Tag: 2015 News

The National Safety Council is calling on employers to develop workplace policies around the use of opioid prescription painkillers after reviewing research and court cases showing the negative impacts of these medicines on employee safety and worker’s compensation costs. Many workers who have taken opioid painkillers following on-the-job injuries have become addicted, suffered additional injuries or fatally overdosed. As a result, courts have ordered employers and worker’s compensation insurance carriers to pay for detoxification, medication-assisted treatment and death benefits to surviving family members.

The findings and synopses of recent court cases are detailed in the Council’s new report, Prescription pain medications: A fatal cure for injured workers.

“Employers have a moral and legal responsibility to protect their employees,” said Deborah A.P. Hersman, president and CEO of the National Safety Council. “Addressing the use and abuse of prescription painkillers is as important as identifying drug and alcohol abuse in the workplace.”

Workers who use opioid painkillers for more than a week to treat on-the-job injuries have double the risk of being disabled one year later.[i] Worker’s compensation claims also skyrocket. The average lost time worker’s compensation claim for workers using opioid painkillers can total as much as $117,000 – 900 percent higher than the cost for workers who do not take opioid painkillers.[ii]

To help protect injured workers and mitigate liability, the Council recommends employers:

1) Educate workers about the risks of opioid painkillers
2) Work with insurance carriers to identify inappropriate opioid painkiller prescribing and adopt procedures to manage worker’s opioid use
3) Ensure medical providers follow prescribing guidelines and use state Prescription Drug Monitoring Programs, which track prescribing history
4) Provide supervisor education focused on identifying impaired employees
5) Expand drug testing programs that include testing for all common opioids
6) Evaluate employee assistance programs and make sure they include access to treatment

Employers are also encouraged to download the free Prescription Drug Employer Kit for resources and tips to develop policies and manage opioid use at work.

Founded in 1913 and chartered by Congress, the National Safety Council is a nonprofit organization whose mission is to save lives by preventing injuries and deaths at work, in homes and communities, and on the road through leadership, research, education and advocacy.

The U.S. House of Representatives on Friday passed a sweeping bill to speed new drugs to the market after lawmakers defeated last-minute amendments that threatened to derail it. According to the report in Reuters Health, the House voted 344 to 77 in favor of the 21st Century Cures Act, which would require the FDA to streamline its drug approval process, consider more flexible forms of clinical trials and incorporate patient experience into its decision-making process.

The bill was developed by the House Energy and Commerce Committee and spearheaded by Republican Fred Upton and Democrat Diana DeGette. A similar bill in the Senate is expected to be voted on before the end of the year. The program would be paid for with the sale of 80 million barrels of crude oil from the Strategic Petroleum Reserve (SPR) over eight years.

“The strong bipartisan support for the Cures Act in the House, together with broad support from the Obama Administration, are strong indications that the Senate will approve the Cures Act with small changes,” said Ross Muken, an analyst at Evercore ISI, in a research note.

One challenge may come from Republican Senator Lisa Murkowski, head of the Senate Energy Committee, who has said she opposes the use of SPR sales to fund anything other than national energy security.

The House bill would increase funding to the National Institutes of Health by nearly $8.75 billion over five years and increase funding to the Food and Drug Administration by $550 million over the same period.

The bill would overhaul the FDA’s regulatory framework for approving drugs. It would create incentives for companies to develop drugs for rare diseases. It would allow certain antibiotics to be approved based more limited testing and establish other measures to shorten the drug development time.

A contingent of local and state law enforcement raided a San Jose marijuana dispensary last Thursday and arrested its owner and manager, based on allegations of illegal marijuana sales and workers’ compensation fraud, authorities said.

According to the report in the San Jose Mercury News, police and investigators from the Santa Clara County District Attorney’s Office led the operation at San Jose Organics, on Tully Road east of Monterey Road, aided by agents from the state Board of Equalization and the Employment Development Department.

Deputy District Attorney Edward Liang said the search of the club stemmed from an investigation into illicit marijuana trafficking and possible tax and workers’ compensation fraud. He declined to provide additional details about the scope of, or what spurred the probe, only that it involved violations including operating in an unlawful location and outside of prescribed regulations.

Authorities arrested on site the business’s manager, Brian Wong, a San Francisco resident. The owner, Ben Lew, was arrested in San Francisco. Both were booked on suspicion of possessing marijuana for sale, selling marijuana and maintaining a place to unlawfully sell marijuana, Liang said.

Agents carried boxes of evidence out of the storefront shop. Liang said the investigation continues, and that additional charges could be considered.

Following arrests made earlier today, a federal indictment was unsealed charging three southern California defendants with conspiracy to commit health care fraud and 15 counts of health care fraud.

Chiropractor Bahar Gharib-Danesh, 38, of Woodland Hills, was arrested in Los Angeles; Chiropractor Na Young Eoh, 41, of Bakersfield, was arrested in Bakersfield; and clinical psychologist John Terrence, 72, of Marina Del Rey, is expected to voluntarily appear before the U.S. District Court in Fresno within the next 30 days.

