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Four More Charged in Elaborate Capping Scheme

Four more people have been charged in a capping scheme, including two QMEs accused of running a clinic that paid $1.8 million+ for patient referrals.

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Mileage Reimbursement for Injured Workers to Increase

The California Workers’ Compensation Institute has announced that reimbursement for injured workers traveling to medical appointments will increase from 54.5 cents/mile to 58 cents/mile.

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California WCAB Issues En Banc Decision in Suon v. California Dairies

Yesterday, the California Workers’ Compensation Appeals Board (WCAB) issued an important decision in the case of Sandab Suon v. California Dairies.

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Head of Numerous California Imaging Centers Indicted for Fraud

The U.S. Attorney for the Southern District of California has issued an indictment and arrest warrant against Sam Solakyan, who headed numerous imaging centers in the state tied to fraud allegations. Solakyan allegedly paid $8.8 million in kickbacks for referrals, which were used to bill workers’ compensation payers for $284 million.

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DWC Dismisses over 4,000 Liens Connected to Drobot Conspiracy

The California Division of Workers’ Compensation has dismissed almost 5,000 liens filed by companies associated with Michael R. Drobot, including Industrial Pharmacy Management and California Pharmacy Management. This marks the first major case involving a provision in AB 1244 which requires the DWC to dismiss liens held by individuals convicted of fraud.

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Federal CA Officials Secure Restitution and Guilty Plea in Two Fraud Cases

On Thursday, a federal judge in Northern California ordered Pain Free Diagnostics Inc. to deposit the $1.2 million it owes in restitution to over 24 defrauded carriers. In an unrelated case, the U.S. Attorney’s Office for Southern California obtained a guilty plea from a doctor for accepting kickbacks for prescriptions and therapy.

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BREAKING: CA Supreme Court Rules Workers’ Comp Law Exclusive Remedy In King v. CompPartners

Today, the California Supreme Court decided in King v. CompPartners that an injured worker’s claims against a utilization review (UR) doctor are exclusively compensable as part of the workers’ compensation system.

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California DWC Suspends 11 More Medical Providers

The California Division of Workers’ Compensation (DWC) has suspended 11 more medical providers from participation in the California workers’ compensation system. 274 total providers have been suspended thus far in 2018.

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Two More Providers Indicted in Pacific Hospital Kickback Scheme

Dr. Jacob Tauber of Beverly Hills and Dr. Serge Obukhoff of Malibu have been indicted by a federal grand jury for participating in a kickback scheme involving referrals to Pacific Hospital of Long Beach, bringing the total cost of the scheme to almost $1 billion.

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DWC Establishes Pharmacy & Therapeutics Committee

The California Division of Workers’ Compensation has announced the formation of the Pharmacy & Therapeutics Committee, which will consult with and advise the DWC on updates to the Medical Treatment Utilization Schedule Drug Formulary.

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California Department of Insurance Orders Workers’ Comp Insurers to Report Tax Savings

The California Department of Insurance has ordered that every insurer licensed to write workers’ compensation insurance in the state is required to report their yearly tax savings due to the tax Jobs and Cuts Act of 2017, beginning in 2018.

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More Providers Charged in Pacific Hospital Fraud Scheme, Compounded Drugs Kickback Scheme

This week, federal prosecutors in Los Angeles indicted several medical providers, as well as an attorney, in numerous scams to defraud Medicare, private health insurers, workers’ compensation insurers and programs, and a military health insurance program.

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Heat Warnings in California Prompt Safety Precautions

The National Weather Service has announced heat warnings across California; employers should follow certain steps in order to protect their employees working outdoors from heat illness.

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Senate Bill 189 Provisions May Affect Workers’ Compensation Policies

Beginning July 1, 2018, provisions in Senate Bill 189 governing changes in employee and waiver status for the purpose of workers’ compensation coverage will become effective, and may impact coverage.

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TTD Min. and Max. Rates Increase for 2019

The California Division of Workers’ Compensation (DWC) has announced the 2019 minimum and maximum temporary total disability (TTD) rates.

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California Supreme Court Denies Review of Ruling on TD Benefit Statutory Cap

The California Supreme Court has decided not to review a 4th District Court of Appeal decision placing a five-year statutory cap on temporary disability benefit duration.

