Tag: 2023 News

The California and New York Attorney General just announced a joint investigation into allegations of employment discrimination and a hostile work environment at the National Football League. The NFL has offices in New York and California with more than 1,000 employees.

The joint investigation will examine the workplace culture of the NFL and allegations made by former employees, including potential violations of federal and state pay equity laws and anti-discrimination laws. The Attorneys General issued subpoenas to the NFL seeking relevant information.

The joint press release cites examples such as the February 2022 New York Times report on more than 30 former female employees alleging gender discrimination and retaliation after they had filed complaints with the NFL’s human resources division.

According to the times, the women they interviewed “described a stifling, deeply ingrained corporate culture that demoralized some female employees, drove some to quit in frustration and left many feeling brushed aside.”

The women said this culture has persisted despite a promise from N.F.L. Commissioner Roger Goodell – made after the 2014 release of a video that showed running back Ray Rice punching his fiancée unconscious – that the league would take a stricter stance on domestic violence and sexual assault and hire more female executives.

The Times also reports that the former Miami Dolphins coach Brian Flores, who is Black and Hispanic, sued the league for racial discrimination in its hiring practices, and two former employees of the newly renamed Washington Commanders told Congress that the team’s owner, Daniel Snyder, had placed his hand on a female employee’s thigh at a staff dinner and hosted a work event where team executives hired prostitutes.

The AG announcement specifically noted that, in April 2023 Jennifer Love, a former director for NFL Enterprises LLC, filed an employment discrimination lawsuit in Los Angeles Superior Court, alleging age, sex and gender discrimination and a hostile work environment. She alleged “pervasive sexism” in the workplace and a “boys’ club” mentality among male peers, while attributing her 2022 layoff to retaliation for her complaints.

According to the AG press release, additional lawsuits have been filed against the NFL pertain to race discrimination targeting a Black female employee and sexual harassment of a female wardrobe stylist, amongst others.

Last year, the U.S. Congressional Committee on Oversight and Reform initiated a congressional inquiry into allegations of workplace misconduct by an NFL team owner. The Committee held oversight hearings to determine the magnitude of the situation, including the role played by NFL leadership.

The Committee’s investigation report said that “sexual harassment, bullying, and other toxic conduct pervaded the Commanders workplace, perpetuated by a culture of fear instilled by the Team’s owner. Despite the NFL’s knowledge, through its internal investigation, that the Team’s owner permitted and participated in the workplace misconduct, and engaged in tactics used to intimidate, surveil, and pay off victims, the NFL aligned its legal interests with the Commanders, failed to curtail these abusive tactics, and buried the investigation’s findings.”

“Today’s report reflects the damning findings of the Committee’s year-long investigation and shows how one of the most powerful organizations in America, the NFL, mishandled pervasive sexual harassment and misconduct at the Washington Commanders,” said Chairwoman Carolyn B. Maloney.

Despite reports and allegations of abuse perpetrated by both players and male staff, the Attorney General claims allegations that the NFL has not taken sufficient effective steps to prevent discrimination, harassment and retaliation from occurring in the workplace persist.

The Attorneys General of California and New York say they are exercising their legal authority to seek information from the NFL regarding allegations of gender pay disparities in compensation, harassment, and gender and race discrimination.

The N.F.L. employs about 1,100 people, 37 percent of them women and 30 percent people of color, according to the league spokesman Brian McCarthy. Like corporations around the country, it has poured more effort into diversifying its hiring. It has also put in place measures intended to signal support of a diverse work force, such as mandatory antiracism training and an anonymous hotline – called Protect the Shield – for employees’ concerns.

A few days ago Sedgwick announced it has launched Sidekick, which they say is an industry-first integration using Microsoft’s OpenAI tools and services to give claims professionals an advantage in their daily work.

