Tag: 2022 News

The Omicron BA.2 sub-variant, also dubbed “stealth Omicron,” has been detected in at least 40 countries worldwide.

Labs in countries including Denmark and Norway have reported that the sub-variant has been gaining ground, accounting for nearly half of all COVID cases in the former as of January 20, marking a sharp increase in recent weeks.

In a press release issued last Friday, the U.K.’s Health Security Agency (HSA) said that the Omicron variant sub-lineage known as BA.2 has been designated a variant under investigation by the Agency.

The Agency went on to report that In total, 40 countries have uploaded 8,040 BA.2 sequences to GISAID since 17 November 2021. At this point it is not possible to determine where the sublineage may have originated.

The first sequences were submitted from the Philippines, and most samples have been uploaded from Denmark (6,411). Other countries that have uploaded more than 100 samples are India (530), Sweden (181), and Singapore (127).

Dr Meera Chand, COVID-19 Incident Director at UKHSA, said “It is the nature of viruses to evolve and mutate, so it’s to be expected that we will continue to see new variants emerge as the pandemic goes on. Our continued genomic surveillance allows us to detect them and assess whether they are significant.”

A press release from Denmark’s Statens Serum Institut (SSI) infectious disease research institution last week stated that the subvariant BA.2 accounted for 20% of all covid-19-cases in Denmark in December. And other countries also experience an increase in BA.2 cases: E.g. Great Britain, Norway and Sweden

One notable aspect of BA.2 is that it lacks a genetic characteristic that scientists had used to identify Omicron cases previously -giving credence to its “stealth Omicron” monicker.

However, Cornelius Roemer, a computational biologist at the University of Basel in Switzerland, posted to Twitter that BA.2 is still detectable on PCR tests and branded news reports to the contrary as “totally wrong.”
“Depending on the PCR test used it may not look like BA.1 (the other Omicron). But it will still give a positive result,” he added.

Insurance Commissioner Ricardo Lara has been under fire since 2019, when news media reported questionable campaign contributions from associates of Applied Underwriters, while Applied was under investigation by the CDI, and seeking approval of the sale of the company..

Lara reported accepting more than $50,000 in donations from insurance company executives and their apparent spouses, according to a 2019 San Diego Union-Tribune analysis of campaign funding data.

At that time, Lara reported $31,000 in contributions from Stephen Acunto and his wife, Carole. Acunto is president of CINN Group, a New York publishing and financial services firm. Acunto, who also has served as a spokesman for Applied Underwriters.

The donations from the Acuntos to Lara came on April 30 2019, one month before Applied Underwriters alerted the California Department of Insurance that the company was in the process of being sold.

Although most news media discontinued following the story, Consumer Watchdog pursued the investigation with Freedom of Information Act requests. The requests were follow up by a Public Records Act lawsuit, brought by attorneys for Consumer Watchdog was filed in early 2020. Consumer Watchdog is a non-profit public interest organization.

And the lawsuit provided evidence this month that Lara and top lieutenant Bryant Henley communicated with two former lawmakers representing a workers’ compensation insurer at the heart of a pay-to-play scandal. The communications occurred while a high-profile merger and other regulatory matters involving the insurer were pending before the California Department of Insurance.

A new declaration from former legislator-turned-lobbyist Rusty Areias confirms that Commissioner Lara and Special Counsel Bryant Henley were in contact with Mr. Areias and former Assembly Speaker Fabian Nunez, Lara’s friend and political mentor. The declaration states that Areias and Nunez identified themselves as representing Applied Underwriters, the workers’ compensation insurer that directed tens of thousands of dollars in campaign donations to Lara’s 2022 re-election campaign.

The communications occurred around the time Henley intervened in at least four proceedings on Commissioner Lara’s behalf to benefit Applied Underwriters. When the scandal became public in mid-2019, Lara returned the campaign contributions, stating “I believe in transparency….. I believe effective public service demands constant adherence to the highest ethical standards.”

Despite Commissioner Lara’s pledge of “transparency,” Consumer Watchdog says the the Department of Insurance failed to search for, let alone produce, records of meetings and communications with individuals “representing” the workers’ compensation insurer, including Nunez and Areias.

