Tag: 2023 News

The Leapfrog Group, an independent national nonprofit driving a movement for patient safety founded in 2000 by large employers and other purchasers, just released its fall 2023 Hospital Safety Grades, assigning a letter grade to nearly 3,000 general hospitals on how well they prevent medical errors, accidents and infections.

The Leapfrog Hospital Safety Grade is the only hospital ratings program based exclusively on hospital prevention of medical errors and harms to patients. It is fully transparent and free to the public, and grades are updated biannually in the fall and in the spring.

The latest grades show hospitals reducing health care-acquired infections (HAIs) post-pandemic, after significant increases in infection rates during the COVID-19 pandemic. This cycle, nearly 30% of hospitals earned an “A,” 24% earned a “B,” 39% earned a “C,” 7% earned a “D,” and less than 1% earned an “F.”

Out of 3000 hospitals surveyed, 11 of them were given a score of “F.” Four of those 11 are in California.

– – Memorial Hospital of Gardena
– – Mission Community Hospital (Panorama City)
– – Pacifica Hospital of the Valley (Sun Valley)
– – Providence St. Mary Medical Center (Apple Valley)

New York is the state with the second most on the “F” list with two hospitals receiving an “F” grade.

Utah is the state with the highest percentage of “A” hospitals in the country this fall. After Utah, the top ten states for “A” hospitals are: Virginia, North Carolina, Pennsylvania, South Carolina, Connecticut, Montana, Tennessee, Florida and Texas.

“Now that we have pre- and post-pandemic data for patient safety measures, we are encouraged by the improvement in infections and applaud hospitals for reversing the disturbing infection spike we saw during the pandemic,” said Leah Binder, president and CEO of The Leapfrog Group. “However, there’s still more work to be done. It’s deeply concerning that patient reports about their health care experience continues to decline.”

Late last month, President Biden issued an Executive Order to establish new standards for artificial intelligence (AI) safety and security with the goal of ensuring the U.S. leads the way in seizing the promise and managing the risks of AI. The Executive Order also aims to protect privacy, advance equity and civil rights, stand up for consumers and workers, promote innovation and competition, as well as advance U.S. leadership around the world.

The Order is more than 100 pages in length and is a directive across the “whole of government” to begin regulating this new technology. The order directs or makes requests of countless federal agencies, from the Departments of Energy and Homeland Security to the Consumer Financial Protection Bureau and the Federal Housing Financing Agency, and more. These agencies, in turn, have the authority to issue regulations that carry the force of law. The order also mandates the creation of new AI Governance Boards and Chief AI Officer positions across federal agencies, laying a possible groundwork for a new centralized AI agency.

And the reaction to this Order across America is not all good. Forbes responded with the article “Biden’s New AI Executive Order Is Regulation Run Amok.” and the author believes that this “may prove one of the most dangerous government policies in years” citing several scenarios of potential unintended negative consequences in various industries.

Some industry groups have expressed concern that the order’s regulatory requirements will stifle innovation in the AI sector. For example, the NetChoice trade group has warned that the order could “put any investment in AI at risk of being shut down at the whims of government bureaucrats.”

Other critics have argued that the order is too vague and lacks specific details about how the government plans to implement and enforce its provisions. For example, the Algorithmic Justice League, a civil rights group, has said that the order “does not go far enough” to protect people from the harms of AI.

Some experts have also criticized the Biden administration for failing to consult more broadly with the public and stakeholders before issuing the order. For example, the Brookings Institution think tank has said that the order “reflects the administration’s own priorities, but not necessarily the priorities of the broader AI community.”

The American Civil Liberties Union (ACLU) has warned that the order’s focus on national security could lead to the government using AI for mass surveillance and other purposes that could violate civil liberties.

Citing the announcement of this Executive Order, the National Safety Council issued a responsive statement. saying that it believes data and AI can be used to gain insights into workplace safety programs and that employers can apply those same insights and technology to reduce the risk of serious injuries and fatalities for workers.

The National Safety Council is America’s leading nonprofit safety advocate – and has been for 110 years. As a mission-based organization, we work to eliminate the leading causes of preventable death and injury, focusing our efforts on the workplace and roadways.

Over the past five years, NSC has focused specifically on how technology, including AI, can improve health and safety outcomes on the job through its Work to Zero initiative, which continues to reveal how technology works well and can be improved to save lives.

Some of the prevailing AI technologies include machine learning, computer vision, natural language processing, as well as predictive and prescriptive analytics engines. All these technologies serve as powerful tools to identify risk factors for musculoskeletal disorders and other injuries, reduce employee incidents and streamline manual tasks.

