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Showing posts sorted by date for query federalization. Sort by relevance Show all posts
Showing posts sorted by date for query federalization. Sort by relevance Show all posts

Tuesday, February 25, 2014

Throw The Book At 'Em

There seems to be no limit in the amount of fraudulent conduct that transpires within the workers' compensation system. If employer fraud is not enough, the system is constantly undergoing abuse from business interests, ie. medical provo\iders, who abuse the system. The Federal Governments role in enforcement is ever increasing and expansion is trending wider. The gobal expanssion nationally of a universal program for monitoring and enforcement of medical fraud is encouraging. Today's post is shared from David DePaolo http://daviddepaolo.blogspot.com/

It's a shame that hundreds, if not thousands, of injured workers underwent unnecessary spinal fusion surgeries and must live with the debilitating aftermath of significant disability because of people whose greed overrides the well being of fellow humans.

I had learned about Michael Drobot and Pacific Hospital of Long Beach, and their co-conspirators, preying on workers' compensation patients some time ago.

On Friday though, Federal prosecutors announced that Michael D. Drobot faces up to 10 years in prison after he pleaded guilty to paying kickbacks in a $500 million fraud scheme relating to spinal fusions and admitted to bribing state Sen. Ron Calderon to delay legislation to repeal the separate reimbursement for spinal hardware.

Calderon, D-Montebello, was indicted one day earlier on 24 charges, including bribery, money laundering, wire fraud and filing a false tax return. His brother, former...

[Click here to see the rest of this post]


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Read more about "Federalization of Workers' Compensation"
Jul 05, 2012
United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation's workers' compensation system. By it's recent decision, upholding the mandate for insurance care under the ...
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...
Jun 14, 2012
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally .


Friday, May 17, 2013

Obamacare Will Be Collecting Workers' Compensation Medical Records

The implementation of Affordable Care Act data collection regulations will include the collection of medical information concerning work related accidents and injuries.  The coalition of this information will broadly advance the concept of universal medical care and impose yet another route for the Centers for Medicare and Medicare to strengthen enforcement under the Medicare Secondary Payer Act.

The largest and most expansive database of personalized medical information is being established under the umbrella of an newly created unit under the authority granted to the Internal Revenue Service, The Federal Data Services Hub. Personal medical records, including electronic medical records, will be incorporated into the program. 

"On March 23, 2010, the President signed into law the Patient Protection and Affordable Care Act 
(P.L. 111-148). On March 30, 2010, the Health Care and Education Reconciliation Act of 2010 
(P.L. 111-152) was signed into law. The two laws are collectively referred to as the Affordable 
Care Act. The Affordable Care Act creates new competitive private health insurance markets –
called Exchanges – that will give millions of Americans and small businesses access to 
affordable coverage and the same insurance choices members of Congress will have. Exchanges 
will help individuals and small employers shop for, select, and enroll in high quality, affordable 
private health plans that fit their needs at competitive prices. The IT systems will support a 
simple and seamless identification of people who qualify for coverage through the Exchange, tax 
credits, cost-sharing reductions, Medicaid, and CHIP programs. By providing a place for onestop shopping, Exchanges will make purchasing health insurance easier and more understandable 
and will put greater control and more choice in the hands of individuals and small businesses."

Read more about "Federalization" and workers' compensation:

Thursday, May 16, 2013

Do I Need To File A Tax Return On My Workers Compensation?

Today's post comes from guest author Paul J. McAndrew, Jr. from Paul McAndrew Law Firm.

If you received workers’ compensation benefits, you may be wondering if you will need to report this money to the IRS and pay taxes on it. Under the Iowa Workers’ Compensation Act, money that you receive as workers’ compensation benefits is not taxable, with a few exceptions. You will have to pay taxes on your work comp benefits if:
  • if the benefits are retirement plan benefits (this is true even if you retired due to disability)
  • if part of your workers’ compensation benefit money lowers the amount you receive from your Social Security or Railroad Retirement Benefits. In that case, that the part of your workers compensation benefits is considered part of your Social Security (or RRB) and may be taxable.
If you return to work, your salary will be taxable again, as is it was before you received workers’ compensation benefits.

Monday, February 11, 2013

Jobs, Growth & Universal Healthcare


Robert Reich, in a 3 minute video, states the reasons why jobs, growth and universal healthcare are needed to expand the US economy. 

