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Tag: 2021 News

Physician Dispensed Pain Dermatologicals New Cost Driver

A new FlashReport from the Workers Compensation Research Institute (WCRI) finds that in most states, dermatological agents and nonsteroidal anti-inflammatory drugs (NSAIDs) have become more important than other drug groups as a share of total prescription payments. The 28 states in the study include California.

“This study finds that prescription payments are decreasing in a majority of state workers’ compensation systems, but prescription payments continue to vary widely,” said John Ruser, president and CEO of WCRI. “This study breaks prescription drugs into groups (dermatological agents, NSAIDs, opioids, compounds, etc.) so you can see where workers’ compensation prescribing dollars are being spent and whether spending for those groups of drugs is going up or down.”

The following is an abbreviated list of the study’s other findings:

– – Dermatological agents: Per-claim payments varied widely, from $7 per claim in Iowa to $181 per claim in Illinois and $190 per claim in Louisiana in 2020Q1. Physician dispensing accounted for the majority of payments for the drug group in 12 of the 28 study states. Between 2017Q1 and 2020Q1, payment shares increased by more than 10 percentage points in 5 states (Connecticut, Kansas, Louisiana, South Carolina, and Virginia) and physician dispensing contributed to the rapid growth.
– – NSAIDS: Payment shares for this drug group changed little in many states, but per-claim payments varied widely in 2020Q1, from $21-$22 per claim in Delaware and Massachusetts to $126 per claim in Louisiana.
– – Anticonvulsants: Both payment share and per-claim payment for this group decreased in many states over the study period. The decrease happened mostly between 2019Q2 and 2019Q3, when generic formulations of Lyrica® became available.
– – Opioids: The substantial decline for opioids during the study period continues the declines seen in previous periods. The per-claim payments for opioids decreased by 56 percent in the typical state, and the rate of reduction ranged from 40 percent in Louisiana to 81 percent in California.

In the dermatological category, prescriptions for diclofenac sodium gel accounted for the majority of the prescriptions in the median state, Vennela Thumula, policy analyst for WCRI said, and lidocaine was also commonly prescribed.

While about 56% of the workers prescribed topical diclofenac had documented diagnoses of soft tissue injuries of joints – for which the drug is approved – about 40% of workers were using it for treatment not recommended, often for shoulder and back pain, she said.

Another cost driver in dermatologicals is private-label topicals, which are independently manufactured and not recommended by evidence-based guidelines and also have a much higher price tag compared to comparable products” approved by the Official Disability Guidelines Workers’ Compensation Drug Formulary, also known as ODG, Ms. Thumula said.

Among claims with topicals, private-label topicals are rarely dispensed in half of the study states, but at least a third of the claims have private-label topicals in Louisiana, New Mexico, Maryland, Illinois and South Carolina, and it’s even higher in Delaware,” she said.

Cal/OSHA Delays Changes to Emergency Temporary Standards (ETS)

On May 19, 2021, the eve of a vote by the Occupational Safety and Health Standards Board to adopt proposed substantial changes to the existing Cal/OSHA COVID-19 Emergency Temporary Standards (ETS), Eric Berg, Deputy Chief of Cal/OSHA, asked that the Standards Board not vote the next day, on May 20, 2021, to adopt Cal/OSHA’s proposed ETS revisions.

Berg asked that the Standards Board allow Cal/OSHA to present a new proposal at a future meeting with a targeted effective date of June 15, 2021, for its new proposal.

May 13, 2021, the U.S. Centers for Disease Control and Prevention (CDC) updated its guidance to allow fully-vaccinated individuals to forego masks in some situations.

Cal/OSHA also explained that four days after the CDC’s announcement, on May 17, 2021, the California Health & Human Services Agency secretary had expressed that California intended to implement the CDC’s masking guidance on June 15, 2021. This is the same date that Governor Newsom announced as the state’s goal for reopening California’s economy fully.