The NSC said it urges the White House, Congress and other policymakers to examine these findings as it continues to incorporate learnings into this effort.

The Biden Executive Order on AI is just the beginning of the process of regulating AI in the United States. It remains to be seen how the order will be implemented and enforced, and whether it will be effective in addressing the risks and challenges posed by AI.

Rose Jones was employed at the University of California, Irvine campus as the Director of Scholarship Opportunities .

On the day of the incident, at the end of her workday, she exited her office suite at UCI’s science library, walked her bike a short distance to the bike path on Outer Ring Road, mounted her bike, and began riding toward her home. After riding for about 10 seconds, Jones reached a trench, cordoned off with orange posts and caution tape. Upon noticing the obstacle, she swerved and attempted to brake but fell off her bike and sustained injuries.

She subsequently sued the University alleging premises liability and negligence, and her husband alleging loss of consortium. The parties and the trial court subsequently treated Jones’s claims as a claim for dangerous condition of public property under Government Code section 835.

The University moved for summary judgment, claiming that Jones’s injuries occurred within the course of her employment and that the workers’ compensation exclusivity rule therefore barred this action. It noted Jones was still on the University’s premises and argued her injuries were subject to the workers’ compensation scheme under the premises line rule. The University alternatively contended Jones could not recover under Government Code section 835 because she did not exercise due care at the time of the accident.

The trial court granted the University’s motion for summary judgment. It concluded the exclusivity rule barred Jones’s claim because her injuries occurred within the course of her employment as a matter of law based on the premises line rule. It further concluded that, as a matter of law, Jones did not use due care at the time of the accident.

The Court of Appeal affirmed the trial court in the unpublished case of Jones v. Regents of the University of California -G061787 (October 2023)

Under the judicially created “going and coming rule” an employee’s injury while commuting to and from work is not compensable under the workers’ compensation system absent “special or extraordinary circumstances.”

In an effort to create a sharp line of demarcation as to when the employee’s commute terminates and the course of employment commences, courts adopted the premises line rule, which provides that the employment relationship generally commences once the employee enters the employer’s premises. The same rule applies when the employee is leaving the work premises, provided he does not unnecessarily loiter thereon.

Highlighting the merits of the premises line rule, our Supreme Court explained in General Ins. Co. v. Workers’ Comp. Appeals Bd. (1976) 16 Cal.3d 595 “The ‘premises line’ has the advantage of enabling courts to ascertain the point at which employment begins-objectively and fairly.”

The Court of Appeal wrote we “conclude the worker’s compensation exclusivity rule barred appellants’ claims because Jones’s injuries occurred in the course and scope of her employment as a matter of law. Her accident occurred on UCI’s campus, undisputedly owned by the University, just after she left her workstation. Under these circumstances, the premises line rule brought Jones’s injuries within the worker’s compensation scheme. (General Ins. Co., supra, 16 Cal.3d at p. 598.)”

Henry Geoffrey Watson, a medical doctor residing in Oakland, California, was convicted by a federal jury of charges that included accepting kickbacks for patient referrals to home health agencies, health care fraud, and false statements relating to a health care matter.

The jury found that 67 year old Watson engaged in three health care kickback schemes from 2013 to 2019, using his position as a licensed medical doctor. The first scheme involved a conspiracy in which Watson agreed to refer patients to home health agency Amity Home Health Carein exchange for illegal kickback payments. The evidence at trial proved that Watson and employees of Amity and its CEO, Amanda Singh, conspired to pay Watson regular and recurring amounts, sometimes in the form of cash payments of $3,000 a month, to ensure that Watson referred Medicare patients to Amity each month.

Title 42, United States Code, Section 1320a-7b, the Anti-Kickback Statute, makes it a crime for any person to knowingly solicit, offer, or pay a kickback, bribe, or rebate for furnishing services under a Federal health care program including Medicare.

In the second scheme proved at trial, Watson accepted kickback payments from an undercover FBI agent posing as a home health agency representative seeking Watson’s agreement to refer his patients to a particular Bay Area home health agency. The evidence at trial included video recordings of Watson accepting envelopes of cash, for a total of more than $10,000, at four meetings in 2017. The jury heard evidence that Watson also suggested other doctors who he believed would be willing to accept illegal payments for referrals from the undercover agent.

The third scheme proved at trial involved a conspiracy between Watson and others to repeatedly and falsely certify individuals for Medicare-funded home health services that the individuals did not seek and did not need. The evidence at trial showed that Watson and co-conspirators arranged for Watson to briefly meet large numbers of unwitting elderly residents of Bay Area retirement homes. After these meetings, held in common areas or recreation rooms, Watson certified that each and every resident he met was homebound, meaning they had a normal inability to leave the home. In fact, according to the evidence and the jury’s verdict, Watson knew that the patients were not homebound and did not need the services he prescribed.