According to Mr. Areias’s declaration, submitted under penalty of perjury, Nunez and Areias began communicating with Commissioner Lara and Bryant Henley as early as February 2019. Yet, not a single record of meetings or phone calls between Nunez and Areias and Lara and Henley or other Department staff has been disclosed – no phone records, no calendar entries, no emails or text messages.

Nunez and Areias have emerged as central figures in the scandal following a lawsuit filed by Fabian Nunez’s former lobbying firm to collect a $2 million “success fee” from Applied Underwriters related to the sale of the company. The payment was to be made in exchange for Nunez and Areias’s successful efforts to protect a $60 million deposit.

The declaration of Mr. Areias was filed in Los Angeles Superior Court with a motion seeking to compel the Department to produce 200 internal communications regarding Consumer Watchdog’s public records requests. Consumer Watchdog expects that “these communications likely reflect the Department’s decision to withhold key information from the public.” This Motion is scheduled for April 27, 2022 at 9:30 a.m. Department 86 of the Los Angeles Superior Court.

In a first-of-its kind study, Ametros found that over 34,000 claims per year were denied to Medicare beneficiaries’ post-settlement because Workers’ Compensation Medicare Set Aside (WCMSA) funds were responsible for the payments.

Following settlement resolution of a workers’ compensation claim, the MSA may only be used to “…pay for medical treatment or prescription drugs related to [the underlying] claim, and only if the expense is for a treatment or prescription Medicare would cover. This is true even if you are not yet a Medicare beneficiary… ” See Self-Administration Toolkit for WCMSAs, v1.3, Sec. 4 & WCMSA Reference Guide, Sec. 17.3

An MSA administrator is responsible for accurate record keeping of payments made from the account. On an annual basis, within 30 days from the anniversary of the settlement, the administrator reports attestation information to CMS. This attestation is a “statement that payments from the WCMSA account were made for Medicare-covered medical expenses and Medicare- covered prescription drug expenses related to the work- related injury, illness, or disease.” (WCMSA Reference Guide, v3.5, Sec. 17.5). An attestation is also reported in instances where an annuitized MSA has been temporarily depleted prior to annual re-funding of the account as well as when an account is permanently exhausted. Id.

The Centers for Medicare and Medicaid Services (CMS) has long warned that it requires WCMSA funds to be used appropriately before Medicare benefits will pay for injury-related treatment. CMS’s WCMSA Reference Guide states in Section 17.3 “Medicare will deny all [workers’ compensation] injury-related claims until the WCMSA administrator can demonstrate appropriate use equal to the full amount of the WCMSA.”

Despite this, many in the industry have questioned whether Medicare ever denies claims. Ametros decided to find out.

Collaborating with ResDac researchers, Ametros analyzed Medicare Part B claim data from 2018-2020 and has published “A Study of CMS Policy on Treatment Denials for Injured Workers with a Medicare Set Aside.”

Examining a random sample of five percent of the Medicare beneficiary population over a three-year period, researchers estimated Medicare denied 35,980 WCMSA claims in 2018, 36,060 in 2019, and 30,720 in 2020 because the individual’s WCMSA account should have paid the claims.

The report provides a state-by-state chart of denial breakdowns along with definitions and explanations of the Medicare Secondary Payer and MSA terms, how CMS tracks MSAs, and MSA post-settlement administration and compliance obligations.

Almost a third of all denials were in California, which has a robust workers’ compensation claim volume. Less populated states like Indiana, Colorado, and Maryland also had a substantial amount of denied claims.

The data shows a robust tracking system is in place for Medicare to identify and deny payment when an individual with an MSA submits a claim and they have properly attested to exhausting their funds.

The report concludes by saying “it’s evident that individuals who choose to self-administer risk being denied future treatments and services by Medicare because they have not properly complied with Medicare’s guidelines. This includes setting up their account incorrectly or not using their MSA settlement funds appropriately.”

Ametros will present the study’s findings in a February 15 webinar hosted by John Kane, Shawn Deane, and Jayson Gallant starting at 1 p.m. EST. Register here.

The Division of Workers’ Compensation announces its emergency regulation for Medical-Legal Evaluations became effective on January 18, 2022 and will expire on July 19, 2022.

There are two possible 90 day extensions (in accordance with Government Code section 11346.1(h)).