However, labor officials and worker advocates are pushing back against adoption of the loosened masking guidance for fully vaccinated individuals.

Cal/OSHA had published the draft ETS proposal on May 7, 2021. Labor law lawyers say that these new developments appear to be the reason that Cal/OSHA asked that the Standards Board not adopt the draft ETS proposal on May 20, 2021. Given the recent CDC guidance and California’s impending reopening, Cal/OSHA appears to be reconsidering the proposal it wishes to present to the Standards Board.

For now, the Society for Human Resource Management (SHRM) recommends that while we wait for new proposed revisions to Cal/OSHA’s ETS, it is important to remember that California employers are still under the current safety standard – which makes no accommodation for fully vaccinated employees when it comes to masking.

The only loosened restriction that California employers may currently follow is the updated guidance easing quarantine restrictions for fully vaccinated asymptomatic employees in non-healthcare workplaces.

Foster Farms and Staffing Agencies Cited for COVID Violations

Cal/OSHA has cited Foster Poultry Farms, Inc. in Livingston (Foster Farms) and four staffing agencies for not protecting workers from COVID-19.

Cal/OSHA opened its inspection after receiving notification that an employee had died from COVID-19 complications, and subsequently determined that Foster Farms and one of its staffing agencies did not timely report the COVID-19 fatality as required.

Cal/OSHA also opened a separate inspection at the facility’s distribution center. Foster Farms utilized employees from the following staffing agencies that were also cited for COVID-19 violations.

– – Foster Poultry Farms, Inc. – (Poultry Plant) – $103,100.
– – Foster Poultry Farms, Inc. – (Distribution Center) – $78,400.
– – Human Bees, Inc., DBA Human Bees – (Staffing) – $41,000.
– – Marcos Renteria Ag Services, Inc. – (Staffing) – $36,000.
– – Intermountain Employment Services, DBA Ascend – (Staffing) – $18,000.
– – Staffing Solutions Inc. DBA Balance – (Staffing) – $16,200.

Cal/OSHA cited Foster Farms $103,100, for five serious, one repeat regulatory, and two regulatory violations at its Livingston plant; and $78,400 for three serious, one repeat regulatory, and two regulatory violations at the distribution center.

Regulatory violations were issued in both Foster Farms inspections and to Human Bees, Inc. for their failure to timely report work-related fatalities. Additionally, Cal/OSHA issued serious violations related to their Injury and Illness Prevention Programs many of which stemmed from failing to properly communicate, assess, correct, and train on COVID-19 workplace hazards.

The third serious violation at the plant was cited for a blocked eyewash station.

A full list of employers cited for COVID-19 violations is posted on Cal/OSHA’s website.

WCAB Reversed for Ignoring Supreme Court COLA Case

Charles Hart worked for Town Los Gatos as an engineering inspector.

On August 19, 2003, while inspecting a construction site, Hart slipped, fell onto a pile of rebar, and injured his lower back. Town accepted liability for the claim. Hart was off work for eight days – from August 20 until August 27, 2003 – and returned to work on full duty. Hart was off work again for 30 days in 2004 – from July 10 until August 8, 2004 – and returned to work on full duty. Hart continued to work for Town until he retired on December 11, 2009, at age 68.

The case went to trial before a WCJ in 2017. Since Hart’s date of injury and the last day for which TD benefits had been paid were both before January 1, 2005, the WCJ held that Hart’s PD was to be rated under the 1997 permanent disability rating schedule, which is not based on the Guides and relies on a different system to rate work related impairments.

Hart’s vocational rehabilitation expert opined that Hart was unable to obtain and sustainably retain competitive gainful employment and that he was not amenable to vocational rehabilitation services.

The WCJ found the injury caused 100 percent PD and awarded Hart total PD payments of $602 per week for life. Since he was injured after January 1, 2003 and was awarded 100 percent PD, the WCJ found that Hart was entitled to annual COLA’s on his total PD benefits, permanent and stationary in May 2011, his first COLA was due on January 1, 2012 and every January 1 thereafter.

