An eight-week group program focused on mindfulness-based stress reduction may help with short-term function and long-term pain for people with chronic low back problems, according to a new study published in the JAMA Internal Medicine and reported in Reuters Health.

“Most people would think mindfulness meditation would help stress,” said lead author Dr. Natalia Morone of the University of Pittsburgh. “They would not typically think it could actually lead to reduced pain or lead them to have less pain interference during their day to day activities.”

The researchers studied 282 older adults, with an average age of 74, in the Pittsburgh area with functional limitations due to chronic low back pain between 2011 and 2014. The participants were randomly separated into two groups. Both groups entered into an eight-week program followed by monthly sessions for an additional six months.

In the mindfulness group, participants were taught four methods of meditation, using directed breathing and mindful awareness of thoughts and sensations in sitting, walking or lying down positions. They also learned mindful stretching during the initial eight weeks. During the six months of booster sessions, participants met to meditate and discuss themes of the mindfulness program.

Those in the comparison group met for the same amount of time in groups of the same size with the same amount of “homework” and time with a facilitator, but instead focused on education based on the 10 Keys to Healthy Aging, which does not address pain. They learned about managing high blood pressure and did the same chair stretches as the mindfulness group.

The participants had monthly 15-minute phone interviews about the back pain, function, mindfulness, and doctor or hospital visits. Based on disability questionnaires, the people in the mindfulness group had improved more after eight weeks than the control group, though disability scores were again similar by the six-month point.

The mindfulness group also had more improved current and most severe pain scores at the six-month point, as reported in JAMA Internal Medicine.

“In terms of mechanism for pain reduction, the study gives us a clue as patients in the mind-body program reported more self-efficacy toward pain – they were able to better cope with their pain,” Morone told Reuters Health by email.

She and her coauthors did not compare the mindfulness program to other back pain treatments, but it should be seen as an option for some patients that does not involve medication or surgery, she said.

The authors did not report how consistently the treatments were delivered or how faithfully participants practiced outside of their sessions, which would be important information, Dr. M. Carrington Reid of Weill Cornell Medical Center in New York and coauthors wrote in a commentary alongside the paper.

But “chronic pain is one of the most common conditions encountered by health care professionals, particularly among patients 65 years and older,” and barriers often prevent treating it with medication, so studies on non-medication options like mindfulness are important, they wrote.

The Mindfulness-Based Stress Reduction Program is offered in many medical centers, communities and online.

The case of Saul Zuniga v. Interactive Trucking, Inc.; SCIF involves another challenge to the constitutionality of the IMR process, asserting that the anonymity of the IMR reviewers violates due process and the IMR statute violates the guarantee of right to appellate review.

After successfully appealing an IMR determination and obtaining an order remanding the matter back to IMR for review by a different physician reviewer, Zuniga filed a discovery motion seeking the disclosure of the IMR reviewers’ identities. While the discovery motion was pending, the second IMR decision was issued authorizing additional, but not all, of the prescribed medications. Thereafter, over defendant’s objections, a trial was set on the issue of the disclosure of the IMR physicians’ identities. The Workers’ Compensation Judge issued a decision finding that he could not release the names of the IMR physicians pursuant to Labor Code section 4610.6(f).

Zuniga filed a petition for reconsideration, which was denied. He then filed a petition for writ of review in October 2014 arguing that the anonymity of the IMR reviewers violates due process and that the IMR statutes violate the guaranteed right to appellate review. SCIF filed its answer arguing: (1) The petitioner lacks standing since he did not exhaust his administrative remedies by filing an appeal of the second determination and therefore the petition for review was premature; (2) the petition failed to name the DWC, which is an indispensable party; (3) the WCJ was correct in finding that he lacked the authority to order the disclosure of the reviewing doctors; and (4) not revealing the reviewers’ identities did not deprive the petitioner of his due process rights.

The briefing in this case was completed in December 2014 and the case remained idle for over a year.

In February 2016, the petition for writ of review was granted in case Saul Zuniga v. Interactive Trucking, Inc.; SCIF California Court of Appeal, First Appellate District, Div. 2, Case No. A143290. The Court issued the following order.

“Petitioner is directed on or before February 5, 2016 to serve a copy of his petition on the Administrative Director of the Division of Workers’ Compensation, who has the option to file an informal opposition to the petition on or before February 23, 2016. The clerk of this court need not issue a formal writ in this proceeding. It appears to this court that the record provided by the parties is a complete record of the Board’s proceedings on the issues raised in the petition. Accordingly, unless a party or the Administrative Director of the Division of Workers’ Compensation serves and files an objection, in writing, within 20 days of the date of this order, the Board need not prepare a certified record in this matter. Absent further order of the court, no further briefing in this matter is contemplated. The justices will be familiar with the facts and issues, will have conferred among themselves, and will not require oral argument. If oral argument is requested, the request must be served and filed within 20 days of the date of this order. If no such request is received, the court will deem oral argument waived.”

