wages due to the employee at the time of separation. This penalty is calculated by taking the employee’s daily rate of pay and multiplying it by the number of days the employee was not paid, up to a maximum of 30 days.

Enforcement investigations typically include a payroll audit of the previous three years to determine minimum wage, overtime and other labor law violations, and any payments owed and penalties due are calculated.

Federal officials are charging 601 people in the largest bust of health care fraud in U.S. history. Southern California criminal cases named a total of 33 defendants. Nine new defendants being charged as part of Operation “Spinal Cap.” The scheme was spearheaded by Michael Drobot, the former owner of Pacific Hospital in Long Beach.

In the cases announced in Operation Spinal Cap Daniel Capen, 68, of Manhattan Beach, an orthopedic surgeon, has agreed to plead guilty to conspiracy and illegal kickback charges. Capen accounted for approximately $142 million of Pacific Hospital’s claims to insurers, on which the hospital was paid approximately $56 million.

Timothy Hunt, 53, of Palos Verdes Estates, another orthopedic surgeon who referred spinal surgery patients to Capen and other doctors, has agreed to plead guilty to a conspiracy charge involving his receipt of illegal kickbacks stemming from various financial relationships with Pacific Hospital and related entities.

George William Hammer, 65, of Palm Desert, the former chief financial officer of the physician management arm of Pacific Hospital, has agreed to plead guilty to tax charges based on the fraudulent classification of illegal kickbacks in hospital-related corporate tax filings.

Lauren Papa, 52, of Tarzana, a chiropractor, has agreed to plead guilty to a conspiracy charge involving her receipt of illegal kickbacks to refer patients to a neurosurgeon with the understanding that the neurosurgeon would perform the surgeries at Pacific Hospital.

Tiffany Rogers, 53, of Palos Verdes Estates, an orthopedic surgeon, was named in an indictment unsealed Wednesday in connection with receiving illegal kickbacks to refer patients for spinal surgeries at Pacific Hospital.

Brian Carrico, 64, of Redondo Beach, a chiropractor – along with Performance Medical & Rehab Center, Inc., which was partially owned by Carrico; and One Accord Management, Inc., which Carrico wholly owned – were charged in connection with the receipt of illegal kickbacks to influence the referral of patients to Pacific Hospital. An indictment unsealed Wednesday alleges that these defendants and other co-conspirators were responsible for approximately $80 million in claims submitted to the federal workers’ compensation program and were paid approximately $56 million in connection with patients that Performance Medical referred to Pacific Hospital.

William Parker, 64, of Redondo Beach, was charged in a separate indictment unsealed on Wednesday in connection with the same kickback scheme involving Carrico and his companies.

In San Diego, the cases include Marco Antonio Chavez, a licensed medical doctor specializing in psychiatry, was charged with 30 counts of health care fraud in connection with over $928,000 in bills he submitted to TRICARE for services he never provided. He was also charged with five counts of aggravated identity theft and one count of obstruction of a federal audit..

Four defendants, including two chiropractors, a physical therapist and an acupuncturist, were charged with conspiracy to commit health care fraud and honest services fraud and to pay unlawful kickbacks stemming from their operation of R.I.S.E. Medical Center. According to the indictment, R.I.S.E. operated several “Wellness Centers” in San Diego County, including Bonita and Oceanside, and offering a range of services including physical therapy, diagnostic tests, massages, chiropractic treatments, and acupuncture..

Joserodel Zavala Candelario, a chiropractor and owner of R.I.S.E., imposed quotas for non-reimbursable services and treatments, allegedly telling staff that they were expected to provide a certain number of diagnostic tests, “no matter what”; to “grab patients in lobbies to put into provider schedules”; and to ply patients with complimentary treatments so R.I.S.E. could continue to fraudulently bill TRICARE and Medicare.  

In addition, Candelario was also charged with paying a patient recruiter over $18,000 to refer TRICARE patients to the R.I.S.E. clinic. The recruiter, Mariam Reyes, was charged separately with conspiring to solicit and receive kickbacks.

In a separate indictment, Candelario was charged with participating in a scheme to defraud California Workers’ Compensation insurers and R.I.S.E. patients by receiving illegal kickbacks and bribes to refer patients to certain providers. According to the indictment, Candelario paid kickbacks to his co-schemers through a front company in exchange for referrals of Workers’ Compensation patients, and then concealed these kickbacks through sham “marketing” agreements.

One of Candelario’s co-schemers, Boris Dadiomov, was charged separately for his role in the fraudulent conspiracy. As a result of their unlawful cross-referral kickback scheme, Candelario and the other schemers received over 500 illegal patient referrals and submitted over $6.6 million in false billings to insurance companies.

Larry Tripplett was a professional football player who played defensive tackle for the Indianapolis Colts from 2002 to 2006, then played for the Buffalo Bills from 2006 to 2008, and played briefly for the Seattle Seahawks in 2008. In his six-year career, Triplett played approximately 110 games of professional football, but only played two games in California.

