The Workers' Compensation Daily News for Feb 22, 2012
Workers' Compensation Subrogation Efficiency Increases
Wed, 22 Feb 2012 07:09:21 - Pacific Time
Results are now available for the 2011 Workers' Compensation Subrogation Study conducted by Ward Group on behalf of the National Association of Subrogation Professionals (NASP). Findings of the study show workers' compensation subrogation efficiency has markedly increased over the past few years. The number of days from when a workers' compensation claim is identified as having subrogation potential to when that subrogation file is closed has decreased 14% from 418 days in 2008 to 368 days in 2010.
The comprehensive study focused on subrogation organizational structure, business practices and performance metrics and includes aggregated results from 2008 to 2010 for a diverse group of companies representing 35% of the total U.S. workers' compensation market.
The increase in efficiency was primarily driven by an increase in the speed of closure of files without subrogation recoveries. Companies are more quickly identifying and closing lower value files without subrogation potential in order to focus on those claims more likely to result in recovery.The study identified several notable trends for workers' compensation subrogation practices, including:
- 88% of companies now have a centralized subrogation organizational structure.
- Only 27% of companies utilize software to identify subrogation opportunities.
- 68% of subrogation files were closed without recovery in 2010.
Feds Recover Record $4.1 Billion From Fraudsters
Wed, 22 Feb 2012 07:03:00 - Pacific Time
Federal officials said they recovered more than $4.1 billion from Medicare and Medicaid fraud-busting efforts in fiscal 2011."This is an unprecedented achievement, and represents the highest amount recovered in a single year," Attorney General Eric Holder told reporters in a conference announcing the latest Health Care Fraud and Abuse Control Program Report.
According to the report, the government won or negotiated $2.4 billion in health care fraud judgments last fiscal year. With other fees and results from previous years, they ultimately deposited $4.1 billion with the Treasury Department or the Centers for Medicare and Medicaid Services. The Medicare Trust Fund got about $2.5 billion, the government said.Holder said last year federal officials opened 1,100 criminal health care fraud investigations, charging more than 1,400 and convicting more than 700. The DOJ also opened nearly 1,000 new civil cases, and netted $2.4 billion under the False Claims Act, Holder said.
The Health Care Fraud and Abuse Control Program report said every dollar invested in Medicare fraud-fighting efforts returned $7.2 to tax payers on average for the past three years. The return on investment since the program’s inception in 1997 is $5.1 for every dollar spent, the report said. Federal officials credited some of their success to work by nine so-called strike force teams, joint DOJ and HHS operations that target fraud "hot spots," such as Miami and Detroit, where Medicare and Medicaid scams are unusually prevalent.
Other strike force cities include Los Angeles, Houston, New York, Baton Rouge, Tampa, Chicago and Dallas. Sebelius said the department hoped to use some of the additional $300 million discretionary funding they requested in the 2013 fiscal budget to pay for new strike force teams in other hot spot cities, although she said the department has a policy of not naming future targets. "We don’t name the next possible cities," she said. "We’re constantly looking at the predictive modeling data, and that determination is made by errant billing practices." Read More...
Medical Group Targets Excessive Medical Testing
Mon, 20 Feb 2012 07:10:23 - Pacific Time
A leading group of U.S. doctors is trying to tackle the costly problem of excessive medical testing, hoping to avoid more government intervention in how they practice, according to a story in Reuters Health. The American College of Physicians (ACP), the largest U.S. medical specialty group, is rolling out guidelines to help doctors better identify when patients should screen for specific diseases and when they can be spared the cost, and potentially invasive procedures that follow. ACP members include more than 132,000 physicians, mainly focused on internal medicine.
"Excessive testing costs $200 billion to $250 billion (per year)," Dr. Steven Weinberger, CEO of ACP said in an interview from his office in Philadelphia. "There's an overuse of imaging studies, CT scans for lung disease, overuse of routine electrocardiograms and other cardiac tests such as stress testing." For Weinberger, establishing guidelines on when to perform a range of diagnostic tests in order to cut waste out of the healthcare system is one of his top priorities at ACP.
