(c) 2015 Jon L Gelman, All Rights Reserved.

Sunday, January 25, 2015

Insurance Fraud: California insurance broker ordered to repay victim

Today's post is shared from
A Marina man was placed on felony probation and ordered to pay victim restitution after pleading to two counts of theft of funds by a broker/agent and one misdemeanor count of identity theft, District Attorney Dean Flippo announced.
Ernie Morris, 45, was ordered to repay $33,444, Flippo said, after investigators determined that he was conducting insurance business without a license.
The investigation began after a complaint by the FirstComp Insurance Agency to the California Department of Insurance (CDI).
The investigation revealed that the defendant fraudulently obtained workers’ compensation insurance and auto insurance premiums from multiple clients and failed to remit the money to the insurance companies.
Flippo said the defendant claimed to have a license to sell insurance and then became partners with another individual who obtained a license. The defendant used his partner’s license in order to sell workers’ compensation and auto insurance policies to clients.
The defendant then deposited the victim’s money into his own personal and single business account without obtaining the policies and diverting the money for his own personal use.
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Saturday, January 24, 2015

The Cold Winds of Workers' Comp Reform Are Blowing in Wisconsin

Today's post is shared brom Bob Wilson at

I have it on excellent authority that major changes to the Wisconsin workers’ compensation system will be proposed with the release of the state’s budget bill on February 3, 2015. The rumored changes are said to be significant, with some viewing it as a complete dismantling of the current workers’ comp system there. In the absence of the release of the actual budget and proposals, it still sounds like the most dramatic reforms to hit a state since Tennessee and Oklahoma conducted complete overhauls of their WC systems.

Currently in Wisconsin, the Workers’ Compensation Division is part of the larger Department of Workforce Development (DWD). On January 12, 2015, WC Division managers apparently learned of this proposal from the DWD Secretary’s office. It is believed that the person behind this effort is DWD Secretary, Reggie Newsom. Under Newsom’s proposal, the Worker’s Compensation Division would be entirely removed from the auspices of DWD. Other agencies would absorb some of the functions, while some current practices and procedures would cease to exist.

One group that appears to be subject to the greatest changes would be Wisconsin’s current Administrative Law Judges. Under the proposed changes, they would only be responsible for trying cases.  They would not manage claims functions or act in any advisory role for industry stakeholders. They would...

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A Video Interview Of Benjamin Marcus: The History of Workers' Compensation

Attorney Benjamin Marcus, the 1946 founding president of NACCA (The National Association of Compensation Claimants Attorneys), was interviewed by attorneys: N. Michael Rucka, Karen Spencer, Timothy Bott and Roy Portenga. The interview took place on January 1, 1997 in Michigan.

The video project was inspired by N. Michael Rucka under his leadership of WILG (Workplace Injury Litigation Group).  WILG was originally created as a litigation group of ATLA (The Association of Trial Lawyers of America). Subsequently, WILG established itself as an independent organization.

NACCA eventual expanded by became ATLA (The Association of Trial Lawyers of America) and is now known as AAJ (The American Association for Justice).

Big Whistleblower Predictions for 2015

Today's ost is shaed from

About a year ago, we ran a post positing that 2014 would be huge for corporate whistleblowers on a number of fronts. The experts with whom we spoke then hit the nail on the head: every prediction came true.

They were right about more Securities and Exchange Commission whistleblower awards arriving (including one for a record $30 million-plus), False Claims Act cases hitting a new record and courts further defining who counts as a whistleblower.

Here what some whistleblower experts think may happen in the year ahead:

More focus on employment contracts. The SEC has said it is scrutinizing companies’ use of contracts that forbid employees from reporting suspected wrongdoing to the government. “That’s of very big interest to them,” said Rebecca Katz, a member at law-firm Motley Rice LLC and head of its SEC whistleblower practice.

That could mean the agency could take action against a company that has used these contracts, Ms. Katz said.