The WCJ cited Duncan v. Workers’ Comp. Appeals Bd. (2009) 179 Cal.App.4th 1009 (Duncan) in support of his COLA award which was, overruled in by the California Supreme Court in Baker Workers’ Comp. Appeals Bd. (2011), 52 Cal.4th 434 at page 437. eight years before the WCJ made his award.

Town petitioned for reconsideration, and argued that the WCJ erred in ordering the COLA to start on January 1, 2012 and that the correct start date for the COLA was January 1, 2017 (the January 1st after Hart’s TD benefits ended and he became entitled to receive total PD benefits). Reconsideration of this issue was denied with the WCAB failing to discuss the effect of Baker overruling Duncan.

The Court of Appeal Reversed in the unpublished case of Town of Los Gatos v W.C.A.B.

The Court of Appeal ruled that the “WCAB’s decision regarding the start date for the section 4659 COLA’s was clearly erroneous.”  Based on the plain language of section 4659(c), the Supreme Court held that to “receive the benefit of a COLA on any given January 1, a worker who has sustained an industrial injury must meet two conditions.

First, he or she must have been injured ‘on or after January 1, 2003 . . . .’ ” (Baker, supra, 52 Cal.4th at p. 443, quoting § 4659(c).) Hart meets that condition since he was injured on August 19, 2003. Second, the injured worker “must ‘become entitled to receive a life pension or total permanent disability indemnity . . .’ ” (Baker, at p. 443.)

“Town argues that the WCAB erred by failing to follow binding Supreme Court precedent in Baker. We agree. Indeed, as noted, rather than cite Baker in his opinion on decision in 2020, the WCJ relied on Duncan, supra, 179 Cal.App.4th 1009, which was superseded by a grant of review in 2010 and overruled in Baker in 2011. Even after that error was briefed by Town in its petition for reconsideration, the WCJ (and the WCAB) continued to ignore Baker. “

So.Cal. Orthopedist to Serve 15 Months for $623K In Kickbacks

An orthopedic surgeon was sentenced to 15 months in federal prison for accepting nearly $623,000 in bribes and kickbacks in exchange for referring his patients to receive spinal surgeries at a corrupt Long Beach hospital.

Dr. Jeffrey David Gross, 55, who resides in Dana Point and Las Vegas, was sentenced by United States District Judge Josephine L. Staton, who also ordered him to forfeit $622,936. Gross pleaded guilty in August 2020 to one felony count of conspiracy to commit honest services mail and wire fraud.

The kickback scheme centered on Pacific Hospital in Long Beach, which specialized in surgeries, especially spinal and orthopedic procedures. The owner of Pacific Hospital, Michael D. Drobot, conspired with doctors, chiropractors and marketers to pay kickbacks in return for the referral of thousands of patients to Pacific Hospital for spinal surgeries and other medical services paid for primarily through the California workers’ compensation system.

During its final five years, the scheme resulted in the submission of more than $500 million in fraudulent medical bills. To date, 15 defendants have been convicted for participating in the kickback scheme.

From 2008 to 2013, Gross, a licensed neurosurgeon who operated Oasis Medical Providers Inc. in Laguna Niguel, agreed with Drobot to participate in a scheme to defraud patients of their right to honest services by accepting bribes and kickbacks that were paid to induce Gross to refer patients to Pacific Hospital for spinal surgeries and other medical services.

In February 2008, Gross agreed with Drobot to sublease Oasis’s medical office space to a Pacific Hospital-affiliated company, Pacific Specialty Physician Management Inc. (PSPM), in return for monthly payments of $15,000. In November 2008, Gross entered into an option contract with PSPM in which Oasis was paid $15,000 per month to purchase the accounts receivable and all other tangible assets of Oasis.

