Menu Close

Tag: 2023 News

RFA for Expedited UR Review Must Be Supported by Evidence of Necessity

WorkCompAcademy

Frank Diaz claimed injury to his head, neck, back, shoulders, chest, ribs, hips, and buttocks, while employed by Pacific Coast Framers as a construction worker on April 16, 2020.

On August 22, 2023, treating physician Dr. Miller issued an RFA wherein he requested a re-evaluation with neurologist, Dr. Nudleman, a re-evaluation with Dr. Salkinder, an ENG/VNG [electronystagmogrophy/videonystagmography] examination, six sessions of vestibular rehabilitation, a nurse evaluation for home care needs, and a request for 30-day inpatient at Casa Colina with physiatrist Dr. Patterson and neuropsychological evaluation with Dr. Elizabeth Cisneros.

Regarding the 30-day Casa Colina inpatient request, Dr. Miller stated, “This is an expedited request.”

The August 31, 2022, UR recommendation, stated that the request was first received by State Compensation Insurance Fund on August 26, 2022, and was received by Genex (UR) on August 30, 3022.

The UR recommendation certified/authorized the requested treatment except for the 30-day Casa Colina inpatient request that was non-certified. It also stated that Dr. Miller’s request for expedited review was not “accompanied by evidence reasonably establishing that the injured worker faces an imminent and serious threat to his … health; or that the timeframe for utilization review under 8CCR 9792.9.1(c)(3) would be detrimental to the injured workers’ condition.”

The parties went to trial raising as one of the issues whether the UR denial, dated August 31st, 2022, in regard to PTP Dr. Lawrence Miller’s RFA, dated August 22nd, 2022, was untimely inasmuch as applicant contends the RFA called for expedited review.

The WCJ found that the August 31, 2022 Utilization Review [UR] was timely so the Appeals Board does not have jurisdiction to determine whether the medical treatment and services requested by Lawrence Miller, M.D., pertaining to the Casa Colina referral, is reasonably required to cure or relieve applicant from the effects of his industrial injury. Applicant’s Petition for Reconsideration was denied in the panel decision of Diaz v Pacific Coast Framers -ADJ14244911 (August 2023).

The Labor Code section 4610-time limits within which a UR decision must be made are mandatory. The Appeals Board has jurisdiction to determine whether a UR decision is timely.

However, the Appeals Board does not have jurisdiction to address whether treatment requested in a timely UR decision is reasonably required. The “IMR process is the exclusive mechanism for review of a utilization review decision.” (King v. CompPartners, Inc. (2018) 5 Cal.5th 1039, 1048 [83 Cal.Comp.Cases 1523]; Dubon v. World Restoration, Inc. (2014) 79 Cal.Comp.Cases 1298 (Appeals Board en banc).)

Here, as explained by the WCJ: “Dr. Miller was required to document at the time of submission of the RFA, that the applicant is facing an imminent or serious threat to his health or safety or that the normal UR timelines would be detrimental to the applicant’s life or health and the reasons, therefore. Dr. Miller did not do so.”

“In total, between the two trials conducted in this case, applicant offered, and this Court admitted 22 separate exhibits. Of those exhibits, Applicant’s Exhibits 1 through 17 pre-date Dr. Miller’s report and RFA dated August 22, 2022. Despite Petitioner’s representation to the contrary, not one of those medical reports document that applicant is facing an imminent or serious threat to his health or safety or that applicant presented a danger to himself and to those around him. Further, none document that applicant required in-patient care at Casa Colina.“

Having reviewed the trial record, the WCAB Panel agreed with the WCJ that none of the reports from Dr. Miller constitute evidence that applicant’s condition was an imminent and serious threat to his health that would warrant the 72-hour expedited review delineated in AD rule 9792.9.1(c)(4).

View More

“Brokered” Radiology Services is Illegal Unlicensed Practice of Medicine

WorkCompAcademy

In 2020, Allstate Insurance Company and several of its affiliates filed two qui tam actions alleging insurance fraud in violation of the California Insurance Frauds Prevention Act (IFPA) (Ins. Code, § 1871 et seq.) and the Unfair Competition Law (UCL) (Bus. & Prof. Code, § 17000 et seq.) against three medical corporations, a medical management company and its parent company, four physicians, and Sattar Mir, an individual.

