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(c) 2010-2026 Jon L Gelman, All Rights Reserved.

Sunday, November 29, 2015

Drivers' Protected From Being Forced to Violate Safety Regulations

The U.S. Department of Transportation’s Federal Motor Carrier Safety Administration (FMCSA) today announced the publication in the Federal Register of a Final Rule to help further safeguard commercial truck and bus drivers from being compelled to violate federal safety regulations.  The Rule provides FMCSA with the authority to take enforcement action not only against motor carriers, but also against shippers, receivers, and transportation intermediaries.

“Our nation relies on millions of commercial vehicle drivers to move people and freight, and we must do everything we can to ensure that they are able to operate safely,” said U.S. Transportation Secretary Anthony Foxx.  “This Rule enables us to take enforcement action against anyone in the transportation chain who knowingly and recklessly jeopardizes the safety of the driver and of the motoring public.”

The Final Rule addresses three key areas concerning driver coercion: procedures for commercial truck and bus drivers to report incidents of coercion to the FMCSA, steps the agency could take when responding to such allegations, and penalties that may be imposed on entities found to have coerced drivers.

“Any time a motor carrier, shipper, receiver, freight-forwarder, or broker demands that a schedule be met, one that the driver says would be impossible without violating hours-of-service restrictions or other safety regulations, that is coercion,” said FMCSA Acting Administrator Scott Darling.  “No commercial driver should ever feel compelled to bypass important federal safety regulations and potentially endanger the lives of all travelers on the road.”

In formulating this Rule, the agency heard from commercial drivers who reported being pressured to violate federal safety regulations with implicit or explicit threats of job termination, denial of subsequent trips or loads, reduced pay, forfeiture of favorable work hours or transportation jobs, or other direct retaliations.

Some of the FMCSA regulations drivers reported being coerced into violating included: hours-of-service limitations designed to prevent fatigued driving, commercial driver’s license (CDL) requirements, drug and alcohol testing, the transportation of hazardous materials, and commercial regulations applicable to, among others, interstate household goods movers and passenger carriers.

Commercial truck and bus drivers have had whistle-blower protection through the Department of Labor’s Occupational Safety and Health Administration (OSHA) since 1982, when the Surface Transportation Assistance Act (STAA) was adopted.  The STAA and OSHA regulations protect drivers and other individuals working for commercial motor carriers from retaliation for reporting or engaging in activities related to certain commercial motor vehicle safety, health, or security conditions.  STAA provides whistleblower protection for drivers who report coercion complaints under this Final Rule and are then retaliated against by their employer.

In June 2014, FMCSA and OSHA signed a Memorandum of Understanding to strengthen the coordination and cooperation between the agencies regarding the anti-retaliation provision of the STAA.  The Memorandum allows for the exchange of safety, coercion, and retaliation allegations, when received by one agency, that fall under the authority of the other.

For more information on what constitutes coercion and how to submit a complaint to FMCSA, see: www.fmcsa.dot.gov/safety/coercion.  Please note: the Final Rule takes effect 60 days following its publication in the Federal Register.
This rulemaking was authorized by Section 32911 of the Moving Ahead for Progress in the 21st Century Act (MAP-21) and the Motor Carrier Safety Act of 1984 (MCSA), as amended.

For a copy of today’s Federal Register announcement, see: www.federalregister.gov/articles/2015/11/30/2015-30237/prohibiting-coercion-of-commercial-motor-vehicle-drivers.
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Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thompson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson-Reuters). 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.

Wednesday, November 18, 2015

NJ Medical Payments Stabilize - But Why?

A recent study by an insurance based data organization has reported that NJ is experiencing a leveling of medical costs. The real question is "why?" Are declining medical benefits caused by fewer claims based on a shift of challenging employment status in the shared economy or a shift of medical costs under Obamacare to the private sector? 
Medical payments per workers’ compensation claim in New Jersey were stable from 2010 to 2013, in contrast to rapid growth in the 2008 to 2010 period, according to a recent study by the Workers Compensation Research Institute (WCRI).
The report, CompScope™ Medical Benchmarks for New Jersey, 16th Edition, indicates results for New Jersey differed from those of other states WCRI studied, many of which experienced moderate to rapid growth in medical payments per claim.
The study found the following to be contributing factors: 
  • Increased use of networks, which may be linked to a decrease in prices paid for non hospital care. In recent years, two-thirds of total medical payments came from non hospital services.
  • Flat or decreasing trends in utilization of many non hospital services.
  • Slower growth in hospital outpatient payments per service.
  • A continued decrease in the percentage of claims that had hospital inpatient care.
“From 2010 to 2013, medical payments per claim with more than seven days of lost time rose less than 2 percent per year in New Jersey,” said Ramona Tanabe, executive vice president and counsel for WCRI. “From 2008 to 2010, payments rose nearly 10 percent per year.”
WCRI studied medical payments, prices, and utilization in 17 states, including New Jersey, looking at claim experience through 2014 on injuries that occurred in 2013 or earlier. WCRI’s CompScope™ Medical Benchmark studies compare metrics of medical costs and care from state to state and across time.