This is reflective of the issues plaguing the nation's workers' compensation system, especially soaring medical delivery costs (administrative, clinical and pharmaceutical).  

Read more about "universal healthcare" and workers' compensation:

Feb 01, 2013
Medical care afforded by workers' compensation delivery systems will ultimately be merged into a universal national program, despite all the opposition along the way. My friend, and cycling inspiration, who keeps me trying to ...
Nov 09, 2012
Going forward it is imperative that a universal medical program be established to provide medical treatment for all work-related occupational injuries and exposures. The delay and denial of medical benefits to those who suffer ...
Jul 05, 2012
Those efforts demonstrate a commitment to bring the nation ever closer to a universal care medical program incorporating the entire patchwork of workers' compensation medical delivery systems. The US Supreme Court has ...
Mar 05, 2011
Vermont Universal Health Care to Embrace Workers Compensation. A two-stage bill in Vermont is geared to establishing a single-payer medical health care system that would include medical for workers' compensation ...

Friday, February 1, 2013

Universal Medical and Workers' Compensation: It's Not "If", It's "When" - California

The Affordable Care Act (ACA) is going to definitely change the landscape of medical delivery over the coming future. Medical care afforded by workers' compensation delivery systems will ultimately be merged into a universal national program, despite all the opposition along the way.

My friend, and cycling inspiration, who keeps me trying to think I can enter the Tour de France while under the influence of Starbucks coffee, David DePaolo, points out that the "fusion" may be coming slowly through legislation of unintended consequences in California.
"The concept of universal care, 24 hour care, single stop shop, etc. has been floating for a couple of decades now with very little progress.

"But the passage of the Affordable Care Act, the signing of HB 1 back in February 2009, and other Federal health related laws and regulations including ERISA, have accelerated the fusion of workers' compensation medicine and general health medicine. Outsourcing MPN [Medical Provider Networks] oversight to a health care related agency is just another step towards this outcome.
David, an expert in analyzing what's around the curve, sees the next wave of change coming to workers' compensation. For so many reasons, including the expansion/reimbursement integration of the Medicare program, the writing is on the wall on this one. 

Every time the lobbyists think that have eliminated the imminent threat of Federal intrusion, ie. Enactment of The SMART Act, the reality of which is that the regulations will eat up the statute, and also their lunch. I plan to write more on The SMART Act in the coming weeks. Maybe that wasn't so smart after all for the cottage industries that supported it.

Wednesday, September 12, 2012

Health Care Continues to Eat Away at Employee Earnings

Family Health Premiums Rise 4 Percent to Average $15,745 in 2012, National Benchmark Employer Survey Finds


Throughout the nation Workers' Compensation systems have been impacted by health care costs that now take a large piece of the premium dollar. Traditional health care offered by employers mirrors the same problem of economic stress. Running two parallel systems creates added costs and  delays the delivery of medical care. The recent Kaiser Survey just released for 2012 reports that costs in the health care field continue to outpace employee compensation. 

Annual premiums for employer-sponsored family health coverage reached $15,745 this year, up 4 percent from last year, with workers on average paying $4,316 toward the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2012 Employer Health Benefits Surveyreleased today.

This year’s premium increase is moderate by historical standards, but outpaced the growth in workers’ wages (1.7 percent) and general inflation (2.3 percent). Since 2002, premiums have increased 97 percent, three times as fast as wages (33 percent) and inflation (28 percent).

“In terms of employee insurance costs, this year’s 4 percent increase qualifies as a good year, but it still takes a growing bite out of middle-class workers’ wages, which have been flat or falling in real terms,” Kaiser President and CEO Drew Altman, Ph.D. said.

“Premium growth is at historic lows, which greatly benefits workers. Continuing to ensure that Americans have coverage options that are affordable is vitally important for our nation’s health,” said Maulik Joshi, Dr.P.H., president of HRET and senior vice president for research at the American Hospital Association.

The 14th annual Kaiser/HRET survey of more than 2,000 small and large employers provides a detailed picture of trends in employer-sponsored health insurance costs and coverage. In addition to the full report and summary of findings being released today, the journal Health Affairs is publishing a Web First article with select findings, and Dr. Altman authored a “Pulling It Together” column reflecting on this year’s results.

The survey reveals significant differences in the benefits and worker contributions toward family premiums between firms with many lower-wage workers (at least 35 percent of workers earn $24,000 or less a year) and firms with many higher-wage workers (at least 35 percent of their workers earn $55,000 or more a year).