The first action was filed against Discovery Radiology Physicians, P.C., a professional medical corporation; Mir; and radiologists Drs. Safvi and Feske.

The second action was filed against Mir; OneSource Medical Diagnostics, LLC, a medical management company owned by Mir; 1st Source Capital, LLC, OneSource’s parent company; Safvi Medical Corporation and Expert MRI, P.C., professional medical corporations; and radiologists Drs. Safvi, Mazhar, and Khan.

The complaints alleged that the three medical corporations – Discovery Radiology, Expert MRI, and Safvi Medical – were formed and controlled by Mir, who is not a physician, to broker radiology services. The medical corporations solicited patients, referred the patients to MRI facilities and radiologists with whom Mir had contracted, and then billed Allstate for the MRIs. The bills represented that the MRIs had been performed by the defendant medical corporations, but the MRIs actually were performed at MRI facilities whose identities were not disclosed, and were read by radiologists under contract with the medical corporations. The resulting bills falsely identified the technical and professional services as having been provided by one of the three defendant medical corporations and grossly inflated the fees for the services provided.

Demurrers were filed to amended complaints by the defendants in both actions. The trial court sustained the demurrers without leave to amend. It found, first, that Allstate did not comply with the court’s prior order because it did not identify the dates of each allegedly false bill, the persons or entities who prepared the bills, the persons or entities who transmitted the bills to Allstate, or which defendants made each alleged false statement. Second, the court found the complaints “woefully lacking in the required specificity.”

The trial court also said it was insufficient for Allstate to “invoke the mantra of ‘structural fraud.’ Importantly, Allstate makes no claim here that: (1) MRIs were not administered; (2) MRIs were not medically necessary; or (3) qualified radiologists did not read the MRIs. . . . [¶] . . . [Instead, Allstate argues] that this case involves the unlawful corporate practice of medicine and that ‘Mir engaged in the unlawful practice of medicine.”

The Court of Appeal reversed in the Published case of P. ex rel. Allstate Ins. Co. v. Discovery Radiology etc. -B315264 (August 2023).

This appeal presents four basic issues: (1) Are the business models alleged in the amended complaints unlawful? (2) If the alleged business models are unlawful, do they give rise to causes of action under the IFPA and the UCL? (3) Do the amended complaints plead fraud with sufficient particularity? (4) Does the Discovery action adequately allege delayed discovery to survive demurrer on statute of limitations grounds?

The answer to each of these questions was “yes.” First, the operative complaints allege the unlicensed practice of medicine in violation of the Medical Practice Act (§ 2000 et seq.) and related statutes. Second, claims submitted to an insurer for medical services rendered in violation of the Medical Practice Act may give rise to causes of action under the IFPA and the UCL. Third, Allstate’s claims are pled with adequate specificity. Finally, as alleged, the claims asserted in the Discovery action are not time-barred as a matter of law.

Defendants asserted , that the business practices alleged in the complaints were lawful because Mir and OneSource allegedly provided only managerial and/or administrative services, not medical care, and thus did not engage in the unlicensed practice of medicine.

The Court of Appeal was not aware of any appellate decisions that have discussed the unlicensed practice of medicine in the specific context of referrals for radiology services. However, the Attorney General has twice opined that selecting a radiology provider involves the practice of medicine. In an opinion issued in 2000, the Attorney General stated that a management services organization may not, for a fee, select, schedule, secure, and pay for radiology diagnostic services ordered by a physician because that would constitute the unlicensed practice of medicine.

Subsequently, in a 2009 opinion the Attorney General “reiterate[d] [its] view that professional radiology services – specifically including the selection of a suitable radiologist, and the selection of a suitable radiology facility with appropriate equipment and personnel, as well as preparing and interpreting radiological images – involve the exercise of professional judgment as part of the practice of medicine.” (92 Ops.Cal.Atty.Gen. 56 (2009).)

“The amended complaints state claims against each defendant for engaging in or assisting in the unlicensed practice of medicine because they allege an unlawful degree of control by non-physicians over the medical corporations’ provision of diagnostic radiology services.”

