Oroville Hospital was founded in 1962 and is a 153-bed acute care facility that offers a variety of services, including inpatient and outpatient care, a radiology department, and multiple physician practices. It’s a Level 3 Trauma Center, which means its Emergency Service Department treats all but the most severe neurological, pediatric, and burn patients. It is owned by OroHealth Corporation, a private, non-profit organization. OroHealth Corporation has two subsidiaries: Oroville Hospital, an acute care inpatient and outpatient facility, and OroLake Corporation, a regional sales and service organization. .

Oroville Hospital has agreed to pay $10.25 million to the United States and the State of California to resolve allegations that it violated the False Claims Act and the Anti-Kickback Statute, U.S. Attorney Phillip A. Talbert announced today.

The settlement resolves allegations that Oroville Hospital engaged in an illegal kickback and physician self-referral scheme by paying kickbacks to physicians for patients they admitted to the hospital, and that it knowingly submitted false claims to Medicare and Medi-Cal for medically unnecessary hospital admissions and claims that included false diagnosis codes. Oroville Hospital will pay $9,518,954 to the federal government and $731,046 to the State of California.

The settlement resolves allegations that, to increase hospital admissions, Oroville Hospital illegally paid kickbacks to its physicians who were responsible for deciding whether individuals should be admitted as inpatients. These physicians allegedly received a bonus based on how many patients they admitted, according to the settlement agreement.

The settlement also resolves allegations that Oroville Hospital admitted patients as inpatients when it knew inpatient care was not medically necessary. Oroville Hospital then submitted claims to Medicare and Medicaid for inpatient care, which is more expensive. Oroville Hospital further allegedly submitted claims to Medicare and Medicaid that included false diagnosis codes for systemic inflammatory response syndrome (SIRS), resulting in excessive reimbursement to the Hospital.

In connection with the settlement, Oroville Hospital entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) that requires, among other requirements, the implementation of a risk assessment and internal review process designed to identify and address evolving compliance risks. The Corporate Integrity Agreement also requires an independent review organization to, among other requirements, annually assess both the medical necessity and appropriateness of select claims billed to Medicare and policies and systems to track arrangements with some referral sources.

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Cecilia Guardiola. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. Cecilia Guardiola v. Oroville Hosp., Case No. 2:20-CV-1558 (E.D. Cal.). As part of the settlement announced today, Ms. Guardiola will receive approximately $1.8 million.

“Physicians should make decisions based the best interests of their patients, not their own personal financial interests,” said U.S. Attorney Talbert. “Hospitals engaging in kickback schemes betray the trust placed in them by their communities and distort care decisions that should be untainted by illegal kickbacks. This settlement demonstrates my office’s commitment to preserving the integrity of public healthcare programs and ensuring that the well-being of patients remains paramount.”

“Improperly billing federal health care programs depletes valuable government resources used to provide medical care to millions of Americans,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “We will continue to advocate for the appropriate use of Medicare and Medicaid funds, and we will pursue health care providers who defraud taxpayers by knowingly submitting false claims.”

Assistant U.S. Attorney Steve Tennyson handled the case for the U.S. Attorney’s Office. The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Eastern District of California, the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the Department of Health and Human Services, Office of the Inspector General, and the California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse.

The claims resolved by this settlement are allegations only, and there has been no determination of liability.

54 year old Jingjin “Kathy” Bian, who lives in Cupertino, was arraigned on felony charges of insurance fraud after a California Department of Insurance investigation revealed she allegedly received over $900,000 in undeserved long-term care insurance benefits for her and her father.

Bian, a former insurance agent, was in a car accident in August 2018, resulting in a back injury and her filing claims to enact her long-term care benefits on her life insurance policy.

The benefits were approved by her insurance company in January 2019 and she ended up receiving over $300,000 in benefits including for caregiver reimbursement.

The Department of Insurance began its investigation after her insurance company suspected fraud. Through surveillance she was observed performing activities independently, with no caregiver present, directly contradicting her claimed disabilities and reasons needing for caregiver reimbursement.

