The California Attorney General’s office announced the arrest of and filing of charges against Dr. Arash Malian Padidar, a Santa Clara County physician with an office located at 105 N Bascom Ave Ste 104 San Jose, CA 95128.

He is accused of illegally prescribing opioids to patients. The arrest and charges are the result of an investigation into an alleged two-years-long illegal prescription scheme by the California Department of Justice (DOJ). Padidar was arrested by DOJ agents and booked into the Santa Clara County Jail.

DOJ investigators found that Padidar’s illegal prescription scheme was carried out between October 2018 and October 2020 and involved the highly addictive pain medication Norco. He is facing charges on seven felony counts, including for obtaining opioids by fraud, deceit and misrepresentation, issuing prescriptions without a legitimate medical purpose, forging the name of another physician who’s name he allegedly obtained, and issuing a prescription, unlawful use of personal information and conspiracy to commit a crime.

According to the allegations on the criminal complaint, Padidar wrote prescriptions that were given to an unnamed conspirator, who filled the prescriptions at several Wallgreen and other pharmacies, and then the unnamed coconspirator gave the pills back to Padidar.

Padidar’s alleged activity was uncovered when an employee who had helped with the scheme came forward a month or two after being fired by the doctor in July 2019, according to a criminal complaint filed with Santa Clara County Superior Court.

The investigation and arrest were conducted by DOJ’s Division of Medi-Cal Fraud & Elder Abuse (DMFEA), which was alerted to the alleged crimes by the DEA.

DMFEA protects Californians by investigating and prosecuting those who defraud the Medi-Cal program as well as those who commit elder abuse. These investigations are made possible only through the coordination and collaboration of governmental agencies, as well as the critical help from whistleblowers who report incidences of abuse or Medi-Cal fraud at oag.ca.gov/dmfea/reporting.

DMFEA receives 75% of its funding from HHS under a grant award totaling $53,792,132 for federal fiscal year 2022-2023. The remaining 25% is funded by the State of California. The federal fiscal year is defined as through September 30, 2023.

“Doctors are trusted with the immense responsibility of protecting our health and our lives,” said Attorney General Bonta. “When a bad actor exploits their position for personal gain, they not only shatter our trust, they harm vulnerable patients. Let today’s arrest serve as a warning: The California Department of Justice will not tolerate abuses of power and will hold perpetrators accountable.”

“This investigation focused on a trusted member of the medical community who allegedly utilized forgery and fraud to obtain highly addictive opioids for his own personal benefit,” said Drug Enforcement Administration (DEA) Special Agent in Charge Brian M. Clark. “Healthcare professionals have a duty to prescribe controlled substances in a manner that ensures the well-being of the public. DEA will continue to keep communities safe and healthy by holding those accountable who put them in harm’s way. I want to thank CA DOJ Division of Medi-Cal Fraud and Elder Abuse and DEA Diversion for their exceptional work in this investigation.”

Hospital acquisitions have consolidated care into fewer and larger health systems. From 2000 to 2020, the share of hospital beds that are part of health systems has risen from 58 percent to 81 percent nationally. A quarter of hospital markets no longer had any independent hospitals by 2020.

A new study published by Elevance Health describes how prices, costs, and quality change when previously independent hospitals are acquired by systems.

Hospital care is the largest segment in the $4.3 trillion U.S. healthcare sector, with $1.3 trillion in annual spending. Despite a decline in inpatient volume over the last decade, hospital spending as a share of the sector increased from 30 to 31 percent over this time.

Most prior studies did not have access to negotiated prices between plans and hospitals, and therefore had to rely on average prices inferred from accounting data reported to the federal government. However, recent work has shown that these imputed prices are only weakly correlated with true prices. As a result, the new study draws conclusions about efficiency gains of the hospitals. Prior studies have not comprehensively evaluated the impact of efficiency gains for independent hospitals after acquisition.  