View More

NLRB Sets New Standard for Assessing Lawfulness of Work Rules

WorkCompAcademy

The NLRB issued a decision in Stericycle Inc., adopting a new legal standard for evaluating employer work rules challenged as facially unlawful under Section 8(a)(1) of the National Labor Relations Act.

The decision overrules Boeing Co. (2017), which was later refined in LA Specialty Produce Co. (2019). The new standard builds on and revises the Lutheran Heritage Village-Livonia (2004) standard. The Board had previously invited parties and amici to submit briefs addressing whether the Board should reconsider the Boeing standard.

The former “Boeing Standard” established a new test: when evaluating a facially neutral policy, rule or handbook provision that, when reasonably interpreted, would potentially interfere with the exercise of NLRA rights, the Board will evaluate two things: (i) the nature and extent of the potential impact on NLRA rights, and (ii) legitimate justifications associated with the rule.

Applying the new standard, the Board concluded that Boeing lawfully maintained a no-camera rule that prohibited employees from using camera-enabled devices to capture images or video without a valid business need and an approved camera permit. The Board majority reasoned that the rule potentially affected the exercise of NLRA rights, but that the impact was comparatively slight and outweighed by important justifications, including national security concerns.

And pursuant to Boeing, the Board also announced that, prospectively, three categories of rules will be delineated to provide greater clarity and certainty to employees, employers, and unions.

In Stericycle, Board explained that the primary problem with the Boeing and LA Specialty Produce standard was that it permitted employers to adopt overbroad work rules that chill employees’ exercise of their rights under Section 7 of the Act. Under that standard, an employer was not required to narrowly tailor its rules to promote its legitimate and substantial business interests without unnecessarily burdening employee rights. The Board also rejected Boeing’s categorical approach to work rules, under which certain types of rules were held to be always lawful, regardless of how they were drafted or what interests a particular employer cited in defense of the rule.

Under the new standard adopted in Stericycle, the General Counsel must prove that a challenged rule has a reasonable tendency to chill employees from exercising their rights. If the General Counsel does so, then the rule is presumptively unlawful.

However, the employer may rebut the presumption by proving that the rule advances a legitimate and substantial business interest and that the employer is unable to advance that interest with a more narrowly tailored rule. If the employer proves its defense, then the work rule will be found lawful to maintain. In line with this framework, the Board rejected the categorical approach of Boeing in favor of case-specific consideration of work rules.

“Boeing gave too little consideration to the chilling effect that work rules can have on workers’ Section 7 rights.  Under the new standard, the Board will carefully consider both the potential impact of work rules on employees and the interests that employers articulate in support of their rules.  By requiring employers to narrowly tailor their rules to serve those interests, the Board will better support the policies of the National Labor Relations Act,” said Chairman Lauren McFerran.

Members Wilcox and Prouty joined Chairman McFerran in issuing the decision. Member Kaplan dissented.

The NLRB’s latest decision regarding workplace rules affects both unionized and non-unionized workplaces. The new standard will be applied retroactively, thus a workplace rule created under the Boeing Standard is likely unlawful.

In his dissent, Member Kaplan, among other issues, argued that the “Board must not apply a new rule of decision retroactively – meaning in all pending cases in whatever stage – if doing so would work a manifest injustice. SNE Enterprises, 344 NLRB 673, 673 (2005). To determine whether retroactive application would cause manifest injustice, the Board considers ‘the reliance of the parties on preexisting law, the effect of retroactivity on accomplishment of the purposes of the Act, and any particular injustice arising from retroactive application.’ Id. Each of these considerations militates against retroactive application.”

Kaplan also lamented that “the full breadth of my colleagues’ decision cannot be understood until the Board addresses the question of safe harbor language in future cases.”

View More

S&W Misconduct Increase Not Applicable to Industrial Disability Leave

WorkCompAcademy

In August 2002, Michael Ayala was severely injured in a preplanned attack by inmates while at his job as a correctional officer at the Lancaster State Prison

He filed a workers’ compensation claim and alleged that the injury was caused by the serious and willful misconduct of his employer, California Department of Corrections and Rehabilitation (CDCR).