For both the sublease and option agreements, Gross knew and understood that one purpose of the agreements was to induce him to bring certain spinal surgery patients to Pacific Hospital, though that information wasn’t specified on the lease agreement, nor did Gross disclose that information to his patients.

PSPM paid Oasis $145,000 under the sublease agreement and $105,000 under the option agreement.

In April 2009, Gross entered into an outsourced collections agreement with Pacific Hospital that called for him to assist with collections on some of the spinal surgery cases that he performed at that hospital in exchange for 15 percent of any amounts the hospital collected in relation to those surgeries. This agreement, later amended, called for Gross to be paid 10 percent of the collected amount on other outpatient surgeries. During surgeries, if Gross used hardware from International Implants (I2), a Drobot-formed hardware distribution company, he was advanced $5,000 regardless of subsequent collections. Once again, Gross did not disclose this information to his patients. Pacific Hospital paid Oasis $372,936 under this agreement.

In total, between April 2008 and May 2013, Drobot paid Gross $622,936 pursuant to these agreements. During the same period, Gross referred dozens of patients to Pacific Hospital for spinal surgeries based in part on payments made to him under those agreements.

Worker’s Injury Suit Against Employer Dismissed

Christopher Renfro filed suit against numerous defendants primarily for injuries he allegedly sustained after being exposed to agricultural chemicals while employed as a truck driver.

He sued his former employer, Young’s Commercial Transfer, Inc. (YCT), as well as a host of other defendants who were involved in the application of the chemicals. These other defendants are Lakeland Aviation, Inc.; Erik J. Hansen; H&G Farms, Inc.; J.G. Boswell Co.; J.G. Boswell Tomato Co-Kings; and J.G. Boswell Tomato Co-Kern.

He contended that during his employment, YCT on multiple occasions sent him to pick up loads of tomatoes in an area where the Applicators were applying agricultural chemicals to fields via an airplane. YCT allegedly should have known of the Applicators’ crop-dusting activities. Renfro claimed his exposure to the chemicals caused multiple injuries, including injuries to his nervous system and internal organs, vision impairment, and memory loss.
YCT was represented by one law firm, and the Applicators were represented collectively by another firm. In addition to the personal injury-related claims, Renfro alleged various labor and employment-related causes of action.

The trial court granted YCT’s demurrer to Renfro’s third amended complaint, Renfro was allowed leave to amend only as to his non-personal injury causes of action. Renfro failed to file a fourth amended complaint within the time allowed. motions were brought by ex parte application. The court entered judgments of dismissal for the defendants, and Renfro appeals from both judgments.

The Court of Appeal affirmed the dismissal in the unpublished case of Renfro v. J.G. Boswell Co.

A plaintiff’s failure to file an amended complaint within the time specified by the trial court after a demurrer is sustained with leave to amend subjects the action to dismissal “in the court’s discretion under section 581, subdivision (f)(2).”

Rule 3.1320(g) affords a plaintiff 10 days’ leave to amend their complaint following a ruling on a demurrer unless otherwise ordered. Section 1013, subdivision (c), provides, as relevant here, that service by Express Mail is deemed complete at the time the notice is deposited for pick up and extends any period of notice by two court days. As such, Renfro had 10 days plus two court days from April 10 – the date the order was deposited in the mail for delivery via Express Mail – to file his fourth amended complaint. The deadline was therefore April 24.

Rule 3.1320(h) authorizes a section 581, subdivision (f)(2), motion to be made by ex parte application.

SCIF to Install 150 Solar EV Charging Stations at 7 Facilities

State Compensation Insurance Fund announced that construction has begun on an extensive sustainability and solar energy program that includes solar, electric vehicle charging stations and energy storage at seven locations throughout California.

Designed and constructed by ENGIE North America, through its affiliate ENGIE Services U.S. Inc., and JLL, State Fund will install 9.8 MW of solar, 2 MW/4.3 MWh of energy storage and 150 Level II and DC charging stations, offsetting nearly 230,000 metric tons of green-house-gas emissions over a 20-year period and saving nearly $65,000,000 in energy costs over the life of the project.

