Menu Close

Tag: 2021 News

500 L.A. Firefighters File Suit Over Vaccine Mandate

The Los Angeles Times reports that a group of 500 Los Angeles firefighters filed a lawsuit Friday against the city over its requirement that L.A. employees be vaccinated against COVID-19.

The lawsuit, filed in Los Angeles County Superior Court, claims the city’s mandate is a violation of employees’ constitutionally protected autonomous privacy rights.

The lawsuit was filed on behalf of the Firefighters 4 Freedom Foundation, a nonprofit representing 529 members, said Kevin McBride, the group’s attorney.

The firefighters are “pawns in a political chess match, ordered by thirteen politicians on the Los Angeles City Council to inject themselves with an experimental vaccine – over their objections – or lose their jobs,” the lawsuit states.

A group of employees in the Los Angeles Police Department also sued last week over the vaccination mandate.

The city of L.A. moved to require city employees to be fully vaccinated against COVID-19 by early October, while granting exemptions to employees with medical conditions or “sincerely held religious beliefs.”

More than 460 exemption requests have been submitted by LAFD employees, according to city data – a number equal to 12.5% of the department workforce. However, it is possible that some employees may have turned in multiple requests.

The lawsuit filed Friday claims that the city mandate violates the firefighters’ right to privacy under the California Constitution. It seeks a temporary restraining order prohibiting the city’s vaccination mandate from going into effect until a preliminary injunction hearing and further order of the court.

The lawsuit alleges the city doesn’t have the power to “order forced vaccinations of its employees or residents” and that “the vaccine mandate is both unnecessary and ineffective in protecting the public.”

A LAFD spokesman told The Times on Friday that 58.5% of the sworn members have been fully vaccinated and 66% have received at least one dose.

The total number of LAFD employees who have tested positive for COVID-19 is 1,079, according to city data. A total of 1,056 LAFD employees have recovered and returned to duty. Two firefighters have died after contracting COVID-19.

City Atty. Mike Feuer said he was confident the city would prevail. “The U.S. Supreme Court and courts across the country have upheld vaccination mandates by government and they’ve done so because they said the greater good compels it,” Feuer said. “The greater good compels this right now.”

New Law Bans Discrimination Settlement Non-Disclosure Clause

In a sweeping expansion of existing law, Fisher Phillips reports that Governor Gavin Newsom signed legislation that broadly prohibits non-disclosure clauses in settlement agreements involving workplace harassment or discrimination on any protected bases, not just sex.

SB 331 – known as the “Silenced No More Act” – takes what state lawmakers believe will be a final stand against employers preventing employees from discussing unlawful acts in the workplace. The new law, which takes effect on January 1, 2022, will nullify and make void provisions within any agreement entered on or after that date that prevent or restrict an employee from disclosing factual information on any type of harassment, discrimination, or retaliation.

SB 331 builds on SB 820, also known as the STAND (Stand Together Against Non-Disclosure) Act, which California passed in 2018 in response to the #MeToo movement. To address what advocates of the movement coined as “secret settlements” used to cover up cases of sexual harassment involving high-profile executives, the STAND Act prohibited the use of confidentiality provisions in settlement agreements for actions including claims based on sex. As such, for several years, the STAND Act has allowed employees to discuss factual information relating to sexual harassment in the workplace.

Primarily, SB 331 amends Code of Civil Procedure Section 1001 (previously enacted by SB 820 in 2018) to expand the prohibition of confidentiality provisions in agreements entered into on or after the effective date for all acts of workplace discrimination or harassment, not only based on sex. For example, this includes acts based on race, religion, color, national origin, ancestry, disability, medical condition, familial status, sex, gender, age and other protected characteristics as described in various subdivisions of Sections 12940 and 12955 of the Government Code.

With its substantial changes, the new law importantly preserves the existing protection against disclosure of the settlement amount. While employees may discuss the underlying facts of the case, employers can still insist on clauses that prevent disclosure of the amount of money paid to settle the claim. Therefore, employers remain somewhat shielded against current and former employees “piggybacking” off a settlement with the aim of seeking a similar payout.

