Lower back pain (LBP) is one of the most common health conditions globally, incurring substantial health and economic costs due to disability, general ill health and lost days at work. Despite its high prevalence, the source of pain is often unclear, with the result that it is often described as “non-specific LBP.”

The article in Medical News Today, reports that previous studies have suggested that LBP involves impairments in the control of the deep trunk muscles. These muscles are responsible for maintaining the coordination and stability of the spine. Motor control exercise (MCE) was developed with the aim of restoring the coordination, control and capacity of the trunk muscles that support the spine. It is widely prescribed for people with LBP. MCE involves training the isolated contraction of deep trunk muscles, with further integration of these muscles into more complex static, dynamic and functional tasks. It should also improve coordination and optimal control of the global trunk muscles. Patients are initially guided by a therapist to practice normal use of the muscles through simple tasks; as their skill increases, more complex exercises are set, including the functional tasks needed to perform work and leisure activities.

In the the new study, published in the Cochrane Review Library, researchers, led by Bruno Saragiotto, a physiotherapist from The George Institute, University of Sydney in Australia, gathered data from 29 randomized trials involving a total of 2,431 men and women, aged 22-55 years. The team looked at MCE’s effectiveness as a treatment for lower back pain compared with other forms of exercise or doing nothing. The treatment programs lasted from 20 days to 12 weeks, with one to five sessions per week. MCE appeared to bring about some reduction in pain, disability and perceived quality of life, compared with minimal intervention at all follow-up periods.

The researchers describe this as “low to moderate quality evidence that motor control exercise (MCE) is more effective than a minimal intervention for chronic low back pain.” When results were compared for pain and disability between MCE and other types of exercise at intervals between 3-12 months, the difference was not considered clinically significant.

Despite the low quality of evidence, it is thought that MCE might be slightly more effective than exercise plus electrophysical agents (EPA) for pain, disability, global impression of recovery and physical quality of life in the short and intermediate term.

No clinically important difference was observed between MCE and manual therapy for any of the outcomes investigated.

The researchers conclude that despite minimal evidence of MCE being better than other forms of exercise, it appears to be a safe form of exercise.

Former state senator Ronald Calderon is charged with ten counts of mail and wire fraud through the deprivation of honest services (18 U.S.C. §§ 1341, 1343, and 1346), four counts of bribery (18 U.S.C. § 666), one count of conspiracy to commit money laundering (18 U.S.C. § 1956(h), seven counts of money laundering (18 U.S.C. § 1956(a)(1)(B)(i), and two counts of tax fraud (26 U.S.C. § 7206(2). Thomas Calderon, a former state assemblyman, is charged with one count of conspiracy to commit money laundering (18 U.S.C. § 1956(h) and seven counts of money laundering (18 U.S.C. § 1956(a)(1)(B)(i)).

The 28-page indictment filed back in 2014 accuses Ron Calderon of accepting $100,000 in cash bribes, as well as plane trips, gourmet meals and golf resort junkets in exchange for championing laws favorable to those who paid him and fighting laws that could harm them. He is allegedly involved in taking bribes from Michael Drobot to perpetuate an audacious, $500 million Pacific Hospital of Long Beach health care and workers’ compensation fraud, setting up high courtroom drama reminiscent of ABSCAM in the 1970s and ’80s, or ShrimpGate in the 1990s. Drobot has pleaded guilty and agreed to cooperate with investigators.

Ronald is represented by a celebrity lawyer, Mark Geragos. Clients that Geragos has represented include Michael Jackson, actress Winona Ryder,politician Gary Condit, Susan McDougal and Scott Peterson. He was also involved in the Whitewater controversy. Geragos represented suspended NASCAR driver Jeremy Mayfield; Paul and Kulbir Dhaliwal, two brothers injured after a tiger escaped in San Francisco Zoo; and musician Chris Brown, who pleaded guilty in the assault of his then girlfriend Rihanna.

The Calderon case was set for trial on March 1, 2016. Thomas Calderon is currently out of custody on a $25,000 bond and Ronald Calderon is currently out of custody on a $50,000 bond pending trial. The parties estimate that the trial in this matter will last approximately 10 days. The Court has previously continued the trial date four time in this case, most recently from August 11, 2015 to March 1, 2016.

The parties jointly moved for the fifth continuance of the trial date because Geragos said he has five cases scheduled to begin trial over the next two months and needs more time to prepare. U.S. District Judge Christina Snyder granted the motion, and the trial is continued to May 10, 2016 at 9:30 AM.

Since the Drobot arrest, many defendants in addition to Drobot have pleaded guilty and agreed to “fully” cooperate in a wide-ranging federal investigation into the fraud, dubbed “Operation Spinal Cap” by the FBI and other federal authorities. For those who have pleaded guilty, sentencing has not yet occurred. It appears that the sentences are being held over their heads to incentivize “cooperation.” Currently cooperating defendants include orthopedic surgeons Philip Sobol M.D., Mitchell G. Cohen M.D. The Calderons are among the few accused who have not yet entered a guilty plea, been convicted or acquitted.

Kirk King suffered anxiety and depression due to chronic back pain resulting from the back injury at work in 2008. In 2011, he was prescribed an anti-anxiety medication known as Klonopin to be provided through Workers’ Compensation. The request for this medication was sent to UR.

Naresh Sharma, M.D, an anesthesiologist who conducted the utilization review determined the drug was unnecessary and decertified it. As a result, Kirk was required to immediately cease taking the Klonopin. Typically, a person withdraws from Klonopin gradually by slowly reducing the dosage. Due to the sudden cessation of Klonopin, King suffered four seizures, resulting in additional physical injuries.