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Southern California Surgeons Charged in Pacific Hospital Kickback Scheme

Drs. Jeffrey Gross, David Payne, and Lokesh Tantuwaya have been charged with conspiracy and fraud for collectively receiving over $4 million in kickbacks for surgeries and referrals at Pacific Hospital in Southern California.

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California DWC Suspends 18 Medical Providers

The Division of Workers’ Compensation (DWC) has suspended 18 more medical providers from  California’s workers’ compensation system, bringing the total number of providers suspended in 2018 to 263.

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California District Court Rules in DIR Lien Stay Case

A California District Court ruled in favor of the Department of Industrial Relations, allowing the granting of lien stays to criminally charged providers.

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California Supreme Court Rules in Independent Contractor Case

The Supreme Court of California made a key decision in distinguishing between independent contractors and employees that sets an important precedent in employer-worker relations.

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California DIR Director Christine Baker Retires

Christine Baker, director of the California Department of Industrial Relations, announced her immediate retirement this past weekend.

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California DWC Suspends 27 Medical Providers

The Division of Workers’ Compensation (DWC) has suspended 27 more medical providers from  California’s workers’ compensation system, bringing the total number of providers suspended in 2018 to 234.

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20 More Medical Providers Suspended by California DWC

The California Division of Workers’ Compensation (DWC) has suspended 20 more medical providers from the state’s workers’ compensation system for fraud and related criminal actions, or for loss of license.

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California DWC Suspends 7 More Medical Providers

In the first suspension announcement of 2018, the California Department of Workers’ Compensation has suspended 7 more medical providers from the state’s workers’ comp system. 

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21 More Medical Providers Suspended by California DWC

The California Division of Workers’ Compensation (DWC) has suspended 21 more medical providers from the state’s workers’ compensation system for fraud and related criminal action. 

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9 More Medical Providers Suspended

The California Division of Workers’ Compensation (DWC) has suspended 9 more medical providers from the state’s workers’ compensation system.

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1st DCA Accepts Appeal of SCIF v. WCAB (Stevens) Ruling

The California 1st District Court of Appeal has accepted a petition for review of the WCAB’s decision in the well known Stevens case.

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California DIR Suspends Another 12 Medical Providers

The Division of Workers’ Compensation (DWC) announced that it has suspended 12 more medical providers from the state’s workers’ compensation system. Nine of these providers were suspended for fraud or criminal actions, while three were suspended for administrative reasons. These suspensions bring the total number of medical providers suspended in California this year to 85.  The following providers were suspended: Paul … Continued

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California DWC Suspends 21 More Medical Providers

The Division of Workers’ Compensation (DWC) announced that it has suspended another 21 medical providers from the state’s workers’ compensation system. A total of 73 medical providers have been suspended in California this year. 

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WCAB Issues En Banc Decision in Jose Guillermina Rodriguez and Consolidated Cases

On September 14, 2017, 1200 Petitions for Reconsideration were filed by and through lien claimant Maximum Medical. These Petitions requested reconsideration of the enforcement of new lien assignment statutes, challenging an administrative action in the DWC’s Electronic Adjudication Management System (EAMS) that would have resulted in the automatic dismissal of liens due to an alleged failure to timely file declarations. The Appeals Board has consolidated the cases in its decision.

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Eight Medical Providers Suspended for Fraud by Division of Workers’ Compensation

The California DIR’s Department of Workers’ Compensation (DWC) has suspended an additional 8 medical providers who were found guilty of fraud. Orders of Suspension from California’s workers’ compensation system were filed against the following medical providers: Abraham Khorshad – This Beverly Hills investor in Aspen Medical Resources was also a co-conspirator with providers Jeffrey Campau and … Continued

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400 QMEs File Lawsuit Claiming License Terminated by DIR Without Hearings

Three former qualified medical evaluators (QMEs) who were denied re-appointment are suing the Department of Industrial Relations (DIR) and its director Christine Baker for using “underground regulations” to deny them re-appointment.

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Medicaid Systems Able to Pursue Full Settlement Amounts on Oct. 1

As the result of a federal law effective October 1, state Medicaid systems will likely intensify their efforts to collect money they’re owed from workers’ compensation settlements. 

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California DWC Posts Searchable Database of Liens Dismissed by Operation of Law

The California DIR’s Department of Workers’ Compensation (DWC) has posted a searchable database of liens dismissed by operation of law.

