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Tag: 2022 News

Former O.C. Cop Pays Over $5.2M Restitution for Premium Fraud

The Orange County District Attorney’s Office has recovered $5.2 million in unpaid workers’ compensation payments from a former Orange County Reserve Sheriff’s Captain who intentionally underreported the number of unarmed security guards he had working for him and his payroll in order to avoid paying $17.2 million in insurance premiums. An additional $8.56 million in additional restitution is expected to be paid by the defendant when he is sentenced in May.

Simon Semaan was charged on September 8, 2021 with seven felony counts of Insurance Fraud Section 11760 – one count for each policy year in which he intentionally and falsely underreported his payroll and the number of employees to two different workers’ compensation carriers in order to substantially lower his premium payments.

Semaan was charged with the white collar crimes enhancement pursuant to Penal Code section 186.11 because the loss in the case was over $500,000. Semaan faced a maximum exposure of 16 years in state prison. OCDA seized $9 million dollars of the defendant’s assets to ensure the victims received restitution in this case.

Semaan ran Pacwest Security (d.b.a PSMG, Inc., PS, Inc., PSSA, Inc.)- a company providing licensed unarmed security guards to more than 40 clients, including Coca-Cola, the City of West Hollywood, United Port of San Diego, Cushman & Wakefield, Inc. and the Water Replenishment District of Southern California.

According to the Worker’s Compensation Insurance Rating Bureau records, Semaan carried a workers’ compensation policy for a company called PSSM, Inc. with QBE-Praetorian insurance company (QBE) between May 2013 and May 2017, and Redwood Fire and Casualty, between May 2017 and May 2020. During those seven policy years, the defendant intentionally and falsely underreported his payroll and the number of his employees to both workers’ compensation carriers in order to substantially lower his premium payments and avoid paying a combined $17 million in insurance premiums.

On March 3, 2022, Semaan pled guilty to a court offer that required him to plead guilty to all the charged counts and enhancements. In exchange the Court will sentence him to up to 365 days in custody to be served via electronic monitoring and grant him probation. The Court ordered the defendant to pay victim QBE $5.2 million and Redwood Fire and Casualty up to $8.56 million in restitution.

On March 11, 2022, Semaan paid $5.2 million dollars in restitution to QBE as ordered by the Court. Restitution payments of $8.56 million is expected to be paid to Redwood Fire and Casualty by the time Semaan is sentenced.  Sentencing is scheduled for May 13, 2022.

CMS Releases WCMSA Reference Guide Version 3.6

The Centers for Medicare and Medicaid Services (CMS) has released an updated Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (Version 3.6, March 15, 2022).

Clarification has been provided, in this new update, regarding the use of non-CMS-approved products to address future medical care (Section 4.3), as well as documentation and re-review tips (Sections 9.4.1.1 10.2, and 16.1).

By way of background, CMS added Section 4.3 into the WCMSA Reference Guide Version 3.5 in January 2022 and the agency discussed the changes as part of its recent WCMSA update webinar.

This section, titled “The Use of Non-CMS-Approved Products to Address Future Medical Care,” sets-forth CMS’s policy and position regarding what is commonly referred to as “evidenced-based” or “WCMSA non-submit” MSAs which are future medical arrangements that are not submitted by the settling parties to CMS for the agency’s review and approval, although the settlement meets CMS’s WCMSA review thresholds.

As part of Section 4.3, CMS states that they view these arrangements, as “a potential attempt to shift financial burden by improperly giving reasonable recognition to both medical expenses and income replacement” and when a settlement includes a non-CMS approved MSA, CMS may deny payment for Medicare covered medical services related to the WC injuries until it is satisfied that the entire net settlement amount was spent for claim related treatment.

After CMS introduced Section 4.3 in January, two questions that remained unclear concerned (1) whether CMS’s policy would apply retroactively or prospectively and (2) whether CMS intended this policy to apply to non-CMS approved MSAs that parties may include in settlements that do not meet CMS’s WCMSA review thresholds.

The new Reference Guide 3.6, CMS has now added language to Section 4.3 attempting to clarify these two issues.

