Tag: 2024 News

According to recent studies published by the National Council on Workers’ Compensation (NCCI) workers’ compensation has experienced a long-term decline in overall claim frequency, thanks to automation, robotics and continued advances in workplace safety.

However, for WC Motor Vehicle Accident (MVA) claims, the story is quite different, with frequency declining for many years and then suddenly turning upward. These accidents can be very severe and are responsible for a significant portion of fatal WC claims. MVA lost-time claims continue to cost over 80% more than the average lost-time claim, because MVA claims tend to involve severe injuries (e.g., head, neck, and spine).

In its 2020 update, NCCI noted that according to the National Highway Traffic Safety Administration (NHTSA) “the installation of automatic emergency braking (AEB) was part of a voluntary commitment by 20 automakers to equip virtually all new passenger vehicles with low-speed AEB that includes forward collision warning by September 1, 2022. The NHTSA further noted that “manufacturers have made great strides in providing advanced safety to consumers compared to 2018, when only 30% of their new vehicles were equipped with AEB.” The the Insurance Institute for Highway Safety maintains that autobraking is making driving safer, estimating that the technology could cut rear-end collisions in half.

This month the voluntary efforts of these 20 automakers have become a mandatory requirement for all of them.

The National Highway Traffic Safety Administration (NHTSA) finalized Monday a new Federal Motor Vehicle Safety Standard which makes automatic emergency braking (AEB), including pedestrian AEB, standard on all passenger cars and light trucks by September 2029. According to the agency, this safety standard is expected to significantly reduce rear-end and pedestrian crashes, saving at least 360 lives a year and preventing at least 24,000 injuries annually.

AEB systems use sensors to detect when a vehicle is close to crashing into a vehicle or pedestrian in front and automatically applies the brakes if the driver has not. The new standard requires all cars be able to stop and avoid contact with a vehicle in front of them up to 62 miles per hour and that the systems must detect pedestrians in both daylight and darkness. In addition, the standard requires that the system apply the brakes automatically up to 90 mph when a collision with a lead vehicle is imminent and up to 45 mph when a pedestrian is detected.

In June 2023, the National Safety Council (NSC) supported NHTSA’s notice of proposed rulemaking to require AEB and pedestrian AEB on new passenger cars and light trucks. The standard fulfills a provision in the Infrastructure Investment and Jobs Act to establish minimum performance standards requiring that all passenger vehicles be equipped with AEB and also aligns with the Department of Transportation’s National Roadway Safety Strategy, further embracing the Safe System Approach by directly taking a step toward making safer vehicles, a pillar of the holistic approach to roadway safety.

NSC believes the development, design, and accessibility of vehicle technology are key components to addressing the tragic trend of roadway fatalities. Improvements in vehicle safety must take into account risks to both vehicle occupants and non-occupants, and ways to mitigate these risks must be clearly communicated to the public.

The Leapfrog Group is a non-profit organization in the United States that focuses on patient safety, quality, and transparency in healthcare. It was founded in 2000 by large employers and healthcare experts to work to improve the healthcare system through public reporting initiatives.

For more than 20 years, The Leapfrog Group has collected, analyzed, and published hospital data on safety and quality in order to push the health care industry forward. Leapfrog’s bold transparency has promoted high-value care and informed health care decisions – and helped trigger giant leaps forward in the safety, quality, and affordability of U.S. health care.

Leapfrog just released its spring 2024 Hospital Safety Grades, assigning an “A,” “B,” “C,” “D” or “F” to nearly 3,000 general hospitals on how well they prevent medical errors, accidents and infections. Nationally, patient experience – a set of measures using patient-reported perspectives on hospital care – indicates significant signs of improvement since the fall 2023 Safety Grades, and preventable health care-associated infections show a sustained drop after unprecedented rates during the height of the pandemic.

In addition to assigning letter grades to individual hospitals, The Leapfrog Group also reports best patient safety performance by state and, for the first time, by metro area based on highest percentage of “A” hospitals. In spring 2024, Utah ranks number one among states for the second cycle in a row. The top three metro areas are Allentown (Pennsylvania), Winston-Salem (North Carolina), and New Orleans (Louisiana).

Three California hospitals made the Leapfrog list of the 10 nationwide to receive an “F” grade in The Leapfrog Group’s spring safety rankings, released May 1.

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

There are 15 hospitals Leapfrog has rated with 25 consecutive “A” grades. Two of them are in California.

– – French Hospital Medical Center (San Luis Obispo)
– – Kaiser Permanente Orange County-Anaheim Medical Center

Twice a year, the nonprofit healthcare watchdog organization publishes a letter grade for 3,000 hospitals on how well they prevent medical errors, accidents and infections. Among the 3,000 hospitals evaluated nationwide, fewer than 1 percent received an “F.”

The owner and operator of addiction treatment facilities in Orange County has been charged by a federal grand jury indictment alleging he paid nearly $175,000 in illegal kickbacks to so-called “body brokers” in exchange for finding him new patients. He pleaded not guilty on April 29, and trial has been set for June 25th.

