Task force shuts down Valley ‘prescription mills’

A task force comprising local, state and federal agencies has shut down four San Fernando Valley clinics that engaged in Medicare fraud and served as “prescription mills” from which bogus prescriptions for the powerful pain killer OxyContin were being issued, authorities said today.

The clinics raided Thursday, when three people were arrested, include two in the 7000 block of Reseda Boulevard in Reseda, one in the 8600 block of Reseda Boulevard in Northridge and one in the 8100 block of Van Nuys Boulevard in Van Nuys, said sheriff’s Capt Mike Parker.

The raids — which resulted in the seizure of computers, financial documents and patient records — were carried out by the Health Authority Law Enforcement Task Force, which comprises the Los Angeles County Sheriff’s Department, Los Angeles Police Department, L.A. County Department of Health, California Department of Health Care Services, and the U.S. Health and Human Services Department.

Parker said the investigation climaxing in Thursday’s raids also involved the FBI, Internal Revenue Service, Drug Enforcement Administration, Monterey Park Police Department, California Department of Justice, California Medical Board, and California Labor Commission.

The investigation, he said, was prompted by “recent deaths due to prescription overdoses and complaints from devastated loved ones.”

Parker said that suspects have been caught throughout the western United States trying to fill prescriptions for OxyContin that they obtained from the now-shuttered clinics. “Others were caught trafficking large quantities of OxyContin using prescriptions obtained at the four clinics,” he said.

Moreover, numerous legitimate patients said their identities had been stolen through medical care identity theft involving the clinics, Parker said.

They reported that prescriptions had been filled in their names, then billed to Medicare, he said, adding that “the billings were credited against the legitimate Medicare patients’ medical histories, resulting in records indicating that they were using part of their limited allowance.”

The four clinics raided Thursday are linked to incidents or investigations in Arizona, Nevada, Oregon, Utah, Washington state and nearly every large county in California, Parker said.

Besides the bogus prescriptions, the investigation is also focusing on allegations of false claims resulting in Medicare fraud, and illegal kickbacks to Medicare beneficiaries who sold the use of their Medicare card to prescription drug dealers, Parker said. He said Medicare was also billed for medical services that were never performed.

Sheriff’s Sgt. Steve Opferman, a task force member, said most of the criminal activity attributed to the four clinics “involved the prescription drug OxyContin.”

“The investigation included undercover investigators who purchased prescription drugs just by presenting false identification at the clinics. No medical examinations were ever performed,” he said.

Two arrests were made at the clinic in Northridge, Parker said. One of the suspects had 23 vials containing more that 2,000 pills with a street value of about $40,000, he said, and the second had false identification that he used to fill fraudulent prescriptions. Their names were not released.

Also arrested as part of the investigation was a woman named Anush Davtyan, who was taken into custody at her home in Encino, said FBI spokeswoman Laura Eimiller. Davtyan was named in a federal arrest warrant, Eimiller said, declining to cite the charges pending against the woman.

Parker said the evidence being reviewed in the aftermath of Thursday’s raids could produce charges against doctors, clinic managers, office employees, drug dealers and others. The charges could include state and federal felonies, among them drug trafficking, health care fraud and tax fraud.

 

 

Source: WorkComp Academy; The Daily Breeze

Attorney Fees To Be Covered

Shawna Alonzo, an employee of the Children’s Hospital of Orange County is entitled to $38,169 in attorney fees. Alonzo was injured while driving in the back of the ambulance and sued the drivers Casey Bear Brennan and Filyn Corp., who were doing business as Lynch Ambulance.

Tristar Risk Management, the workers’ compensation third party administrator for the hospital, intervened into Alonzo’s suit. Tristar alleged that the hospital was self-insured, and that it was forced to provide Alonzo benefits because of Lynch Ambulance’s negligence.

Alonzo’s lawyer declared that he spent approximately 300 hours on the case and that his billing rate was $300 per hour.

The trial court awarded Alonzo and her attorney $38,169 in attorney fees, and $5,717 in costs, creating a total award of $43,886.

Filyn and Brennan appealed.

The court has analyzed that the trial court did not abuse its discretion, therefore, disposition, affirmed.

 

Source: WorkComp Central

Premiums Likely To Level Off

Workers’ Compensation premiums inCalifornia, which have been creeping up the past four years, look like they’ll stabilize in 2012.

