April 18, 2014

 

This morning, ABC's Good Morning America shone its media arclight on Cathy Caswell as she spun the great big wheel on The Price is Right, not once, but twice. But while doing so Ms. Caswell was drawing $3000 per month in workers comp indemnity payments, according to ABC. And she was collecting those payments because of a shoulder injury, which prevented her from standing, running, reaching or grasping, as reported by ABC's eagle-eyed Cecilia Vega. Vega "reported" that Caswell was one of "the countless people accused of faking an injury" to the tune of "hundreds of millions of dollars."

The report then cut to some fraud words of wisdom from private eye, "master of disguise" (not my words; they're Vega's), Bob Keane who fancies himself cut from the James Bond cloth. Keane claimed that if you're committing fraud the only way to avoid being caught by him is "by completely staying in your house for three to five years," because if you venture outside he's going to "get you."

By using phrases like "countless people" and "hundreds of millions of dollars" ABC implies that Ms. Caswell is merely the tip of a very big iceberg. Frankly, I think Ms. Vega skipped Philosophy 101 - Aristotelian Logic. You know, the part about faulty inductive arguments going from the particular to the general? But I digress.

We all know that there are people who commit workers comp fraud. In fact, some of them are workers who fake injuries or malinger trying to milk the system. But the fraud committed by workers is dwarfed by that of many others in the system.

Consider Devon Lynn Kile and her husband Michael Petronella. In 2010, while Ms. Kile sought to appear on the Bravo TV series "The Real Housewives of Orange County," the couple gained a different kind of notoriety when federal authorities, after raided their three roofing businesses as part of a two year probe, charged them with 31 felony counts involving tens of millions of dollars of underreported workers comp premiums. Petronella went to jail for 10 years, and Kile was sentenced to 10 years probation and ordered to make $2.8 million in restitution.

There are many dimensions to fraud in the workers comp system. While many people think of fraud primarily as a problem involving employees, in dollar terms most fraud is committed by other players in the system. There are opportunities for wrong-doing in virtually every financial transaction within a system that generates multiple billions of dollars every year.

Just to be clear, fraud can be committed by, yes, employees, but also by employers (see Devon Kile), attorneys, medical providers, claim adjusters, insurance agents and even investment firms (see the "Coingate" scandal in Ohio).

Despite the many opportunities for fraud in the comp system, outright fraud is relatively rare. The vast majority of transactions within the comp system, involving all of the above players, are carried out with integrity and good faith. Nonetheless, vigilance is always necessary to ensure that comp dollars are spent prudently and wisely.

ABC has scheduled an expanded report on Ms. Caswell, et al, this evening on its World News Tonight program. It should make for some interesting, if infuriating, entertainment, faulty logic and all.

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April 11, 2014

 

Check out the freshly posted Health Wonk Review - The April Fools' Edition at Healthcare Lighthouse. Think we're a little late on the date? Nope. Host Billy Wynne says the spirit of April Fools' lives on as the blogosphere's smartest health wonks gather to correct foolish notions and misconceptions floating around in certain pockets of our national dialogue.

Billy has been contributing to Health Wonk Review for some time now but this is his first time at bat in hosting, so be sure to give him a a visit. While you are visiting this edition, take a minute to explore other resources at Healthcare Lighthouse beyond the blog. Billy is the CEO and founder - he has gathered an impressive advisory board.

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April 9, 2014

 

The U.S. Food and Drug Administration (FDA) has acknowledged that prescription drug overdoses are now the leading cause of injury-related death in America, surpassing auto accidents. Couple that with the Agency's approval last October of Zohydro ER, the first pure opiate painkiller, and you begin to understand why many lawmakers are left scratching their heads. More than half the states' attorneys general have asked the FDA to withdraw approval of the drug. But the Agency is unrepentant. FDA Commissioner Margaret Hamburg told the Senate that the drug is a safe and effective option for patients with excruciating pain.

In late March, a stymied Governor Deval Patrick took the highly unusual step of banning the sale in Massachusetts of the controversial opioid made by California-based Zogenix, Inc. Many in the Massachusetts legislature as well as a number of workers compensation claims professionals thought it was the best thing any governor had ever done, a bold step to protect the citizenry.