The application, which leverages OpenAI’s GPT-4 technology, is Sedgwick’s first use case of GPT. Designed for internal use within the company’s secure Azure environment,

And Corvel Corporation has also just announced the integration of generative AI into its claims and care solution, launching what they say is the next generation in intelligent, efficient claims automation. The Company says it is driving to set the industry standard by offering the advantages of generative AI through its award-winning CareMC claims platform.

This technology, the latest iteration of CorVel’s CogencyIQSM service offerings, will introduce new capabilities to improve efficiencies throughout the claims management process. Leveraging generative AI to automate objective tasks will increase the amount of time adjusters spend interfacing directly with injured workers, which will, ultimately, improve outcomes.

At the same time, customers will continue to benefit from CorVel’s existing risk management tools which leverage artificial intelligence and predictive analytics to provide insights such as claim and clinical risk scores, litigation avoidance, and severity modeling.

As CorVel continues to integrate its services with generative AI technologies, benefits will include:

– – Automated tasks to reduce the need for human intervention and speed up the claims processing cycle. For instance, generative AI can summarize medical documents, extract keywords, answer specific questions, and bring overlooked items to the attention of adjusters or nurses.
– – AI technologies can learn from past claims and generate new information that matches established patterns, thereby reducing the workload of claims administrators and enabling faster claim closures. Additionally, analyzing claim data can help identify potential fraud cases by detecting patterns and anomalies.
– – AI-powered chatbots can enhance customer service and engagement by answering queries and providing support throughout the claims process. For example, they can offer a claim overview, explain benefits, and provide status updates using natural language processing.
– – AI can help increase the retention of valued employees by making their work more meaningful and person-centered, boosting job satisfaction and engagement.

“Generative AI will revolutionize claims administration in the next several years, transforming how insurance companies, third-party administrators, and medical management firms manage claims processing,” said Michael Combs, President and CEO of CorVel. “With these capabilities, we will reach new standards of efficiency, results, and lower costs of risk.”

Generative AI is a subset of artificial intelligence techniques that involve the creation of new content or data using machine learning models. While discriminative AI identifies and classifies existing patterns in data, generative AI creates new patterns and content. Implementation of generative AI functionality for Risk Management will use proprietary, fully segmented data sets.

GPT stands for Generative Pre-trained Transformer (GPT), a type of language model that uses deep learning to generate human-like, conversational text. GPT-4 is the newest version of OpenAI’s language model systems. Its previous version, GPT 3.5, powered the company’s wildly popular ChatGPT chatbot when it launched in November of 2022.

Last month we reported that GPT-4, the new multimodal deep learning model from OpenAI, has passed the Uniform Bar Exam, demonstrating an enormous leap for machine learning and proving that an artificial intelligence program can perform complex legal tasks on par with or better than humans, according to a new paper co-authored by Daniel Martin Katz, professor of law at Illinois Institute of Technology’s Chicago-Kent College of Law.

And now Google has announced the latest version of Med-PaLM a large language model (LLM) designed to provide high quality answers to medical questions.

Med-PaLM harnesses the power of Google’s large language models, which have been aligned to the medical domain with a set of carefully-curated medical expert demonstrations.

Developing AI that can answer medical questions accurately has been a long-standing challenge with several research advances over the past few decades. While the topic is broad, answering US Medical License Exam (USMLE)-style questions has recently emerged as a popular benchmark for evaluating medical question answering performance.

Google’s first version of Med-PaLM, preprinted in late 2022, was the first AI system to surpass the pass mark on US Medical License Exam (USMLE) questions. Med-PaLM also generates accurate, helpful long-form answers to consumer health questions, as judged by panels of physicians and users.

Google introduced its latest model, Med-PaLM 2, at its annual health event The Check Up. Med-PaLM 2 achieves an accuracy of 85.4% on USMLE questions. This performance is on par with “expert” test takers, and is an 18% leap over its own state of the art results from Med-PaLM.

Google assessed Med-PaLM and Med-PaLM 2 against a benchmark it called ‘MultiMedQA’, which combines seven question answering datasets spanning professional medical exams, medical research, and consumer queries.