As another slight reprieve, employers may still include non-disparagement clauses or similar provisions in agreements provided there is specific language stating the employee’s right to disclose information about unlawful acts in the workplace. Absent that language, the provision would be against public policy and unenforceable. Certainly, crafting such language to ensure enforceability is best handled by consulting with legal counsel.

For those employees with privacy concerns who wish to protect themselves against public attention, the Silenced No More Act leaves untouched the exception allowing claimants to maintain privacy. Therefore, at the request of the claimant, a settlement agreement may still include a provision that shields the claimant’s identity and all facts that could lead to the discovery of their identity. Consistent with prior law, this exception does not apply if a government agency or public official is a party to the settlement agreement.

18 Ex-NBA Players Arrested for $4M Health Care Fraud

Federal prosecutors announced the indictment of 18 former professional basketball players and one spouse, who are accused of submitting fraudulent reimbursement claims for fictitious medical and dental expenses.

The alleged “ringleader” of the scheme was said to be Terrence Williams. He was drafted by the then-New Jersey Nets as their 11th overall pick in 2009. Williams allegedly recruited other NBA health plan participants into the scheme, providing them with falsified invoices to claim medical and dental services that were never rendered.

Terrence Williams, Alan Anderson, Anthony Allen, Desiree Allen (Alan’s wife), Shannon Brown, William Bynum, Ronald Glen Davis, Christopher Douglas-Roberts, a/k/a “Supreme Bey,” Melvin Ely (former Fresno State standout), Jamario Moon, Darius Miles, Milton Palacio, Ruben Pattierson, Eddie Robinson, Gregory Smith, Sebastian Telfair, Charles Watson Jr., Antoine Wright, and Anthony Wroten are each charged with one count of conspiracy to commit health care fraud and wire fraud, which carries a maximum sentence of 20 years in prison. Tennence Williams is also charged with one count of aggravated identity theft, which carries a mandatory minimum sentence of two years in prison.

Ronald Glen Davis will be prosecuted in the Central District of California. The other defendants will be prosecuted in other jurisdictions. Anthony Allen Douglas-Roberts, and Robinson remain at large. Milt Palacio, a current Trail Blazers assistant coach, was put on administrative leave by the team after being one of the 18 players arrested.

The indictment charges the defendants with conspiracy to commit health care fraud and wire fraud, in connection with a scheme to defraud the National Basketball Associations Health and Welfare Benefit Plan out of nearly $4,000,000.

The National Basketball Association Players’ Health and Welfare Benefit Plan is a health care plan providing benefits to eligible active and former players of the NBA.

From at least 2017, up to about 2020 the defendants engaged in a widespread scheme to defraud the Plan by submitting and causing to be submitted fraudulent claims for reimbursement of medical and dental services that were not actually rendered.  

Williams orchestrated the scheme to defraud the Plan. He recruited other Plan participants to defraud the Plan by offering to provide them with false invoices to support their fraudulent claims. Williams provided some of the other defendants with false provider invoices, which those defendants then submitted to the Plan for reimbursement of fraudulent claims. Several of the fake invoices stood out because, “they are not on letterhead, they contain unusual formatting, they have grammatical errors.”

Williams provided the other charged defendants fake invoices from a particular Chiropractic Office in California, which were created by individuals working with Williams. In addition, Williams obtained fraudulent invoices from a dentist affiliated with dental offices in Beverly Hills, California, and from a doctor at a Wellness Office in Washington State. The fraudulent invoices purported to document that some of the defendants,and, in some cases, members of their families, had been recipients of expensive medical and dental services.

But the defendants had not received the medical or dental services described in the invoices Williams provided them. In many instances, the defendants were not even located in the vicinity of the service providers on the dates the invoices stated they received medical or dental services. In particular, GPS location information and/or documents, such as flight records, show that the defendants were in locations other than the vicinity of the medical or dental offices falsely claimed as the providers of services.

In return for his provision of false supporting documentation for their fraudulent claims, many of the defendants paid Williams kickbacks, totaling at least $230,000. Williams also used the personal identifying information of an employee of the Administrative Manager, which managed the Plan, in the course of the fraud scheme.

