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Tag: 2020 News

14 Charged in So. Cal. $22M SJDB Fraud Scheme

The first of 14 defendants charged in three separate cases was arraigned on November 23, for their roles in a workers’ compensation re-training voucher fraud scheme that caused a loss to insurance carriers in excess of $22 million.

The 14 defendants are charged with a variety of counts including conspiracy, insurance fraud, capping, and receiving kickbacks.

An investigation started in January 2019 when the Riverside County DA’s Office, assisted by the California Department of Insurance and the California Bureau for Private Post-Secondary Education, started looking into suspected fraud at two for-profit vocational schools.

The fraud involved Supplemental Job Displacement Benefits (SJDB) provided by workers’ compensation insurance carriers, and was suspected at Ryon College in Riverside and Sutech School in Los Angeles.

The investigation revealed that two of the charged defendants, Oswaldo Forero, of Irvine; and Melbe Zepeda, of Bellflower, operated the two “sham” schools that were primarily funded by workers’ compensation vouchers.

These vouchers, with values ranging from $6,000 to $10,000, were intended for injured workers to be re-trained or to assist them in learning new skills to accommodate their disabilities enabling them to re-enter the workforce.

It is alleged that Forero and Zepeda employed numerous “cappers” to illegally recruit students to the two schools they operated.

These “cappers” were paid to sign up as many students as possible to attend the schools, even if the student didn’t have the requisite educational background – a high school diploma or equivalent.

The priority of the defendants was to make money using various tactics such as over-billing for laptops and tools, collecting lucrative vouchers for students that never or rarely attended the school, faking admission tests, and giving students cash for their vouchers.

Third COVID-19 Vaccine in Final Testing Stages

Drugmaker AstraZeneca says that late-stage trials show its COVID-19 vaccine is highly effective, buoying the prospects of a relatively cheap, easy-to-store product that may become the vaccine of choice for the developing world

The results are based on an interim analysis of trials in the U.K. and Brazil of a vaccine developed by Oxford University and manufactured by AstraZeneca. No hospitalizations or severe cases of COVID-19 were reported in those receiving the vaccine.

AstraZeneca is the third major drug company to report late-stage data for a potential COVID-19 vaccine as the world waits for scientific breakthroughs that will end a pandemic that has pummeled the world economy and led to 1.4 million deaths.

But unlike the others, the Oxford-AstraZeneca vaccine doesn’t have to be stored at freezer temperatures, making it potentially easier to distribute, especially in developing countries.

The Oxford-AstraZeneca vaccine was 90% effective in preventing COVID-19 in one of the dosing regimens tested; it was less effective in another. Earlier this month, rival drugmakers Pfizer and Moderna reported preliminary results from late-stage trials showing their vaccines were almost 95% effective.

While the AstraZeneca vaccine can be stored at 2 degrees to 8 degrees Celsius (36 degrees to 46 degrees Fahrenheit), the Pfizer and Moderna products must be stored at freezer temperatures. In Pfizer’s case, it must be kept at the ultra-cold temperature of around minus-70 degrees Celsius (minus-94 Fahrenheit).

The AstraZeneca vaccine is also cheaper. It has pledged it won’t make a profit on the vaccine during the pandemic, and has reached agreements with governments and international health organizations that put its cost at about $2.50 a dose. Pfizer’s vaccine costs about $20, while Moderna’s is $15 to $25, based on agreements the companies have struck to supply their vaccines to the U.S. government.

All three vaccines must be approved by regulators before they can be widely distributed.

Oxford researchers and AstraZeneca stressed they weren’t competing with other projects and said multiple vaccines would be needed to reach enough of the world’s population to end the pandemic.

AstraZeneca said it will immediately apply for early approval of the vaccine where possible, and it will seek an emergency use listing from the World Health Organization, so it can make the vaccine available in low-income countries.

The results reported Monday come from trials in the U.K. and Brazil that involved 23,000 people. Of those, 11,636 people received the vaccine – while the rest got a placebo.

Late-stage trials of the vaccine are also underway in the U.S., Japan, Russia, South Africa, Kenya and Latin America, with further trials planned for other European and Asian countries.