Bian was also the legal representative for her 81-year-old father, who lived with her and also had a life insurance policy with the same insurance company.

In February 2018 Bian’s father was diagnosed with Parkinson’s disease and he filed a claim to enact the long-term care benefits on his insurance policy. The claim stated he required hands on assistance and required a walker when going outside. Bian’s father’s claim application for benefits was approved by the insurance company in February 2019 and he received over $600,000 in benefits.

Surveillance observed Bian’s father performing activities independently, with no caregiver present, directly contradicting his claimed disabilities. The investigation found that Bian was listed as her father’s legal representative in all correspondence and that all of her father’s policy correspondence, care provider scheduling, and billing were handled by Bian.

Bian’s alleged actions resulting in a loss of $900,000 to the insurance company. Bian is out on bail and is scheduled to return to court on April 16, 2025. The Santa Clara County District Attorney’s Office is prosecuting this case.

The Leapfrog Hospital Safety Grade is the only hospital ratings program focused exclusively on preventing medical errors and patient harm. It is fully transparent, free to the public and updated biannually in the fall and spring.

The Group released its fall 2024 Hospital Safety Grade, evaluating nearly 3,000 hospitals on their ability to prevent medical errors, accidents and infections.

The Hospital Safety Grade uses up to 30 performance measures to assign an “A,” “B,” “C,” “D” or “F” to individual hospitals and uses a public, peer-reviewed methodology, calculated by top patient safety experts under the guidance of a National Expert Panel. It is transparent and free to the public. Leapfrog analysts use the data to observe national performance trends and state rankings.

For fall 2024, Utah ranks number one with the highest percentage of “A” hospitals for the third cycle in a row, followed by Virginia and Connecticut in second and third. The latest Grades also show hospitals are making progress in patient safety across several performance measures including notable improvements in healthcare-associated infections, hand hygiene and medication safety.

“Preventable deaths and harm in hospitals have been a major policy concern for decades. So, it is good news that Leapfrog’s latest Safety Grades reveal that hospitals across the country are making notable gains in patient safety, saving countless lives,” stated Leah Binder, President and CEO of The Leapfrog Group. “Next, we need hospitals to accelerate this progress – because no one should have to die from a preventable error in a hospital.”

Key findings on state performance on the fall 2024 Leapfrog Hospital Safety Grade include:

– – The states with the highest percentages of “A” hospitals are Utah, Virginia, Connecticut, North Carolina, New Jersey, California, Rhode Island, Idaho, Pennsylvania, Colorado and South Carolina.
– – Utah ranks #1 in percentage of “A” hospitals for the third Safety Grade cycle in a row.
– – California ranks in the top 10 for the first time since fall 2014.
– – There were no “A” hospitals in Iowa, North Dakota, South Dakota or Vermont.

Regrettably, Pacifica Hospital of the Valley in Sun Valley California received a grade of “F” and seventeen California hospitals received a grade of “D.” Pacifica Hosptial was rated “D” in fall of 2021, and fell to “F” in sprint 2022 and has remained at “F” ever since.

Detailed hospital performance information, including patient experience and safety measures, as well as grades for individual hospitals searchable by states and localities is available at HospitalSafetyGrade.org.

In 1938, President Roosevelt signed the Fair Labor Standards Act (FLSA) into law. It was a landmark piece of civil rights legislation designed to protect the rights of workers.

At the time, there was a fear that people with disabilities would be disadvantaged by the law and experience high rates of unemployment if employers had to pay comparable wages to people with and without disabilities. Therefore Section 14(c) of the FLSA (14(c)) was written into the law to allow employers to pay workers with disabilities lower wages.

Accordingly, California also included similar exemptions in its state Labor Code, in Sections 1191 and 1191.5.

The Fair Labor Standards Act authorizes the Secretary of Labor to issue certificates allowing employers to pay productivity-based subminimum wages to workers with disabilities, but only where such certificates are necessary to prevent the curtailment of opportunities for employment. Employment opportunities for individuals with disabilities have vastly expanded in recent decades, in part due to significant legal and policy developments.