In September 2013 another request for Klonopin was made by the PTP. Ali, a psychiatrist, conducted a second utilization review and also determined Klonopin was medically unnecessary. Neither Sharma nor Ali examined Kirk in-person, and neither warned Kirk of the dangers of an abrupt withdrawal from Klonopin. Sharma and Ali were employees of CompPartners a Workers’ Compensation utilization review company.

King then sued CompPartners, Inc. and Sharma for (1) professional negligence; (2) negligence; (3) intentional infliction of emotional distress; and (4) negligent infliction of emotional distress. Kirk’s wife, Sara King, sued for loss of consortium. The trial court sustained defendants’ demurrer without leave to amend. The Court of Appeal sustained the demurrer but reversed the denial of leave to amend in the published case of King v. CompPartners Inc.

CompPartners contended the Labor Code set forth a procedure for objecting to a utilization review decision, and that procedure preempted the Kings’ complaint. The Kings contend the trial court erred in sustaining the demurrer because their causes of action are not preempted by the Workers Compensation Act.

“To the extent the Kings are faulting Sharma for not communicating a warning to Kirk, their claims are not preempted by the WCA because that warning would be beyond the “medical necessity” determination made by Sharma. To the extent the Kings are faulting Sharma for incorrectly deciding the medical necessity decision because Klonopin was medically necessary until Kirk was weaned, and thus a particular number of pills, e.g., 10, 20, should have been authorized for weaning, the Kings’ claims are preempted by the WCA because the Kings are directly challenging Sharma’s medical necessity determination.”

Case law provides a utilization review doctor has a doctor-patient relationship with the person whose medical records are being reviewed. Palmer v. Superior Court (2002) 103 Cal.App.4th 953.

The trial court “should have granted the Kings leave to amend because it is possible… that, when more details are provided they could support a conclusion that, under the circumstances, the scope of Sharma’s duty included some form of warning Kirk of or protecting Kirk from the risk of seizures.”

California allows apportionment of disability based upon causation. The potential for apportionment using this landmark change in the law has yet to be fully implemented in claim administration. Now a new study just published in the Proceedings of the National Academy of Sciences may lead the way to a new apportionment concept.

Two decades of research indicate causal associations between social relationships and mortality, but important questions remain as to how social relationships affect health, when effects emerge, and how long they last. Drawing on data from four nationally representative longitudinal samples of the US population, researchers from the University of North Carolina, Chapel Hill, and others implemented an innovative life course design to assess the prospective association of both structural and functional dimensions of social relationships (social integration, social support, and social strain) with objectively measured biomarkers of physical health (C-reactive protein, systolic and diastolic blood pressure, waist circumference, and body mass index) within each life stage, including adolescence and young, middle, and late adulthood, and compare such associations across life stages.

The researchers found that a higher degree of social integration was associated with lower risk of physiological dysregulation in a dose – response manner in both early and later life. Conversely, lack of social connections was associated with vastly elevated risk in specific life stages.

For example, social isolation increased the risk of inflammation by the same magnitude as physical inactivity in adolescence, and the effect of social isolation on hypertension exceeded that of clinical risk factors such as diabetes in old age.

Analyses of multiple dimensions of social relationships within multiple samples across the life course produced consistent and robust associations with health. Physiological impacts of structural and functional dimensions of social relationships emerge uniquely in adolescence and midlife and persist into old age.

Thus, according to the researchers “Our study strengthened support for causal linkages between social relationships and physical functioning.”

Cross – industry fraud – where healthcare fraud, property/casualty and workers’ compensation fraud intersect – is the next step in identifying potentially bad providers. LexisNexis completed a study that revealed an overlap between providers who commit fraud on the healthcare side and those who do it on the property/casualty side. In addition, there was a greater probability that those providers would be involved in identity theft, tax evasion as well as other criminal activity.

“There was about a 22 percent overlap of seeing the same doctors generally practicing on both the healthcare side and the auto side,” says Todd Fannin, director of claims for LexisNexis Risk Solutions. “Within that data set, about four percent of those had been identified as being potentially bad providers by either property/casualty or healthcare insurers.”

Additional studies seeking to determine the prevalence of cross-industry fraud across the insurance, credit, financial and wider private industry markets have demonstrated how a collaborative approach between industry members can shine a light on previously hidden fraud patterns. In a recent LexisNexis Risk Solutions survey of fraud mitigation professionals, 84 percent of respondents from insurance, health care, government, financial services, communications and retail indicated that they are seeing at least some cross-industry evidence in fraud cases they investigate, and more than three quarters indicated that the impact of fraud that was linked to other industries had a moderate to extremely high financial impact on their organization.

Traditional data analytics tools are limited in that they have focused primarily on data sets that are too narrow. There is therefore a need for fraud mitigation professionals to expand their field of vision. Such an initiative helps organizations detect and intercept fraud before it happens, to safeguard from losses due to fraud. This is significant because traditional “pay-and-chase” models that prioritize recovery over prevention have been exposed as overly costly and less effective than advanced “prevention-based” models that attempt to stop the fraud before it occurs.

The National Health Care Anti-Fraud Association (NHCAA) sponsors the Special Investigation Resource and Intelligence System (SIRIS), where members share information regarding fraud cases they have encountered for the purpose of helping to mitigate fraud elsewhere. The Association was founded in 1985 by several private health insurers and federal and state government officials. It is focused exclusively on the fight against health care fraud. As a private-public partnership – members comprise more than 100 private health insurers and those public-sector law enforcement and regulatory agencies having jurisdiction over health care fraud committed against both private payers and public programs. One mission is serving as a national resource for health care anti-fraud information and professional assistance to government, industry and media.