Labor Code section 4553 provides that ‘[t]he amount of compensation otherwise recoverable shall be increased one-half . . . where the employee is injured by reason of serious and willful misconduct” by the employer. Ayala and CDCR agreed that the injury caused Ayala 85 percent permanent disability, but they could not agree whether CDCR engaged in serious and willful misconduct.

A WJC found that CDCR did not engage in serious and willful misconduct. However, on reconsideration, the Workers’ Compensation Appeals Board (the Board) rescinded the decision and reversed, finding that CDCR had engaged in serious and willful misconduct. Over a dissent, a Board majority found that CDCR “failed to act on a credible threat of inmate violence that was specifically reported to be planned for the day of the attack and took the facility off lockdown despite this threat even though it possessed additional information . . . that this had long been planned.”

The Board’s determination established Ayala’s entitlement to an additional 50 percent of “compensation otherwise recoverable” per section 4553. Ayala and CDCR disagreed, however, about what constituted the “amount of compensation otherwise recoverable” under that section.

While he was temporarily totally disabled Ayala was paid his full salary because he was on industrial disability leave and enhanced industrial disability leave. However the WCJ found that the compensation upon which the penalty applies was what Ayala would have been paid in temporary disability. But on reconsideration, the Board again rescinded and reversed the workers’ compensation judge’s decision, this time finding that the base compensation was what Ayala was paid on industrial disability leave and enhanced industrial disability leave.

The Court of Appeal reversed in the published case of Cal. Dept. Corrections & Rehabilitation v. Workers’ Comp. App. Bd. -E079076 (August 2023).

The Court of Appeal first noted Labor Code Section 3207, entitled “Compensation,” which states that “‘[c]ompensation’ means compensation under this division and includes every benefit or payment conferred by this division upon an injured employee, or in the event of his or her death, upon his or her dependents, without regard to negligence.” However it stated that the definition is “is as capacious as it is circular.“

“Equally unambiguous, though, is that industrial disability leave benefits are not ‘compensation,’ as such benefits are not provided by Division 4 of the Labor Code. They in fact are provided outside of the Labor Code altogether. Supplied by section 19871 of the Government Code, industrial disability leave is an alternative to temporary disability and is available to certain state officers and employees, such as those who are members of the Public Employees’ Retirement System (Gov. Code, § 19869).”

Industrial disability leave provides an employee his or her full salary (net of certain taxes), but only for 22 days; after 22 days, the pay becomes two-thirds of full pay. (Gov. Code, § 19871, subd. (a).) However, a subset of eligible workers, defined in the Government Code as “excluded employees,” are entitled to receive enhanced industrial disability leave. (Gov. Code, §§ 19871.2, 3527, subd. (b); Cal. Code Regs., tit. 2, § 599.769.)

Enhanced industrial disability leave extends the period of full pay from 22 days to one year. (Gov. Code, § 19871.2.) If a worker continues to be temporarily disabled after industrial disability leave and enhanced industrial disability leave benefits terminate, then temporary disability payments begin. (Gov. Code, § 19874, subd. (a).)

There is no ambiguity here. “Compensation,” as the term is used in section 4553, includes only items provided by Division 4 of the Labor Code, but industrial disability leave is provided by the Government Code. Accordingly, the “amount of compensation otherwise recoverable” under section 4553 does not include industrial disability leave.

However, the Board concluded that section 4553 base compensation includes industrial disability leave, mainly relying on Brooks v. Workers’ Comp. Appeals Bd. (2008) 161 Cal.App.4th 1522 .

When the Court of Appeal decided Brooks it took the view that industrial disability leave equated to leave provided by the Labor Code. However in doing so Brooks construed a different statute, Labor Code section 4656, subdivision (c)(1), than does Ayala in this case. In Brooks the issue was whether the year of industrial disability leave payments the worker received counted toward the statute’s two-year limitation or whether the limitation period started only when industrial disability leave stopped and temporary disability payments began.

To the extent that Brooks could be read as support for the proposition that any features of or limitations on temporary disability necessarily must apply to industrial disability leave because of the way industrial disability leave is defined “we respectfully disagree.”  “Compensation” under section 3207 “still requires that it be provided by Division 4 of the Labor Code, just as it always has.”  