Hospitals experienced large cost efficiencies and higher revenues after system acquisition.

– – Operating expenses declined by 6 percent, above market trend, at the acquired hospital following system ownership, without any offsetting increase in costs at the acquirer system.
– – Reductions in personnel spending accounted for about 60 percent of the total decline in operating costs.
– – Independent hospital acquisitions by hospital systems increased average inpatient prices for commercially insured patients by 5 percent above market trend, holding procedure intensity constant.
– – Across the top seven Major Diagnostic Categories by volume, prices increased 5-8 percent, with digestive, infectious diseases, labor & delivery, respiratory, and the circulatory system experiencing the largest price increases.
– – The size of the acquiring system size did not seem to matter with respect to price increases at the acquired hospital, suggesting that price increases were uniform at acquired independent hospitals.

Hospital quality declined following acquisition, leading to worse outcomes for patients.

– – For Elevance Health’s affiliated members receiving cardiac care, readmission rates increased by 10-12 percent and remained elevated for three years after the acquisition.
– – Readmission rates for Medicare patients admitted with acute, non-deferrable conditions conservatively increased by 2-3 percent.
– – Acquired hospitals that experienced greater staff reductions experienced greater readmission rate increases, suggesting the reduction in personnel may be a contributing factor.

Access to care was generally reduced for patients at acquired hospitals.

– – The study observed the closure of maternity wards, which were concentrated in rural hospitals.
– – Given aforementioned price increases and staff reductions, one could expect a decrease in hospital patient volume, however the study did not detect a change.
– – Access to medical technology did not change after acquisition.

The Study Authors conclude by saying “This brief highlights that independent hospital mergers have negative consequences for insurers, employers, and consumers. Specifically, payers and patients are exposed to higher prices without a commensurate increase in quality of hospital care.”

“Further, access to care does not improve, with acquired systems no more likely to expand access to medical technology or services. Instead, patients are likely to experience a reduction in access to maternity wards and reduction in staff. As hospital mergers continue to occur at a high rate, it is important that stakeholders understand their implications.”

According to a new report – “The Future of Workplace Safety Technology Is Now” – just published by the National Council on Compensation Insurance (NCCI) technology, part 1 of a 3 part report, the workplace, and the role of workers are changing more dramatically today and at a faster pace than ever before.

Along with shifting jobs and evolving workplaces come new and changing exposures to worker injuries. Questions continue to arise about the status and evolution of safety technologies. In fact, some insurers are testing or discussing these technologies, and in some cases, providing them to their customers/policyholders.

Based on interviews with multiple workers compensation insurers, safety technology vendors/suppliers, and insureds, this series is a presentation of perspectives from various stakeholders. In this article, the first installment of NCCI’s series it explores carrier viewpoints on the latest trends in safety technology.

The safety technology industry has evolved since NCCI published its first article on this topic in 2019. The four insurers that it interviewed for this article are currently using or exploring multiple types of safety technologies, including wearables, Artificial Intelligence (AI)/Computer Vision, the Internet of Things (IoT), software applications, and drones.

Key insights include:

– – Insurers are exploring multiple types of advanced safety technologies and are at various stages of implementation
– – Back injury prevention is a common focus for new workplace safety technology; however, applications are available to address many other injury types
– – Manufacturing, warehousing, and logistics industries are mentioned as principal target industries for modern safety solutions
– – An employer culture of “safety and trust” is seen as critical to the adoption and sustainable use of advanced safety technologies
– – Integrating workplace safety and operational efficiency may result in wider adoption of safety technologies
– – More testing and analysis are needed to fully quantify the value of modern workplace safety technologies
– – Safety technologies are deemed to be a “game-changer” by some industry experts; all interviewees see these technologies playing a major role in the future of worker injury prevention

For example, the report said that Drones, also known as Unmanned Aircraft Systems (UAS), can evaluate certain exposures without putting workers at risk for injury. Drones can evaluate roofing conditions and cell phone towers, as well as monitor air quality in confined spaces.