“Breaking ground on this project is a huge step forward in our drive to reduce our use of fossil fuels, limit the load we place on local and statewide electrical grids, and improve air quality throughout California,” said Andreas Acker, Executive Vice President and Chief Administrative Officer at State Fund. “Increasing our efforts and investments around sustainability initiatives will bring a number of benefits to our customers, employees, and California as a whole.”

The State Fund construction sites are located in Vacaville, Pleasanton, Redding, Fresno, Bakersfield, Sacramento and Riverside. The portfolio of solar projects is projected to produce 311 GWh over 20 years, enough to power more than 26,500 homes, and provide a reduction in CO2 emissions equivalent to taking 47,000 gas vehicles off the road.

“In addition to supporting State Fund’s greater environmental strategy, the construction helps the California economy during this critical time for recovery after the pandemic,” said Courtney Jenkins, General Manager and Vice President for Cities & Communities at ENGIE North America. “State Fund is truly a partner that aligns with ENGIE’s mission to help our customers decarbonize and optimize energy use.”

State Fund’s EV charging stations will be available to its employees and used by the company’s fleet vehicles. State Fund’s fleet currently includes eight battery electric vehicles, three of which are new long-range BEVs that allow employees to travel between State Fund locations while lowering their reliance on fossil fuels.

“JLL is proud to play an active role in initiatives that support adoption of renewable and sustainable energy like State Fund’s, a trend whose adoption is quickly accelerating,” said Kyle Goehring, Executive Vice President, JLL Clean Energy Solutions. “As a global company, we have an inherent responsibility to drive sustainability and corporate social responsibility efforts. We embrace technology to meet the needs of today and opportunities of tomorrow.”

San Diego County Targets Employers for Labor Violations

A series of proposals under consideration by the San Diego County Board of Supervisors aim to rein in workplace abuses that disproportionately impact immigrant workers in many of the same industries identified during the pandemic as essential.

According to the report in Voice of San Diego, elected officials directed county staff in March to come up with an ordinance that requires subcontractors on development projects approved by the county to publicly disclose more information, including proof that they have workers’ compensation insurance.

In May, Chairman Nathan Fletcher also recommended the creation of a new Office of Labor Standards and Enforcement to “correct patterns we see over and over again” in workplaces.

Labor leaders and workers told Voice of San Diego they’ve seen or experienced exploitation that includes not being paid for all the hours they worked and not being allowed to take days off when sick or injured.

The task of documenting such abuses has typically fallen on advocacy groups and unions, not law enforcement. With both proposals, though, the county is signaling that it’s taking workplace violations more seriously and trying to serve as a bridge between prosecutors and workers who often feel they can’t come forward because it might get them fired or even deported.

The construction industry relies heavily on unauthorized immigrants as workers, said Kimberley Robidoux, a local attorney who works on immigration employment matters with companies.

In other industries, like agriculture, there have even been documented abuses of workers with visas, which led the U.S. Government Accountability Office to call for increased protections of foreign workers.

A janitorial company, Prizm Janitorial Services, has also come under fire locally for wage theft – and it did so while under city contract.

A 2016 audit of Prizm found the city had paid Prizm roughly $600,000 for janitorial services, inewsource reported, but its payroll records showed it only paid its workers about $200,000.

The company, according to the audit, required workers to get their own business licenses, so they could be classified as independent contractors. The audit also found the company paid some employees in cash with handmade receipts for which it couldn’t provide stubs. Employees weren’t given sick leave or paid overtime.

In addition to the efforts at the county to make contracting more transparent, there’s also an effort in the Legislature to punish employers who intentionally steal from their workers. A bill written by Assemblywoman Lorena Gonzalez would make employers criminally liable for wage theft totaling $950 during a consecutive 12-month period. The California Chamber of Commerce, a statewide business group, was initially against the bill, but dropped its opposition last month at a hearing.