Since the early 2000’s rates soared and that drove business away fromCalifornia.

Now the insurance industry’s advisory board told state officials that premiums should stay about the same beginning next January.

Premiums have risen about 10 percent the past four years, according to the bureau’s statistics.

Still, they’re about 60 percent less than their peak in 2003, when complaints about sky-high premiums generated a massive political debate overCalifornia’s business climate.

Former Gov. Arnold Schwarzenegger signed a major overhaul of the system into law, cutting costs and leading to reduced premiums. However, the costs are still fifth-highest in the nation, according to an annual survey byOregoninsurance regulators.

We know it’s hard to predict how much the premiums will go down, but we must remember that every little bit helps.

 

Source: TheSacramentoBee

Committee Wants Better Protection for State Hospital Workers

By Greg Jones, Western Bureau Chief

SACRAMENTO,Calif.– California lawmakers looking into the increasing incidents of violence in the state’s mental health hospitals heard from workers on Wednesday who said staff members are regularly punched, kicked, slapped, scratched and spit on, and that the state agency running the facility isn’t doing anything to improve working conditions.

There are more than 11,000 workers employed at five mental hospitals throughout the state, and assaults by patients occur on an almost daily basis, according to workers who testified before the Assembly Select Committee on State Hospital Safety.

Part of the problem is that the patients being housed at these facilities are different than they were 20 years ago, according to a 2010 security report on the state’s hospital system published by the California Department of Mental Health.

In the 1990’s, the majority of patients were civilly committed individuals found by a court to be disabled and unable to care for themselves because of mental illness. Today, 93% of patients are committed by a court after being involved in crimes. As a criminal population has increased, so have incidents of aggressive behavior, the Mental Health department report says.

In 2010, there were 8,000 aggressive incidents and 5,000 injuries reported by workers at state hospitals, according to committee Chairman Michael Allen, D-Santa Rosa. The Napa Valley Register reported in March that there were 928 attacks on staff members in 2010 at theNapaStateHospital. The Los Angeles Times reported in July that there were 1,324 assaults on workers at theMetropolitanStateHospitalinNorwalkin the same year.

Allen didn’t say how much this is costing the state, and his office did not return calls on Tuesday about this information.

However, Dr. Patricia Tyler, a staff psychiatrist atNapaStateHospital, testified that the injuries are costing the state close to $96 million a year based on a 1989 estimate that 10% of personnel costs for state hospitals go to cover the cost of workplace injuries. The fiscal year 2009-10 Department of Mental Health budget allocated $961 million for personnel expenses.

Tylersaid she thinks the number could be higher now that the population in the hospitals is different, but that better workplace safety measures would allow the state to see significant savings. That’s an important consideration with revenue projections used to craft the 2011-12 budget falling short by about 10%. The budget contains trigger mechanisms to make additional cuts of up to $2.5 billion if revenue is below expectations.

The Department of Mental Health report outlines safety measures, such as better alarm systems. Video surveillance and tables and chairs that cant be thrown. Cliff Allenby, acting director of the department, said he is dedicated to protecting workers, but there are limits to what can be done because of the state’s budget problems. He attributed much of the violence to a combination of a more aggressive population of patients and fewer staff members to work with them.

He said Gov. Jerry Brown’s office lifted the hiring freeze for his department in April and the agency is doing what it can with its resources to improve safety at the facilities.

Assemblywoman Mariko Yamada, D-Davis, questioned how the department is spending its money, noting that the agency is appealing a number of citations issued by the California Division of Occupational Safety and Health (Cal-OSHA).

Cal-OSHA fined Metropolitan $9,560 in May for not addressing hazards posed to workers by violent patients.

In June, Cal-OSHA fined theNapaStateHospital$16,875 after an investigation into an attack that left a therapist with serious head injuries. State safety officials said the hospital did not have adequate alarm systems, injury-and illness-prevention program and escort procedures.

Yamada suggested that money could be better used to remediate the problems identified by Cal-OSHA, rather than fighting the citations.

Ellen Widess, Cal-OSHA chief, added that while the hospital is appealing the fines, any abatement orders are stayed until the appeal is completed. Yamada asked whether the Legislature should look at a bill requiring employers to fix hazards identified during a workplace inspection before the appeals process is completed.