Section 14(c) was little known and rarely used until the 1950s when sheltered workshops began to flourish. Sheltered workshops were started with good intentions as parents were seeking a way to keep their children out of institutions. The law currently has about 40,000 American workers laboring for half the minimum wage or less, according to the Labor Department.

However a proposed new rule, announced on December 4 with a Notice of Proposed Rulemaking (NPRM), would end the issuing of 14(c) certificates, which permit businesses to pay people with disabilities below the federal minimum wage of $7.25 an hour. If implemented, the proposal would phase out 14(c) certificates altogether over a 3-year period, ending subminimum wage nationwide.

The Labor Department’s proposal follows a review of the program, and the new rule would not take effect until a public comment period ends on Jan. 17, 2025, days before President-elect Donald Trump takes office. The new administration could review and respond to the comments and issue a final rule, or withdraw it entirely.

If finalized, the proposed federal rule would not require workers with disabilities to leave their current places of employment and would not require current section 14(c) certificate holders to amend the employment setting or type of services they provide.

Subminimum wage for disabled workers in California will however end this January.

In 2021, Disability Rights California sponsored legislation to phase out subminimum wage in California. With the passage of SB 639 (Durazo), subminimum wage for Californians with disabilities will be fully phased out at the start of 2025.

California joins more than a dozen states and the District of Columbia that have already banned the program.

Today, unemployment rates among people with disabilities remain disproportionally high, despite the continued use of 14(c) and California exemptions. In 2019, California ranked 22nd in the nation for its employment of people with disabilities. People with disabilities experienced employment rates at 36.9 percent compared to 75.6 percent for their peers. Additionally, people with disabilities also represent a larger portion of the population not included in the labor force. Nationally, about 8 in 10 were not in the labor force in 2019, compared with about 3 in 10 of those with no disability.

Safety National® is a specialty insurance and reinsurance provider with its corporate headquarters in St. Louis Missouri . It is a wholly-owned subsidiary of Tokio Marine Holdings, Inc., a Tokyo-based global insurer with a presence in over 40 countries.

Safety National just announced the winners of its annual Safety First Grant Program. Three policyholders will be awarded matching grants in order to develop the creative risk control ideas they submitted into formal safety programs.

“As a market leader and safety advocate, we are committed to identifying industry innovation that reduces the risk of employee injury and illness,” said Mark Wilhelm, Executive Chairman of Safety National. “Over the last 10 years, the Safety First Grant Program has funded 32 risk control projects, responding to the emerging needs of our clients while building a blueprint for safer workplaces.”

Winners of the 2024 program included:

– – First Place: Berry Global was awarded the $10,000 matching grant for the addition of radar technology capable of detecting human motion inside of an industrial robot cell. This innovation will prevent dangerous machine restarts, which can result in significant injury.
– – Second Place: Bigge Group was awarded the $5,000 matching grant toward the implementation of an enterprise-wide system used to monitor workplace temperature. These sensors can detect rising heat levels, mitigating heat-related illnesses.
– – Third Place: Lam Research was awarded the $2,500 matching grant to install ergonomic improvement equipment, including over 30 pneumatic and electric adjustable tables. This technology will eliminate problematic manual material handling tasks that lead to musculoskeletal disorders.

Nominees for the annual Safety First Grant Program must be an active Safety National policyholder with a risk-reducing solution that applies to the workers’ compensation line of coverage. The applied solutions must relate to an identifiable and quantifiable loss source and include an anticipated estimate of injury cost savings for the policyholder.

“Each year, our applicants submit increasingly impressive innovative and creative risk management ideas for this program, finding new ways to build a safer workplace for their employees,” said Matt McDonough, Assistant Vice President Risk Control of Safety National. “In celebrating these winning submissions, we hope other organizations are inspired to discover their next great risk-reducing solutions.”

Full details on the 2024 Safety First Grant Program winning solutions can be found on its website.

The 2025 grant application period will open in June 2025.