When asked if safety technology is a “game-changer,” the responses varied, ranging from “It can be ” – to “Absolutely.” Safety technology was mentioned as a potential differentiator to offer higher service and value. It was also noted that “safety technology will point out problems but may not point out solutions. But pinpointing the problem could lead to a solution.”

Part 1 of The Future of Workplace Safety Technology Is Now is available at no charge on the NCCI website.

Long COVID, also known as post-acute COVID-19 syndrome (PASC), is a condition where people experience symptoms of COVID-19 for weeks, months, or even years after their initial infection. The symptoms can be mild or severe, and can affect any part of the body. The World Health Organization (WHO) defines Long COVID as “the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation.”

Roughly 25 million people in the U.S. and over 17 million people in Europe have long COVID symptoms, with many more in other parts of the world.

The Workers’ Compensation Insurance Rating Bureau of California (WCIRB) has released an updated COVID-19 report, Medical Treatments and Costs of COVID-19 Claims and “Long COVID” in the California Workers’ Compensation System – 2023 Update. The study provided an early assessment of the prevalence of “long COVID” (post-acute sequelae of SARS-CoV-2 infection, PASC) in the workers’ compensation system. The study estimated that approximately 11% of COVID-19 claims with an initial mild infection received medical treatment for long COVID symptoms over a 4-month post-acute care period. The rate of long COVID spiked to about 40% for those hospitalized for the initial infection.

A recent study from the Workers Compensation Research Institute (WCRI) found that 7 percent of workers with COVID-19 claims received treatment for long COVID after the acute period of the infection. While long COVID prevalence was the highest among workers who were hospitalized during an acute stage of disease, even some workers with limited medical care early after the infection developed long COVID symptoms.

For these Long COVID cases, the claim administrator will likely need to resolve the permanent disability component, and apportionment. Labor Code § 4663(a) provides that “(a) Apportionment of permanent disability shall be based on causation.” That begs the question about causation of Long COVID under this standard. Perhaps a newly published study by the Genome-wide Association Study of Long COVID is a good start at an answer.

The COVID-19 Host Genetics Initiative (COVID-19 HGI) ) was launched to investigate the role of host genetics in COVID-19 and its various clinical subtypes. It also conducted the first genome-wide association study (GWAS) specifically focused on Long COVID. This part of the study includes data from 24 studies conducted in 16 countries, totalling 6,450 individuals diagnosed with Long COVID and 1,093,995 controls.

The new research, which was an international collaboration between dozens of scientists, describes how some people carry a version of a single gene, FOXP4, that is associated with developing long COVID. FOXP4 has been previously associated with COVID-19 severity, lung function, and cancers, suggesting a broader role for lung function in the pathophysiology of Long COVID.

Conversely, scientists estimate that over 20% of people who get infected with COVID never have any symptoms – and a portion of them never even know they were infected. Now a new study published in Nature on July 19 says their genetics might be why the virus didn’t make them sick.

Some people have a version of a gene in their immune system called HLA-B that protects them from feeling the effects of the virus. The study found that people with this special HLA-B variant are 2 to 8 1/2 times more likely to be asymptomatic than those without the variant.

Jill Hollenbach, an immunologist at the University of California, San Francisco, was one of the scientists who led the research on asymptomatic COVID. She says she was “surprised and excited” about the new long COVID findings.

“The fact that the authors were able to detect this association [between the FOXP4 gene and long COVID], I think, is spectacular,” Hollenbach says.

Dr. Hollenbach would obviously be a local expert to consult for further information on possible apportionment in a claim for permanent disability in a Long COVID case.

Dalila Tututi filed two Applications for Adjudication of Claim against Big Merryluck GG. On October 4, 2019, PCT Medical Services Gilbert filed a lien for medical treatment expenses incurred by or on behalf of applicant, pursuant to Labor Code section 4600.  On December 9, 2019, the parties requested a lien trial on unresolved liens, including that of PCT Medical Services.

