The California Division of Workers’ Compensation (DWC) and MAXIMUS Federal Services invite all interested parties to attend a one-hour webinar on the Independent Billing Review (IBR) process. This webinar is set for May 13, 2014 from 10:00 to 11:00 am. It provides attendees with key information related to the IBR process, including but not limited to an explanation of the current IBR workflow.

Space is limited and pre-registration is required to attend this free meeting. The DWC and MAXIMUS Federal Services will also address questions that relate to the current IBR process during the webinar. Please submit questions in advance via email to IBRHelp@maximus.com. Questions need to be submitted no later than Wednesday, May 7, 2014.

To register for the webinar, click here.

The state Senate on Monday approved a measure that would give families of deceased firefighters and police officers more time to file for workers’ compensation death benefits. This bill provides an extension for dependents of deceased firefighters and peace officers to file for workers’ compensation death benefits if the death resulted from any of the following: cancer, tuberculosis, methicillin-resistant Staphylococcus aureus (MRSA) skin infections, or bloodborne infectious disease. This extension is for up to 420 weeks from the date of injury, but in no case more than one year from the date of death, as specified. This bill requires the extension to sunset on January 1, 2019.

According to the Senate Appropriations Committee, this bill results in an increase in workers’ compensation costs related to state employees who are firefighters and peace officers. The specific state departments that would be impacted are the Department of Forestry and Fire Protection and the California Highway Patrol. The amount of the increase is unknown.

Assemblyman John Pérez (D-Los Angeles) wrote the measure that would give families an extension of 420 weeks from the date of injury but no more than one year from the date of death to file claims.

“The families of fallen public safety officers face an extraordinary emotional and financial toll when they lose a cherished loved one,” said Sen. Anthony Cannella (R-Ceres). “Simply put, AB 1035 is the right thing to do.”

The bill is supported by a host of public employee unions, and opposed by the California Association of Joint Powers Authorities, the California Coalition of on Workers’ Compensation California, the State Association of Counties, the County of Los Angeles, CSAC, the Excess Insurance Agency League of California Cities and the Rural County Representatives of California

Opponents argue that this bill will increase costs on local governments and counties at a time when budgets are limited and the full impact of the 2012 Workers’ Compensation reform is unknown. Opponents also argue that this bill is being considered at the same time as other bills which add to the number of peace officers who qualify for existing presumptions, and that these bills could increase the fiscal impacts of this bill. Opponents also maintain that the recent National Institute of Occupational Safety and Health study only noted increases in some cancers, while the existing workers’ compensation presumption covers all cancers.

The bill now goes back to the Assembly for a vote on amendments. It was backed by public employee unions but opposed by groups such as the League of California Cities and the California State Assn. of Counties.

Gov. Jerry Brown vetoed a similar measure last year, but Cannella said changes have been made to address the governor’s concerns, including a Jan. 1, 2019, sunset date for the extension.

Former Pacific Hospital owner Michael Drobot pleaded guilty on Thursday to federal charges related to his role in a medical fraud scheme that authorities have said may be the largest of its kind in California history. Drobot, who agreed to plead guilty in February, is scheduled to be sentenced in December, according to the story in the Press Telegram.

Federal prosecutors charged Drobot, who lives in Corona del Mar, with conspiracy and paying kickbacks to other doctors in connection with a federal health care program. He faces 10 years in federal prison. As laid out in previous court filings and statements from government officials, Drobot is accused of paying kickbacks of $10,000 to $15,000 to doctors who referred patients to the facility formerly known as Pacific Hospital for spinal surgeries. Drobot paid for the kickbacks by taking advantage of a loophole in California law to overcharge for the reimbursable costs of spinal hardware employed in the surgeries. The activities may have led to as much as $500 million worth of fraudulent claims, mostly filed through the state’s workers compensation system.  As of Thursday, federal officials have not filed charges against anyone else who may have broken the law as part of the conspiracy.

The Drobot case is related to the corruption cases that have been filed against state Sen. Ron Calderon, D-Montebello, and his brother, former Assemblyman Tom Calderon.  Drobot has told federal officials that he bribed Ron Calderon in order to keep on the books the law that made it possible to seek inflated reimbursements for spinal hardware. Calderon, whom the FBI has also accused of taking bribes from agents posing as filmmakers seeking a more favorable tax credit law, has pleaded not guilty to all charges filed against him. Tom Calderon has also pleaded not guilty to charges of conspiracy and money laundering for allegedly helping his brother commit crimes.

Drobot’s attorney, Jeffrey H. Rutherford, could not be reached for comment Thursday. When Drobot pleaded not guilty for procedural reasons last month, Rutherford said his client was cooperating with an expanding federal investigation. “He has acknowledged and accepts responsibility for his actions,” Rutherford said at the time.

Pacific Hospital is now called College Medical Center. Santa Fe Springs-based College Health Enterprises owns the facility and has hired a Molina Healthcare affiliate to operate it.

Lisa Weilmann and the employer United Temporary Services resolved this case by way of Stipulated Award on 7/18/02. The award provided future medical treatment to bilateral upper extremities, neck, fibromyalgia and psyche. The current dispute between the parties involved four UR denials. Two involved a request for Botox to treat migrain, an two were a request for Xyrem for shoulder tendentious, The employer’s UR physicians declined to authorize the treatment. The applicant proceeded to hearing and the WCJ found defendant’s UR denials invalid and ordered the employer to provide treatment without finding a medical necessity.