The emergency regulations can be found on the DWC website.

The regulation allows a QME or AME to complete a medical-legal evaluation through telehealth when a hands on physical examination is not necessary and all of the following conditions are met:

– – There is a medical issue in dispute which involves whether or not the injury is AOE/COE (Arising Out of Employment / Course of Employment), or the physician is asked to address the termination of an injured worker’s indemnity benefit payments or address a dispute regarding work restrictions; and
– – There is agreement in writing to the telehealth evaluation by the injured worker, the carrier or employer, and the QME. Agreement to the telehealth evaluation cannot be unreasonably denied. If a party to the action believes that agreement to the telehealth evaluation has been unreasonably denied under this section, they may file an objection with the Worker’s Compensation Appeals Board, along with a Declaration of Readiness to Proceed to set the matter for a hearing;
– – The telehealth evaluation conducted by means of a virtual meeting is consistent with appropriate and ethical medical practices, as determined by the QME and the relevant medical licensing board; and
– – The QME attests in writing that the evaluation does not require an in person physical exam.

During the time this regulation is in effect, section 34(b) of title 8 of the California Code of Regulations is suspended, and for purposes of QME telehealth evaluations conducted under this regulation, the medical office listed on the panel selection form for the QME shall be deemed the site of the telehealth evaluation.

For all other telehealth evaluations conducted under this regulation, the medical office of the physician that is within a reasonable geographic distance from the injured worker’s residence shall be deemed the site of the telehealth evaluation.

A continuing crush of patients in the South Bay became so severe Tuesday that the San Diego region’s two main medical facilities declared internal disasters, a term used to indicate that conditions have worsened to the point where patient care may be affected.

According to the report in the San Diego Union Tribune, Chris Van Gorder, chief executive officer of Scripps Health, said that the emergency department at Scripps Mercy Hospital Chula Vista had 73 patients mid-afternoon filling its 24 emergency beds and 23 more inside tents in the parking lot. Twenty more were in beds set up in emergency room hallways with additional spaces taken in areas traditionally used for recovery from surgical procedures or medical imaging.

He added in an email just after 9 p.m. that Scripps was able “to move some patients” and exit disaster status “for now.”

While such a cascade did not appear to be underway, a second facility – Sharp Chula Vista Medical Center – experienced similar levels of stress Tuesday, declaring the same internal disaster status.

The largest hospital serving the South Bay, Sharp Chula Vista had 30 of its 48 emergency beds occupied by patients waiting to be admitted to the main hospital, which was already full. As of 7 p.m., 116 of the medical center’s 349 total beds were filled with patients fighting COVID-19.

Statewide, California continues to struggle with large numbers of its residents testing positive. According to the Los Angeles Times, California recently hit the 7 million case mark, just one week after hitting 6 million, a record pandemic pace.

When the number of emergency patients exceeds an individual hospital’s resources, facilities traditionally turn to diversion, a system that allows them to significantly reduce ambulance deliveries, providing a few hours for harried staff to catch up.

But that option was taken off the table last week when the county’s emergency medical services director temporarily suspended self-directed diversion for all hospitals through Jan. 27. The move came as a way of coping with the fact that high patient volume was regularly forcing a large percentage of the region’s hospitals to simultaneously go on bypass.

Declaring an internal disaster is, in some significant sense, hospitals telling the region’s emergency medical services system that despite a ban on bypass, they can’t handle the volume and are closing their doors to additional ambulance patients.

Dr. Eric McDonald, the county’s chief medical officer, said Tuesday afternoon that duty officers who run the local emergency medical services system were working to help alleviate the disaster conditions at the two South Bay locations. The situation countywide, he added, did not appear to be as impacted as it was Tuesday in the South Bay.

Scripps said Tuesday afternoon that it has shifted some patients out of Chula Vista to other hospitals it operates across San Diego County. Transfers as far north at Tri-City Medical Center in Oceanside, Van Gorder said, were occurring. Tri-City confirmed in a short statement Tuesday evening that it recently requested and received “some staffing support to address the challenging environment caused by elevated demand for services and workforce limitations during the current surge.”

Tri-City did not provide the total number of supplemental staff that the state sent to supplement its Oceanside workforce. McDonald said the number was about 50.