This important case has not received much attention from the Workers’ Compensation community notwithstanding the significance of the outcome. Thus far the stakeholders have not appeared in this case as amicus.

Last December, the WCAB sitting en banc issued a Notice of Intention to suspend the privilege of Javier Jimenez to appear in any proceeding as a representative of any party before the Appeals Board, or any of its workers’ compensation administrative law judges (WCJs) for one hundred eighty (180) days. Notice was also given in the Notice of Intention that the Appeals Board intended to further order that any suspension continue until there is full compliance with the sanction orders described in the Notice of Intention.

The Notice claimed that over the last three years Mr. Javier Jimenez has been sanctioned numerous times for engaging in bad-faith actions or tactics that are frivolous or solely intended to cause unnecessary delay while acting for lien claimants as their Labor Code section 5700 agent before the WCAB. “His misconduct has resulted in the repeated imposition of sanctions against him and his clients and has injured other parties and wasted judicial resources.”

Sanctions have been imposed for knowingly proceeding to trial without necessary evidence, repeatedly presenting meritless arguments, making a false statement of material facts in a petition presented to the Appeals Board, impugning the integrity of the WCAB and WCJs, and other willful failures to comply with statutory and regulatory obligations.

Several examples were provided in the Notice. In one case he appeared as a hearing representative on behalf of lien claimant Universal Psychiatric Medical Center (UPMC). Hearing were scheduled in that case and the lien claimant failed to offer evidence in support of its lien claim. The WCJ jointly and severally ordered IMM and UPMC to pay a $2,500.00 sanction and to pay defendant’s reasonable attorney’s fees of $3,500.00.

In another illustrative case, Mr. Jimenez represented lien claimant Joyce Altman Interpreters. The WCJ jointly and severally sanctioned Mr. Jimenez and Altman $2,500.00 for failing to present evidence showing that the lien claims were not barred by the statute of limitations, and because they “failed to provide relevant and probative evidence to support the reasonableness and necessity of the services rendered and reasonableness of the charges,” that they “knew or should have known that their insistence on trial without relevant and probative evidence is frivolous,” and that their activities and those of their hearing representatives “were egregious and frivolous.”

Other examples were provided of a similar nature. However response to the Notice Of Intention and no request for further hearing was received from Mr. Jimenez. Therefore it was ordered that the privilege of Javier Jimenez to appear in any proceeding as a representative of any party before the Appeals Board or any of its workers’ compensation administrative law judges is hereby suspended for one hundred eighty (180) days

A new CWCI study provides an updated look at California workers’ compensation independent medical review (IMR) decisions rendered in 2015 and finds that even though IMR physicians continue to uphold the vast majority of utilization review (UR) physicians’ denials or modifications of treatment, total IMR volume rose 19% last year.

The Institute’s latest analysis uses data from all 163,826 IMR determination letters issued in 2015 in response to applications submitted to the state after a utilization review (UR) physician modified or denied a requested medical service. Although state lawmakers who enacted IMR expected that the number of disputed treatment requests would decline as doctors, attorneys and others involved in the process became familiar with the types of services that would meet the evidence-based medicine standards and be approved through UR and IMR, the latest data show that after 2 years, IMR volume remains high, with 26,065 more cases in 2015 than in 2014.

CWCI’s review of the 2015 IMR decisions reveals the IMR physicians upheld the UR doctor’s modification or denial of the service 88.6% of the time, just shy of the 91% uphold rate for 2014. The mix of services reviewed by IMR physicians was also similar, with prescription drug requests accounting for half of last year’s IMR decisions, versus 48% in 2014, and the UR determination was upheld in nearly 90% of those pharmaceutical IMRs. Disputes over prescription drugs, physical therapy, durable medical equipment, injections and MRI/CT/PET scans accounted for 75% of all services that went through IMR in 2015, while surgery requests accounted for 4.2%, which was down from 4.7% in 2014. Uphold rates ranged from 80% to 90% for most services, with the exception being Evaluation and Management services – primarily requested referrals for consultations – where nearly 1/3 of the UR modifications or denials were overturned by the IMR physician.