View More

CMS Updates Medicare Set Aside Self-Administration Toolkit

WorkCompAcademy

Last month the Centers for Medicare and Medicaid Services (CMS) updated the Self-Administration Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements (Toolkit) to version 1.4. If a Medicare beneficiary decided to self-administer their WCMSA, they should review the Self-Administration Toolkit for WCMSAs.

This Toolkit describes the process and guidelines for beneficiaries managing their WCMSA account and walks them through the set-up of their WCMSA through its depletion (exhaustion).

Also available are copies of the Account Expenditure for Lump Sum Account (Attestation Letter), Account Expenditure for Structured Annuity (Attestation Letter) and a Transaction Record Sample.

Medicare beneficiaries can use the Transaction Record Sample (or a similar document) to keep track of all deposits to and withdrawals from their WCMSA account. The account expenditure letters are blank and can be used to submit the required annual attestation that the Medicare beneficiary correctly used the funds in the WCMSA account.

This Toolkit:

– – Describes the self-administration process and guidelines, from when you first set up the WCMSA bank account until all of its funds have been used.
– – Explains who you will work with to manage your WCMSA account.
– – Discusses the two types of WMCSA accounts, lump sum and structured. The lump-sum account is discussed first, and the Toolkit includes a section on Topics Unique to Structured WCMSA Accounts later on.
– – Covers special circumstances, such as when your Medicare beneficiary status changes.

A WCMSA may be funded in one of two ways. A lump sum, in which the beneficiary receives one check or deposit for the entire WCMSA, from their settlement. Or a structured settlement, in which the beneficiary receives an initial deposit and smaller annual payments in following years.

Once a WCMSA account is set up, it can only be use it to pay for medical treatment or prescription drugs related to the beneficiary’s WC claim, and only if the expense is for a treatment or prescription Medicare would cover. This is true even if the beneficiary is not yet a Medicare beneficiary (not yet enrolled in Medicare).

If an item or service is not covered by Medicare, the beneficiary will have to pay for it themselves or with other insurance. WCMSA funds may not be used for services that Medicare does not cover.

The WCMSA account may also be used to pay for the following costs when they are directly related to the account:

– – Cost of copying documents
– – Mailing fees/postage
– – Any banking fees related to the account
– – Income tax on interest income from the account

Beneficiaries will need to keep clear and accurate records of everything they do with the WCMSA account. Medicare will use these records to determine if the account funds were spent properly.

View More

City of Los Angeles Freelance Ordinance Now In Effect

WorkCompAcademy

Freelance workers in the City of Los Angeles received more protections with the Los Angeles City Council’s adoption on February 24, 2023 of Ordinance 187782 which is intended to protect the Freelance industry. The new law became effective on July 1, 2023 and employers must now comply with the provisions of this ordinance.

The Ordinance defines a Freelance Worker as “an individual natural person, or an entity whose legal and beneficial interests are held entirely and whose work is performed entirely by no more than one individual natural person, hired or engaged as a bona fide independent contractor to perform services for a Hiring Entity in exchange for compensation” with some exceptions to this definition.

And a Hiring Entity is defined as “means an entity regularly engaged in business or commercial activity. A hiring entity is regularly engaged in business or commercial activity if the hiring entity owns or operates any trade or business, including a not for profit business, or represents itself as engaging in any trade, or business. A “Hiring Entity” does not include an entity that hires app-based transportation and delivery drivers to provide prearranged services.”

And the provisions of this new Ordinance apply to “a written or oral contract between a Freelance Worker and a Hiring Entity entered into on or after July 1,2023; and to work performed within the City by a Freelance Worker that is entitled to payment of $600 or more in a calendar year for the same Hiring Entity.

If the Freelance Worker and the Hiring Entity fall under the provisions of this Ordinance, they must have a written agreement that includes, at a minimum, all of the following information:

– – The name, mailing address, phone number, and, if available, email address of both the Hiring Entity and the Freelance Worker;
– – An itemization of all services to be provided by the Freelance Worker, the value of the services to be provided pursuant to the contract, and the rate and method of compensation; and
– – The date by which the hiring entity must pay the contracted compensation or the manner by which such date will be determined.