Med-PaLM was the first AI system to obtain a passing score on USMLE questions from the MedQA dataset, with an accuracy of 67.4%. Med-PaLM 2 improves on this further with state of the art performance of 85.4%, matching expert test-takers.

Google will soon release a preprint for Med-PaLM 2. In the coming months, Med-PaLM 2 will also be made available to a select group of Google Cloud customers for limited testing, to explore use cases and share feedback, as we investigate safe, responsible, and meaningful ways to use this technology.

A plastic surgeon in Beverly Hills, along with his son, medical practices and billing company, have agreed to pay $23.9 million to resolve allegations that they violated the False Claims Act by submitting or causing the submission of false claims to both Medicare and Medicaid.

The settlement resolves allegations that Dr. Joel Aronowitz; Daniel Aronowitz; Joel A. Aronowitz, M.D., a medical corporation; Tower Multi-Specialty Medical Group; Tower Wound Care Center of Santa Monica, Inc.; Tower Outpatient Surgery Center, Inc.; and Tower Medical Billing Solutions falsified the place of service for skin grafts and billed multiple times for single-use skin substitute products.

The United States contends that the settling parties manipulated the place of service code on claims for skin grafts to fraudulently maximize reimbursement from Medicare and Medicaid. The United States further contends that Dr. Aronowitz failed to properly dispose of unused portions of single-use skin graft materials and, instead, used them in later procedures involving other Medicare and Medicaid beneficiaries, resulting in thousands of instances of double billing.

In connection with the settlement, the United States Department of Health and Human Services, Office of Inspector General (HHS OIG), negotiated the voluntary exclusion of Dr. Aronowitz and Tower Multi-Specialty Medical Group from Medicare, Medicaid, and all other federal health care programs for a period of 15 years. Daniel Aronowitz will be excluded for three years.

Medicaid is funded jointly by the states and the federal government. The state of California paid for a portion of the Medicaid claims at issue and will receive a total of approximately $497,619 from the settlement.

The civil settlement includes the resolution of claims brought under the qui tam, or whistleblower, provisions of the False Claims Act by parties that worked for Dr. Aronowitz and his associated medical practices and businesses: TDP, a billing company; Dr. Jason Morris, a podiatrist; and Harold Bautista, a billing department employee.

Under the qui tam provisions, a private party can file an action on behalf of the government and receive a portion of any recovery. The civil lawsuits, all of which were filed in federal court in Los Angeles, are captioned: United States ex rel. TDP RCM Servs., LLC v. Aronowitz, et al., United States ex rel. Morris, et al. v. Tower Wound Care Ctr. of Santa Monica, Inc., et al., and United States ex rel. Bautista et al. v. Tower Outpatient Surgery Center, Inc., et al.. The amount to be recovered by the private parties has not been determined.

The resolution obtained in this matter was the result of a coordinated effort between the United States Attorney’s Office in Los Angeles and the United States Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section. HHS OIG assisted in the investigation.

The matter was handled by Assistant United States Attorney Aaron Ezroj of the Civil Fraud Section and Trial Attorney Lyle Gruby of the Justice Department’s Civil Division. The exclusions of the individuals and entity were negotiated by Senior Counsel Patrice Drew for HHS OIG.

The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).

The claims resolved by the settlement are allegations only and there has been no determination of liability.

In recent panel decisions the WCAB seems to be less forgiving of litigants who assert what seems to be obvious facts in a case, but then do not submit substantial evidence to prove their assertion. The lesson here it to make sure every essential detail needed to win an issue has been meticulously documented and proven at trial.

In this case, Sherrill Claytor was injured on June 12, 2014 while employed as a doctor’s assistant by Alexander T. Latteri, M.D. She treated with Dr. Spencer as her PTP from 2014 to 2019.