Bay Area Pot Club Owners Charged for Lack of Comp Coverage

Co-owners of a medical marijuana dispensary in the Bay Area who have been battling local officials over the legality of their shop are facing charges for not obtaining workers’ compensation coverage, the Oakland Tribune reports.

Teddy Miller and Bob Uwanawich, owners of NBD Collective inNewark, were hit with 25 felony charges on August 12, one day after the collective reopened, following a June 28 raid. Charges filed by the Alameda County District Attorney’s Office include a misdemeanor count of failure to obtain workers’ compensation insurance.

Miller and Uwanawich have a long running dispute with city officials who maintain thatNewarkzoning laws prohibit marijuana clubs, and therefore the owners need a land-use permit, which they do not have, to legally operate NBD Collective.

In addition to the workers’ comp charges, miller and Uwanawich were charged with 14 felony counts of tax fraud and multiple charges of conspiracy to sell marijuana and possession of marijuana to sell. Both are out on $100,000 bail and schedule to appear at the Fremont Hall of Justice on August 25, according to the tribune.

 

Source:OaklandTribune

Cheerleader – Turned – Cop Files Harassment Suit Against City

A former cheerleader for the Oakland Raiders now working as a police officer in Vacaville filed a $1.5 million lawsuit against the city, alleging she was falsely accused of filing a workers’ compensation claim in retaliation for reporting instances of sexual harassment and alleging violations of the Fair Employment and Housing Act (FEHA) to city officials.

According to court documents filed Monday in the U.S. District Court for Eastern California, Nicole Rosenstiel, 35, was injured during a training exercise in October 2006 and was placed on modified duty from March 14, 2007, through July 6, 2008.

When she attempted to return to full duty, she realized she was still injured and asked to be returned to light duty. Her request was denied.

Rosenstiel requested a leave-of-absence for post-traumatic stress disorder, which she said was caused by her physical disability, stress from being denied modified duty, sexual harassment and a hostile workplace. She filed a complaint with the city manager at the same time, alleging that she was subjected to gender-based harassment from February 2005 through October 2006.

As a result of the complaint, the police department conducted an internal investigation. Lt. Craig Courtemonche, who conducted the investigation, forwarded allegations to the Solano County District Attorney’s Office that Rosenstail was faking her injuries and failed to report previous injuries.

The district attorney filed 10 felony charges of insurance fraud against Rosensiel. She was also told that the charges would be dropped if she resigned, according to her complaint.

Rosenstiel didn’t resign, and a Solano County Superior Court judge dismissed the charges, following a two-day probable cause hearing on March 9, 2011.

Rosenstiel said in her complaint filed on Monday that the motivation for the charges was to force her retirement without paying her medical benefits and retaliation for filing a complaint alleging sexual harassment and a hostile workplace.

The complaint names as defendants the city, Police Chief Richard Word and Courtemonche. The defendants have 21 days from August 16 to respond to the complaint.

 

Source: WorkComp Central

Fitted Sheets and Workers’ Comp??

There’s currently a proposal moving forward through the Legislature that has stirred up some controversial. It would require that hotels use fitted sheets. “We are now going to make it a crime in Californianot to use a fitted sheet? Really?” state Sen. Sam Blakeslee (R-San Luis Obispo) asked during a debate before the Senate passed the measure in June.

When the bill returns from a month of recess it is to address the back injuries sustained by hotel housekeepers. State Sen. Kevin De Leon (D-Los Angeles), said scores of housekeepers suffer back injuries each year lifting heavy mattresses to replace flat sheets, and the issue is a personal one for him.

“My mother was a housekeeper and worked herself to the bone,” said De Leon, who said his measure would be the first law of its kind in the nation. It also would require special tools to enable maids to clean bathrooms without having to stoop or get down on their hands and knees.

“Housekeepers have the highest rate of lower-back injuries in the hotel industry, and these workers deserve much better,” the senator said.

According to the state Industrial Relations Department, 7,400 housekeepers inCalifornia hotels have filed a workers’ compensation claim and 833 of those said they injured their backs.

What does this mean you may ask? If the bill should pass,Californiahotels will have to purchase fitted sheets for their rooms.

 

Source: workcomp academy

Couple committed Medicare Fraud

Pastor Christopher Iruke, at hisSouth Los Angelesstorefront church, along with his wife and employee are guilty of healthcare fraud and conspiracy. They committed fraud in a scheme that involved $14 million in illegitimate Medicare claims.