The AstraZeneca trials were paused earlier this year after a participant in the U.K. study reported a rare neurological illness. While the trials were quickly restarted in most countries after investigators determined the condition wasn’t related to the vaccine, the FDA delayed the U.S. study for more than a month before it was allowed to resume.

AstraZeneca has been ramping up manufacturing capacity, so it can supply hundreds of millions of doses of the vaccine starting in January, Chief Executive Pascal Soriot said earlier this month.

DIR Occupational Safety Board Sets COVID Safety Standards

The Department of Industrial Relations’ (DIR) Occupational Safety and Health Standards Board unanimously adopted emergency temporary standards to protect workers from hazards related to COVID-19. The emergency standards will be in effect immediately if approved by the Office of Administrative Law in the next 10 calendar days.

The temporary standards apply to most workers in California not covered by Cal/OSHA’s Aerosol Transmissible Diseases standard. Under the new regulations, employers must have a written COVID-19 Prevention Plan that addresses the following:

System for communicating information to employees about COVID-19 prevention procedures, testing, symptoms and illnesses, including a system for employees to report exposures without fear of retaliation.
— Identification and evaluation of hazards – screening employees for symptoms, identifying workplace conditions and practices that could result in potential exposure.
— Investigating and responding to cases in the workplace – responding immediately to potential exposures by following steps to determine who may have been exposed, providing notice within one business day about potential exposures, and offering testing to workers who may have been exposed.
Correcting COVID-19 hazards – including correcting unsafe conditions and work practices as well as providing effective training and instruction.
— Physical distancing – implementing procedures to ensure workers stay at least six feet apart from other people if possible.
Face coverings – providing face coverings and ensuring they are worn.
— Adopting site-specific strategies such as changes to the workplace and work schedules and providing personal protective equipment to reduce exposure to the virus.
— Positive COVID-19 case and illness recording requirements and making the COVID-19 Prevention Plan accessible to employees and employee representatives.
Removal of COVID-19 exposed workers and COVID-19 positive workers from the workplace with measures to protect pay and benefits.
Criteria for employees to return to work after recovering from COVID-19.
Requirements for testing and notifying public health departments of workplace outbreaks (three or more cases in a workplace in a 14-day period) and major outbreaks (20 or more cases within a 30-day period).
— Specific requirements for infection prevention in employer-provided housing and transportation to and from work.

The Standards Board will file the rulemaking package today with the Office of Administrative Law, which has 10 calendar days to review and approve the temporary workplace safety standards enforced by Cal/OSHA.

Once approved and published, the full text of the adopted emergency standards will appear in the new Title 8 sections 3205 (COVID-19 Prevention), 3205.1 (Multiple COVID-19 Infections and COVID-19 Outbreaks), 3205.2 (Major COVID-19 Outbreaks) 3205.3 (COVID-19 Prevention in Employer-Provided Housing) and 3205.4 (COVID-19 Prevention in Employer-Provided Transportation to and from Work) of the California Code of Regulations. Pursuant to the state’s emergency rulemaking process, after an initial effective period the board will have two opportunities to readopt the temporary standards.

Cal/OSHA will expeditiously convene a stakeholder meeting that will include industry and labor representatives to review the requirements of the emergency regulation and solicit feedback and recommend updates.

The Occupational Safety and Health Standards Board, a seven-member body appointed by the Governor, is the standards-setting agency within the Cal/OSHA program. The Standards Board’s objective is to adopt reasonable and enforceable standards at least as effective as federal standards. The Standards Board also has the responsibility to grant or deny applications for variances from adopted standards and respond to petitions for new or revised standards.

So. Cal. Edison Electrician Charged with 63K Comp Fraud

Mark Redheffer, 48, of Fontana, was arraigned on felony counts of insurance fraud and attempted perjury after allegedly lying and concealing information in a workers’ compensation claim in order to receive over $63,000 in undeserved temporary disability benefits from his employer, Southern California Edison.

After receiving a referral from Redheffer’s employer, SCE, the Department of Insurance launched an investigation into Redheffer’s claim that he suffered injuries while working as a linesman apprentice in 2015.

The extensive investigation, which included surveillance of Redheffer to confirm the legitimacy of his claimed physical limitations and injury, exposed his workers’ compensation claim to be fraudulent.