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10 Attorneys and 6 Cappers Charged in Massive Workers’ Compensation Insurance Referral Scheme

Charges have been filed against 10 attorneys and six cappers in a multi-million dollar workers’ compensation insurance referral scheme in Orange County.

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Apportionment and Genetic Factors of Disability

The Court of Appeal, Third Appellate District, in City of Jackson v. WCAB (Rice) (4/26/17), has issued a decision that will provide substantial assistance in achieving the Legislature’s directive in Labor Code Section 4663 with respect to apportionment.

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State Charges 26 in $40 Million SoCal Kickback Scheme

Orange County prosecutors recently charged 26 business owners, pharmacists, and doctors in a $40 million kickback scheme in Southern California.

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Aguilera v. Collins Chiropractic Group

In a recent decision, the Workers’ Comp Appeals Board affirmed its prior decision in Aguilera v. Collins Chiropractic Group which said that a plaintiff’s industrial injury caused only 88% permanent disability rather than the 100% determined by the Workers’ Comp Judge.

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Gilpin v Porterville USD 2017 Cal. Wrk. Comp. P.D. LEXIS 4

Gilpin filed two actions against two separate employers. One of the defendants filed a Petition for Consolidation.

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Maxham v California Department of Corrections Clarifies Agreed Medical Examiner (AME) Distinction

When is a communication not information? Is there a distinction between the two or are there consequences from a failure to correctly categorize? The Workers’ Compensation Appeals Board, in its January 23, 2017 En Banc Decision in Maxham v California Department of Corrections, has provided the answers.

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DIR Stays 200,000 Liens with Claimed Value of $1 Billion

The Department of Industrial Relations (DIR) announced on January 18, 2017 that it stayed 200,000 liens worth more than $1 billion in an effort to prevent ongoing workers’ compensation fraud.

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Billing Fraud

As reported by workcompcentral, The Division of Workers’ posted proposed emergency regulations to implement the legislative mandate to suspend doctors convicted of billing fraud or harming patients.

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Your MPN May Still Be Valid, Despite a Lack of Multiple Physicians

Maria Soto v. Sambrailo Packaging, Zenith Insurance Company, 2016 Cal. Wrk. Comp. P.D. LEXIS 26, a panel decision, reaffirms the WCAB’s recent trend of finding valid MPN access standards where there are no physicians available within applicant’s preferred specialty.

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Petitions for Dismissal for Failure to Appear

In Nunez v Petrochem Insulation, Inc, 2016 Cal. Wrk. Comp P.D. LEXIS, the Court was presented with a scenario which did not result in the achievement of the objective of the California Constitution, Article 16, that cases be resolved expeditiously, inexpensively and without encumbrance of any character.

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UR IMR versus MPN IMR

On October 13, 2016, applicant attorney filed a Petition for Writ of Review to the 4th DCA in Parrent v. Workers’ Compensation Appeals Board/Pacific Bell Telephone Co. SBC, Case Number D071162, with the defendant filing an Answer on November 7, 2016.

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What Is A Good Faith Personnel Action

A WCAB panel clarified that not all actions taken by an employee are considered “personnel actions” under LC3208.3(h) in Ferrell v. County of Riverside 2016 Cal. Wrk. Comp PD Lexis.

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A Penalty Under LC5814 Is Possible For Unreasonable Delay of SJDB Vouchers But Only On the Amount Actually Delayed

The WCAB has issued several cases recently in which they essentially state that LC § 5814 does apply to the unreasonable delay/denial of supplemental job displacement benefits, but the penalty of up to 25% is only on the amount actually used by the applicant, not the entire amount.

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Three Physicians In Any Specialty Are All That Is Needed For A Valid MPN

In a split panel decision of Luna v. The Home Depot, the WCAB stated that the defendant’s MPN is valid even though it did not have three orthopedists within the applicable geographic radius to act as primary treating physician (PTP).

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Independent Medical Review (IMR)

One of the hallmark provisions of the most recent statutory amendments to the Labor Code, Independent Medical Review (IMR) has generated much litigation and even more speculation as to its ramifications and ultimate constitutionality.

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SCIF v. WCAB (Margaris) 2016 Cal. App. LEXIS 491 (DCA opinion on 6/22/16)

As noted above and in previous Quarterly Reviews, SB 863 continues to generate controversy, the California workers’ compensation community is still trying to make sense of UR/IMR and learn how to incorporate the basic process into their practice.

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