Specifically, as to the first question, CMS has added language indicating that the policy set forth in Section 4.3 applies to “all notifications of settlement that include the use of a non-CMS-approved product received on, or after, January 11, 2022.”

Regarding the second question, CMS has added language stating that it “does not intend for this policy to affect any settlement that would not otherwise meet its WCMSA review thresholds,” although it reminds the settling parties that its “comment does not relieve the settling parties of an obligation to consider Medicare’s interests as part of the settlement.”

In the third paragraph of Section 4.3 it is noted that CMS has changed what originally read as “will” to “may at its sole discretion deny payment for medical services related to WC injuries … ”

From these changes, it appears CMS has softened the original language contained Section 4.3 released in WCMSA Reference Guide Version 3.5 which, presumably, were made to provide CMS the flexibility to assess the amount allocated in non-CMS approved MSAs.

This would seem to align with one point CMS discussed as part of its recent WCMSA webinar. Specifically, on the webinar CMS indicated that if the claimant can demonstrate that a non-CMS approved MSA was properly and fully exhausted, it may review the allocation to determine if the amount was reasonable. If the allocation is determined to be reasonable, then CMS may choose not to require full exhaustion of the net settlement amount.

However, it may be reasonable to assume that CMS is likely to apply the CMS WCMSA allocation review standards as the baseline to measure reasonableness and, consequently, unless the allocation was priced in accordance with those standards, there is significant risk that CMS would disagree with the allocation amount upon exhaustion.

CMS’s updated language in Section 9.4.1.1 stating that medical records are required, even in denied cases, is a culmination of CMS’s trend to formally tighten its review process to make the approval of zero MSAs more challenging. Further, CMS’s update to its re-review process as noted in Section 16.1 may prove particularly problematic given the current absence of a formal appeals process.

In conclusion, section 4.3’s addition to the Reference Guide can be viewed as CMS essentially putting the industry on notice that it may enforce its EBMSA/non-submit policy against applicable settlements that do not include a CMS-approved WCMSA after January 11, 2022.

Ventura Farm Labor Contractor Pleads Guilty to Premium Fraud

The Ventura County District Attorney announced that 50-year old Robert Zermeno Delara, who lives in Fillmore, pled guilty to felony workers’ compensation fraud and admitted a special allegation that the theft totaled more than $100,000.

Delara is the owner-operator of two farm-labor contracting businesses located in Ventura County, Pacific Coast Farm Labor and B&R Farm Labor. Through these businesses, Delara provides farm-labor and harvesting services to local agricultural producers who rely upon him to provide a skilled workforce while adhering to the safety and workplace injury reporting requirements of California law.

Delara was charged with three felony counts of violating Insurance Code section1871.4 for making false or fraudulent statements to discourage injured employees from seeking medical care. And was also charged with four additional felony counts of violating Penal Code section550(b)(3) for concealing or failing to disclose information that would impact his injured employees’ entitlement to benefits.

In his plea, Delara admitted to discouraging his employees from obtaining medical care for on-the-job injuries they sustained. He also admitted making material misrepresentations to his insurance carriers about the occurrence of such injuries in order to lower his insurance premiums.

At the time the case was filed, the Ventura County District Attorney’s Office Workers’ Compensation Fraud Unit obtained a court order seizing over $1 million in Delara’s bank accounts and assets in connection with the fraud. As a condition of his plea, these assets will be liquidated to pay victim restitution and fines.

Delara is scheduled to be sentenced on June 2, 2022, at 9:00 a.m. in courtroom 23 of the Ventura County Superior Court. He faces a maximum sentence of eight years in jail.

“The District Attorney’s Office will not tolerate the abuse of farmworkers in our county,” said District Attorney Erik Nasarenko. “Any employer who conceals workplace injuries to fraudulently obtain lower insurance rates will be held accountable.”

Failure to Properly Serve UR Determination Ends Ongoing RFAs

Remyna Castillo, while employed as a production line worker, sustained an industrial injury to her head and brain in 2017.

On July 9, 2019, the PTP again submitted an RFA for continuation of the outpatient services at Casa Colina. Defendant continued to provide outpatient care to applicant until July 16, 2019, when defendant’s UR denied the request based on the Medical Treatment Utilization Schedule (MTUS) guidelines for traumatic brain injury.