The prosecution of this case is being overseen by the Office’s Complex Frauds and Cybercrime Unit. Assistant United States Attorneys Kristy J. Greenberg and Ryan B. Finkel are in charge of the prosecution.

Improving Outcomes for Work-Related Concussions

A new study, published in the latest issue of the Journal of Occupational and Environmental Medicine, Improving Outcomes for Work-Related Concussions: A Mental Health Screening and Brief Therapy Model, assessed the efficacy of a neurocognitive screening evaluation and brief therapy model to improve RTW outcomes for workers who experienced mild head injuries.

There has been increased interest in both the immediate and long-term consequences of mild head injuries in basic and applied health sciences for the past few decades. To some extent, this interest has been fueled by the very public debate about the dangerousness of sports-related repeated mild head trauma in both children and adults.

There has also been media interest in non-sports-related head trauma in adults especially the elderly due to falls, in military populations, and after motor vehicle accidents.

The increased public attention to these issues has also increased awareness and concern regarding mild head injuries in the workplace. Many patients with work-related mild head trauma show delayed recovery resulting in significant increases in both medical services utilization and work leave.

Neuropsychological assessment to clarify the extent of cognitive features and psychosocial factors can be used effectively to rule out symptom magnification and secondary gain issues, as well as to provide additional objective data to clients about their subjective distress and cognitive complaints.

The current study is a multiple time-line design within an integrated care model combining outpatient medical and mental health services to address delayed recovery from mild Traumatic Brain Injury (mTBI) and Postconcussional Syndrome (PCS ) for 157 injured employees receiving workers compensation benefits.

Based on the outcome of the assessment, clients were either determined to be at MMI and discharged, or treatment recommendations were made for either mental health or Health and Behavior Assessment and Intervention (HBAI services). There were also several clients where biopsychosocial factors were identified which appeared to be affecting the individual’s recovery, that is, poor sleep patterns, inactivity, or other health behaviors, or anxiety, depressed mood, psychosomatic or post-traumatic symptoms which did not rise to the level of warranting a mental health diagnosis.

Overall, 155 of the 157 patients (98.7%) returned to work at full duty without further restrictions or accommodations. The findings of this study support the view that prolonged mTBI and PCS are strongly influenced by psychological factors. Conducting a brief and readily accessible neurocognitive assessment to reassure injured workers that their concerns about mTBI/concussion were being carefully considered and thoroughly addressed appeared to have dramatic effects on decreasing chronicity in this study.

9th Circuit Rejects Constitutional Challenge to AB 5

A three-judge Ninth Circuit panel affirmed a federal court dismissal of a lawsuit filed by the American Society of Journalists and Authors and the National Press Photographers Association challenging the State’s passage of Assembly Bill 5 and its various amendments.

The American Society of Journalists and Authors and the National Press Photographers Association filed a federal lawsuit challenging, on First Amendment and Equal Protection grounds, California’s Assembly Bill 5 and its subsequent amendments, which codified the more expansive ABC test previously set forth in Dynamex Operations West, Inc. v. Superior Court of Los Angeles, 416 P.3d 1 (Cal. 2018), for ascertaining whether workers are classified as employees or independent contractors.

AB5 and its subsequent amendments, now codified at section 2778 of the California Labor Code, provides for certain occupational exemptions.

Because freelance writers, photographers and others received a narrower exemption than was offered to certain other professionals, plaintiffs sued, asserting that AB5 effectuates content-based preferences for certain kinds of speech, burdens journalism and burdens the right to film matters of public interest.

The panel in the published case of ASJA v Bonta held that section 2778 regulates economic activity rather than speech. It does not, on its face, limit what someone can or cannot communicate. Nor does it restrict when, where, or how someone can speak.

The statute is aimed at the employment relationship – a traditional sphere of state regulation. The panel further acknowledged that although the ABC classification may indeed impose greater costs on hiring entities, which in turn could mean fewer overall job opportunities for certain workers, such an indirect impact on speech does not necessarily rise to the level of a First Amendment violation.