Monday, November 16, 2015

CMS MSP FInal Conditional Payments Portal To Open

Upcoming Updates to the Medicare Secondary Payer Recovery Portal (MSPRP) Modification for Inclusion of Final Conditional Payment (CP) Process Functionality

As part of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), the MSPRP will be modified to include Final CP process functionality by January 1, 2016.  This new functionality will permit authorized MSPRP users to notify CMS that a recovery case is 120 days (or less) from an anticipated settlement and request that the recovery case be a part of the Final CP process.
When the Final CP process is requested, any disputes submitted through the MSPRP will be resolved within 11 business days of receipt of the dispute.  Once all disputes have been resolved, and the case is within 3 days of settling, the beneficiary or their authorized representative will be able to request a Final Conditional Payment Amount on the MSPRP.  Once calculated, this amount will remain the Final Conditional Payment Amount as long as:
  1. The case is settled within 3 calendar days of requesting the Final Conditional Payment Amount, and
  2. Settlement information is submitted through the MSPRP within 30 calendar days of requesting the Final Conditional Payment Amount.

Friday, November 13, 2015

Demolition of Paterson NJ Armory Highlights Present Danger of Asbestos

The emergency demolition of the decades old Paterson NJ Armory, an historic site, highlights that asbestos, a known carcinogen, remains a hazard to workers when older buildings require renovation or demolition.
asbestos remains a clear and present danger to workers. Despite the fact that asbestos may not be used as a new construction material,

Asbestos, a naturally occurring mineral, was used for years as a construction material because of its fire retardant and heat insulation properties.

The hazards of asbestos are well known. Exposure to asbestos may cause the latent development of: asbestosis, lung cancer and mesothelioma.

The Paterson NJ Armory caught fire several days ago and resulted in  a major North Jersey fire alarm requiring the participation of firefighters to be called in from multiple jurisdictions to be be brought under control. Unable to reach and extinguish some parts of the fire, the Paterson Fire Department ordered that the historic building be demolished on an emergency basis.

Despite the knowledge of the fatal hazards of asbestos use, it  has yet to be banned in the United States.
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Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thompson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson-Reuters). 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.

Thursday, November 12, 2015

NY Corporate Workers' Compensation Fraud Leads to Criminal Charges

New York State Inspector General Catherine Leahy Scott announced today the arrests of four Central New York and Southern Tier business owners on fraud and theft charges as part of an ongoing series of investigations into employers and employees who defraud the State Workers’ Compensation system. Under State law, employers are required to maintain Workers’ Compensation coverage for their employees, and employees are expected to provide truthful information regarding their work activity to insurance carriers and the Workers’ Compensation Board during the time they are receiving benefits.

Today’s arrests are part of an ongoing coordinated effort by Inspector General Leahy Scott with local and State law enforcement partners involving multiple investigations across New York. Additional arrests are expected imminently. It also coincides with enhanced outreach efforts, including stakeholder trainings by the Inspector General, to increase public awareness of Workers’ Compensation fraud in the State.

“The Workers’ Compensation system is meant to assist and protect employees who are unable to work due to an illness or injury, and those who abuse the system should fully expect they will be caught,” said Inspector General Leahy Scott. “In these arrests today, the defendants are accused of using fraud and deceit to undermine their legal and moral responsibilities, and I will use the resources of my office to relentlessly pursue anybody who abuses the system at the expense of honest, hard-working New Yorkers.” Workers’ Compensation fraud impacts all New Yorkers, from increased insurance premiums to increased workloads for coworkers and an overall reduction in workforce productivity.

Arrested today were:

Douglas S. Griffen, 53, of 330 Halseyville Road, Ithaca, owner of Fingerlakes Excavating LLC, was charged with Grand Larceny in the Third Degree and Falsifying Business Records in the First Degree, felonies, as well as the Workers’ Compensation crimes of Fraudulent Practices, a felony, and Failure to Secure Compensation, a misdemeanor. Inspector General Leahy Scott’s investigation found that Griffen, last summer, provided a Tompkins County home building company false documents that purported to show that his own company had valid Workers’ Compensation coverage in order to qualify for two construction contracts with the home builder worth $72,000. Griffin had no Workers’ Compensation coverage and would not have been awarded the contracts if he had not provided the false documents to the home builder. Griffen was arraigned in Ithaca City Court and sent to Tompkins County Jail in lieu of $5,000 cash or $10,000 bond bail and is due back in court Tuesday, Nov. 17.