A Hiring Entity must provide full payment to the Freelance Worker on or before the date specified in the written contract or, if the written contract does not specify a due date or if there is no written contract, no later than 30 calendar days after services are rendered.

A Hiring Entity and Freelance Worker shall each retain written records related to this article for no less than four years, including contracts, payment records, and any other written or electronic records to demonstrate compliance.

A waiver by a Freelance Worker of any provision in this article shall be deemed contrary to public policy and shall be void and unenforceable.

A Freelance Worker may either file a civil action for violations under this Ordinance, or file a complaint with the Office of Wage Standards of the Bureau of Contract Administration within the Department of Public Works is the “Designated Administrative Agency” or “DAA.”

If a Hiring Entity fails to respond to the DAA’s request for information and/or documents within 20 calendar days, the Freelance Worker shall be entitled to a procedural rebuttable presumption in any subsequent civil action that the Hiring Entity committed the violations alleged in the corresponding complaint filed with the DAA.

If the Freelance Worker prevails in a civil action, in addition to damages provided in the Ordinance, they are entitled to recover all reasonable attorney’s fees and costs, injunctive relief, and other remedies as deemed appropriate by a court.

Employers should carefully read the entire Ordinance, and it would be wise to consult with legal counsel if you are unclear about the requirements of this Ordinance.

View More

Whistleblower Triggers Radiologist’s Arrested for Illegal Opioid Prescriptions

WorkCompAcademy

The California Attorney General’s office announced the arrest of and filing of charges against Dr. Arash Malian Padidar, a Santa Clara County physician with an office located at 105 N Bascom Ave Ste 104 San Jose, CA 95128.

He is accused of illegally prescribing opioids to patients. The arrest and charges are the result of an investigation into an alleged two-years-long illegal prescription scheme by the California Department of Justice (DOJ). Padidar was arrested by DOJ agents and booked into the Santa Clara County Jail.

DOJ investigators found that Padidar’s illegal prescription scheme was carried out between October 2018 and October 2020 and involved the highly addictive pain medication Norco. He is facing charges on seven felony counts, including for obtaining opioids by fraud, deceit and misrepresentation, issuing prescriptions without a legitimate medical purpose, forging the name of another physician who’s name he allegedly obtained, and issuing a prescription, unlawful use of personal information and conspiracy to commit a crime.

According to the allegations on the criminal complaint, Padidar wrote prescriptions that were given to an unnamed conspirator, who filled the prescriptions at several Wallgreen and other pharmacies, and then the unnamed coconspirator gave the pills back to Padidar.

Padidar’s alleged activity was uncovered when an employee who had helped with the scheme came forward a month or two after being fired by the doctor in July 2019, according to a criminal complaint filed with Santa Clara County Superior Court.

The investigation and arrest were conducted by DOJ’s Division of Medi-Cal Fraud & Elder Abuse (DMFEA), which was alerted to the alleged crimes by the DEA.

DMFEA protects Californians by investigating and prosecuting those who defraud the Medi-Cal program as well as those who commit elder abuse. These investigations are made possible only through the coordination and collaboration of governmental agencies, as well as the critical help from whistleblowers who report incidences of abuse or Medi-Cal fraud at oag.ca.gov/dmfea/reporting.

DMFEA receives 75% of its funding from HHS under a grant award totaling $53,792,132 for federal fiscal year 2022-2023. The remaining 25% is funded by the State of California. The federal fiscal year is defined as through September 30, 2023.

“Doctors are trusted with the immense responsibility of protecting our health and our lives,” said Attorney General Bonta. “When a bad actor exploits their position for personal gain, they not only shatter our trust, they harm vulnerable patients. Let today’s arrest serve as a warning: The California Department of Justice will not tolerate abuses of power and will hold perpetrators accountable.”

“This investigation focused on a trusted member of the medical community who allegedly utilized forgery and fraud to obtain highly addictive opioids for his own personal benefit,” said Drug Enforcement Administration (DEA) Special Agent in Charge Brian M. Clark. “Healthcare professionals have a duty to prescribe controlled substances in a manner that ensures the well-being of the public. DEA will continue to keep communities safe and healthy by holding those accountable who put them in harm’s way. I want to thank CA DOJ Division of Medi-Cal Fraud and Elder Abuse and DEA Diversion for their exceptional work in this investigation.”