Workers at lower-wage firms on average pay $1,000 more each year out of their paychecks for family coverage than workers at higher-wage firms ($4,977 and $3,968, respectively). This occurs even though the firms with many lower-wage workers on average pay less in total premiums for family coverage than firms with many higher-wage workers ($14,694 and $16,427, respectively).

In addition, workers at lower-wage firms are also more likely to face high deductibles than those at higher-wage firms. Specifically, 44 percent of covered workers at firms with many low-wage workers face an annual deductible of $1,000 or more, compared with 29 percent of those at firms with many high-wage workers. Across all employers, a third of covered workers (34 percent) face a deductible of that size, including 14 percent with deductibles of at least $2,000 annually.

“This year’s survey suggest that working families at the low end of the wage scale face significant out of pocket costs for coverage,” said study lead author Gary Claxton, a Kaiser Vice President and director of the Foundation’s Health Care Marketplace Project. “Firms with many lower-wage workers ask employees to pay more out of pocket than firms with many higher-wage workers even though the coverage itself tends to be less comprehensive.”

Health Reform and Employers

The survey estimates that 2.9 million young adults are currently covered by employer plans this year as a result of a provision in the 2010 Affordable Care Act that allows young adults up to age 26 without employer coverage of their own to be covered as dependents on their parents’ plan. That’s up from the 2.3 million in the 2011 survey. Young adults historically have been more likely to be uninsured than any other age group.

The survey also finds that 48 percent of covered workers are in “grandfathered” plans as defined under health reform, down from 56 percent last year. Grandfathered plans are exempted from some health reform requirements, including covering preventive benefits with no cost sharing and having an external appeals process. To retain this status, employers must not make significant changes to their plans to reduce benefits or increase employee costs.

Employer Expectations for 2013

In addition to the comprehensive survey conducted in the spring, employers were asked in August whether they had information about the change in premiums (or total cost for self-funded plans) for their current health plan with the largest enrollment. The average increase reported by employers who had received information for their current plan is 7 percent.

These early reports may not match what employers and workers ultimately end up paying next year, as firms can raise deductibles or otherwise change the health benefits and plans they offer to lower premiums. This year, for example, more than half (54 percent) of employers who offer health benefits reported that they had shopped around for new coverage. Of that group, significant shares switched carriers (18 percent) or changed the type of plans they offer (27 percent).

Other findings from the study include:
Worker-only coverage. Premiums for worker-only health coverage increased 3 percent in 2012 to reach $5,615 annually. Workers on average pay $951 toward this coverage.
Offer rate. This year, 61 percent of firms offer health benefits to their workers – statistically unchanged from last year. 

Cost-sharing for office visits, emergency care and drugs. Covered workers facing co-payments for in-network physician office visits on average pay $23 for primary care and $33 for specialty care. For emergency-room visits, average co-pays are $118. For drug plans with three or more tiers, average co-pays are $10 for generic drugs, $29 for preferred brand-name drugs, $51 for non-preferred brand-name drugs, and $79 for specialty drugs.
Domestic partner benefits. In 2012, 31 percent of employers offer health benefits to same-sex domestic partners, up from 21 percent three years earlier. This year 37 percent of firms offer such benefits to unmarried opposite-sex partners, up from 31 percent in 2009.
Flexible Spending Accounts and Pre-Tax Premiums. Large employers are more likely than small ones to allow workers to pay their share of premiums with pre-tax income (91 percent, compared to 41 percent) and to contribute pre-tax dollars to Flexible Spending Accounts (76 percent, compared to 17 percent).

Now in its 14th year, the survey is a joint project of the Kaiser Family Foundation and the Health Research & Educational Trust. The survey was conducted between January and May of 2012 and included 3,326 randomly selected, non-federal public and private firms with three or more employees (2,121 of which responded to the full survey and 1,205 of which responded to a single question about offering coverage). A research team at Kaiser, HRET and NORC at the University of Chicago, led by Kaiser’s Gary Claxton, designed, conducted and analyzed the survey. For more information on the survey methodology, please visit the Survey Design and Methods Section at http://ehbs.kff.org.
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For over 3 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 work related accident and injuries.

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Saturday, September 1, 2012

California Takes an Austerity Axe to Workers Compensation

English: Jerry Brown's official picture as Att...
Governor Jerry Brown
(Photo credit: Wikipedia)
Tonight the California Legislature took an axe to its ailing workers' compensation system, as part of major election year austerity measures. Targeting both medical and legal costs of operating the program, at the encouragement of Governor Jerry Brown,  Democratic legislators pushed through changes (SB863) with little public discussion.