 Roger Camby, 60, of 1119 Teall Avenue, Syracuse, owner of an online retail candle business, was charged with the Workers’ Compensation crime of Fraudulent Practices, Insurance Fraud in the Second Degree and Grand Larceny in the Second Degree, all felonies. Inspector General Leahy Scott’s investigation found that Camby, a former truck driver out from work on a Workers’ Compensation claim since 2010, was operating several businesses while certifying to the Workers’ Compensation Board that he was not working in any capacity. Between early 2011 and the summer of 2013 he received more than $56,000 in Workers’ Compensation benefits while also running a candle business, Lovesoy Candles and Gifts, as well as working as a consultant for three multi-level marketing businesses.

Camby was arraigned in Town of Tully Court and is due to appear in Syracuse City Court tomorrow, Nov. 13. John A. Francher, 73, of 20 Vista Street, Auburn, owner of the Greenbriar Home for Adults in Homer, was charged with the Workers’ Compensation crime of Effect of Failure to Secure Compensation, a felony.

Inspector General Leahy Scott’s investigation found that Francher operated a business with more than five employees without obtaining required Workers’ Compensation coverage. He employed approximately 10 people at the Greenbrier Home. Francher was previously convicted in February 2014 of a misdemeanor charge of failure to secure compensation at Briarcliff Manor in Bath. Francher was arraigned in Town of Homer Court and is due back in court next Tuesday, November 17.

Steven M. Spratley, 58, of 179 Prospect Ave, Walton, owner of Spratley and Sons Tree Surgeons, was charged with Fraudulent Practices, a felony under the Workers’ Compensation Law. Inspector General Leahy Scott’s investigation found that Spratley falsely denied at a 2013 Workers’ Compensation Board hearing that a man who was severely injured while working for him in 2011 was actually an employee.

The investigation found that Spratley made the false statements to avoid liability for the employee’s claim for Workers’ Compensation due to the injury, which made him unable to work. Spratley is due to appear in the Town of North Norwich Court at a future date. Inspector General Leahy Scott thanked the Workers’ Compensation Board, the State Insurance Fund, Liberty Mutual Insurance and the Ithaca Police Department for their assistance during the investigations; the Ithaca Police Department and the New York State Police for their assistance with making the arrests; and Onondaga County District Attorney William J. Fitzpatrick, Tompkins County District Attorney Gwen Wilkinson, Cortland County District Attorney Mark D. Suben and Chenango County District Attorney Joseph A. McBride and their offices for prosecuting these cases.

The defendants are presumed innocent until and unless proven guilty in a court of law.

For an audio file of Inspector General Leahy Scott’s remarks, click HERE

Emerging Concepts for Future Workers' Compensation Benefits: Portability Now

Workers' Compensation as a benefit program is beginning to evolve under the concept of "The Shared Economy." Attacked from within and without, challenged by abuse and fraud, drained by the cottage industries and vendors, national lawmakers, labor leaders, insurance companies, governmental agencies, and the media, are speaking out to change the century old system that fails to integrate with current social, political, economic and medical programs.

A recent letter from national labor leaders has called for a "portable" system of benefits that will replace the current patch-work of systems called "workers' compensation programs.":

"We need a portable vehicle for worker protections and benefits.Traditionally, benefits and protections such as workers compensation, unemployment insurance, paid time off, retirement savings, and training/development have been, largely or partly, components of a worker’s employment relationship with an employer. The Affordable Care Act has disrupted that model, providing more independent workers a different avenue of access to health insurance. Another new model is needed to support new ways of work. We believe this model should be:

Independent: Any worker should be able to access a certain basic set of protections as an individual regardless of where they source income opportunities.

Flexible and pro-rated: People are pulling together income from a variety of sources, so any vehicle should support contributions that can be pro-rated by units of money earned, jobs done, or time worked, covering new ways of micro-working across different employers or platforms.

Portable: A person should be able to take benefits and protections with them in and out of various work scenarios.

Universal: All workers should have access to a basic set of benefits regardless of employment status.

Supportive of innovation: Businesses should be empowered to explore and pilot safety net options regardless of the worker classification they utilize.

California Workers' Compensation $25 Million Medical Fraud: US Attorney Charges Providers

San Diego Nov 10 2015: Eight medical professionals and associates are charged in federal grand jury indictments with buying and selling patients in a bribery scheme involving $25 million in improper claims for medical services and devices which were then billed to California Workers’ Compensation insurance companies.