In an article published last month in the Annals of Internal Medicine, the ACP cited 37 clinical situations where screening did not promote health and might actually hurt patients. They included performing coronary angiography - a procedure that uses a special contrast agent and X-rays to see inside the heart's arteries - in patients with chronic, stable chest pain that is being controlled by drugs or who lack specific high-risk criteria on exercise testing. "It's medical gluttony," said Dr. Otis Brawley, chief medical officer of the American Cancer Society.
Health economists and other policy advisers question whether doctors can be trusted to make the right calls. A study published in the October 2011 issue of the British Medical Journal showed that almost half of doctors involved in setting clinical guidelines in the United States and Canada for diabetes and cholesterol between 2000 and 2010 had conflicts of interest. "I don't trust professional societies to do it because that's how they make money - by doing tests and procedures," said MIT healthcare economist Dr. Jonathan Gruber. He cites estimates that about $800 billion - or nearly one-third of all healthcare spending - is wasted in unnecessary diagnostic tests, procedures and extra days in the hospital. Treatment guidelines will help curb overuse, but Gruber and others would prefer the government set them.
The ACP last year published guidelines on using imaging studies to evaluate lower back pain, a common ailment where expensive diagnostic evaluation does not always help and sometimes hurts patients. Medicare data show that doctors often order MRI scans for patients with lower back pain who have not tried less invasive, less expensive treatments such as physical therapy. An MRI frequently leads to surgery, data show. One study by the National Institutes of Health that used data from the government's Medicare health plan for the elderly concluded doctors who prescribe MRI scans, which can cost $3,000, tend to follow up with even more expensive surgery.
Dr. Daniel Resnick, a neurosurgeon who specializes in spine surgery, has been involved for years in establishing guidelines with the North American Spine Society, which represents 6,500 physicians. He said some fellow surgeons "got very angry" when his group rolled out guidelines. For years, spine surgeons treated certain types of back pain by fusing the front and the back of two disks, which for billing purposes were two separate procedures, he said. Today, guidelines recommend fusing either the front or the back of the disks, not both. "It's like wearing a belt and suspenders. There was a 'more is better' type of thinking. But we found evidence that doing more was worse than doing less," he said. "There was pushback. Some felt guidelines interfered with their decision-making. That they were promoting cookbook medicine." Resnick said he respects the ACP effort and believes it is the responsibility of medical societies to develop guidelines. "Certainly doctors have biases, but you can deal with those biases by having guidelines and having them reviewed externally," he said. Read More...
DWC Electronic Filing Expo in San Bernardino Set For Feb. 28
Mon, 20 Feb 2012 07:04:40 - Pacific Time
The Division of Workers’ Compensation (DWC), in conjunction with its vendor partners, will host an electronic filing expo in San Bernardino on Tuesday, Feb. 28. The event is free and anyone interested in e-filing or JET File is encouraged to attend. This is the fifth e-filing expo hosted by DWC, following events in Santa Ana, Los Angeles, Van Nuys and Oakland. It is the first in San Bernardino County. "The expo gives filers a chance to explore options in electronic filing and take a closer look of JET File," said Mark Fudem, acting associate chief judge for EAMS. "This will also be an opportunity for filers to get answers to their questions and to sign up to e-file."
Electronic filing is the fastest way to get documents into EAMS, DWC’s electronic case management system for the workers’ compensation courts. There are two ways to file electronically: e-forms and JET File. JET File is best suited for large-volume filers of the six most used court forms, while e-forms are available for all forms. The Feb. 28 expo will provide information about, and demonstrations of both filing methods. Filers looking for faster, easier and more cost-effective alternatives to paper forms are encouraged to attend this electronic filing expo:
Tuesday, Feb. 28
10 a.m.-noon (morning session)
1-3 p.m. (afternoon session)
DWC San Bernardino District Office
1st floor, Rehab Conference Room
464 W. Fourth Street
San Bernardino, CA 92401
Please note there may be costs for parking in this area. No registration is necessary. Filers can drop in any time between 10 a.m. and 3 p.m. The program will repeat through the day. There will be an hour lunch break from noon until 1 p.m.The expo will include:
- A walkthrough of each electronic filing method and its benefits for filers
- Access to tech and business experts, who will be available for consultation and questions about each filing method
- Approved software and third-party filing service providers, who can demonstrate and answer questions about products that help filers take advantage of the speed and efficiency of electronic filing
- Ability to sign up for electronic filing immediately
- Refreshments
- Prizes.