Defendant attempted to serve the July 16, 2019 UR determination on applicant’s attorney. However, it was served to an incorrect suite number and was not received at applicant’s attorney’s office. (8 Cal. Code Regs. § 9792.9.1; and Cal. Code Civ. Pro. § 1013(a).

The WCJ found that defendant’s improper service of the Utilization Review (UR) determination renders it invalid, and the determination of medical necessity for the treatment may be made by the Appeals Board. The WCJ found defendant is liable for continuing applicant’s outpatient physical rehabilitation, consisting of transitional living center day treatment, transportation, and interpreter services, until they are no longer reasonably required.

Reconsideration of this finding and award was denied in the panel decision of Castillo v Midnight Impressions ADJ11092501 (March 2022).

Defendant contended that the evidence does not justify the award continuing applicant’s outpatient rehabilitation, transportation, and interpreter services, arguing the WCJ exceeded his jurisdiction by primarily relying on Patterson v. The Oaks Farm, 79 Cal. Comp. Cases 910, 2014 LEXIS 98 (Patterson), to extend the provision of applicant’s outpatient physical rehabilitation “in perpetuity” circumventing its right to request an RFA.

In Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298, 1299 (Appeals Board en banc) (Dubon II), the Appeals Board held that if a UR decision is untimely, the UR decision is invalid and not subject to independent medical review (IMR).

If a UR decision is untimely, the determination of medical necessity for the treatment requested may be made by the Appeals Board.  Subsequent to Dubon II, in a significant panel decision, the Appeals Board held that a UR decision that is timely made, but is not timely communicated, is untimely. (Bodam v. San Bernardino County/Dept. of Social Services (2014) 79 Cal.Comp.Cases 1519.)

In this case, the WCJ correctly determined that the UR was invalid and that applicant should continue to receive treatment at Casa Colina because the need for continued treatment is supported by substantial medical evidence.

Applicant must still meet her burden to prove the treatment she requested is medically necessary. On this record, the WCAB panel was persuaded that applicant requires continued participation in the multi-disciplinary neuro-rehabilitation treatment program in order for her to make further improvements and sustain the progress she has made.

In a recent case, the Second District Court of Appeal denied a defendant’s Petition for Writ of Review, wherein the defendant asserted that the WCAB erred in relying on Patterson to award an applicant continued inpatient care at Casa Colina. (Nat’l Cement Co., Inc. v Workers’ Comp. Appeals Bd. (Rivota) (2021) 86 Cal. Comp. Cases 595, 2021 Cal. Wrk. Comp. LEXIS 21.)

In affirming the WCAB’s decision, the Court of Appeal stated that the applicant was not required to provide ongoing requests for authorization for his ongoing inpatient stay at Casa Colina, that defendant could not force applicant to be discharged from the facility by obtaining utilization review without showing a change in applicant’s condition or circumstance, and that applicant’s continued stay at Casa Colina absent a change in circumstances was required to prevent disruption of his medical care and promote continuity in his living situation.

Additionally, in Ferrona v. Warner Brothers (2015) 2015 Cal. Wrk. Comp. LEXIS P.D. 220, the WCAB, citing Patterson, upheld the WCJ’s decision and found that defendant was not entitled to unilaterally terminate applicant’s home health care services because there was no evidence of change in applicant’s condition or circumstances to indicate that home care services were no longer reasonably required to cure or relieve from effects of industrial injury.

EDD Faces New Scammers Sending Fake Text Messages

A new round of deceiving text messages are popping up on cell phones, sent by scammers claiming to be from the California EDD or Bank of America. According to a report by KTVU, several Californians say that in recent weeks, they have received phishing scam texts that attempt to get pin, debit card numbers, or account information related to unemployment benefits.

It’s not new. But California’s Employment Development Department warned the sophisticated schemes are still trying to trick people into clicking a link that takes them to a website that may look legitimate.

Since the start of the pandemic, $181 billion has been paid out in unemployment insurance payments. A chunk of that has gone to fraudsters, according to former EDD Director Michael Bernick. Bernick has been in close contact with officials at the EDD since the pandemic began, keeping an eye on claims, rampant fraud and department challenges.