According to the indictment returned on July 2, 2015, Gharib-Danesh was a chiropractor and the manager of Pain Relief Health Centers (PRHC). PRHC was headquartered in Los Angeles, and had clinics in Bakersfield, Visalia and Fresno, as well as in Los Angeles County. Eoh was also a chiropractor, and was the treating physician for PRHC’s Kern County workers’ compensation claims. Terrence was a clinical psychologist who saw patients from the Bakersfield clinic.

According to the indictment, PRHC recruited patients who were workers claiming to have an injury. In treating the patients, Gharib instructed her staff to add as many injured body parts for treatment as possible to generate higher billings. The treatment plan generally included shock wave therapy, electro stimulation therapy, myo-facial release/massage, physical therapy, chiropractic manipulation, compound creams, and psychological evaluation. Nearly every patient was scheduled for the same treatments, and the maximum amount of treatments allowed by law was generally billed to the insurance company. Eoh operated out of the Bakersfield Clinic, the Visalia Clinic, and the Fresno Clinic and would sign the treatment plans and referral forms.

If the claim of injury was denied by the insurance company, a lien would be filed, and the claims would either be litigated before the California Workers’ Compensation Appeals Board or be settled by negotiations through the parties. Lien settlements for less than the full amount of the claim were acceptable because of the high volume of patients recruited and by the large amount of medical fees generated.

The indictment further alleges that Gharib directed Eoh to refer all patients who came into the clinic to Terrence for a psychological evaluation, regardless of the injury the patient reported. Terrence submitted bills and reports for each patient that were virtually identical. He also allegedly fraudulently billed for patients at a rate higher than legally allowed. According to the indictment, Terrence provided each patient with approximately 20.8 hours of psychological evaluations in a single day. On one day, Terrence billed a total of 291.2 hours for treating 14 patients. In one period of two weeks, Terrence billed over a thousand hours treating patients and writing reports. Between 2005 and 2012, Terrence submitted claims for psychological services in workers’ compensation cases totaling in excess of $5.6 million.

If convicted, each defendant faces a maximum statutory penalty of 20 years in prison and a $250,000 fine on each count of the indictment.

A new analysis of 2015 independent medical review (IMR) outcomes shows there was no significant reduction in IMR volume in the first quarter of this year, even though the independent medical reviewers continue to concur with the utilization review (UR) physician’s denial or modification of treatment in about 90 percent of the cases.

The CWCI analysis compares data from 33,909 IMR determination letters issued in the first three months of this year in response to applications submitted to the state after a utilization review (UR) physician modified or denied a requested medical service to similar data from the 137,781 IMR decisions issued in 2014.

State legislators who enacted IMR expected the volume of requests would decline following an initial learning curve as doctors, attorneys and others involved in the process became familiar with the types of treatment that would meet the evidence-based medicine standards and be approved through UR and IMR, but the new data indicate that after more than 2 years, IMR volume has yet to subside.

A review of the IMR decisions issued in the first quarter shows that after reviewing the patient’s records and any additional information provided in support of the request, the IMR physicians upheld the UR doctor’s modification or denial of the service 89 percent of the time, nearly matching the 91 percent uphold rate from 2014.

The mix of services submitted for IMR also showed little change, as prescription drugs again topped the list, accounting for 48 percent of the first quarter IMR decisions (vs. 45 percent in 2014), with the UR denial or modification upheld in 92 percent of those cases. Requests for prescription drugs, physical therapy, durable medical equipment, injections and diagnostic tests and measurements together accounted for ¾ of all services submitted for IMR in the first quarter, though requests for surgery, which accounted for 4.4 percent of the IMR cases (vs. 4.7 percent in 2014) surpassed diagnostic tests and measurements as the fifth most common type of service submitted for IMR, even though the uphold rate for modifications or denials of surgical requests held steady at 89 percent.

The first quarter IMR results also show that a relatively small number of physicians continue to account for the majority of the disputed medical services, as the top 10 percent of physicians named in IMR decision letters (516 providers) accounted for 70 percent of the IMR requests, though that was down from 83 percent last year, while the top 1 percent of physicians (52 providers) accounted for 28 percent of the disputed service requests in the first quarter, down from 44 percent last year.

In addition, the study documents continued geographic variation, with 38 percent of the first quarter IMR decision letters addressed to Los Angeles County recipients – 1.5 times the proportion of claims that come from that region, whereas in all other regions of the state the percentage of IMR decisions was either in line with or disproportionately low relative to the percentage of claims from the region.

CWCI has published more details on the first quarter IMR outcomes in a Spotlight Report, “California Workers’ Compensation Independent Medical Review: 1st Quarter 2015 Outcomes,” which CWCI members and subscribers can access in the research section of the Institute’s website.