DWC Plans Open Forums for Stakeholder Input
Fri, 17 Feb 2012 06:44:37 - Pacific Time
The Department of Industrial Relations and the Division of Workers' Compensation are planning open forums across the state to begin discussions on the current issues in the workers' compensation system and to gather information from stakeholders and members of the public on suggestions for improvements.
"We want to gather input on areas of improvement for the workers’ compensation system in our effort to ensure a balanced approach for both injured workers and employers," said DIR Director Christine Baker. "Our effort is to identify efficiencies and improvements that will ensure adequate and timely benefits to injured workers while ensuring that the costs of the system are sustainable. Those who are familiar with the workings of the system are more likely to be able to point out areas of focus for our efforts." "Improvements are needed to get injured workers back to work and to remove the imbalance of costs and benefits currently in the system," said DWC Administrative Director Rosa Moran.
DIR Director Christine Baker and DWC Administrative Director Rosa Moran will host the forums and topics of discussion will include:
- Provision of appropriate medical treatment without unnecessary delay, the medical provider network (MPN), utilization review (UR) or other issues
- Enabling injured workers to return to work as quickly as medically feasible
- Adequate compensation for permanent disabilities
- Reducing the burden of liens on the system
- Identification of appropriate fee schedules
- Reducing;unnecessary litigation costs
- Assessing appropriate use of opiates and other care
- Any other improvements needed
- Tuesday, April 10, 2012 - West Sacramento, CA 95605 (click here to register)
- Monday,April 16, 2012 - Los Angeles, CA 90013 (click here to register)
- Wednesday, April 18, 2012 - Fresno, CA 93721 (click here to register)
- Tuesday, April 24, 2012 - San Bernardino, CA 92401 (click here to register)
- Wednesday, April 25, 2012 - La Mesa, CA 91942 (click here to register)
- Monday April 30, 2012 - Oakland, CA 94612 (click here to register)
Berkeley City Council Startled by Workers' Compensation Costs
Fri, 17 Feb 2012 06:43:47 - Pacific Time
Workers’ compensation costs the City of Berkeley between $5 and $6 million each year, according to a report presented at a recent City Council meeting. According to a story in Berkleyside, the figures, although not new, seemed to startle councilmembers who said they were determined to bring the cost down. "There needs to be a cultural change at the actual work level," said Councilmember Linda Maio. "I was floored when I saw we are paying out $5 million a year in claims. We can’t do that."
Other councilmembers pointed out the concentration of claims in a few departments. The most claims come from the fire department, where last year 28 of the 118 sworn employees filed indemnity claims. The police department accounts for the second highest number, with 24 of 157 sworn employees filing claims last year. "The problem is fire, police, parks and public works," said Mayor Tom Bates. "And the health department is trying to get into the big five. There hasn’t been any measurable success in those areas. We have to figure out what’s going wrong."
Councilmember Gordon Wozniak pointed out that the concentration of costs goes beyond identifying individual departments. "We have 3% of our employees - 38 employees - who have generated 20% of the claims," Wozniak said. "Are they working in an unsafe environment, do they not have the right equipment, are they just unlucky? You have to find out why and there should be a corrective action plan filed."
Margarita Zamora, senior human resources analyst, said some departments had introduced a "buddy system" where a supervisor was paired with an individual to reduce the "recidivism rate." Both Maio and Councilmember Max Anderson said that other local employers had found significant success in reducing workers’ comp by having a concerted effort to introduce a more safety-oriented culture. Maio cited Lawrence Berkeley National Laboratory while Anderson pointed to Bayer.
Maio and Wozniak said that a council subcommittee should be formed to address the issue, but the council decided last night to refer it to Acting City Manager Christine Daniel, and consider a subcommittee at a later date. Read More...
DWC Increases Ambulance Fee Schedule by 2.4%
Thu, 16 Feb 2012 07:29:59 - Pacific Time
The Division of Workers' Compensation has adopted an order adjusting the ambulance services section of the official medical fee schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.
The effective date of the changes is March 1, 2012 for ambulance services paid for under the California workers’ compensation OMFS. The adjustment incorporates the 2012 ambulance inflation factor which has been announced by the Centers for Medicare and Medicaid Services (CMS).