View More

Cal/OSHA Increased Physical Presence and Inspections in 3 Counties

WorkCompAcademy

Cal/OSHA announced it will be increasing its physical presence in Fresno, Santa Barbara and Riverside counties – allowing Cal/OSHA field inspectors to respond more efficiently in the Central Valley, Inland Empire and Central Coast areas, while providing services and resources to workers, employers and community-based organizations in these areas.

The Division is setting up temporary satellite offices and is in the process of establishing permanent office locations in:

– – Regional Office in Fresno
– – High Hazard Office in Fresno
– – District Office in Santa Barbara
– – District Office in Riverside

“While Cal/OSHA has been performing outreach and enforcement work in these regions, this planned expansion ensures a more permanent presence in these communities to serve as a resource for workers and employers,” said Department of Industrial Relations Director Katie Hagen.

“These new offices will represent an important step in continuing to scale our efforts to meet workers where they are and ensure their health, safety and rights are safeguarded.”

The additional office locations are prompted by operational needs and increased demand for responses to complaints, accidents and proactive high-heat inspections at workplaces in these areas, especially in high-hazard industries. Updates on these new offices will be posted on Cal/OSHA’s Enforcement Office location webpage.

“We are working to secure office space and hiring is already underway,” said Cal/OSHA Chief Jeff Killip.

“We invite those who want to make a significant impact on workplace safety in California to join our dynamic team at Cal/OSHA. Our team is dedicated to ensuring that employees know their rights and that employers in our state provide safe work environments. If you want to make a difference, come join our team!”

Cal/OSHA has openings for district managers, senior safety engineers, and associate safety engineers in the new Fresno, Santa Barbara and Riverside offices. Additionally, openings for industrial hygienists, public health professionals, attorneys, health and safety analysts and more will be posted soon.

Those with biology, chemistry, toxicology or environmental science degrees are also encouraged to visit the Work at Cal/OSHA webpage and apply.

View More

Study Shows Independent Hospital Acquisitions Tied to Higher Prices

WorkCompAcademy

Hospital acquisitions have consolidated care into fewer and larger health systems. From 2000 to 2020, the share of hospital beds that are part of health systems has risen from 58 percent to 81 percent nationally. A quarter of hospital markets no longer had any independent hospitals by 2020.

A new study published by Elevance Health describes how prices, costs, and quality change when previously independent hospitals are acquired by systems.

Hospital care is the largest segment in the $4.3 trillion U.S. healthcare sector, with $1.3 trillion in annual spending. Despite a decline in inpatient volume over the last decade, hospital spending as a share of the sector increased from 30 to 31 percent over this time.

Most prior studies did not have access to negotiated prices between plans and hospitals, and therefore had to rely on average prices inferred from accounting data reported to the federal government. However, recent work has shown that these imputed prices are only weakly correlated with true prices. As a result, the new study draws conclusions about efficiency gains of the hospitals. Prior studies have not comprehensively evaluated the impact of efficiency gains for independent hospitals after acquisition.  

Hospitals experienced large cost efficiencies and higher revenues after system acquisition.

– – Operating expenses declined by 6 percent, above market trend, at the acquired hospital following system ownership, without any offsetting increase in costs at the acquirer system.
– – Reductions in personnel spending accounted for about 60 percent of the total decline in operating costs.
– – Independent hospital acquisitions by hospital systems increased average inpatient prices for commercially insured patients by 5 percent above market trend, holding procedure intensity constant.
– – Across the top seven Major Diagnostic Categories by volume, prices increased 5-8 percent, with digestive, infectious diseases, labor & delivery, respiratory, and the circulatory system experiencing the largest price increases.
– – The size of the acquiring system size did not seem to matter with respect to price increases at the acquired hospital, suggesting that price increases were uniform at acquired independent hospitals.

Hospital quality declined following acquisition, leading to worse outcomes for patients.