The felony complaint alleges that Redheffer concealed material information relating to his medical history during an evaluation by a Qualified Medical Examiner, who determined that Redheffer suffered significant physical limitations and was no longer able to perform his job duties.

Additionally, Redheffer is charged with lying in a deposition in pursuit of the workers’ compensation claim.

Redheffer was charged with three felony counts of insurance fraud and attempted perjury. Prior to Redheffer’s arraignment on November 19, 2020, an arrest warrant had been issued in the amount of $50,000.

Redheffer is scheduled to return to court on January 29, 2021.

The case is being prosecuted by the San Bernardino County District Attorney’s Office.

California Leads the Nation in COVID-19 Civil Lawsuits Filed

As employers continue to grapple with the fallout from the pandemic, the immediate threat of COVID-19 litigation looms large. To help stay one step ahead, the Jackson Lewis COVID-19 Employment LitWatch tracks complaints filed in federal and state courts nationwide that allege labor and employment law violations related to COVID-19.

The Jackson Lewis COVID-19 Employment LitWatch tracks civil complaints filed in federal and state courts across the country that both are related to the COVID-19 epidemic and raise labor and/or employment law issues. Cases that merely referenced COVID-19 are not included. The COVID-19 Employment LitWatch is meant to provide trends and should not be considered an exhaustive dataset.

Jackson Lewis has a dedicated team tracking and responding to the developing issues facing employers as a result of COVID-19, which includes members from:

Class Actions and Complex Litigation
— Corporate Diversity Counseling
Disability, Leave and Health Management
— Employee Benefits
— General Employment Litigation
— Labor and Preventative Practices
— Wage and Hour
— Workplace Safety and Health

The LitWatch data is based on a feed of thousands of civil complaints filed per day that is provided by Courthouse News Service (CNS).

A review of COVID-19-related labor and employment complaints filed between January – August 2020, determined that an overwhelming majority (approximately two-thirds) of complaints involve an allegation of wrongful termination. Typically, each of these complaints contains an underlying claim that led to the employee’s termination, such as, for example, an employee requesting an accommodation.

The database reflects a total of 1,107 civil complaints nationwide as of today. Not unexpectedly, 214 of these cases have been filed in California, of which 199 are in state and 15 are in federal courts.

The healthcare industry has generated 263 total complaints, followed by manufacturing with 89, and retail and consumer goods 76.

CMS Reports Aggressive Efforts Reduce Fraud by $15 Billion

Aggressive corrective actions aimed at reducing Medicare fee-for-service (FFS) improper payments have resulted in less healthcare fraud, waste, and abuse, as well as $15 billion in savings, according to the latest data from CMS.

The data released earlier today also revealed that the Medicare FFS improper payment rate declined to 6.27 percent in fiscal year (FY) 2020 from 7.25 percent in FY 2019. It was the fourth consecutive year that the Medicare FFS improper payment rate was below 10 percent, CMS reported.

Medicare FFS improper payments decreased the most in home healthcare. CMS reported $5.9 billion in savings attributed to fewer improper payments to home health agencies between FY 2016 and 2019.

The agency also saw a $1 billion reduction in estimated improper payments made to skilled nursing facilities in the last year.

Reductions in both the home health and skilled nursing facility improper payment rates can be attributed to CMS efforts to educate providers through the Targeted Probe and Educate program, as well as changes to the policy related to supporting information for physician certification and recertification for skilled nursing facility services, CMS stated.

Improper payments occur when reimbursements do not meet statutory, regulatory, administrative, or other legally application requirements, CMS explained. A common example is insufficient or missing documentation for a claim.

Without proper documentation or errors in the documentation, CMS cannot verify if its programs correctly reimbursed for the services rendered. As a result, CMS may over or underpay the provider for the claim.

Additionally, a smaller portion of improper payments should never have been made largely because of issues with medical necessity, coding, beneficiary eligibility, and other errors on the claim. These end up as losses to the government.

The agency has developed a five-pillar program integrity strategy for reducing improper payments.  The five components of CMS’ strategy are stopping bad actors who have defrauded federal healthcare programs; preventing fraud; mitigating emerging programmatic risks related to value-based payment programs; reducing provider burden; and leveraging new technology (e.g., artificial intelligence and machine learning).