“We’ve seen the enormous amount of money washing through the system,” he said. “I think that’s the new normal in government benefits.”

The EDD has put new identity safeguards in place over the last year, which has prevented some fraud. Bernick said unemployment insurance has long been the primary target of identity thieves, but he expects sophisticated scams to also hit disability insurance, food stamps, and welfare programs.

The EDD warned Californians to be on alert with several tips.

– – Never click a link in an unexpected text message
– – Messages asking to reactivate a debit card are scams
– – Verify if an EDD text message is legitimate by logging onto “UI Online”
– – Call Bank of America using the phone number on the back of the debit card to confirm bank-related messages
– – Do not respond to suspicious text messages
– – EDD only sends text messages from the number 510-74 or 918-06

Californians who receive suspicious cell phone or email phishing communications should report those scam attempts to the Federal Trade Commission (FTC) at ReportFraud.ftc.gov. Phishing emails can be forwarded to the FTC’s Anti-Phishing Working Group at reportphishing@apwg.org and phishing text messages can be forwarded to the FTC at 7726. You can also call the EDD Fraud Hotline at 1-800-229-6297.

CHSWC Annual Report Estimates COVID Costs at $1.25 B

The Commission on Health and Safety and Workers’ Compensation (CHSWC) examines the health and safety and workers’ compensation systems in California and makes recommendations to improve their operation. Annual Reports are prepared by CHSWC covering the performance of the California workers’ compensation system, including discussion of reforms, recent legislation, current research and data from various sources.

CHSWC just released its 294 page 2021 Report. Some of the highlights of the new report include statistics on the estimated effects on the COVID-19 pandemic on worker safety, the effects of legislation to reduce adverse effects, and the associated cost projections on the worker’s compensation system.

According to the current report, the California WC system covers an estimated 17,385,000 employees working for over 1,039,079 employers in the state. These employees and employers generated a gross domestic product of $3.01 trillion in 2020. A total of 645,409 occupational injuries and illnesses were reported for 2020,ranging from minor medical treatment cases to catastrophic injuries and deaths. The total paid cost to employers for workers’ compensation in 2020 was an estimated $18.7 billion.

The COVID-19 pandemic presents unique conditions, in which many jobs that had not been typically considered hazardous suddenly became dangerous, and the mandatory rules of claim denials were changed by the State of California. Workers at a high risk of exposure to the virus while at work received WC insurance coverage due to efforts by Governor Newsom and his administration that started as Executive Order N-62-20 and culminated in SB 1159 on September 17, 2020.

For the dates of injury from late 2019 to June 1, 2021, about 150,000 COVID-19 claims had been filed in the California WC system. Over one-half of these COVID-19 claims were filed within the insured system.

Almost half (49 percent) of all COVID-19 claims in the first year of the pandemic in 2020 were filed by women. This share was 10 percentage points higher than the average share (39-40 percent) of women in claims for all non-fatal work injuries in California. Women make up a large share of the labor force on the front lines of the pandemic and in industries and occupations that have taken particularly large hits during the COVID-19 crisis. In 2021, 44 percent of COVID-19 WC claims were filed by women and 55 percent by men. During the peak of the Omicron pandemic in January 2022, 47 percent of COVID-19 claims were filed by women and 53 percent by men.

From March 2020 to January 2022, Los Angeles (27 percent) and the Inland Empire (24 percent) regions together accounted for 51 percent of California’s COVID-19 WC claims, followed by the Bay Area (15 percent), the Central Valley (13 percent), San Diego (7 percent), and the more rural Central Coast (5 percent) and the Sacramento Valley (5 percent). The Eastern Sierra Foothills, North State- Shasta, and the North Sacramento Valley regions, comprised of several counties with a small number of claims, together accounted for 4 percent of the COVID-19 WC claims filed during the same period.

Currently the projected costs of COVID-19 claims in the insured sector for accident years 2020 and 2021 are over $1 billion in total, with over $850 million in 2020 and $210 million in 2021, when estimated using the actual claim counts and reported cost information. The estimated systemwide cost of the COVID-19 claims in 2020 is $1.25 billion.