On September 3, 2019, Claytor sent State Fund a letter selecting Scott Small, M.D. as her PTP and request to change her PTP. Dr. Small provided treatment to her from 2019 into 2020 and she also continued to receive treatment from Dr. Spencer from July 2019 to at least December 2019 while also treating with Dr. Small.

On June 1, 2020, Claytor sent a letter to SCIF requesting to treat with Dr. Spencer as her PTP again. On June 15, 2020, SCIF replied stating that it ended the contract with Harbor Health Systems as the MPN administrator of the State Fund MPN by Harbor Health effective July 27, 2020. But it also said that “State Fund will allow you to continue your treatment with your current primary treating physician, treating physicians and/or providers after July 27, 2020.”

The matter proceeded to trial on December 1, 2020 with the sole issue identified as: “Can the Applicant resume treatment with Dr. Spencer as the PTP outside of the MPN.” By the F&O, the WCJ found that applicant is permitted to treat with Dr. Curtis Spencer outside of defendant’s medical provider network (MPN).

The State Fund petition for Reconsideration was denied in the panel decision of Sherrill Claytor v SCIF – ADJ11059073 (January 2023).

If an employer has established an MPN, injured workers are generally limited to treating with a physician from within the employer’s MPN. However, if the employer neglects or refuses to provide reasonably necessary medical treatment, whether through an MPN or otherwise, then an injured worker may self-procure medical treatment at the employer’s expense.

The Appeals Board has held en banc that “a defendant may satisfy its obligation under Labor Code section 4600 to provide reasonable medical treatment by transferring an injured worker into an MPN in conformity with applicable statutes and regulations regardless of the date of injury or the date of an award of future medical treatment.” (Babbitt v. Ow Jing (2007) 72 Cal.Comp.Cases 70, 71 (Appeals Board en banc).)

Here SCIF argues that Claytor was brought back into the MPN when she selected Dr. Small as her PTP and thus, she may not now choose a non-MPN physician absent a denial of care.

To this argument the panel noted that if “Dr. Small is a member of defendant’s MPN (whether the old or new MPN), there may be a viable argument that applicant voluntarily returned herself to the MPN by selecting Dr. Small as her PTP and she may not now choose a PTP outside the MPN absent a denial of care. However, this conclusion presumes that Dr. Small is actually in the MPN, a fact that applicant has not conceded and is not supported by substantial evidence in the record.”

“We do not presume Dr. Small is in the MPN based solely on defendant’s assertion that he is a member of it.“

Defendant contends that applicant’s September 3, 2019 letter selecting Dr. Small as her PTP “should be sufficient for a finding that Dr. Small was in State Fund’s MPN at the time.”

“We disagree that applicant’s September 3, 2019 letter is sufficient to show that Dr. Small is in the MPN.” “Put simply, there is not substantial evidence showing that applicant was treating within the MPN when she requested to have Dr. Spencer resume his role as PTP. There is also no evidence in the record that defendant objected to applicant’s June 1, 2020 request to have Dr. Spencer act as her PTP again.”

“There is substantial evidence to show years of treatment outside the MPN and no effective transfer of care returning applicant to treatment within the MPN. Under these circumstances, applicant is entitled to resume treatment with her non-MPN physician, Dr. Spencer, as her PTP.“

However, the WCJ expressly found that defendant may return applicant to the MPN by complying with the statutory and regulatory requirements for transfer of care and continuity of care policies. Defendant must comply with the process outlined in AD Rule 9767.9(f) for transferring care.

The transfer of care provisions in Rule 9767.9(f) require defendant to make a determination regarding whether applicant’s condition satisfies – or fails to satisfy – one of the four conditions set forth in subsections (e)(1)-(4). This section requires that defendant determine whether applicant has a condition which would allow her to complete treatment with her PTP.

Furthermore, the regulation requires that defendant notify applicant of its determination regarding completion of care. This notification must also be sent to applicant’s PTP, be in English and Spanish, and use layperson’s terms to the maximum extent possible.