In 2009, Tripplett filed a claim for workers’ compensation benefits, alleging injury to multiple body parts throughout the course of his National Football League (NFL) career. Each of the defendant football teams and insurers denied his claim. Both Buffalo and Seattle disputed California jurisdiction. Trial proceeded on the jurisdiction issue.

At that trial, Tripplett testified about his hiring by Indianapolis, explaining that his agent David Dunn, who was located in Newport Beach, negotiated all of his contracts. Tripplett asserted he was living in Los Angeles when he signed his Indianapolis contract in his agent’s Newport Beach office. At the end of Tripplett’s cross-examination, he moved to “‘elect against the Indianapolis Colts. Since jurisdiction was not contested by the Colts even prior to this trial, over the objection of the Indianapolis Colts, the Court allowed the election.’”

The matter proceeded to a further trial against Indianapolis. However, after Tripplett was provided with a copy of that agreement, showing he and his agent, Joby Branion, had signed separate copies of the signature page, he acknowledged “I honestly don’t remember” where he signed the agreement. Tripplett also testified that although he “put a lot of trust in [his] agent” to negotiate his employment agreements, and “whatever he advised me to do, that’s what I signed,” it was Tripplett himself who “had the final say.”

The WCJ found that the WCAB had jurisdiction over the claim. The WCAB granted the petition for reconsideration and reversed the WCJ’s finding of jurisdiction based on Tripplett’s hiring in California. The Court of Appeal affirmed the dismissal in the unpublished case of Tripplett v. WCAB.

Tripplett relies on Labor Code section 3600.5(a), which specifies that “[i]f an employee who has been hired or is regularly [employed] in the state receives personal injury . . . arising out of . . . [such] employment outside of this state, he . . . shall be entitled to compensation according to the law of this state,” and 5305, which specifies the WCAB has “jurisdiction over all controversies arising out of injuries suffered outside the territorial limits of the state in those cases where . . . the contract of hire was made in this state.”

But when courts have grappled with the issue of determining the location at which an injured employee was hired for purposes of workers compensation law, they have done so by applying traditional principles of contract formation.

Here, Tripplett’s agent’s negotiation of terms to be included in a written employment contract was not sufficient to bind Tripplett to anything. And because those negotiations were the only contract-related activity that took place in California, there is no basis to conclude the contract was formed in this state.

The Workers’ Compensation Insurance Rating Bureau (WCIRB) has prepared a new report containing estimated California workers’ compensation costs for 2017 based on insured employer experience. The report also reflects payments made by the California Insurance Guarantee Association (CIGA)

Key findings in the report include:

Total insurer combined losses and expenses incurred in 2017 were $16.2 billion, or 91% of calendar year premium, compared to $16.9 billion (or 94% of calendar year premium) in 2016.

Calendar year 2017 earned premium totaled $17.7 billion (as compared to the $18.0 billion of premium earned in 2016).

Medical losses paid in 2017 were $4.7 billion, or 56% of total loss payments. Of these payments, $1.3 billion were paid for physician services, $1.3 billion were payments made directly to injured workers, $0.7 billion were paid for inpatient or outpatient services, $0.2 billion were paid for pharmaceuticals, and $0.3 billion were paid for medical-legal evaluations.

Beginning with claims incurred on policies incepting on or after July 1, 2010, the cost of medical cost containment programs is required to be reported to the WCIRB as allocated loss adjustment expense rather than as medical loss.The total cost of medical cost containment programs in 2017 was $443 million compared to $468 million in 2016.

Indemnity benefits paid in 2017 were $3.7 billion, or 44% of total loss payments. Of this amount, temporary disability benefits paid totaled $1.8 billion and permanent partial disability benefits paid totaled $1.5 billion.

Medical-legal cost data for 2017 shows that orthopedic evaluations accounted for about 55% of the cost of all medical-legal evaluations. The exhibits also show that the average cost of a medical-legal evaluation was $1,496. Psychiatric evaluations were the most expensive, averaging $3,268.

Incurred loss adjustment expenses (allocated and unallocated) in 2017 were $3.3 billion, or 19% of earned premium. (This includes the full cost to insurers of administering, adjudicating and settling claims.) Incurred loss adjustment expenses include $894 million in defense attorney expenses incurred in 2017. (For comparison purposes, in 2016, incurred loss adjustment expenses were 16% of earned premium, including $827 million in defense expenses.)

In total, California insurers have incurred about $6.7 billion in expenses in 2017, or 38% of 2017 earned premium. (For comparison purposes, in 2016, total incurred expenses were 34% of earned premium.)

Although generally part of incurred indemnity losses rather than expenses, the amount paid in 2017 to applicant attorneys was derived from the WCIRB’s Annual Expense Call. In 2017, applicant attorneys were paid $413 million. (In 2016, applicant attorneys were paid $408 million.)