CMS implemented the strategy in 2019. Since then, there has been a $3.17 billion reduction in Medicare FFS improper payments, according to the new data.

Compromise and Release Resignation Letter Bars FEHA Claim

Reinier Razon began working for Southern California Permanente Medical Group at its Kaiser Sunset location in January 2014, as a clinical laboratory scientist.

In 2016 Razon was involved in a dispute with Darren Wallace, the union steward assigned to the clinical laboratory scientists. According to Razon, Wallace assaulted him. Razon was treated two days later at the Kaiser emergency room for anxiety and diagnosed with “emotional stress reaction,” which he believed was due to his encounter with Wallace.

Razon filed a workers’ compensation claim for stress and anxiety arising from his encounter with Wallace. That claim was pending when he filed his lawsuit against SCPMG in April 2017, for disability discrimination, failure to accommodate and failure to engage in the interactive process in violation of the California Fair Employment and Housing Act.

In March 2018 Razon settled his workers’ compensation claim for $45,000, as reflected in a standard, preprinted compromise and release form. He also signed a separate voluntary resignation letter. The document states it “releases Kaiser from any and all claims, known or unknown, which may exist at the time of execution of this Agreement.” It specifically included “causes of action under Title VII of the Civil Rights Act of 1964 (race, color, religion, sex and national origin discrimination); the Americans with Disabilities Act; 29 USC section 62 (age discrimination). However, this list is expressly understood by the parities [sic] not to be all-inclusive.”

The trial court granted SCPMG’s motion for summary judgment and entered judgment in favor of SCPMG, ruling Razon’s civil FEHA lawsuit was barred by his written release of all claims relating to his employment with SCPMG. The court of appeal affirmed the dismissal in the unpublished case of Razon v. Southern California Permanente.

Razon argues the release set forth in his voluntary resignation letter is enforceable only if the letter was attached to the preprinted compromise and release form used to resolve his workers’ compensation claims. No authority cited by Razon established attachment as a requirement. To the contrary, the Supreme Court in Claxton Court (34 Cal.4th at pp. 370, 378) expressly recognized release of the non-workers’ compensation claims could be effected through a separate document, independent of the workers’ compensation preprinted form. That is exactly what occurred here

Razon argues the absence of any express reference to his FEHA claims in the release creates a triable issue of fact whether the lawsuit, pending at the time the release was executed, was included within its scope. The Supreme Court in Claxton expressly rejected the need for the specificity that Razon suggests.

In his declaration in opposition to the summary judgment, Razon insisted he did not intend by signing the letter to release his FEHA claims. That undisclosed intent, however, is irrelevant to the interpretation of the release. (Otay Land Co., LLC  v. U.E. Limited, L.P. (2017) 15 Cal.App.5th 806, 855).

DWC Corrects Outpatient/Ambulatory Fee Schedule

On October 7, the Division of Workers’ Compensation’s Administrative Director issued an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers Fee Schedule portion of the Official Medical Fee Schedule to conform to changes in the Medicare system, effective for services rendered on or after October 1, 2020.

Subsequently, on October 21, 2020, the Centers for Medicare and Medicaid Services (CMS) issued a corrected Addendum A and corrected Addendum B to supersede the previous documents.

The Administrative Director has issued an order dated November 5, 2020, to adopt CMS’ corrected Addendum A and Addendum B for Hospital Outpatient Departments/Ambulatory Surgical Centers services rendered on or after October 1, 2020. The order makes the following changes:

— Incorporates by reference CMS’ HOPPS addendum A found in the October 2020 CORRECTION Addendum A (ZIP) – updated 10/21/2020 file, in place of the original file, for services rendered on or after October 1, 2020
— Incorporates by reference CMS’ HOPPS addendum B found in the October 2020 CORRECTION Addendum B (ZIP) – updated 10/21/2020 file, in place of the original file, for services rendered on or after October 1, 2020
— Corrects a clerical error in the reference to the Integrated Outpatient Code Editor provisions relating to Comprehensive APC (J1 and J2) Status Indicator.