The projected average cost of a COVID-19 claim differs significantly by the severity of the illness, increasing from $3,000 for the mild symptom cases to $382,000 for the death claims. The average cost of all COVID-19 claims based on reported information was $19,000 which is below the initial projections of $34,000 due to a higher proportion of mild claims being filed than initially projected. Also a much higher than projected share of COVID-19 claims were filed by younger workers who are more likely to have mild COVID-19 symptoms.

Potential losses are associated with aggravation of preexisting conditions and the possibility that a claimant could become a “long-hauler” (one who continues to suffer the effects of COVID-19 long after a typical recovery course). Up to an estimated 10 percent of COVID-19 cases will experience prolonged symptoms occurring across all levels of disease severity – from mild cases to those requiring hospitalization and intensive care. Management of procedures and treatments related to long-haul COVID-19 cases are considered serious medical cost drivers.

The federal National Institutes of Health launched an initiative to study the causes, means of prevention, and treatment of long-haul COVID-19 cases.

Experts Say Drugmakers Influence Clinicians One Meal at a Time

An expert in pharmaceutical policy has said that the frequent interactions between pharmaceutical companies and health professionals can pose a conflict of interest for clinicians.

Prof. Barbara Mintzes told The Epoch Times that research has demonstrated that there was a corollary between health professionals receiving a low price meal while being promoted a drug and the rate of the professional then prescribing that medication compared to generic alternatives of similar quality.

Mintzes said a common example is pharmaceutical companies sponsoring events to provide food and drinks for health professionals.

“If you survey doctors, they will say, I can’t be bought for the price of a pizza or I can’t be bought for the price of a sandwich,” Mintzes said but she noted that research in the US found physicians that receive a meal promoting the drug of interest, averaging less than $20, had a significantly higher rate of prescribing that medication compared to generic alternatives of similar quality.

The study also found a dose-response where “the more meals provided; the more likely doctors are to prescribe the product.

Mintzes noted that while the decision may not be conscious, “we’re all human and there is a tendency to reciprocity whether we’re conscious of it or not.”

“You would also expect that the companies are also looking at the returns on investment on their marketing activities and would not continue with marketing activities that were ineffective in terms of stimulating sales.”

Prior to 2015, Medicines Australia required its member companies to publicize each event they had sponsored, including information of the event such as the number of health professionals and who had attended, how much money was spent and what was spent on with spending on food and drinks by far the most common.

Additionally, from Medicines Australia’s data from 2011 to 2015, Mintzes’s team found that on average, corporate sponsored events for pharmaceuticals were being held at hospitals and universities over 600 times every week, averaging 30 attendees per event.

However, since October 2015, Medicines Australia changed its codes of conduct from requiring food and drink payments being reported to have companies only listing clinicians they provided funding for.

Whilst this enhanced transparency around the identification of individual health professionals, subsequent studies led by the University of Sydney also observed a 34.1 percent reduction in disclosed spending in 2016 and decreased expenditure reports in the year following.

Despite Medicines Australians change in 2015, Mintzes’s recent co-authored study on underreporting of conflicts of interests by health professionals has raised further questions about the limitations of a self-reported system.

The team examined Medicines Australia’s public data and found that nearly half of pharmaceutical trials with Australian authors had omitted or incomplete conflicts of interest declarations when the research team received commercial funding.

“It certainly seems that it’s not a situation where there are just like one or two bad apples, who are hiding their conflicts of interest, it seems more of a situation where it’s quite widespread,” she said.

Modesto Wastewater Surveillance Key to Early COVID Detection

William Wong, director of utilities for Modesto, oversees water and sewage operations. Since early in the pandemic, he’s wanted to monitor the city’s sewage for SARS-CoV-2. It’s a natural extension of his work.

Kaiser Health News reports that across the country, academics, private companies, public health departments, and sewage plant operators have been working to hone a new public health tool, one with uses that could reach well beyond covid.

Wastewater surveillance is not a new concept, but the scale and scope of the current pandemic have vaulted the technique over the narrow walls of academic research to broader public use as a crucial tool for community-level tracking of covid surges and variants.