One notable study in 2008 surveyed more than 4,000 workers in the three biggest labor markets: New York, Los Angeles and Chicago. It found that the core protections many Americans take for granted – including access to workers’ compensation when injured – barely exist in retail, restaurants, home health care and construction, to name a few.

WCRI Releases 13th Edition of Medical Price Index

The Workers Compensation Research Institute released an updated version of its study that helps compare prices paid for medical professional services across 36 states and monitor price changes from 2008 to 2020, which includes the beginning months of the COVID-19 pandemic.

“The study shows how prices paid for these services compare across states, how the prices have changed, and whether price growth is part of a broader phenomenon or unique to a state. The study also discusses the price comparison results and price trends in relation to the principal policy mechanism for regulating prices – fee schedules,” said Ramona Tanabe, WCRI’s executive vice president and counsel.

The study, WCRI Medical Price Index for Workers’ Compensation, 13th Edition (MPI-WC), focuses on professional services (evaluation and management, physical medicine, surgery, major and minor radiology, neurological testing, pain management injections, and emergency care) billed by physicians, physical therapists, and chiropractors. The following are among the study’s findings:

– – Prices paid for a similar set of professional services varied significantly across states, ranging from 29 percent below the 36-state median in Florida to 167 percent above the 36-state median in Wisconsin in 2020.
– – States with no fee schedules for professional services had higher prices paid compared with states with fee schedules – 44 to 179 percent higher than the median of the study states with fee schedules in 2020.
– – Most states with no fee schedules experienced faster growth in prices paid for professional services compared with states with fee schedules—the median growth rate among the non-fee schedule states was 37 percent from 2008 to 2020, compared with the median growth rate of 9 percent among the fee schedule states.
– – Eight study states (Arizona, Illinois, Kentucky, Massachusetts, New York, North Carolina, Texas, and Virginia) had substantial changes (i.e., an increase or a decrease of 10 percent or more) in overall prices paid following major fee schedule changes during the study period.

This edition covers 36 states that represent 88 percent of the workers’ compensation benefits paid in the United States. These states are Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wisconsin.

The authors of this study are Dr. Rebecca Yang and Dr. Olesya Fomenko. To download a FREE copy of this report, visit WCRI’s website.

New Medical-Legal Fee Schedule Predicted to Cost $270M

A review of information by Business Insurance predicts that the new medical-legal fee Schedule changes could increase costs by as much as $270M.

The modifications to the medical-legal fee schedule are predicted to increase fees for such reviews by 22%, according to the WCIRB.

Modifications to E&M services reimbursements, which account for about 15.9% of overall medical costs in the California workers comp system, including self-insureds, could have an estimated system impact of $170 million, WCIRB analysts said. The change to medical-legal review reimbursements, which comprise about 6.5% of overall medical costs, could have an estimated $100 million system impact.

While the E&M system increases stem mainly from changes in procedure codes, about 11% of the potential price increase in medical-legal reviews comes from a record review reimbursement overhaul that has many defense attorneys concerned.

The prior schedule, which had been in place since 2006, had paid QMEs an hourly fee. The new schedule, introduced by the California Division of Workers Compensation in February, will pay QMEs a flat fee of $2,015 for a comprehensive case review plus an additional $3 per page for any records in excess of 200 pages.

Often medical records contain duplicative and irrelevant material which applicant and defense attorneys may not necessarily exclude from the materials sent to the evaluator, thus driving up the costs. Additionally, both sides may send the QME the same records which are included in the page count.

“Taking all of this together, this is not particularly good news for the California workers compensation system, and it’s coming just as the small businesses and the economy overall are trying to recover from COVID,” said Robert Hartwig, clinical associate professor and director of the Risk and Uncertainty Management Center at the University of South Carolina in Columbia.