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CA DWC Initiates Procedure to Assess Administrative Penalties for Failure to Submit IMR Medical Records
By Press Release - CA Department of Industrial Relations - November 25, 2014

The Division of Workers’ Compensation (DWC) will initiate the procedure to assess administrative penalties for claims administrator failure to timely submit relevant medical records in cases currently pending Independent Medical Review (IMR).

Under Labor Code section 4610.5(i), DWC is authorized to assess penalties against claim administrators whose conduct has the effect of delaying the IMR process. Under current regulations, Maximus Federal Services, Inc., the organization designated by DWC to conduct IMR reviews, sends the claims administrator a Notice of Assignment and Request for Information (NOARFI) in an IMR case. The notice advises of the relevant medical records to be submitted, which must be provided to Maximus within 15 days of the date on the NOARFI. The regulatory requirements for submitting records can be found at California Code of Regulations, title 8, section 9792.10.5. 

DWC Issues Second 15-Day Notice for Modification to Proposed Medical Treatment Utilization Schedule Regulations
By Press Release - CA Department of Industrial Relations - November 25, 2014

The California Division of Workers’ Compensation (DWC) has posted a second 15-day notice of modification to the proposed Medical Treatment Utilization Schedule (MTUS) regulations to the DWC website. Members of the public are invited to present written comments regarding the proposed modification to until 5 p.m. on Tuesday, December 9.

The proposed modifications include:

Energi and HDI-Gerling Select York to Manage Workers’ Compensation Claims
By Lonce LaMon from Press Release - November 24, 2014

York Risk Services Group, a provider of claims management, managed care and risk management services, today announced it has been selected to manage workers’ compensation claims by Energi, a leading provider of risk management and insurance for the energy industry and HDI-Gerling, commercial property and casualty insurer and strategic insurance partner to Energi. Energi will adopt York’s TeamComp platform, which combines sophisticated data analysis with proactive clinical response to lower claims costs and improve outcomes for injured workers. The partnership was announced at the National Workers Compensation and Disability Conference in Las Vegas, November 19-21.

Sim Hoffman, M.D. And Thomas Heric, M.D. Finally Plead Not-Guilty In Orange County Superior Court After Demurrer Denied
By Lonce LaMon - November 18, 2014

Sim Hoffman, M.D. and Thomas Heric, M.D. were finally arraigned in Orange County Superior Court on Friday, November 7th 2014 and appeared again in court for pre-trial proceedings on November 14th 2014.   They both pled not-guilty; they denied all the allegations and the enhancements.
The not-guilty pleas happened after Hoffman’s demurrer was denied.  A demurrer is a pleading which essentially accepts all or most of the facts, but argues the law—arguing generally that there is no legal basis for the lawsuit.  But clearly the judge saw some legal justification for the lawsuit, as the lengthy demurrer was not sustained. 
A preliminary hearing has now been set for Friday, March 6th 2015 in Department C-57. 
It was a long morning for workers’ compensation insurance fraud in Orange County on November 7th.  Deputy District Attorney Shaddi Kamiabipour was the prosecutor for two other cases in court rooms C-30 and C-45.   Those were the cases of Aspen Medical Resources and Landmark Medical Management, respectively. 
It was anticipated that the hearing for Hoffman and Heric would take place at 8:30 am on November 7th, however, Heric waited on the bench just outside the court room in his black vest with a white long sleeved shirt for nearly two hours, while Hoffman stood up for much of that time in his red tie wearing a dark grey suit. 

More News

November 14, 2014 - California Insurance Commissioner, Dave Jones, Recommends Lower Pure Premium Rate Than Suggested By Workers’ Comp Rating Bureau

November 13, 2014 - Medical Provider Offers Clients Pilates, Then Bills Insurance Companies For Expensive Diagnostic Services. Medical Billing Fraud Worth $77,237 Results In Jury Conviction And A Two-Year Jail Sentence.

November 11, 2014 - Bogus Coffee Burn Photos Lead To Arrest Of McDonald’s Customer For Fraud

November 10, 2014 - Fuel Distributor Cited Nearly $100,000 After Fatal Explosion At Corona, California, Facility Killed Welder

November 5, 2014 - Aspen Medical Resources Trial Set For April 24th 2015 In Orange County, California. Benjamin Gluck Now Representing Majority Aspen Owner, Abraham Khorshad, As Defense Counsel.

November 3, 2014 - Forged Prescription Adding Narcotic Results In Conviction In Riverside County

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