Sewage surveillance is proving so useful that many researchers and public health officials say it should become standard practice in tracking infectious diseases, as is already the case in many other countries. But whether that happens – and which communities get access – depends on the nation’s ability to vastly scale up the approach and make it viable in communities rich and poor.

Like many other public health tools, wastewater testing initially took off in big cities and university towns with access to research expertise, equipment, and money. The Modesto California project offers a glimpse of the challenges and opportunities involved in making this technology available in communities with more limited resources.

In Modesto, wastewater also revealed that the delta variant remained the dominant strain well into January, weeks after omicron had taken over elsewhere. That was important, said Dr. Julie Vaishampayan, the health officer for Stanislaus County, where Modesto is located. because some of the available treatments that don’t work for omicron are effective against delta. Her department told local doctors to keep using the full range of medicines, even after other areas had narrowed their treatment arsenal.

“You should be injecting more resources in places that are underserved since they have the disproportionate burden of disease,” said Colleen Naughton, an engineering professor at the University of California-Merced who is helping set up testing in Merced, Modesto, and surrounding Central Valley farm towns.

For covid surveillance, wastewater isn’t subject to the tricky inconsistencies that come with testing for the coronavirus in humans. Covid testing shortages have been a persistent problem throughout the pandemic, stemming both from supply-chain shortfalls and wide variation in local governments’ response. Long delays in test results can leave health officials weeks behind in detecting and monitoring infection trends.

More recently, at-home tests, whose results rarely find their way to public health departments, have proliferated. And for people living in lower-resource communities, there are incentives not to test at all, said Dr. Vaishampayan. A positive test can be a huge problem for people who can’t take time off work or keep their kids out of school.

By contrast, sewage surveillance is an effective and relatively low-budget enterprise, less reliant on human whim.

Dozens of research projects around the country have shown that the method can be used to accurately track covid trends over time. Upticks and drop-offs in neighborhood- and community-level infections can appear in sludge several days before they show up in tests.

Recent research has found that wastewater surveillance is a reliable method for monitoring flu and the common respiratory illness RSV. The Centers for Disease Control and Prevention told KHN it will soon launch pilot studies to see whether sewage can reveal trends in antibiotic-resistant infections, foodborne illnesses, and candida auris, a fungal infection.

There are places where sewage may not be a great way to keep tabs on covid. That includes communities without sewers; areas with industrial sewage, where treatment techniques can mask the virus; and communities with huge fluctuations in population, such as ski towns.

But where available, the data has already proven powerful. During the winter surge caused by omicron, California, Colorado, New York, and Texas first detected the variant via sewage. Central Valley health officials have said that sewage monitoring has assured them that declines in covid cases are real, and not a distorted reflection of declines in reported testing.

IMR Reviews Hit All Time Low in 2021

A new California Workers’ Compensation Institute study on the Independent Medical Review process, used to resolve workers’ comp medical disputes, shows that the number of IMR decision letters hit an all-time low in 2021 as pharmaceutical disputes – especially those involving opioids – have continued to decline since the state adopted evidence-based chronic pain and opioid guidelines and a prescription drug formulary.

Data for CWCI’s study was derived from more than 1.1 million IMR decision letters issued from 2015 through 2021 in response to applications submitted to the state after a Utilization Review (UR) physician modified or denied a workers’ comp medical service request.

In addition to measuring changes in IMR volume, the authors used the data to measure shifts in the mix of medical services reviewed and uphold rates by major medical service category; IMR response times; regional variations; the distribution of prescription drug IMRs and uphold rates for various drug categories; the proportion of IMRs involving medical service request modifications among six service categories; and the concentration of IMRs involving high-volume medical providers.

The IMR letter count showed that since peaking at 184,735 letters in 2018, IMR letter volume has declined for three years in a row, falling to 163,899 letters in 2019, 136,738 letters in 2020, and 133,494 letters in 2021.

While some of that decline reflects decreasing claim volume in 2020 – the first year of the pandemic – the study found that much of the decline came after the Division of Workers’ Compensation (DWC) incorporated Chronic Pain and Opioid Guidelines into the Workers’ Compensation Medical Treatment Schedule in late 2017 and implemented a Prescription Drug Formulary.

