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NATL. - Questionable Compound Billing Detailed in OIG Report

By Elaine Goodman (medical/business Reporter)
08/14/2018 | 479 | 0 | 25 min read

While the workers’ comp industry has been successfully reducing the use of costly compounded medications, a new government report indicates that pharmacies and clinicians providing questionable prescriptions for compounds have not gone away. In fact, 547 pharmacies were found to have questionable billing for compounded topical drugs in 2016, according to the report from the Office of the Inspector General for the U.S. Department of Health and Human Services. The report looked at compounded topical drugs paid for by Medicare Part D programs from 2010 to 2016. Although the pharmacies are... Read More

TX - Firefighters, Attorneys Say Cities Find Ways To Fight Presumption

By William Rabb (Reporter)
08/14/2018 | 125 | 0 | 20 min read

Texas firefighters and their attorneys are hoping the Legislature will close some gaps in the state's cancer presumption law that they say have made it easier for cities to avoid paying benefits. Several Texas attorneys and firefighters’ union leaders allege a systematic effort by municipalities and their insurance pool to deny firefighters’ claims, to sue families after losing on appeal, and to delay cases unnecessarily in order to cut claimants’ lawyers out of attorneys’ fees. “It never ends. I’ve got one case now that they’ve drawn o... Read More

CA - Employers Seek to Certify Class in Applied Underwriters Lawsuit

By Greg Jones (Deputy Editor)
08/14/2018 | 317 | 0 | 16 min read

A group of small and mid-sized California businesses who say they fell victim to a sophisticated insurance scam involving the EquityComp and SolutionOne programs are asking a federal judge to certify their class in an unfair competition complaint. Shasta Linen Supply, Alpha Polishing and Pet Food Express in separate lawsuits that have been consolidated before the U.S. District Court for Eastern California, allege Applied Underwriters Inc. misled them about how much they would pay for workers' compensation coverage when they signed up for what they believed to be a loss-sensitive program. ... Read More

CA - State Pushes for Decision in Lien Lawsuit, Objects to Additional Filing

08/14/2018 | 465 | 0 | 15 min read

California’s attorney general said a federal court should issue a decision in the lawsuit challenging the constitutionality of the automatic stay on liens filed by criminally charged providers and should deny a motion from plaintiffs seeking permission to file a supplemental pleading. “This case should proceed to a final adjudication of the facts and issues that existed at the time of the original complaint and at the time preliminary relief was granted,” Attorney General Xavier Becerra writes in a brief filed Friday. “Defendants are entitled to obtain certainty in a t... Read More

PA - Employer May Adjust Benefits To Worker Who Rejected Modified Work

By WorkCompCentral
08/14/2018 | 60 | 0 | 10 min read

The Commonwealth Court of Pennsylvania ruled that an employer was entitled to a modification of its payment of benefits to a worker who had rejected its offers of modified work, and that the worker was not entitled to expand the scope of his claim to include additional conditions. Case: Pettine v. WCAB (Verizon Pennsylvania), No. 372 C.D. 2018, 08/08/2018, unpublished. Facts and Procedural History: Ralph Pettine worked for Verizon Pennsylvania for over 35 years. In February 2015, Pettine was struck by a car while marking a road. Verizon accepted liability for a broken leg and injuries to hi... Read More

Column

AL - Holden: Assault Considered Work-Related Despite Extended Period Between Reason and Act

By Joshua Holden
08/13/2018 | 80 | 0

On July 13, the Alabama Court of Civil Appeals released its opinion in Lawler & Cole CPAs LLC and Alabama Retail Association dba Alabama Retail Comp v. Donald Cole, which was on appeal for the Marion County Circuit Court. Joshua Holden In the underlying case, the employee’s estate filed a motion for summary judgment on its claim for death benefits based on the employee’s death as a result of a former client shooting her in her office. The employer also filed a motion for summary judgment, which was denied. The trial court found that the employee’s ... Read More

FL - CGL Carrier Can't Intervene in Paraplegic Worker's Tort Suit

By WorkCompCentral
08/14/2018 | 80 | 1 | 6 min read

Florida’s 2nd District Court of Appeal ruled that a trial judge properly barred a general liability insurance carrier from intervening in a tort suit against its policyholder by a worker who was paralyzed after a fall from the roof of a commercial building. Case: Houston Specialty Insurance Co v. Vaughn, No. 2D17-2713, 08/10/2018, published. Facts and Procedural History: All Florida Weatherproofing & Construction is in the business of pressure washing, roof coating, and ancillary roof-related services. Enoch Vaughn worked for All Florida. Vaughn fell while applying a protecti... Read More

Sullivan On Comp

KS - Court Upholds Award to Worker Injured in Assault by Colleague

By WorkCompCentral
08/14/2018 | 74 | 0 | 20 min read

The Kansas Court of Appeals ruled that a heavy equipment operator was entitled to benefits for his injuries from an assault by a coworker. Case: Billington v. Midwest Minerals, No. 118,503, 08/10/2018, unpublished. Facts and Procedural History: Matthew Billington worked as a heavy equipment operator for Midwest Minerals. In January 2015, Billington exchanged heated words with a coworker, James Chapman. Chapman shoved Billington into a pile of rocks. Billington suffered a rib injury and a punctured lung. When Billington went to the hospital after the incident, he told the doctor th... Read More