The Centers for Medicare and Medicaid Services has determined that the Ambulance Inflation Factor for Calendar Year 2012 is 2.4 percent. This figure results from the subtraction of the 10-year moving average of changes in annual economy-wide private non-farm business multi-factor productivity (MFP) from the consumer price index for all urban consumers (CPI-U). For services provided on or after March 1, 2012, the Ambulance Inflation Factor is to be applied to fees by using the ambulance service fees in the CY 2012 Ambulance Fee Schedule Public Use File. The CY 2012 Ambulance Fee Schedule Public Use File is presently located on the internet at: http://www.cms.gov/AmbulanceFeeSchedule/02_afspuf.asp and is published on the website of the Division of Workers’ Compensation at: http://www.dir.ca.gov/DWC/OMFS9904.htm Read More...
Illegal Contractor Gets Jail Time for Third Offense
Thu, 16 Feb 2012 07:28:15 - Pacific Time
Cesar Resendiz Mendieta, 26, of Salinas, is serving 30 days in the Monterey County Jail after pleading no contest to one count of contracting without a license and another for failure to carry workers’ compensation insurance for employees. During a January 18, 2012, hearing in Monterey County Superior Court, Resendiz also was ordered to pay more than $4,000, with the possibility of an additional $8,000 in fines depending on his successful completion of probation. He also pleaded to a third count of driving under the influence (DUI), and was sentenced to five days in county jail and $1,886 in fines.
As part of his probation, Resendiz cannot contract without a license, must purchase workers’ comp insurance for employees, and must pay them by check with the proper payroll tax deductions. For the DUI, he was ordered not to drive without a valid license and insurance and to complete the county’s first-time offender program.
CSLB’s Monterey County Statewide Investigative Fraud Team (SWIFT) investigator first issued Resendiz a notice to appear in court (NTA) for contracting without a license and failure to provide workers’ comp for employees on February 3, 2011, when tipped that a suspected unlicensed business called “Cesar’s Plastering” was performing work valued at $2,200 at a Carmel restaurant. On March 21, 2011, the investigator followed another tip that “Cesar’s Plastering” was working at an auto repair shop in Monterey, and issued an NTA for contracting without a license for a $6,000 job. Another tip led the investigator to Resendiz on August 26, 2011, where he was performing a $4,000 job at a Pacific Grove home. For this, he received an NTA for contracting without a license and failure to carry workers’ comp.
"Clearly, Mr. Resendiz has gotten the message that operating without a contractor license and the proper employee insurance and tax deductions will not be tolerated," said CSLB Registrar Steve Sands. "We hope that other illegal operators will realize that even if they’ve been caught, CSLB’s goal is to work with them to achieve compliance so they can operate within the law and compete fairly with licensees who comply with state consumer and worker protection laws and provide good jobs in their communities." Read More...
DWC Announces 2012 Carrie Nevans Community Service Awards
Wed, 15 Feb 2012 05:06:57 - Pacific Time
The California Department of Industrial Relations’ Division of Workers’ Compensation announced the winners of the 2012 Carrie Nevans Community Service Award. This year’s award in Southern California goes to defense attorney Saul Allweiss. The Northern California recipient is applicant attorney Lisa Ivancich. The awards will be presented at the upcoming 19th annual DWC educational conference luncheons. (Ms. Nevans was the respected acting administrative director of DWC from 2005 to 2011 who passed away last year.)
"These awards are not only about being outstanding in your field of endeavor, but about taking extra steps for the betterment of the injured workers and employers who are those most significantly impacted by an efficient workers’ compensation system," said DIR Director Christine Baker. "Recognizing outstanding effort is one of the more enjoyable facets of my job and I am very pleased to recognize Lisa and Saul who are living tributes to Carrie Nevans’ selfless efforts to improve our system."
Saul Allweiss has been involved in workers’ compensation since 1976 as a claims adjuster and has operated his own law practice since 2002. Allweiss is an active member of the Workers’ Compensation Enforcement Collaborative (WCEC) to assist injured workers who find themselves without benefits while working for uninsured employers, is a former member of the California State Bar Executive Committee for Workers’ Compensation (where Saul still helps even though his tenure ended). Allweiss also participates in advisory groups and roundtables that deal with a range of issues including the permanent disability rating schedule, return to work, and medical treatment.
