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Friday, October 14, 2011

Florida, Oxycodone Trafficking, Workers Compensation and Blame

The announcement by the US Attorney in Florida of the indictment today of 24 individuals for trafficking Oyxcodone puts a cloud over the claims that the workers compensation system is to blame. With the alleged bad apples caught, the announcement should refocus concern not on the work comp system, but rather on those outsiders who attempt to prey on it for personal gain. 

If anything, the system needs more safeguards to protect both the injured workers as well as the taxpayers. Pending legislation in Florida that restricts prescribed medications in workers' compensation claims only emasculates the social remedial benefit program further forcing the disabled to seek help outside the system. Why blame the victims and punish them.

"Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Mark R. Trouville, Special Agent in Charge, Drug Enforcement Administration (DEA), Christopher B. Dennis, Special Agent in Charge, Health and Human Services, Office of Inspector General (HHS-OIG), José A. Gonzalez, IRS Special Agent in Charge, Director James K. Loftus, Miami-Dade Police Department, Al Lamberti, Sheriff, Broward Sheriff’s Office, and H. Frank Farmer, M.D., State Surgeon General, Florida Department of Health (DOH), announced the unsealing of a federal indictment charging twenty four defendants for their participation in, among other things, conspiracy to distribute oxycodone and oxymorphone, and conspiracy to defraud Medicare. Twenty-one of the defendants, including a doctor, a pharmacist and two pain clinic operators are currently in custody after a multi-agency takedown was executed early this morning. Three defendants, Hattie Mae Green, Eliezer Salgado and Ronald Regains, remain at large.

Researchers from the Centers for Disease Control and Prevention report that Schedule II prescription painkillers, like oxycodone, today cause more drug overdose deaths than cocaine and heroin combined. Oxycodone and other Schedule II drugs have a high potential for abuse and can be crushed and snorted, or dissolved and injected, to get an immediate high. This abuse can lead to addiction, overdose, and sometimes death.

The nine-count indictment, filed on September 30, 2011 and unsealed today, charges all defendants with conspiracy to possess with intent to distribute controlled substances, namely oxycodone and oxymorphone (Count 1), and conspiracy to commit health care fraud (Count 9). Several of the defendants also face substantive charges of possession with intent to distribute controlled substances (Counts 2-6, 8), and attempted possession of controlled substances (Count 7).

Charged in the indictment are Aiman Izzedin Aryan, 40, of Pinecrest, Emerson Carmona, 40, of Miami,Frank J. Ballesteros, M.D., 57, of Miami, Gerardo Gomez, 38, of Miami, Juan De Dios Gomez, 40, of Miami, Danay C. Manso, 22, of Miami, Danilo Falcon, 38 of Miami, Eliezer Salgado, 29, of Hialeah,Francisco Hernandez, 57, of Miami, Leroy Paige, 49, of Madison, Alyssa Lyn Paige, 32, of Madison,Cynthia Suzette Adderley, 53, of Ft. Pierce, Victor D. Alexander, 50, of Ft. Lauderdale, Aaron Lamar Allen, 44, of Ft. Lauderdale, Henry Louis Conley, Jr., 53, of Miami, Hattie Mae Green, 53, of Miami,Petronella Smith Howard, 52, of Ft. Pierce, Eric Fyke Miller, 42, of Ft. Lauderdale, Annie Mims Simmons, 72, of Miami, Bobbie Lee Anderson, 58, of Gifford, Denise Darcelle Dardy, 48, of Miami, Margaret Marie Elliott, 54, of Ft. Pierce, Billy Joe McCoy, 53,of Ft. Pierce, and Ronald Regains, 56, of Ft. Lauderdale.

U.S. Attorney Wifredo Ferrer stated, “According to recent estimates, Florida prescribes ten times more oxycodone pills than all other states combined. Each day, individuals die from prescription drug overdoses. To stop this drug epidemic, we have previously charged clinic owners, operators, and doctors who deal drugs while hiding behind a medical license. Today, we have focused our efforts on those pharmacies who are churning out pills that are fraudulently prescribed at area pain clinics. We will continue to tackle South Florida’s pill mill epidemic from all angles and at all levels to eradicate these drug dealing organizations.”

DEA Special Agent in Charge Mark R. Trouville said, “The Drug Enforcement Administration continues its relentless attack on those who supply the prescription drug epidemic in our country, state, and local communities. With today’s arrests, twenty four people will no longer add to this drug problem.”

“Today’s multi-agency operation makes clear that drug trafficking and health care fraud make for a vile combination that simply cannot be tolerated,” said Christopher B. Dennis, Special Agent in Charge for the HHS-OIG region based in Miami. “Schemes to steal from taxpayers to pay for highly addictive, highly profitable street drugs , as the government alleges in this case, will trigger investigation and prosecution.”

“The Internal Revenue Service will continue to provide its financial investigative expertise to further the prosecution of criminals, especially those involved in complex financial schemes,” said IRS Special Agent in Charge Jose Gonzalez.