The panel rejected plaintiffs’ assertion that the law singled out the press as an institution and was not generally applicable.

Addressing the Equal Protection challenge, the panel held that the legislature’s occupational distinctions were rationally related to a legitimate state purpose.

Amicus briefs were filed in this case by Cato Institute, Reason Foundation, Individual Rights Foundation, Goldwater Institute, Independent Institute and Liberty Justice Center.

AM Best Reports WC Highly Profitable Compared With P/C Lines

AM Best is a global credit rating agency, news publisher and data analytics provider specializing in the insurance industry. According to a new AM Best report underwriters of workers’ compensation insurance have consistently generated better underwriting profits than other property/casualty (P/C) lines of business, again doing so in 2020 amid the pandemic.  

The Best’s Market Segment Report, titled, “Workers’ Compensation Still Outpacing Other Lines” states that underwriting results of workers’ compensation insurers remained strong in 2020, despite a 10% decline in bottom-line net premiums written, owing to the substantial drop in payrolls during the second quarter of the year.

The combined ratio of 91.1 in the workers’ compensation segment in 2020 was a few points higher than in 2019, but still comfortably under the breakeven mark of 100.0, reflecting profitable underwriting. Given the decline in premium, expense ratios rose, but the increase was nominal and did not overly dampen underwriting earnings.

Premium volume for workers’ compensation writers also has been constrained by rate decreases in most states. According to the report, some writers are looking to develop new products and explore new markets in other lines of coverage and allowing their workers’ compensation top-line premium to decline in the states where they generate significant premium.

Despite the smaller premium base, workers’ compensation insurers remained highly profitable in comparison with other P/C lines. Workers’ compensation underwriters have benefited from a decline in lost-time claims frequency tied to efforts to improve workplace safety. Other factors that have benefited the line’s profitability are the declines in fraud, workplace accidents and defense costs.

AM Best also analyzes the overall health of the workers’ compensation line of business through its Workers’ Compensation Composite, which is composed of U.S. companies, including state funds, whose workers’ compensation and excess workers’ compensation net premiums constitute 50% or more of their total net premiums. Even with the 2020 decline in workers’ compensation premium due to the pandemic, the market share of these specialists rose to 26.2% in 2020, up considerably from 16.7% in 2011.

AM Best’s negative market segment outlook for the workers’ compensation segment, the largest component of the U.S. commercial lines market, reflects the continued uncertainty about the effects of COVID-19, from an economic and a regulatory perspective, as well as a legislative one as states consider presumptive legislation stemming from the pandemic. Moreover, although the impact of the pandemic on insurers’ balance sheets to date has been tempered, concerns about the prolonged low interest rate environment persist. As a result, investment returns are expected to remain flat, and insurers may begin seeking riskier investments to generate higher yield.

Employer’s Constitutional Challenge to Safety Citation Rejected

Lion Farms, LLC owned and operated a dried-on-the-vine raisin vineyard in Madera County (Cottonwood Ranch), at which Lion’s employee Isaac Rey Barrientos worked.

On June 10, 2015, Barrientos was killed when he lost control of the Lion-owned ATV he was riding in the vineyard to service Lion’s portable toilets, and the ATV’s right front tire hit an eye ring grape stake, ejecting Barrientos off of the vehicle.

The June 12, 2015, Merced County Sheriff’s Office Report of Autopsy and the Madera County Certificate of Vital Record listed “blunt impact thoracospinal injuries” (not a head injury) as Barrientos’s cause of death. He was not wearing a helmet at the time of his fatal accident.

While Barrientos’s death was not due to the absence of head protection, Division Associate Safety Engineer Randy Chase found that wearing helmets while riding ATV’s would reduce the inherent risk of head injury. However, Chase also found that Lion had no written certification of having conducted a workplace hazard assessment and no requirement that its employees wear helmets as PPE while riding ATV’s.

Lion was therefore cited for violations of workplace safety regulations by the Division of Occupational Safety and Health.