Click here to read: California Lawmakers Overhaul Workplace Insurance (Reuters)

Wednesday, August 15, 2012

The Great California Trade Off 2012

Rumors spread like wildfire this week as alleged secret back-room dealing continued in an effort to reform the failing California workers compensation system, yet again. The great trade-off of 2012 appears to be a major move to control and limit medical delivery and disability benefits at all cost.

Of critical importance is the fact that as goes California so goes the nation. Historically, changes made in California will slowly advance across the country and become adopted as a national wave of reform.

What has been leaked to the media, and some stakeholders, by a coalition of Labor and Industry management representatives, is yet another bandaid attempt to to control medical delivery in an effort to reduce both treatment costs, and ultimately reduce the number of cases utilizing the system.

While on the books it looks great that injured workers may get a potential increase of $700 million in increased permanent disability benefits, the trade-off is the imposition of a stringently controlled, speeded-up, and rationed medical benefits.

For employers to truly benefit from a Workers' Compensation program that works, employees need to receive the best medical treatment available to cure and relieve their work related medical conditions, and an adequate program of disability payments.

The proposed reforms limit medical choice, limit medical protocols, take away disability modifiers and impose penalties for out of network medical care in the name of expediency.

The problems facing California are not unique to that state. The entire nation, both within the workers' compensation system, and without, are facing similar issues.

One would hope that California would set a high standard for the nation, such as it attempted to do with heightened requirements for automobile emission testing and safety. However, to eliminate treatment options available to injured workers merely for the purpose reducing costs is a fast track program that ignores the need to achieve the best medical result and provide adequate compensation to injured workers.

Tuesday, August 14, 2012

CMS Rules Out TENS Units for Low Back Pain

"TENS is not reasonable and necessary for the treatment of CLBP under section 1862(a)(1)(A) of the Social Security Act."

The Centers for Medicare and Medicaid (CMS) has issued a ruling that will impact on the payment of proceeds in Workers' Compensation Medicare Set Aside Agreements (WCMSA). CMS has ruled out the use of TENS (Transcutaneous Electrical Nerve Stimulation) units for the treatment of chronic low back pain.


"For those WC [workers' compensation]cases that were not settled prior to June 8, 2012, and where the  WCMSAs proposal includes funding for TENS for CLBP [chronic low back pain] as part of the WCMSA, CMS  will re-review the cases and remove pricing for TENS for CLBP. (Regional Offices shall  obtain from submitters requests for a case re-review, along with a signed statement  indicating a settlement had not occurred prior to June 8, 2012.)"

Case law throughout the country has been divided on whether TENS units should be authorized to cure and relieve low back pain. 

Click here to read: Decision Memo for Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain (CAG-00429N)

Click here to read: Impact of the Removal of coverage of Transcutaneous Electrical Nerve 
Stimulation (TENS) Units for Chronic Low Back Pain (CLBP) on Workers’ Compensation Medicare Set-Aide Arrangement (WCMSA) proposals – INFORMATION

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For over 3 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.

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Wednesday, August 8, 2012

Citizen Groups Urgently Request Court to Stop Body Scans by TSA

English: Poster prepared by the Transportation...
English: Poster prepared by the Transportation Security Administration summarizing the operation of the Millimeter Wave (MMW) whole body imaging scanner. (Photo credit: Wikipedia)
Whole Body Imaging (WBI) at US airports by The Transportation Safety Administration (TSA) has raised urgent health concerns over causing increased rates of cancer among airport workers and passengers. Parties have requested the US Court of Appeals for the District of Columbia to address the Court's mandate of one year ago that TSA propose formal rule making authority to address the health issues raised before the continued use of the TSA WBI scanners that are used in US airports.

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The European Commission has adopted today a proposal for an European Union legal framework on security scanners. This legislation allows airports and Member States that wish to use security scanners for the screening ...
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At a US Senate hearing last week, Senator Susan Collins (R-Maine) revealed that TSA had made reporting errors in the statistics it has compiled in defense of the use of body scanners. "That is completely unacceptable when ...

Thursday, August 2, 2012

Probable Link Sustains Claim for Renal Cancer & Pulmonary Disability

A NJ appellate court upheld a trial court's decision holding an employer liable for workers compensation benefits for renal cancer and pulmonary disability where a probable link could be demonstrated as a result on a worker's occupational exposure to known carcinogens including asbestos.