FBI agents along with investigators from the California Department of Insurance and the San Diego County District Attorney’s Office served five search warrants and three seizure warrants today at locations in San Diego, Chula Vista, National City, Murietta and Los Angeles. Authorities arrested five people, including a radiologist, a chiropractor, a medical equipment provider, a medical clinic administrator and a so-called medical marketer. An attorney and a medical service provider were summoned to appear in federal court on Thursday.  One indicted defendant, Gonzalo Paredes, remains a fugitive and a warrant has been issued for his arrest.

These defendants, plus six corporations, are charged in three federal grand jury indictments unsealed today with conspiracy and honest services mail fraud. The indictments allege that these players either paid or received tens of thousands of dollars to buy or sell hundreds of patients, without the patients’ knowledge - therefore depriving those patients of their right to their doctors’ honest services.

“Today’s indictments are only the first wave of charges in what we believe is rampant corruption on the part of some physicians and chiropractors in their dealings with the health care system in general, and California’s Workers’ Compensation System in particular,” said U.S. Attorney Laura Duffy. “A patient puts his trust, and his very life, into the hands of his physician. A doctor’s decisions should never, under any circumstances, be influenced by anything other than the patient’s best interest.”

“Today's indictments show how the defendants in this case allowed greed and corruption to influence their patient care decisions and treated their patients as a commodity to be bought and sold,” said FBI Special Agent in Charge Eric S. Birnbaum. “The FBI will continue to use our intelligence and investigative expertise to identify, disrupt and dismantle sophisticated criminal conspiracies that unlawfully enrich individuals at the expense of patient care. The FBI and our law enforcement partners are committed to rooting out corruption in our health care system.”

“This criminal network bought and sold patients like cattle,” said District Attorney Bonnie Dumanis. “They cashed in on people who trusted them with their health and they conspired to illegally game the system on a level that we’ve not seen before. But, the game is over.”

“Our detectives from the California Department of Insurance worked closely with the FBI, United States Attorney's Office and San Diego District Attorney's office to investigate and arrest these medical providers for insurance fraud, which adds crippling costs to California's workers compensation system,” said Department of Insurance Commissioner Dave Jones. “These are not victimless crimes. When medical providers defraud insurers, those costs are passed on to California businesses and consumers, who already are struggling to make ends meet.”

This is how the schemes worked:

Patients who said they were injured on the job filed a workers’ compensation claim with the state of California and sought treatment for their injury. In this round of indictments, the workers sought help from a chiropractor.

The chiropractors were the gateway to a wide-array of health care fraud. In these cases alone they prescribed medical equipment, referred the patients for MRIs and X-Rays, and ordered specialized treatments such as Shockwave therapy.

As alleged in one of the indictments, Los Angeles radiologist Ronald Grusd paid bribes to a San Diego chiropractor in exchange for patient referrals. The bribes were funneled to the chiropractor via Grusd’s corporation, Willows Consulting, a shell company. The checks were labeled “professional services,” but this was a sham.

In order to further hide the illegal kickbacks, checks were issued to intermediaries - defendants Alexander Martinez and his father, Ruben - through their front companies, “Line of Sight” and “Desert Blue Moon.” The Martinezes took their “cut” and then, in turn, paid off the chiropractor.
Grusd’s practice, California Imaging Network Medical Group, has clinics in San Diego, Los Angeles, Beverly Hills, Fresno, Rialto, Santa Ana, Studio City, Bakersfield, Calexico, East Los Angeles, Lancaster, Victorville and Visalia.

In another indictment, a second San Diego chiropractor, Dr. George Reese, with offices on El Cajon Boulevard, referred patients to a Los Angeles area medical service provider (controlled by attorney Lee Mathis and Fernando Valdes, president of Foremost Shockwave Solutions ) in return for bribes. The bribes were set by the conspirators at $100 per patient and paid through an intermediary. After taking a cut amounting to $25 per patient, the intermediary would pay the remaining $75 per patient to Reese.

Although disguised as “office rent” payments, the illegal bribes were paid in cash during clandestine exchanges in restaurants and parking lots. For example, $6,000 in cash was delivered to Reese in the parking lot of the Jolly Roger in Oceanside, hidden in a gift bag. Other times, it was passed in envelopes or stashed inside newspapers.

According to the indictment, Reese and his codefendants generated and submitted bills to insurers totaling in the tens of millions of dollars. Most of these treatments involved the providing of “Shockwave therapy,” which uses low energy sound waves to initiate tissue repair. Proceeds from the insurance claims generated through this scheme were paid to Mathis and Valdes.

In the final indictment, a San Diego chiropractor referred patients to a licensed provider of durable medical equipment, Julian Garcia. In return Garcia paid the chiropractor $50 for each patient – in cash, to disguise the kickbacks. Garcia then improperly billed Workers Comp insurers millions for hot and cold packs for patients who had been secured by bribes.