Lion challenged the citations and the penalties by filing an appeal with the Board. Lion engaged the services of a retained industrial safety expert, who opined in his prepared report that a helmet would represent a hazard in itself and should never be worn while riding an ATV in and under the raisin vine “canopy” of hanging fruit and canes, as a helmet would “most probably become tangled within the vines and pull the rider off the vehicle, causing severe injury or death.”

Following the hearings, the ALJ upheld the citations, and reconsideration was denied. Lion filed its petition for writ of administrative mandate with the trial court, which was denied after a hearing on the merits. The Court of Appeal affirmed the citations in the unpublished case of Lion Farms v. Cal Occupational Safety and Health etc.

Among other issues, Lion claimed that section 3380 (particularly with respect to PPE required in the context of ATV usage in agricultural settings), as applied on the facts and circumstances of this case violated Lion’s substantive due process protections because the regulations were unconstitutionally vague and ambiguous. The Court of Appeal rejected this argument.

An administrative regulation violates due process of law if it forbids or requires the doing of an act in terms so vague that persons of common intelligence must necessarily guess at its meaning and differ as to its application. In considering a vagueness challenge to an administrative regulation, courts do not view the regulation in the abstract; rather they consider whether it is vague when applied to the complaining party’s conduct in light of the specific facts of the particular case. Standards under a regulation may be refined and developed on a case-by-case basis.

Section 3380(f)(1)(A)’s requirement that employers assess their workplaces to determine if hazards necessitating the use of PPE are present or likely to be present (and if such a determination is affirmatively made, select and make available the types of PPE that will protect affected employees from the hazards identified in the workplace assessment) is not impermissibly vague.

Corona Pharmacist Sentenced for $13M Compound Med Fraud

An Orange County pharmacist has been sentenced to 70 months in federal prison for submitting more than $13 million in claims for medically unnecessary compounded medication prescriptions.

42 year old Thu Van Le, a.k.a. “Tony Le,” who lives in Placentia, was sentenced by United States District Judge R. Gary Klausner.

In addition to the prison term, Judge Klausner ordered Le to pay $10,982,759 in restitution to Tricare, the U.S. military’s managed health care plan, and $768,488 in restitution to Amplan, Amtrak’s employee health care benefit plan.

Le, a pharmacist who owned TC Medical Pharmacy located at 760 S. Washburn Ave. #1 in Corona California, pleaded guilty on July 12 to one count of health care fraud.

From March 2015 to December 2016, Le’s pharmacy submitted more than $13 million in total claims to Tricare and AmPlan, against which Tricare paid $10,982,759 and AmPlan paid $768,488. Le, in turn, paid so-called “marketers” handsome kickbacks of up to 50 percent of the Tricare reimbursements.

The marketers used personal and insurance information to generate fraudulent prescriptions for compounded medications, according to court documents. Marketers who participated in the scheme solicited beneficiaries of the health plans through misleading cold calls that promised free compounded medications. In some cases, beneficiaries were not contacted at all and simply received expensive medications that they did not order.

Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient.

Le agreed to be bound by Tricare and AmPlan rules for reimbursement of claims for their beneficiaries. Tricare and AmPlan required that medications be medically necessary, that beneficiaries be examined by physicians, and that Le’s pharmacy collect co-payments. The prescriptions were supposed to be for unique patient needs, but they instead were formulated to maximize reimbursements and were prepared on an assembly-line basis.

The Defense Criminal Investigative Service, the FBI, IRS Criminal Investigation, Amtrak’s Office of Inspector General, the Office of Personnel Management’s Office of Inspector General, the United States Department of Labor – Employee Benefits Security Administration, the Department of Health and Human Services, and the California Department of Insurance investigated this matter.

Assistant United States Attorney Mark Aveis of the Major Frauds Section prosecuted this case.

Pfizer Vaccine Protection Declines to 47% by 5 Months

The Los Angeles Times reports that research conducted in Southern California has confirmed the dramatic erosion of the Pfizer-BioNTech COVID-19 vaccine’s protection against “breakthrough” coronavirus infections.