Johnson v Exxon-Mobile Chemical Co. (2012 WL 3064003 (N.J. Super. A.D.) Decided July 30, 2012

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Wednesday, August 1, 2012

Illinois Man Sentenced to 10 Years in Prison for Clean Air Act Violations Involving Asbestos

The EPA was directed to set standards for radi...
(Photo credit: Wikipedia)
Duane “Butch” O’Malley, 59, of Bourbonnais, Ill., who was convicted by a federal jury on September 26, 2011, for the illegal removal, handling and disposal of asbestos from a Kankakee building in August 2009, was sentenced to 10 years in prison by Federal District Court Judge Michael McCuskey. O’Malley was also ordered to pay restitution of $47,086 to the U.S. Environmental Protection Agency (EPA) related to the clean-up of illegally disposed asbestos and ordered to pay a fine of $15,000. Asbestos is a mineral fiber that has been used commonly in a variety of building construction materials. When asbestos-containing materials are damaged or disturbed by repair, remodeling or demolition activities, microscopic fibers become airborne and can be inhaled into the lungs, where they can cause serious health problems, including lung cancer and mesothelioma.

“Asbestos must be removed in a safe and legal way in order to protect people's health and reduce the risk of exposure,” said Cynthia Giles, assistant administrator for EPA’s Office of Enforcement and Compliance Assurance. “The defendant’s actions endangered the health of his workers and the surrounding community and the sentence shows that those who violate critical environmental safeguards will be prosecuted.”

“To increase his profits, a jury found that O’Malley knowingly disregarded federal environmental laws that require asbestos-containing materials be safely removed and properly disposed,” said U.S. Attorney Jim Lewis, Central District of Illinois. “This sentence is a consequence of the defendant’s flagrant disregard for his workers, the public, and the environment in exposing them to dangerous airborne asbestos fibers.”
During O’Malley’s trial, the government presented evidence that O’Malley, owner and operator of Origin Fire Protection, was hired by Michael J. Pinski in August 2009 to remove asbestos-containing insulation from pipes in a five-story building in Kankakee, Ill. that was owned by Pinski through his company, Dearborn Management, Inc. Evidence was presented that neither O’Malley nor his company was trained to perform the asbestos removal work and that O’Malley agreed to remove the asbestos insulation for an amount that was substantially less than a trained asbestos abatement contractor would have charged to perform the work. Further, O’Malley arranged for James A. Mikrut to recruit and oversee workers to remove the asbestos.

The government’s evidence showed that various provisions of the Clean Air Act (CAA) and EPA regulations were violated, including, failure to properly notify the EPA, failure to have trained on-site representatives present, failure to ensure the asbestos insulation was adequately wetted while it was being stripped and removed, failure to mark vehicles used to transport the asbestos containing waste material and failure to deposit the asbestos in a waste disposal site for asbestos. Instead, the asbestos insulation was stripped from the pipes while dry, and then placed in more than 100 large, unlabeled plastic garbage bags. The bags were then dumped in an open field in Hopkins Park, resulting in soil contamination and exposing the workers hired by O’Malley to dangerous asbestos-laden dust.

Under the CAA there are requirements to control the removal, handling and disposal of asbestos, a hazardous air pollutant. Any owner or operator of a renovation or demolition activity which involves removal of specified amounts of asbestos-containing material must comply with the EPA regulations.

O’Malley was charged in June 2010 with five felony violations of the CAA, along with Michael J. Pinski, 42, of Kankakee, Ill., and James A. Mikrut, 49, of Manteno, Ill. Pinski entered a plea of guilty on Aug. 19, 2011, to one count of violation of the Clean Air Act. Mikrut pleaded guilty on Aug. 24, 2011, to five counts of violation of the CAA. The sentencing hearings for Pinski and Mikrut will be scheduled at a future date.

The charges were investigated by EPA’s Criminal Investigation Division, with assistance from the Illinois Environmental Protection Agency and the U.S. Environmental Protection Agency’s Superfund Division. Assistant United States Attorney Eugene L. Miller and Special Assistant U.S. Attorney James Cha are prosecuting the case.

More information about EPA’s criminal enforcement program: http://www.epa.gov/oecaerth/criminal/index.html


....
For over 3 decades the Law Offices of Jon L. Gelman1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered work related accident and injuries.


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