– – For Elevance Health’s affiliated members receiving cardiac care, readmission rates increased by 10-12 percent and remained elevated for three years after the acquisition.
– – Readmission rates for Medicare patients admitted with acute, non-deferrable conditions conservatively increased by 2-3 percent.
– – Acquired hospitals that experienced greater staff reductions experienced greater readmission rate increases, suggesting the reduction in personnel may be a contributing factor.

Access to care was generally reduced for patients at acquired hospitals.

– – The study observed the closure of maternity wards, which were concentrated in rural hospitals.
– – Given aforementioned price increases and staff reductions, one could expect a decrease in hospital patient volume, however the study did not detect a change.
– – Access to medical technology did not change after acquisition.

The Study Authors conclude by saying “This brief highlights that independent hospital mergers have negative consequences for insurers, employers, and consumers. Specifically, payers and patients are exposed to higher prices without a commensurate increase in quality of hospital care.”

“Further, access to care does not improve, with acquired systems no more likely to expand access to medical technology or services. Instead, patients are likely to experience a reduction in access to maternity wards and reduction in staff. As hospital mergers continue to occur at a high rate, it is important that stakeholders understand their implications.”

View More

Modifications to California Fair Chance Act Take Effect on October 1

WorkCompAcademy

The Fair Chance Act, which went into effect on January 1, 2018, is a California law that generally prohibits employers with five or more employees from asking about a job applicant’s conviction history before making a job offer.

California enacted the Fair Chance Act to reduce barriers to employment for individuals with conviction histories. The Fair Chance Act is part of California’s employment anti- discrimination statute called the Fair Employment and Housing Act (FEHA), which is enforced by the Civil Rights Department (CRD). The Fair Chance Act is codified at Government Code section 12952.

For employers who are unfamiliar with this law, the the Civil Rights Council of the California Civil Rights Department has published an FAQ on its website.

On July 24, 2023, the California Office of Administrative Law approved the California Civil Rights Council’s modifications to regulations which implement the California’s Fair Chance Act. The new regulations take effect on October 1, 2023, and employers are encouraged to understand and implement these changes before the deadline.

Among the many changes to the regulations, is the requirement that if after a conditional offer of employment is made, and subsequently decides to deny the applicant the employment position ” based solely or in part on the applicant’s conviction history,” the employer must have made a reasoned, – and this must now under the new regulations be an “evidence-based determination” – of whether the applicant’s conviction history has a direct and adverse relationship with the specific duties of the job that justify denying the applicant the position.

The new regulations then continue to provide detail on what may be taken into consideration in assessing the factors to determine whether the applicant’s conviction history has a direct and adverse relationship with the specific duties of the job that justify denying the applicant the position.

Many of the new regulations help clarify employers obligations, and some new ones are added. These include expanded definitions which apply only to § 11017.1 “Consideration of Criminal History in Employment Decisions” such as:

– – (1) “Applicant” includes, in addition to the individuals within the scope of the general definition in section 11008(a) of these regulations, individuals who have been conditionally offered employment, even if they have commenced employment when the employer undertakes a post-conditional offer review and consideration of criminal history; existing employees who have applied or indicated a specific desire to be considered for a different position with their current employer; and an existing employee who is subjected to a review and consideration of criminal history because of a change in ownership, management, policy, or practice. An employer cannot evade the requirements of Government Code section 12952 or this regulation by having an individual lose their status as an “applicant” by working before undertaking a post-conditional offer review of the individual’s criminal history.

– – (2) “Employer” includes a labor contractor and a client employer; any direct and joint employer; any entity that evaluates the applicant’s conviction history on behalf of an employer, or acts as an agent of an employer, directly or indirectly; any staffing agency; and any entity that selects, obtains, or is provided workers from a pool or availability list.

Employers are prohibited from including statements in job advertisements, postings, applications, or other materials that no persons with criminal history will be considered for hire, such as “No Felons” or “Most Have Clean Record.”

The new regulation also adds a description of evidence of rehabilitation or mitigating circumstances that an applicant voluntarily may provide to the employer.

And in the event they do voluntarily provide such evidence, the new regulations added a provision prohibiting the employer from refusing “to accept additional evidence voluntarily provided by an applicant, or by another party at the applicant’s request, at any stage of the hiring process (including prior to making a preliminary decision to rescind the applicant’s job offer)”

View More