The analysis also linked most of the disputed medical services that went through IMR to a small number of requesting physicians. The top 10% of physicians named in 2015 IMR decision letters (1,276 physicians) accounted for 85% of the disputed service requests, while the top 1% (128 providers) accounted for 46%. As in 2014, the new results also show significant geographic variation, with 34% of the IMR decision letters addressed to Los Angeles County recipients even though only 22% of all claims came from that region. On the flip side, the percentage of IMR decisions was disproportionately low in rural areas of the state, as well as in the Inland Empire, Orange County and San Diego.  

CWCI has published its complete analysis of 2015 IMR outcomes in a Spotlight Report, “Independent Medical Review Decisions: January Through December 2015.” CWCI members and subscribers can download the report and a summary Bulletin, while others can purchase a copy. at the CWCI store.

California got a $3.1-million piece of the settlement pie when drugmaker Warner Chilcott agreed to pay the federal government $125 million in October over allegations it defrauded Medicare and Medicaid. But the state did much better in a second, lesser known settlement with the drugmaker just two months later. It got $11.8 million. That heftier payout stemmed from a separate but similar case brought under a California law that allows whistle-blowers to file lawsuits alleging fraud against private insurers.

ModernHealthcare.com reports that California and Illinois are the only states with such laws, and until now, not many healthcare lawsuits have been filed under those statutes. That, however, may change, as awareness of the laws — and recognition of the potential rewards for those who use them — grows. Fraudsters face triple damages under the laws, and whistle-blowers are often entitled to larger shares of recovered money than what they can get under the federal False Claims Act.

“We have found that health insurance fraud is one of the biggest problems we have,” said Nancy Kincaid, a spokesperson with the California Department of Insurance. “It’s a multi-billion dollar problem. Everybody is paying for these losses.” Kincaid also expects to see more such cases in California.

The idea behind the laws, which have been on the books for years, is that it’s in a state’s interest to pursue fraud against private insurers because such misdeeds raise healthcare costs for everyone.

An even larger healthcare-related case preceded the Warner Chilcott one in California. In 2013, Sutter Health, which has hospitals throughout northern California, settled a case brought under the statute for $46 million. The whistle-blower in that case alleged that Sutter included extra, false charges for anesthesia on bills sent to patients and insurers. Sutter did not admit to any wrongdoing as part of the settlement.

There are rich rewards for whistle-blowers who file successful cases under the two laws. Whistle-blowers are entitled to 30% to 50% of the money that is recovered. In the Warner Chilcott case, the whistle-blowers got 49% of the recoveries, amounting to about $11.4 million. In the Sutter case, the whistle-blower received about $13.2 million, according to the California Department of Insurance.

There’s no way to track exactly how many cases are now being brought under these laws in California and Illinois. The cases typically remain private – or under seal – at first. In some cases, the cases can stay under seal for years.

But R. Scott Oswald, managing principal of The Employment Law Group in Illinois, which represents whistle-blowers, said he and his colleagues are seeing more whistle-blowers taking action under the Illinois statute. His firm has several cases that have been under seal for years, he said.

Justin Berger, a principal at Cotchett Pitre and McCarthy who represents whistle-blowers in such cases in California, said his firm also seems to be filing more of the cases lately. Berger said he’s also hearing from U.S. attorneys that they’re seeing more of the lawsuits filed in conjunction with Medicare fraud cases. “It’s becoming more common because there’s a little more visibility,” Berger said.

Historically, the California and Illinois laws haven’t grabbed much attention. Over the years, not too many healthcare related lawsuits had been filed under the California law and even fewer had been filed in Illinois, Simmer said.

Insurance companies may not have traditionally been very interested in the laws because they can simply raise rates to absorb the costs of fraud, said Patrick Burns, a co-executive director of the Taxpayers Against Fraud Education Fund, a not-for-profit supporting whistle-blower incentive programs. It’s also possible not as much fraud slips under the noses of private insurers as it does in Medicare and Medicaid because private insurers have their own robust fraud detection programs, Oswald said. A lack of awareness about the laws is also likely to blame for the slow drip of cases filed under them over the years, Oswald said.

Recent cases, however, are raising the profile of the laws, he said.

The California Department of Insurance is now using $4 million set aside from that Sutter settlement to fund a special health insurance enforcement team that investigates complaints and claims of wrongdoing, Kincaid said. “The commissioner is concerned that there have been a number of these that have been brought forward, typically by whistle-blowers or insiders,” Kincaid said of cases brought under the California law.

In recent years, the number of False Claims Act cases involving healthcare has exploded. Two-thirds of federal whistle-blower lawsuits last year were healthcare-related.