Iruke, his wife and employee supplied power wheelchairs to Medicare patients that didn’t need it, for they were capable of walking on their own. They also filed a claim for two individuals who were deceased, according to court papers.

Federal authorities state that Iruke shoved papers of incriminating evidence into a shredder until the machine broke down. He then shoved papers into the toilet and tried flushing them. All of these documents linked him to the frauds he committed against Medicare.

Iruke’s attorney said that it was marketers and clinic operators who were responsible for the phony prescriptions, and that his client was fooled into believing he was conducting legitimate business.

Our position in trial was that he didn’t know, that he was a dupe much the same way the Medicare beneficiaries were, attorney Alan Baum said. All the money he was earning, as far as he knew, was legitimate.

Baum also denied that his client tried to dispose of incriminating evidence.

Iruke, his wife, and employee are to be convicted in November 2011.

 

Source: workcomp academy

County Using Comp Insurance to Target Illegal Contractors

A county in California’s Central Valley is looking at requiring roofing contractors and pool builders to provide proof of workers’ compensation insurance as a way to stamp out the underground economy.

The pilot program will be the first of its kind in the state, according to the Chico Enterprise Record, and closely resembles a pair of California Assembly bills targeting unlicensed contractors. One bill is currently on hold, while the other is up for a third and final vote in the Senate.

Butte County Supervisors on July 26 voted 3-1, with one member abstaining, to direct staff to develop a detailed plan for a pilot program to check whether a swimming pool or roofing contractor has workers’ compensation insurance when applying for a building permit. The program will also identify a way to check the worksites of contractors who claim to be exempt from work comp requirements because they have no employees, according to the Enterprise Record.

The county will originally target only contractors who do roofing and swimming pool work to get a better understanding of the amount of staff and time needed to monitor the insurance status of these permit applicants and analyze what works and what doesn’t in the pilot program, the Enterprise Record reported.

David Fogt, director of enforcement for the Contractors State Licensing Board, said he is assigning someone from his staff to do outreach in Butte County because the board wants to see the pilot project succeed.

Supervisors will discuss the pilot program again at the board’s next scheduled meeting on Aug. 9.

California lawmakers are also targeting contractors who don’t have workers’ compensation insurance with legislation that would require proof of insurance when renewing licenses with the state or local governments.

AB 397 by Assemblyman Bill Monning, D-Carmel, would require contractors to show proof of comp coverage or exempt status when renewing licenses before the State Contractor Licensing Board. The bill is sailing through the Legislature, and is up for a third and final reading in the Senate.

The Senate Business, professions and Economic Development Committee passed the bill 8-0 on June 6, and the Assembly passed the measure 60-0 on April 14.

In may, Assemblyman Bill Berryhill, R-Ceres, pulled AB 465 from consideration this year, but he is hoping for adoption next year in the second year of the two-year legislative session. Berryhill’s bill would require landscaping and gardening businesses to show proof of workers’ compensation coverage when applying for local business licenses.

Evan Oneto, a staff member for Berryhill, said in May the measure was pulled because it was “not ready for prime time.”

 

Source: WorkComp central and Chico Enterprise Record

NFL vs Workers’ Comp

Workers’ compensation is a form of “insurance” that provides wage replacement and medical benefits for employees who get injured on the job, in exchange for mandatory relinquishment of the employee’s right to sue their employer for the tort of negligence.

Everyone knows they have this right, but does it differ between careers?

Being an NFL player may be a career in the limelight, but has many risks. Sure we see the players throw around the ball and run after it, but we also see them get hit…repeatedly. Many of these hits are straight to the head, which with time or even instantly have consequences.

Fred McNeill, former Minnesota Vikings linebacker who played in two super bowls in ‘70’s filed a workers’ compensation claim inCaliforniaagainst his former team.

McNeill was recently tested at the University of California, Los Angeles for chronic traumatic encephalopathy, a progressive and degenerative disease seen in people who have suffered multiple concussions or other forms of head trauma. The condition has been identified in professional football and hockey players, and in 2009, the first college football player who did not play professionally died of this disease.

McNeill’s wife Tia told the Pioneer Press her husband wants to make sure his future medical costs are covered, and he has no animosity toward his former team.

NFL vs Workers’ Comp, score is tied.

 

Source: WorkComp Central