Watson did not conduct any tests or conduct any inquiry about whether they were homebound, according to trial evidence, but he nevertheless made fraudulent referrals to the three home health agencies. During time periods that Watson repeatedly certified that certain individuals were homebound, testimony from these individuals and their regular primary care doctors showed that the individuals were generally healthy and active, engaging in activities such as traveling internationally, shopping, walking stairs, and jogging. The evidence proved Watson falsely billed Medicare for certifying these individuals for home health and for supervising their home health care, despite the fact that the individuals did not need that care. As part of the conspiracy, Watson was paid illegal kickbacks of $100 per patient referral by a co-conspirator working for the three home health agencies.

Criminal charges against Watson were unsealed on September 5, 2019, when the United States Attorney’s Office announced charges by criminal complaint against 30 defendants in a wide-ranging, patients-for-kickback scheme. Those charges included criminal kickback charges against Amity Home Health Care, which was then the largest home health care provider in the San Francisco Bay Area, and Advent Care, a provider of hospice care. In relation to the investigation that led to the charges and conviction of Watson, other individuals and doctors were also convicted of illegal kickbacks:

– – Amity’s CEO, Ridhima Amanda Singh pled guilty to charges of conspiracy to pay kickbacks for the referrals of Medicare beneficiaries on August 5, 2022, in Court Case No. 22-CR-267 CRB.
– – Dr. Bhupinder Bhandari pled guilty to violations of the Anti-Kickback Statute on June 6, 2022, in Court Case No. 20-CR-374 JD.
– – Dr. Zheng Zhang pled guilty to violations of the Anti-Kickback Statute on April 25, 2022, in Court Case No. 22-CR-090 VC.
– – Dr. Gerald Myint pled guilty to violations of the Anti-Kickback Statute on November 18, 2020, in Court Case No. 20-CR-408 CRB.
– – Dr. Juan Posada pled guilty to violations of the Anti-Kickback Statute on January 27, 2021, in Court Case No. 20-CR-420 RS.

All those defendants have been sentenced by the judges assigned to those cases.

Watson remains released on bond pending sentencing. Watson’s sentencing hearing is scheduled for February 28, 2024, before Judge Breyer in San Francisco. Any sentence will be imposed by the court after consideration of the U.S. Sentencing Guidelines and the federal statute governing the imposition of a sentence, 18 U.S.C. § 3553.

A Bakersfield attorney pleaded no contest Monday and was sentenced to two years in jail for his part in a $12.5 million scheme to overbill insurance companies for urine tests at sober living homes in Orange County.

Between January 2008 and December 2016, defendants Pamela and Philip Ganong owned sober living homes in Orange County, Bakersfield, Los Angeles, and San Diego, through their business William Mae Company, which operated as Compass Rose Recovery. In December 2011, the Ganongs formed a medical testing lab called Ghostline Labs.

Philip William Ganong, 70, accepted a plea agreement approved by Orange County Superior Court Judge Joy Markman. He pleaded no contest to 10 felony counts of fraudulent claims for a health benefit.

Multiple charges were filed in 2017 in connection with the scheme allegedly led by Ganong and his wife and co-defendant Pamela Mae Ganong, 67, who owned sober living homes in Orange County, Bakersfield, Los Angeles and San Diego, according to the Orange County District Attorney’s Office.

Pamela Mae Ganong is awaiting trial, but her case has been assigned to a court that handles defendants who are facing questions about whether they are mentally healthy enough to assist in their defense.

Pamela Ganong’s sister, 70 year old Susan Stinson of Carlsbad, was charged with conspiracy to commit medical insurance fraud. Stinson pleaded guilty to two felony counts of fraudulent claim for a health benefit on Wednesday and sentenced to time served behind bars, which was 34 days, according to court records.

Judge Markman ordered Stinson and Ganong to pay the $12.5 million restitution.

Charges against the Ganongs’ son, William Ganong, were dismissed in 2019 after he died, according to court records. Carlos X. Montano, M.D Newport Beach pleaded guilty in 2018 to insurance fraud and was sentenced to one year in county jail. His California medical license was revoked in June 2021.

  The Ganongs formed a medical testing lab in December 2011, and prosecutors said sober living home residents were recruited to join the scheme to overbill insurance companies for urine tests, which involved listing them as employees and signing them up fraudulently for health insurance.

California State Bar records show that Philip Ganong continues to be licensed as an attorney, but does show a cautionary note that he has been charged with a felony.