On January 7, 2020, the parties proceeded to lien trial, at which time Ms. Airhana Hernandez ostensibly appeared on behalf of PCT Medical Services. However, Ms. Hernandez was unable to produce a Notice of Representation.

The WCJ provided lien claimant’s representative additional time in which to produce the required notice, but the lien representative was unable to provide the notice by the end of the morning’s trial setting. The WCJ then issued a Notice of Intention to Dismiss Lien Claim or Lien Balance because “no compliant Notice of Representation per Title 8 CCR §10868, §10751 was filed at or before time of hearing.”

Lien claimant filed an objection to the Notice of Intention to Dismiss requesting discretionary relief pursuant to Code of Civ. Proc., § 473(b) for mistake, inadvertence, surprise or excusable neglect. However the WCJ issued an Order Dismissing Lien Claim or Lien Balance, stating “Even though a timely objection dated 1-17-2020 was filed on 1-17-2020, this objection does not show good cause for non-appearance by lien claimant or their representative at the Lien Trial on 1-7-20.”

The Lien Claimant’s Petition for Reconsideration of the Dismissal was granted, and the Order Dismissing was reversed in the panel decision of Tututi v Big Merryluck GG -ADJ11296374; -ADJ11296239 (August 2023).

Non-attorney representatives who appear on behalf of parties in workers’ compensation proceedings are required to file a valid notice of representation as required by WCAB Rule 10751, and WCAB Rule 10868, which specifies the requirements pertaining to a Notice of Representation involving lien claimants.

Violation of the appropriate rules may give rise to monetary sanctions, attorney’s fees and costs under Labor Code section 5813 and rule 10421.

“Here, there is no dispute that Ms. Hernandez was unable to provide a valid Notice of Representation at the time of lien trial. Following the issuance of the court’s Notice of Intention, and review of lien claimant’s objection, the WCJ dismissed the lien with prejudice.”

Code of Civ. Proc., § 473(b) permits the trial court to relieve a party from a judgment, order or other proceeding taken against him through his mistake, inadvertence, surprise or excusable neglect. A motion seeking relief under section 473 is addressed to the sound discretion of the trial court; its decision will not be overturned on appeal absent a clear showing of abuse of discretion. (Shamblin v. Brattain (1988) 44 Cal.3d 474, 478 [243 Cal. Rptr. 902]; Elston v. City of Turlock (1985) 38 Cal. 3d 227, 233 [211 Cal. Rptr. 416].)

The WCAB panel noted that discretion, “however is not a capricious or arbitrary discretion, but an impartial discretion, guided and controlled in its exercise by fixed legal principles. It is not a mental discretion, to be exercised ex gratia, but a legal discretion, to be exercised in conformity with the spirit of the law and in a manner to subserve and not to impede or defeat the ends of substantial justice.”

The court of appeal confirmed that the section 473(b) may afford relief to other parties to workers’ compensation proceedings in Fox v. Workers’ Comp. Appeals Bd. (1992) 4 Cal.App.4th 1196 [57 Cal.Comp.Cases 149] (Fox).

“We observe that while WCAB Rule 10751 requires the non-attorney representative making an appearance to provide a valid notice of representation, it does not specify a remedy for failure of compliance, and it does not mandate dismissal of the underlying lien claim.”

“We also observe that following notice of the failure to provide the required notice of representation on the day of trial, lien claimant attempted to remedy the deficiency by filing a Notice of Representation in EAMS later that same day.”

“In summary, we are persuaded that lien claimant has taken reasonable action to remedy the procedural deficiencies in its trial appearance, and that lien claimant promptly sought relief from its dismissal for failure to comply with our Rules, and that the public policy in favor of disposition on the merits warrants the rescission of the dismissal of the lien claim.”