Lisa Ivancich is a prominent applicant attorney and her contributions to the legal system also include participation in the WCEC, Legal Aid in Oakland, Asian Law Caucus in San Francisco, Judge Pro Tem at the Oakland Workers’ Compensation Appeals Board, Chairperson of the State Bar Workers’ Comp section, and partner in a law firm bearing her name. Ivancich’s contributions to her community include leadership roles with Lend a Hand Foundation and the Pegnim and Ivancich Youth Foundation. The latter organization recently adopted an elementary school where approximately 98 percent of the students receive public assistance.
The DWC’s 19th annual educational conference is the largest workers’ compensation training in the state and allows claims administrators, attorneys, medical providers, return to work specialists, employers, and others to learn about the most recent developments in the system as well as on-going DWC programs. The Los Angeles conference (Feb. 23-24, 2012) is now sold out. The Oakland training, which takes place March 5-6, 2012 at the Oakland Marriott City Center Hotel, has available space and registrations continue to be accepted. Read More...
DWC is Changing Some E-filing Rules
Wed, 15 Feb 2012 05:06:50 - Pacific Time
The Division of Workers’ Compensation is changing the rules of its e-forms trial to open the electronic filing method to more participants. As of Jan. 15, parties are no longer required to file all of their forms electronically as a condition of being in the e-forms trial. In the past, parties who joined the trial agreed not to file fillable Optical Character Resolution (OCR) paper forms in order to receive a logon and password to file directly into EAMS, the court system’s electronic case management system.
This rule change means that parties have access to all of the available filing methods electronically via the e-forms trial or JET File, or through OCR paper forms. However, parties using e-forms must still attend a training session before receiving a logon and password.
"Now parties have their choice of filing by OCR paper, JET File or e-forms, depending on the situation," said Mark Fudem, acting associate chief judge for EAMS. "We want to give filers more flexibility and at the same time, we want to demonstrate to them that electronic filing through e-forms and JET File is the preferred method - and it is easier and more efficient than ever. Electronic filers are happier with EAMS because they know their documents will get filed on time."
While the rule change means that parties have their choice of filing by paper (OCR forms) or electronic data (e-forms or JET File) in any situation, they will not be able to file duplicates of the exact same form. In other words, if a party decides to file on OCR form of the declaration of readiness to proceed (DOR), and then a day later decides that e-forms will get a faster court date, they can’t refile a DOR e-form for the same case.
Current e-form trial participants may be eligible for an additional logon and password if their filing volume is high. A new e-mail address has been established to assist in e-filing - it is EFORMS@dir.ca.gov. Applications for high volume filing and any other e-mails should be directed to this e-mail address. The E-form Reference Guide and Instructional Manual has also been extensively revised and is posted on the EAMS website. Read More...
Past Week News Archive
Redding Applicant Attorney Appointed to WCAB: Tue, 14 Feb 2012 06:50:35 - Pacific Time: Read More...
11th Edition of California Unemployment Disability Text Announced: Tue, 14 Feb 2012 06:50:29 - Pacific Time: Read More...
Sacramento Bee Employee Convicted of WC Fraud: Mon, 13 Feb 2012 06:37:42 - Pacific Time: Read More...
American Specialty Launches Worker’ Comp Program: Mon, 13 Feb 2012 06:37:34 - Pacific Time: Read More...
WSJ Investigation of WC Spinal Surgery Marketers and Distributors: Fri, 10 Feb 2012 07:10:53 - Pacific Time: Read More...
Proposed Fifth Edition of Psychiatric Diagnostic Manual Mired in Controversy: Fri, 10 Feb 2012 07:10:48 - Pacific Time: Read More...
Chiropractor Sentenced for Workers' Comp Fraud: Thu, 9 Feb 2012 08:03:08 - Pacific Time: Read More...
Claimant Guilty in Fraud Case After Three Week Jury Trial: Thu, 9 Feb 2012 07:54:31 - Pacific Time: Read More...
Man Sentenced to 77 Months in Jail and $10.8 Million Restitution for Fraud: Wed, 8 Feb 2012 05:58:12 - Pacific Time: Read More...
Workplace Homicides Decline: Wed, 8 Feb 2012 05:58:06 - Pacific Time: Read More...