The new study, one of the largest and longest to track the effectiveness of a vaccine in Americans, found that the vaccine’s ability to protect against infection stood at 88% in its first month, then fell to 47% after just five months.

But even as the Delta variant became the predominant strain across the Southland, the vaccine’s effectiveness at preventing COVID-19 hospitalizations held steady at close to 90% for as long as six months. What’s more, it maintained that power across vaccine recipients of all age groups.

The study, funded by Pfizer and published Monday in the journal Lancet, also provides strong new evidence that the waning immunity against infection probably would have been seen with or without the arrival of the Delta variant.

Researchers found that a fresh inoculation with the Pfizer-BioNTech vaccine protected just as well against an infection with the Delta variant as it did against infection with other versions of the coronavirus.

Second, the vaccine’s ability to keep vaccinated people out of the hospital remained high across a span of time when the Delta variant gained ground in Southern California.

And third, breakthrough infections were more closely linked to the amount of time that had lapsed since vaccination than they were to the particular viral variant involved.

By showing that waning immunity, not the Delta variant, was the likely reason for the rise in breakthrough infections, the study suggests it may not be necessary to reformulate a Pfizer-BioNTech booster that specifically targets Delta. For now, at least, a third shot identical to the first two would probably extend the vaccine’s early record of protection against all strains, including Delta.

The protection provided by the Pfizer vaccine beyond six months has been an open question, hinted at only by Israeli studies that suggest COVID-19 hospitalization rates rise in those above 60 years of age.

In another recent study, researchers from Emory University and Stanford found that six months after being inoculated with the Pfizer vaccine, roughly half of 56 young and middle-aged adults had no detectable neutralizing antibodies against the SARS-CoV-2 virus. The reduced immunity was particularly dramatic against the coronavirus variants Delta, Beta and Mu.

That study was posted last week on BioRXiv, a site where researchers share preliminary work before it has been peer-reviewed. But its findings of “a substantial waning of antibody responses” – as well as a drop in the immunity provided by T cells – suggest that a third booster immunization “might be warranted,” its authors wrote.

Fraud Case Dismissed Against Turlock Physician After Full Restitution

Back in May, 2017 a federal grand jury returned an eight-count criminal indictment. charging Dr. Basil Hantash with eight counts of health care billing fraud. The dermatologist is president and medical director of Advanced Skin Institute on Geer Road in Turlock.

According to federal court documents, Dr. Hantash was a dermatologist and the medical director of the Advanced Skin Institute in Turlock California . For about six years Hantash made insurance reimbursement claims to private insurance companies for performing acne surgeries. In fact, however, the indictment states he only performed only cosmetic procedures known as chemical peels or microdermabrasions. The indictment notes Hantash employed estheticians to perform work, but per California law they are prohibited from performing surgeries.

Government records state in 2014 Anthem Blue Cross audited the Advanced Skin Institute. In response Hantash allegedly submitted false documents claiming he did surgeries using surgical blades. In fact, he had not. The indictment includes fraudulent billings submitted to Anthem and Blue Shield.

Then on October 4 2021, the Modesto Bee reported that Federal charges against Dr. Hantash have been dismissed after the doctor complied with a deferred prosecution agreement in the health care billing fraud case. The Department of Justice prosecuted the case in the U.S. District Court in Fresno.

Judge Dale Drozd approved a deferred prosecution agreement in September 2019 obligating Hantash to stop seeking reimbursements from insurance companies for procedures using a dermalinfusion device, unless the practice received prior approval from insurance providers.

Hantash agreed to return insurance company payments received for those procedures between January 2011 and April 2016. According to terms of the agreement, Advanced Skin Institute reimbursed $92,234 to Anthem Blue Cross and $81,515 to Blue Shield of California.

The federal case was dismissed Sept. 27.

Hantash expressed the opinion last week the criminal indictment was not justified. “This was a civil dispute and contractually should have gone to arbitration,” the physician said by email.

Federal authorities seized $687,583 in funds from an Advanced Skin Institute account in 2017. The court agreement called for returning $513,804 to Hantash’s practice after reimbursements of $173,749 to the insurance companies.