MI - Court Finds Injured Worker Suffered No Adverse Employment Action

By WorkCompCentral
08/14/2018 | 52 | 0 | 20 min read

A federal appellate court ruled that an injured worker failed to establish he was subjected to an adverse employment action on the basis of a disability since the record evidence did not support his claim that he was fired when he requested medical leave. Case: Brown v. Square Deal Building Supply, No. 17-2475, 08/10/2018, unpublished. Facts: Marshall Brown began working for Square Deal Building Supply in 1996. He fell from a truck while at work in May 2014 and missed three months of work because of the  injuries. In December 2016, Brown provided Square Deal with a form from his d... Read More

KY - Court Reinstates PTD Award for Emergency Medical Technician

By WorkCompCentral
08/14/2018 | 47 | 0 | 4 min read

The Kentucky Court of Appeals reinstated an award of permanent total disability benefits to an injured emergency medical technician for a cervical condition despite the parties' stipulation to a pre-existing shoulder injury. Case: Mullins v. Rural Metro Corp., Nos. 2016-CA-001152-WC and 2016-CA-001287-WC, 08/10/2018, published. Facts and Procedural History: Michael Mullins worked for the Rural Metro Corp. as an emergency medical technician. He described feeling a "pop in his shoulder" when he attempted to prevent a patient from falling in September 2014. RMC accepted liabi... Read More

VT - Proposed Rules Address Opioid Prescribing, Wage Calculation

08/14/2018 | 76 | 0 | 43 min read

The Vermont Department of Labor is proposing several rule amendments, including a requirement that medical providers who prescribe opioids to injured workers to comply with state protocols. The proposed change to 11.1400 and 12.1730 rule would require medical providers who prescribe opioids to injured workers for chronic pain caused by a compensable work-related injury to comply with the state’s Rule Governing the Prescribing of Opioids for Pain, as amended July 1, 2017. The department announced Monday that it filed the proposal with the Secretary of State. Under t... Read More

PA - MEMIC Hires Two Safety Management Consultants

08/14/2018 | 49 | 0 | 67 min read

The MEMIC Group has hired two safety management consultants, Susan Diffenderfer and Thomas Brennan, to serve the company’s Pennsylvania and New Jersey markets. Diffenderfer, of of Juniata County, Pennsylvania, is a licensed physical therapist with nearly 30 years of experience in industrial health, geriatric care and wound care. She has worked in home health, acute rehabilitation, skilled nursing, personal care, outpatient and hospital settings. Before joining MEMIC, Diffenderfer was a facility rehabilitation manager as well as a regional rehabilitation manager for a large contract pro... Read More

IN - Webinar to Cover Technical Requirements for EDI 3.1, Aug. 21

08/14/2018 | 51 | 0 | 1 min read

The Indiana Workers' Compensation Board will host a training webinar on Tuesday, Aug. 21 on the new 3.1 electronic data interchange standard for first reports and subsequent reports of injury. The webinar will help trading partners understand the extensive new technical requirements for 3.1, which takes effect Jan. 1 in Indiana.  "We strongly encourage all stakeholders to take advantage of this opportunity," the board said in a bulletin. Registration is available online. The webinar will be from 1:30 p.m. to 3:30 p.m. Central time. The session also will be recorded a... Read More

CA - Feds Say Younger Drobot Lied About $250,000 Payment at Sentencing

By Greg Jones (Deputy Editor)
08/13/2018 | 1316 | 1 | 20 min read

A federal judge ordered Michael R. Drobot to appear in person for a hearing to determine whether he should be held in contempt for allegedly misleading the court into thinking he had already paid part of a personal money judgment when he was sentenced. Drobot, who is the son of convicted hospital owner Michael D. Drobot, told the court he made the first payment of $250,000 toward a $1 million forfeiture order when he was sentenced to 41 months in prison on March 8, the U.S. Attorney’s Office said in court filings last week. “That representation was not true, and defendant st... Read More

CA - New Management Hopes to Bring 'Renewed Energy' to CSIMS

By Elaine Goodman (medical/business Reporter)
08/13/2018 | 451 | 0 | 28 min read

The California Society of Industrial Medicine and Surgery is under new management as of July 1, following the departure of Carl Brakensiek, who had led the organization for 37 years. Bryce Docherty CSIMS did not renew its contract with AdvoCal, a company that Brakensiek owns, along with three others, including Steve Cattolica. Brakensiek had served as CSIMS’ executive vice president, while Cattolica was its director of government relations. CSIMS represents private physicians practicing occupational medicine in California. “We were unable to come to terms,” Brakensiek s... Read More

NATL. - New Cream Scheme Described in Latest Indictments

By William Rabb (Reporter)
08/13/2018 | 455 | 0 | 6 min read

Federal prosecutors have announced a guilty plea and a settlement agreement in two more compounding pharmacy kickback schemes, one of which involved $400 million in fraud and is being called the largest health care scam ever prosecuted in Mississippi. In Mississippi, pharmacist Thomas Spell Jr. last week admitted to more than $243 million in false claims to insurance carriers, mostly TriCare, the government health program for the military, veterans and their families, the U.S. Attorney for the Southern District of Mississippi said. The judge in the case authorized federal agents to seize mor... Read More