The Administrative Director update order dated October 7, 2020 remains in effect for services rendered on or after October 1, 2020, except as modified by Administrative Director order dated November 5, 2020. The Orders and regulations can be found at the DWC OMFS web page.

CDC Research Grant to Study Industrial Robots for Better Safety

The Centers for Disease Control and Prevention (CDC) has awarded $1.5 million over three years to the University of Illinois at Chicago and Worcester Polytechnic Institute to fund projects aimed at reducing workers’ exposures to hazards through the development and use of collaborative robots, or co-robots.

CDC’s National Institute for Occupational Safety and Health (NIOSH) partnered with the National Science Foundation (NSF) to fund studies of co-robots in the workplace through NSF’s National Robotics Initiative. The Initiative supports research in the U.S. that will accelerate the development and use of co-robots, an emerging robotic technology that complements, not replaces, human workers. Co-robots work alongside people or other robots and can help improve worker safety.

The future of work includes a workplace where robots work in tandem with, or are even worn by, human workers,” said NIOSH Director John Howard, M.D. “This important research will help guide the development and use of co-robots that can help minimize health and safety risks to workers.”

In healthcare, remote-controlled nursing robots have the potential to reduce workload and the risk of infection, especially in quarantine and intensive care environments. Researchers at Worcester Polytechnic Institute will develop a more intuitive interface to make it easier for nurses to operate robots from a distance. Researchers also will investigate best practices for integrating robots into current nursing education.

In manufacturing, lifting heavy objects can lead to costly and disabling work-related musculoskeletal disorders. Wearable robots, which provide mechanical assistance to the user’s joints, have the potential to reduce injuries from heavy lifting. Researchers at the University of Illinois at Chicago will develop and investigate the effectiveness of a personalized wearable robot worn on the lower body that senses the wearer’s physical effort and responds accordingly using soft-wearable electronics.

Through its Center for Occupational Robotics Research, NIOSH is proactively working across industrial sectors to guide the development and use of occupational robots that enhance workers’ safety, health, and well-being. The Center’s research looks at traditional industrial robots that work in robotic cells and cages away from human workers as well as at emerging robotic technologies such as co-robots; wearable robotics or powered exoskeletons; remotely controlled or autonomous vehicles and drones; and future robots that increasingly use advanced artificial intelligence.

NIOSH is the federal institute that conducts research and makes recommendations for preventing work-related injuries, illnesses and deaths. Additional information on NIOSH grant opportunities via the NIOSH Extramural Research and Training Programs can be found https://www.cdc.gov/niosh/oep/ here.

Remote Workers Less Likely to Take Sick Time When Sick

A new survey finds 66 percent of Americans working remotely believe that taking sick days for anything less severe than COVID-19 would be looked down upon by their employer.

Moreover, three out of four respondents said that since getting coworkers sick is off the table, the bar for symptom severity warranting taking time off has been raised. The OnePoll survey reveals two in three Americans (67%) are much less inclined to take off from work when they are sick now. In fact, seven in 10 have even worked while feeling ill since they started working from home.

The poll, commissioned by ColdCalm, also examined the circumstances under which workers would actually take time off for sickness now that they perform their duties without ever leaving the house.

The survey of 2,000 Americans finds 63 percent feel a sore throat alone simply won’t cut it in 2020. Workers say they would need to actually lose their voice before they felt justified taking time off. Results also revealed that sometimes remote employees have been so desperate for an illness-related respite that half have taken undocumented time off and hoped that it went unnoticed.

Nearly half of respondents believe that COVID has made other illnesses look “minor” in comparison. Forty-five percent said the pandemic has made them more vigilant about avoiding illnesses, and 72 percent are more likely to take medication at the first signs of symptoms.

Even though the physical stress of commuting is eliminated for those working from home, their ability to handle their responsibilities can still be impacted by sickness. Among those Americans who worked from home while sick, 52 percent say their performance “decreased considerably” during their illness. Nearly six in 10 (57%) feel that working remotely through their illness actually enhanced their credibility with coworkers.

Proactive measures like taking a homeopathic medicine, drinking lots of fluids to stay hydrated, and getting plenty of rest at the first sign of illness can mean the difference between having something that can be manageably worked through as opposed to one that knocks you off your feet for a few days.

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