The applicant claimed that there were three material defects in the UR process. One error was the lack of a signature on the UR decision. Pursuant to the Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 313 decision the WCJ ruled that “the absence of a signature on the UR decision is not a minor defect.” Although the WCJ noted that the absence of a signature does not make the report inadmissible pursuant to regulation 10606, but will be considered in weighing the evidence. Nonetheless, no particular rationale was given in the Opinion on Decision as to why a signature was that important.

A second claimed UR defect involved the failure of the employer to provide UR with necessary medical records including prior reports of an AME. In this regard the WCJ held that “because of the complexity of the case the UR reviewers should have either asked for the prior medical reports of the AME or the prior reports should have been given to them.

A third claimed UR defect involved the lack of the UR physicians having appropriate board specializations in the medical areas under review. Labor code 4610 ( e) has a two-tier test. First it must be found that the doctors are competent to evaluate the specific clinical issues. Second, the services must be within the scope of the physicians practice. The WCJ was unable to find that the UR physicians met this test.

The WCJ ordered the defendants to provide the requested medical care without finding medical necessity based upon substantial medical evidence. The employer appealed and the WCAB granted reconsideration in the case of Lisa Weilmann v United Temporary Services.

The WCAB concurred with the WCJ’s determination that the the failure of all of the reviewing physicians to sign their reports and the failure to provide the relevant AME reports that explain necessity for the requested treatments, are sufficient to undermine the integrity of the UR decisions and renders invalid the UR determinations in this case. It did not however agree with her determinations with respect to a lack of the correct medical specialization.

But the WCAB went to to rule that “a finding that the UR determination is not valid to deny the requested treatment does not mandate hat the treatment be authorized. As held in Dubon, the applicant must still provide substantial medical evidence to establish that the requested treatment is reasonable and necessary. After finding the UR determinations were invalid in this case, the WCJ ordered defendant to provide the request treatments without making findings that the treatments are reasonable and necessary. Accordingly, we shall grant reconsideration to amend the Findings of Fact and Order to defer the order authorizing the disputed Xyrem and Botox treatments, pending a determination as to whether the treatments are reasonable and necessary.”

The workers’ compensation claims industry is cautious about the prospect of the rise of claims for “medical” marijuana for those recovering from an industrial injury. Public support seems to have caused a wave acceptance for what remains a federally illegal practice. An now Reuters health reports that a measure to regulate California’s chaotic medical marijuana industry passed a key legislative hurdle on Tuesday, in a move that could lay the groundwork to tax and control recreational use of the drug if it ultimately becomes legal.

U.S. states are increasingly moving to remove curbs on marijuana following landmark voter initiatives in Colorado and Washington state in 2012 that legalized the drug for recreational purposes. Many more states allow medicinal pot. But the drug remains illegal under federal law, leaving states that have opted for medicinal legalization struggling to control a thriving trade in medical cannabis. “The current state of chaos around medical marijuana has got to come to an end,” said state Assemblyman Tom Ammiano, a San Francisco Democrat.

If passed, his proposal, AB 473,  could “set a template” to regulate recreational use of marijuana by adults, Ammiano said, a move he has long favored. The bill marks Ammiano’s second run at regulating medical marijuana in California, where concern has grown over the lack of rules for the hundreds of street-corner pot dispensaries and delivery services that have sprung up since medical marijuana was legalized 15 years ago. Besides the pot shops that authorities struggle to regulate, other problems include inappropriate prescribing by unethical doctors, and a violent, “wild West” culture of illegal cannabis farms in the state’s forests, Ammiano said. His bill would make it illegal for doctors to recommend medical marijuana for patients they have not examined, and bar prescriptions by doctors with a financial interest in a pot dispensary. It would also let the Department of Alcoholic Beverage Control enforce laws regulating marijuana and develop plans to tax it beyond the sales tax now levied, while ensuring it is grown and processed safely and in ways safe for the environment.

Supporters, including the city of Oakland, said the bill would bring order and clarity to the market.

But a law enforcement group criticized Ammiano’s plan to regulate medical cannabis through Alcoholic Beverage Control. “There is no little irony in the department of Alcoholic Beverage Control as the administering agency for the medical marijuana trade,” the California Narcotic Officers’ Association, which opposes legalization, wrote in its testimony. “We know of no other area of law where an agency charged with regulating recreational substances such as alcohol is also given portfolio over matters alleged to be medical.”

California voters rejected a ballot initiative to legalize marijuana for recreational use in 2010, but a poll last fall by the Public Policy Institute of California showed an increase in support, with 60 percent of likely voters favoring legalization.

Ammiano’s plan, which passed the assembly Public Safety committee on Tuesday, is one of two marijuana regulation proposals making their way through the legislature. The senate version, which would regulate the drug via the state health department instead of the Alcoholic Beverage Control department, has won support from some law enforcement agencies, signaling to many that industry regulations may be coming soon, after years of inaction. “I feel a lot of momentum behind these two bills,” said Don Duncan, California director for the medical marijuana advocacy group Americans for Safe Access.

In 2003, the Legislature enacted the Medical Marijuana Program Act (MMPA). Under the guidance of the MMPA, approximately 60 California cities and counties have created medical marijuana access ordinances that can act as a guide for the state. However, many other cities and counties are calling for more guidance and regulation from the state and have passed bans or moratoria on medical marijuana cultivation and distribution while awaiting such guidance.

Last year the California Supreme Court gave local governments the power Monday to zone medical marijuana dispensaries out of existence, a decision that upholds bans in about 200 cities.