“The trafficking of oxycodone and oxymorphone has seeped into our community and extends beyond the borders of Miami-Dade County. We stand committed to working with our state and federal partners in the ongoing effort to apprehend these drug dealers who are destroying lives with their criminal behavior,” said Miami-Dade Police Department Director James K. Loftus.

“Through operations like this one, prescription drug peddlers are getting the message that pill pushing is no longer tolerated in Florida,” Broward Sheriff Al Lamberti said. “Federal and local enforcement efforts have turned the tide but we need to keep up the good work.”

“The Florida Department of Health has been diligently working with our law enforcement partners to identify unscrupulous practitioners who are inappropriately prescribing controlled substances,” stated Florida Surgeon General Dr. Frank Farmer. “When DOH learns that a practitioner is not following the law, we suspend that practitioners license. We will aggressively continue to fight the prescription drug problem in Florida.”

According to the indictment, from as early as November 2007 September 2011, defendants Gerardo Gomez, Juan De Dios Gomez, and Danay C. Manso operated and utilized pain clinics in Miami-Dade and Broward Counties. These pain clinics housed physicians, including defendant Frank J. Ballesteros, M.D., who would fraudulently prescribe oxycodone and oxymorphone for co-conspirator beneficiaries of Medicare and other prescription drug insurance plans. The beneficiaries would then present the fraudulent prescriptions obtained from the Gomezes’ pain clinics at complicit pharmacies operated by defendants Aiman Izzedin Aryan and Emerson Carmona. Once the prescriptions were filled, Aryan and Carmona would bill Medicare, and other insurers, for the cost of the prescriptions, knowing that the drugs were medically unnecessary and were being re-sold by the beneficiaries.

Defendants Leroy Paige, Alyssa Lyn Paige, Cynthia Suzette Adderley, Victor D. Alexander, Aaron Lamar Allen, Henry Louis Conley, Jr., Hattie Mae Green, Petronella Smith Howard, Eric Fyke Miller, and Annie Mims Simmons facilitated the drug-trafficking and health care fraud conspiracies by recruiting the corrupt health insurance beneficiaries to visit the Gomezes’ pain clinics and Dr. Ballesteros. Often, these recruiter defendants further participated by transporting the beneficiaries to the pain clinics to obtain the prescriptions and then to the pharmacies where they were filled. At the pharmacies, these defendants would receive and take control of the drugs from the beneficiaries. Once these defendants had the drugs, they would distribute them to Gerardo Gomez, Juan De Dios Gomez, Danilo Falcon, and Eliezer Salgado.

Defendants Bobbie Lee Anderson, Denise Darcelle Dardy, Margaret Marie Elliott, Billy Joe McCoy, and Ronald Regains were beneficiaries who posed as patients to obtain the fraudulent prescriptions for oxycodone and oxymorphone, which they then sold.

The indictment contains a forfeiture allegation seeking approximately $40,000,000 which is listed as the amount of proceeds derived by the defendants from the drug trafficking offenses charged in Counts 1 to 8 of the indictment.

If convicted, the defendants face a statutory maximum penalty of 20 years in prison on Counts 1 to 8, and a statutory maximum penalty of 10 years in prison on Count 9.

Today’s case, named Operation Gotham, is the result of the ongoing efforts by the Organized Crime Drug Enforcement Task Force (OCDETF), a partnership between federal, state and local law enforcement agencies. The OCDETF mission is to identify, investigate, and prosecute high level members of drug trafficking enterprises, bringing together the combined expertise and unique abilities of federal, state and local law enforcement.

Mr. Ferrer commended the DEA, the HHS-OIG, the IRS, the Miami-Dade Police Department, the Broward Sheriff’s Office, and the Florida Department of Health, for their work on Operation Gotham. This case is being prosecuted by Assistant U.S. Attorney Dwayne E. Williams.

An indictment is only an accusation and the defendants are presumed innocent until proven guilty.

Attachments:
Indictment (PDF)
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida athttp://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

Thursday, October 13, 2011

Dramatic Downturn In Work Comp Underwriting Will Continue Predicts AM Best

Due to the stressed housing market and ongoing economic downturn, 2010 was another difficult year for the title industry, according to an A.M. Best Special Report featured in this week's BestWeek U.S./Canada.

Despite the historically low mortgage interest-rate environment, revenues were pressured from the high unemployment rate and tightened credit standards. As such, operating results deteriorated and total industry written premiums declined slightly, year over year, A.M. Best said. Nevertheless, the title insurance industry managed to report an overall approximate 7% increase in surplus, driven mainly by the equity market recovery in 2010.

Also in BestWeek U.S./Canada, it's unlikely workers' compensation writers will see that line of business turn around anytime soon, despite large-scale workers' compensation reform bills enacted in several states this year, said Edward Keane, a senior financial analyst at A.M. Best.

Keane told BestWeek the deterioration that workers' compensation insurance has seen during the past two years will continue at least until mid-2012, unless the economy makes a dramatic improvement before then.