The SEC will likely continue to focus on whistleblower retaliation, said Jordan Thomas, partner and head of the whistleblower representation practice at law-firm Labaton Sucharow LLP. “It’s becoming a standard area of inquiry with cases involving whistleblowers,” he said.

Last year, the agency brought its first-ever whistleblower retaliation case against a hedge-fund advisory firm.

Companies may...

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Survey Shows Americans Support Social Security Changes; Republicans and Democrats Agree

Massachusetts and Rhode Island residents receiving Social Security benefits can take comfort in the fact that support for the program remains strong across the country. Americans report strong support for Social Security and are willing to pay more in taxes to stabilize the system’s finances and improve benefits, according to a recent survey by the nonpartisan National Academy of Social Insurance.

“At a time when the nation seems deeply divided about the proper size and role of government, Americans show remarkably widespread agreement on Social Security,” said Virginia Reno, the Academy’s Vice President for Income Security Policy and co-author of the new study, Americans Make Hard Choices on Social Security: A Survey with Trade-Off Analysis[PDF], which was supported by the Ford Foundation and the Tufts Health Plan Foundation.

In Massachusetts and Rhode Island, a total of 1.4 million people (or about 18% of the population) receive Social Security benefits, according to December 2013 figures. Their average benefit amount is $1,204 a month, or just under $14,500 a year. On an annual basis, that brought $20.5 billion in income to the area – 4.7% of all personal income in the two states combined, according to the Bureau of Economic Analysis. Americans of all ages value Social Security’s protections, and for seniors in particular – who make up one million of the area’s beneficiaries – its dependable income is vital for healthy aging. As documented in the Massachusetts Healthy Aging Data Report, approximately 28% of the population age 65 and older have incomes less than $20,000 per year. As such, for this population Social Security is the primary source of income.

Large majorities of survey participants, both Republicans and Democrats, agree on ways to strengthen Social Security – without reducing benefits. Fully 69% of Republicans and 84% of Democrats agree “it is critical to preserve Social Security benefits for future generations even if it means increasing the Social Security taxes paid by working Americans.”

When asked the same question about top earners, 71% of Republicans and 92% of Democrats agree that they could pay more. Social Security taxes are paid by workers and their employers on earnings, but only up to a cap ($118,500 in 2015). About 6% of workers earn more than the cap.

Majorities oppose measures to balance Social Security’s future finances by reducing benefits. Fully 75% of respondents oppose increasing the retirement age to 70; and 76% oppose reducing the cost-of-living adjustment (COLA) that retirees receive.

To gauge Americans’ policy preferences, the survey used trade-off analysis — a technique that is widely used in market research to learn which product features consumers want and are willing to pay for. The trade-off exercise allowed survey participants to choose among different packages of Social Security changes. As lawmakers would do, they weighed how each policy change would affect workers, retirees, and the program’s future financing gap, and then chose among different packages of reforms. Seven out of 10 participants prefer a package that would eliminate Social Security’s long-term financing gap without cutting benefits. The preferred package would:

Gradually, over 10 years, eliminate the cap on earnings taxed for Social Security. With this change, the 6% of workers who earn more than the cap would pay into Social Security all year, as other workers do. In return, they would get somewhat higher benefits.
​Gradually, over 20 years, raise the Social Security tax rate that workers and employers each pay from 6.2% of earnings to 7.2%. A worker earning $50,000 a year would pay about 50 cents a week more each year, matched by the employer.
Increase Social Security’s cost-of-living adjustment to reflect the inflation experienced by seniors.
​Raise Social Security’s minimum benefit so that a worker who pays into Social Security for 30 years or more can retire at 62 or later and have benefits above the federal poverty line.

Without any changes, Social Security would be able to pay only about three-quarters of scheduled benefits after 2033. This package would turn the projected financing gap into a small surplus, providing a margin of safety.