Overall, there were more than 51,000 fewer IMR letters in 2021 than in 2018, with more than half of that decline occurring in 2020, when IMR letter volume fell by more than 27,000 letters.

Since 2018, IMR letter counts have been down across all medical service categories, though the huge reduction in IMR disputes involving prescription drug requests has led to a redistribution of IMRs among the major medical service categories.

The biggest percentage increases have been in physical therapy; injections; and durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), each of which saw their share of the IMR letters increase by 2.4 to 3.1 percentage points since 2018. Last year’s overall IMR uphold rate of 92.0 percent was up from 89.4 percent in 2020 and was the highest uphold rate since IMR took effect in 2014, though here too the results varied by medical service category, with uphold rates ranging from 84.9% to 95% among the different categories.

The study’s regional analysis identified areas of the state where 2021 IMR letter volume was high or low relative to each region’s workers’ compensation claim volume.

Los Angeles County, widely known as a hotbed for workers’ compensation litigation, accounted for 24.7% of California’s 2021 workers’ comp claims and 27.6% of the IMR letters, while in contrast, IMR letter volume was disproportionately low in the Inland Empire/Orange County region, which had 20.7% of the state’s claims but 13.9% of the IMR letters.

Surprisingly, the greatest disparity between claim volume and IMR letters was in the San Francisco Bay Area, which had 17.8% of the claims but 25.7% of the IMR letters. The study notes that one factor that likely contributed to that disparity is the prevalence of pain management specialists in the Bay Area.

A review of the doctors with the highest number of IMR disputes last year showed that five of the top six in the state were pain management specialists, and four of the top six were located in the Bay Area, which would at least partially explain the disproportionate share of IMR letters – especially those involving prescription drug disputes – sent to the region.

Scientists Unsure if BA.2 Variant Will Cause Another U.S.Surge

A new omicron subvariant of the virus that causes COVID-19, BA.2, is quickly becoming the predominant source of infections amid rising cases around the world. A new article in the Ventura County Star provided a closer look at what makes it different from previous variants, whether there will be another surge in the U.S. and how best to prepare.

BA.2 is the latest subvariant of omicron, the dominant strain of the SARS-CoV-2 virus that causes COVID-19. While the origin of BA.2 is still unclear, it has quickly become the dominant strain in many countries, including India, Denmark and South Africa. It is continuing to spread in Europe, Asia and many parts of the world.

The omicron variant has three main subvariants in its lineage: BA.1, BA.2 and BA.3. The earliest omicron subvariant to be detected, BA.1, was first reported in November 2021 in South Africa. While scientists believe that all the subvariants may have emerged around the same time, BA.1 was predominantly responsible for the winter surge of infections in the Northern Hemisphere in 2021.

Some scientists have called BA.2 a “stealth” variant because, unlike the BA.1 variant, it lacks a particular genetic signature that distinguishes it from the delta variant. While standard PCR tests are still able to detect the BA.2 variant, they might not be able to tell it apart from the delta variant.

BA.2 is considered to be more transmissible but not more virulant than BA.1. This means that while BA.2 can spread faster than BA.1, it might not make people sicker.

A recent preliminary study that has not yet been peer reviewed of over 1 million individuals in Qatar suggests that two doses of either the Pfizer-BioNTech or Moderna COVID-19 vaccines protect against symptomatic infection from BA.1 and BA.2 for several months before waning to around 10%. A booster shot, however, was able to elevate protection again close to original levels.

Importantly, both vaccines were 70% to 80% effective at preventing hospitalization or death, and this effectiveness increased to over 90% after a booster dose.

CDC data suggests that BA.2 cases are rising steadily, making up 23% of all cases in the U.S. as of early March. Scientists are still debating whether BA.2 will cause another surge in the U.S.

Though there may be an uptick of BA.2 infections in the coming months, protective immunity from vaccination or previous infection provides defense against severe disease. This may make it less likely that BA.2 will cause a significant increase in hospitalization and deaths.

The U.S., however, lags behind other countries when it comes to vaccination, and falls even further behind on boosters.

Whether there will be another devastating surge depends on how many people are vaccinated or have been previously infected with BA.1. It’s safer to generate immunity from a vaccine, however, than from getting an infection.