"I think the way things are going, results are going to get worse before they get better," Keane said, adding that for 2011, A.M. Best is projecting a 121.5 combined ratio. Last year, the combined ratio for the line was 118.1.

And with the election for Louisiana insurance commissioner coming up on Oct. 22, Jim Donelon, the Republican incumbent, and Donald Hodge, a Democrat, spoke to BestWeek about their opposing views.

Donelon has been spending aggressively to increase his name recognition and has continued his effort to court new insurers to the state. His opponent has gone on the attack, targeting Donelon for accepting campaign contributions from insurance companies doing business in the state. In fact, if Hodge had his way, he would be the last elected insurance commissioner in Louisiana.

Outer Continental Shelf Lands Act: US Supreme Court Hears Work Comp Arguments

The US Supreme Court heard oral arguments Tuesday in a mater involving the Outer Continental Shelf Lands Act (OCSLA). The court considered when an outer continental shelf worker, injured on land, is eligible for compensation under the Outer Continental Shelf Lands Act (OCSLA) [43 USC §§ 1331-1356 text].
Click here to read the complete report from Jurist.

Issue: When the Outer Continental Shelf Lands Act, 43 U.S.C., §§ 1331-1356, provides that workers are eligible for compensation for "any injury occurring as the result of operations conducted on the outer Continental Shelf," under what circumstances is an outer continental shelf worker (or his heir) who is injured on land eligible for compensation?

Plain English Issue: When the Outer Continental Shelf Lands Act, 43 U.S.C., §§ 1331-1356, provides that workers are eligible for compensation for "any injury occurring as the result of operations conducted on the outer Continental Shelf," under what circumstances is an outer continental shelf worker (or his heir) who is injured on land eligible for compensation?

Tuesday, October 11, 2011

NJ Rating Bureau Seeks 6.9% Workers Compensation 2012 Rate Increase


Also New 2012 Benefit Rates: "As of Jan. 1, 2012, minimum weekly benefits in New Jersey will increase to $216 from the current $211, while the maximum benefit will increase to $810 a week from the current $792."


News Report From Business Insurance Click Here

Childrens Asthma Caused By Pregnant Mothers Occupational Exposure

A recent study of pregnant working women reveals that their exposure to occupational pollution results in their children's development of asthma. The report was presented at the Eastern European Respiratory's annual meeting in Amsterdam. "The results indicate an association between maternal occupational work exposures and the risk of asthma in the child at age 7 years. "

Reuters reported: "In a Danish review of registry data on 45,658 seven-year-old children and their mothers, 18.6 percent of children of mothers who were exposed to low-molecular-weight particles and irritants at work during pregnancy contracted asthma, compared to 16.1 percent of the general population."

See: Mothers work exposure during pregnancy and asthma in their children, a prospective cohort-study; B. H. Christensen, A. D. Larsen, L. R. Skadhauge, A. M. Thulstrup, K. S. Hougaard, K. S. Hansen, M. Frydenberg, V. Schlünssen (Aarhus, Copenhagen, Esbjerg, Gentofte, Denmark)

Sunday, October 9, 2011

Occupy Wall Street And The Future Of Workers Compensation


The same social/economic forces  present on streets of New York City over a century go, are now re-emerging in the birth of the Occupy Wall Street [OWS] movement. The workers, unions and concerned citizens that are are patriotically seeking to again balance the  social/economic system mirror the century old movement and aspirations that its genesis in the Triangle Shirt Waist tragedy. This time the inspiration generated may evolve into a new and creative system to prevent workplace injuries and compensation. The new system maybe target entirely  to safety and prevention rather than solely compensating for injuries and exposures sustained at work.

Over a century ago the failure of employers to protect workers’ health and safety resulted in the tragedy of the Triangle Shirt Waist factory fire. Following that fatal conflagration emanated the promulgation of the modern day workers’ compensation system. It arose out of frustration and anger and was displayed in the street.

The recent efforts to dismantle the national network of workers’ compensation systems through legislation and regulation has effectively rendered the system both costly to navigate and burdensome to obtain benefits. Efforts have been made to make it more difficult to establish a claim. Occupational disease claims once considered compensable are not being denied and litigated on a regular basis.

The present workers’ compensation system has been emasculated by the competing efforts of Industry to reduce access to benefits at earlier stages of the process, and by a transformed industrial/economic system.  Soaring medical costs necessitated by the need to provide personalized medical treatment protocols to cure for complex diseases are raging havoc to the program. Medical  costs have soared and insurance carriers are continuing to raise rates. The 99% that constitutes the core group of the Occupy Wall Street movement is either unemployed or disabled and unable to work.  They seek good jobs which are safe, and medical benefits that are effectively and efficiently delivered.

Counting failure is no longer an option. Jobs that injury workers and a system that delays and denies benefits for injuries and exposures at work, is not beneficial to nation, its Industry and workers. Hopefully American creativity will give birth to a new system, and the Occupy Wall Street movement will be that catalyst. 

For over 4 decades the Law Offices of Jon L. Gelman  1.973.696.7900  jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.