The package was preferred by large majorities across political parties and income levels. Fully 68% of Republicans, 74% of Democrats, and 73% of independents favor the package, as do 71% of study participants with incomes above $75,000 and 68% of those with incomes under $35,000.

“This study deserves close attention by lawmakers,” said James Roosevelt Jr., CEO of Tufts Health Plan and grandson of Franklin D. Roosevelt, who signed the original Social Security law in 1935. “To get to stronger reforms in our system, we need to negotiate with a better understanding of what people need and are willing to ‘trade-off.’ This survey gets us closer to that.”

About the survey: The survey was conducted online to facilitate use of the deliberative trade-off exercise. Greenwald & Associates partnered with the Academy to survey 2,013 Americans ages 21 and older between June 12 and 23, 2014. Participants were randomly selected from the Research Now consumer panel of nearly 2.2 million individuals. Results are weighted to reflect the U.S. adult population in the March 2013 Current Population Survey. The survey was released nationally in October 2014. The findings of this 2014 survey are consistent with a similar survey by the Academy in 2012, an indication of stability in Americans’ views on Social Security and how they want to remedy its future financing gap.

The National Academy of Social Insurance is a non-profit, nonpartisan organization made up of the nation’s leading experts on social insurance. Its mission is to advance solutions to challenges facing the nation by increasing public understanding of how social insurance contributes to economic security.

Friday, January 23, 2015

1,700 Hospitals Win Quality Bonuses From Medicare, But Most Will Never Collect

Today's post was shared by Kaiser Health News and comes from

Medicare is giving bonuses to a majority of hospitals that it graded on quality, but many of those rewards will be wiped out by penalties the government has issued for other shortcomings, federal data show.

As required by the 2010 health law, the government is taking performance into account when paying hospitals, one of the biggest changes in Medicare’s 50-year-history. This year 1,700 hospitals – 55 percent of those graded – earned higher payments for providing comparatively good care in the federal government’s most comprehensive review of quality. The government measured criteria such as patient satisfaction, lower death rates and how much patients cost Medicare. This incentive program, known as value-based purchasing, led to penalties for 1,360 hospitals.

However, fewer than 800 of the 1,700 hospitals that earned bonuses from this one program will actually receive extra money, according to a Kaiser Health News analysis. That’s because the others are being penalized through two other Medicare quality programs: one punishes hospitals for having too many patients readmitted for follow-up care and the other lowers payments to hospitals where too many patients developed infections during their stays or got hurt in other ways.

When all these incentive programs are combined, the average bonus for large hospitals — those with more than 400 beds — will be nearly $213,000, while the average penalty will be about $1.2 million, according to...

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New Jersey: Toxic legacy remains

Today's post is shared from

One of government's most basic responsibilities is protecting public health. That's not happening in Ringwood with a notorious old dump that is now a Superfund site.

Rather than remove more than 100,000 tons of toxic waste dumped about 40 years ago by the Ford Motor Co., the borough wants to build a recycling center on top of it. That's bad enough.

What's even worse is that the state Department of Environmental Protection is going along with the plan, according to a letter the agency sent recently to an attorney representing the borough. Nearby residents should be outraged that borough and state officials are seemingly so unconcerned about a real risk to public health.

The dumping site, which is off Peters Mine Road and near where many members of the Ramapough Lenape Nation live, has had a particularly sordid history.

Ford, which once had a plant in nearby Mahwah, began disposing paint sludge in the wooded terrain in the late 1960s, when such dumping was not uncommon. The federal Environmental Protection Agency oversaw a cleanup of the site in the early 1990s and, in 1994, proclaimed the area free of contaminants. That was not true. After a series by The Record in 2005 found that huge amounts of waste were still in the ground, properly cleaning up the area was again an issue.

The borough's plan is to cover the contaminated area with a 2-foot layer of soil and synthetic material. A recycling center would then be constructed on top. It is not unusual for old dumps, or...

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