57 year old Scott Raffa who lives in Newport Beach, was arrested Saturday at Los Angeles International Airport. Raffa is charged with 12 counts of illegal remunerations for referrals to clinical treatment facilities.

According to the indictment that a grand jury returned on April 10, Raffa operated Orange County-based sober living homes, including Sober Partners Waterfront Recovery Center, Sober Partners Reef House, and Sober Partners Beach House. These facilities treated patient populations that received health care benefits through health insurers.

Raffa allegedly paid thousands of dollars per patient in illegal kickbacks to individuals who referred patients to his facilities, a practice known as “body brokering.” The body brokers in this case each controlled their own business entities and Raffa allegedly paid them kickbacks by depositing checks or wiring money to bank accounts that the brokers controlled. The kickbacks were intended as compensation for the brokers referring patients and to induce the brokers to continue to refer patients to Raffa’s facilities, the indictment alleges.

Raffa allegedly entered into sham contracts with certain body brokers that were designed to conceal the nature of the illicit payments, including by purportedly prohibiting payments from Raffa’s sober living homes based on “volume or value” of the body brokers’ patient referrals.

The brokers and Raffa allegedly met or would communicate via encrypted messaging services to calculate and negotiate the kickback amounts he owed the brokers for patient referrals. The kickback amounts allegedly were based on the insurance revenues that Raffa expected to receive for the respective patients, factoring in each patient’s insurance provider and the duration of the patient’s treatment at one of his sober living homes. Raffa refused to pay the kickbacks unless patients received at least 21 days’ treatment at one of his facilities, according to the indictment.

From April 2020 to October 2021, Raffa paid a total of $174,600 in illegal kickbacks to body brokers, the indictment alleges.

A report by the Orange County Register said that the DOJ’s Sober Home Initiative began in 2021, after O.C. overtook South Florida as the national epicenter for addiction industry fraud. Historically, the Miami area had that dubious distinction, but crackdowns in Florida pushed the problems westward, Assistant U.S. Attorney Benjamin Barron, chief of the Santa Ana Branch Office, said at the time.

Myriad arrests and guilty pleas have resulted from the Sober Home Initiative. Most recently, Kevin M. Dickau, 35, of Tustin, pleaded guilty to conspiracy to commit health care fraud on April 23 and was sentenced to 15 months in prison and three years of supervised release.

It doesn’t appear that the DOJ is done just yet. Raffa’s indictment mentions mysterious unnamed body brokers, and when we asked if there’d be more indictments coming, spokesperson Ciaran McEvoy said, “We have no comment.” The vast majority of addiction treatment facilities in the state are here in Southern California.

Applicant Abate Villalpando alleged injury to his head, neck, back, psyche, headaches, internal [system], and in the form of sleep disorder, while employed during the period February 1, 2016 to October 15, 2017 by G Burger, insured by Employers Preferred Insurance Company and State Farm Insurance Company administered by Sedgwick CMS; Golden Road Food Services DBA Fresh Brothers Pizza by Liberty Mutual; and Garden Fresh Restaurants DBA Souplantation by Travelers Insurance Company.

Defendants denied all liability for applicant’s claim. On June 13, 2023, the parties prepared a Pre-trial Conference Statement, indicating the need for adjudication of multiple issues, including injury AOE/COE.

On August 8, 2023, applicant filed a Notice of Election as against G. Burger and State Farm. On the same day, parties appeared at Mandatory Settlement Conference, and the matter was set for trial on September 13, 2023.

On September 13, 2023, the parties appeared at trial. However, applicant was unavailable, and the WCJ continued the matter to another trial date. The WCJ further issued a minute order, as follows: “AA’s Election against G Burger under the coverage of State Farm is presently DENIED due to objection to election by State Farm and also because this case involves multiple employers and carriers for a CT claim that may extend past the alleged period and also because the terminal employer/carrier is not G Burger and State Farm.”

On September 27, 2023, applicant filed a Petition for Removal from the WCJ’s September 13, 2023 order denying election.

On October 11, 2023, the WCJ issued an Order Vacating Denial of Election pursuant to WCAB Rule 10955(d) (Cal. Code Regs., tit. 8, § 10955(d)), in which the WCJ vacated the minute order denying applicant’s election, and substituted the following: “AA’s Election against G Burger under the coverage of State Farm is DEFERRED pending adjudication at trial of this threshold issue due to objection to election by State Farm and the need to determine whether the applicant’s alleged CT injury is AOE/COE.”

On October 19, 2023, applicant filed the instant Petition for Removal in response to the WCJ’s amendment of the minute order. Applicant avers his election “falls squarely within the language and legislative purpose of Labor Code § 5500.5,” and that he “should be permitted to proceed against one defendant only, G Burger, as elected, whereas the remaining defendants lose no rights whatsoever except that they must await issuance of applicant’s award prior to contribution issues.”

The WCAB granted the Petition for Removal and affirmed the Order, except that it amend it to reflect that the issue of applicant’s election is deferred pending the creation of an evidentiary record. The WCAB then returned this matter to the WCJ for further proceedings and decision in the panel decision of Villalpando v G Burger -ADJ10620763 (April 2024)

State Farm has filed an Answer, averring that “applicant’s right to elect one defendant is not unfettered; in fact, the Workers’ Compensation Appeals Judge can decline even to allow an election in his or her discretion” citing Schrimpf v. Consolidated Film Industries, Inc. (1977) 42 Cal.Comp.Cases 602 (appeals board en banc)). State Farm contends that the fact that it has five more days of coverage than codefendant Employers Preferred Insurance Company “is not a compelling basis under which to elect against a carrier when considering that for the duration of the case, applicant had engaged in direct litigation and discovery with Employers.”

The WCAB panel noted that “It is the responsibility of the parties and the WCJ to ensure that the record is complete when a case is submitted for decision on the record. At a minimum, the record must contain, in properly organized form, the issues submitted for decision, the admissions and stipulations of the parties, and admitted evidence.” (Hamilton v. Lockheed Corp. (2001) 66 Cal.Comp.Cases 473, 476 [2001 Cal. Wrk. Comp. LEXIS 4947] (Appeals Board en banc)

“Here, the record does not adequately set forth the arguments advanced by the parties, or the evidence relied upon by the WCJ in determining initially to deny applicant’s election pursuant to section 5500.5, and later to defer the election.”

A Tustin California man was sentenced to 15 months in prison for his role in a conspiracy to broker patients as part of a multistate patient scheme in which he directed recruiters to bribe drug-addicted individuals to enroll in drug rehabilitation and received referral fees from the rehabilitation centers.

35 year old Kevin M. Dickau pleaded guilty by videoconference before U.S. District Judge Peter G. Sheridan to an information charging him with one count of conspiracy to commit health care fraud. Judge Sheridan imposed the sentence on April 23, 2024.

Six other individuals have previously pleaded guilty for their roles in the scheme: Peter Costas; Seth Logan Welsh; John C. Devlin; Akikur Mohammad; Lauren Philhower; and Anastasia Passas.

According to documents filed in the case and statements made in court:, Dickau, Welsh, Devlin, and their conspirators owned and operated a marketing company in California. Dickau, Welsh, and Devlin used the marketing company to help orchestrate a scheme in New Jersey, Maryland, California, and other states that involved bribing individuals addicted to heroin and other drugs to enter into drug rehabilitation centers so Dickau, Welsh, Devlin, and their conspirators could generate referral fees from those facilities.

Two facilities in California that paid such referral fees were owned or operated by Mohammad, Philhower, and Passas. One located in Los Angeles, the other in Santa Ana. California Insurance code section 750 criminalizes receiving or paying remuneration for referrals to any person or entity that bills claims under insurance policies, which includes recovery homes, clinical treatment facilities, and laboratories.

The marketing company run by Dickau, Welsh, and Devlin maintained contractual relationships with drug treatment facilities around the country, including the ones run by Mohammad, Philhower, and Passas. The marketing company also engaged a nationwide network of recruiters – including Costas in New Jersey – to identify and recruit potential patients, from New Jersey and other states, who were addicted to heroin or other drugs and who had robust private health insurance.

To convince drug-addicted individuals to travel to and enroll in rehabilitation when they otherwise would not have, Costas and other recruiters offered to bribe them – often as much as several thousand dollars – with the approval of Dickau, Welsh, and Devlin.

Once the patients agreed to enroll in drug rehabilitation in exchange for the offered bribe, Dickau, Welsh, Devlin, and Costas would arrange and pay for cross-country travel to the drug treatment centers in California and other states, in concert with the owners of the facilities themselves, including Mohammad, Philhower, and Passas. Costas would stay in touch with the New Jersey patients at the facilities and specifically instruct them to stay at the facilities long enough to generate referral payments, and he would pass along information to Dickau, Welsh, and Devlin about the patients’ status at the facilities.

Dickau, Welsh, and Devlin would monitor the other patients they brokered by speaking to other recruiters or to the owners and employees of the drug treatment facilities themselves.

The drug treatment facilities run by Mohammad, Philhower, and Passas had contracts with the marketing company. Those facilities typically paid the marketing company a fee of $5,000 to $10,000 per patient referral. Dickau, Welsh, Devlin, and their conspirators shared that money among themselves. Costas and other recruiters received approximately half that amount for each patient they brokered. Dickau, Welsh, Devlin, and their conspirators brokered scores of patients to drug treatment facilities around the country, including the ones run by Mohammad, Philhower, and Passas, and the conspiracy caused millions of dollars of losses for health insurers.

In addition to the prison term, Judge Sheridan sentenced Dickau to three years of supervised release.