Only it's not as simple as that. It's turning out that, however well-intentioned Governor Patrick may be, he probably can't ban the sale of the drug, after all. Yesterday, US District Court Judge Rya W. Zobel told state lawyers that by Monday she wanted to see a lot more research that would buttress the Governor's ban. Nonetheless, she said that she would more than likely grant a preliminary injunction on behalf of Zogenix that would allow Zohydro ER's sale in Massachusetts. Said Zobel, "I think, frankly, the governor is out of line on this."

According to Patrick, his issue with Zohydro ER is that it is not in "an abuse-resistant form," meaning that it is not crush-resistant. Consequently, addicts (or anyone else who has the drug, for that matter,) can crush it and snort it or inject it.

Why would anyone want to do that instead of simply washing it down with a sip of water? Because in its pill form Zohydro ER is an "extended release" medication. That's what the ER stands for. In fact, Zohydro's full legal name is Zohydro ER (hydrocodone bitartrate) Extended Release Capsules. Crushing and snorting or injecting simply bazookas the whole dose at one time, which can be a deadly proposition.

Zogenix's President, Steven J. Farr, attended yesterday's hearing and, afterwards, took pains to let everyone know that Zohydro ER is safer than other hydrocodone drugs because it does not contain Acetaminophen, which can cause liver damage and failure with prolonged, high-dose usage. Farr did not mention that Zohydro ER contains up to five times the hydrocodone found in Vicodin. He did say that the company is in early stage development of abuse-deterrent formulations of the drug. That gave cold comfort to the Governor.

Whatever happens, it is hard to believe that Governor Patrick, a very smart lawyer, actually thinks he's on firm legal footing here, although outside the courthouse that's exactly what he said. As Judge Zobel pointed out (and she was decidedly irate that Patrick banned the drug without ever talking with Zogenix), Patrick cannot blame the Massachusetts opioid epidemic on Zohydro ER because the drug has yet to be dispensed in the state. She urged lawyers for the state and Zogenix to meet before the hearing scheduled for Monday, but she told everyone that Zogenix "probably will prevail."

I have a few thoughts about this little mess:

First, it is not the fault of Zogenix that we have an opioid epidemic in Massachusetts or anywhere else. Yes, there's an epidemic, but drug makers didn't cause it. Irresponsible physicians, doctors who consider the Hippocratic Oath to be a mere suggestion, have placed their patients on the slippery slope to hell by prescribing over and over again strong and addictive narcotics for conditions for which those narcotics were never intended.

Second, the vast majority of physicians would never knowingly over-prescribe any medication. They have not forgotten that Oath and why they went to medical school. The ones I know resent and cannot understand the over-prescribers.

Third, although I wish it had built crush-resistance into Zohydro ER from the beginning, Zogenix did nothing wrong here. In fact, the Zogenix complaint notes: "When FDA approved Zohydro, it considered but rejected the idea of requiring the drug to utilize abuse-deterrent technology." The company did everything it was supposed to do in gaining FDA approval. And that isn't easy. One of the more difficult tasks in the universe is to get FDA approval for a new drug. The camel through the eye of the needle doesn't even begin to describe the process. It takes many years and boatloads of money. So, you can understand that after all those years and money devoted to bringing this drug to market, to have it summarily banned is a bit hard to take.

Fourth, there are many people who suffer with agonizing pain. Think end-stage cancer. Those human beings need and deserve the best pain amelioration they can get, and the goal of the pharmaceutical industry, in addition to making money, is to give them that relief.

Finally, ending the opioid epidemic will require political courage and a much more highly-regulated process to oversee and assure that the relatively few ethically-challenged, weak-kneed and overly greedy physicians who now abuse their privilege are forced to change their bad behavior and follow that "do no harm" rule. If it weren't for them, there would be no epidemic.

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April 9, 2014

 

The use of health monitors and fitness trackers have exploded in recent years -- but expect the next frontier in wearable technologies to be in the workplace. The implications for worker safety and productivity are promising. While Google first introduced its revolutionary Glass to consumers, the current marketing direction is aimed at custom work applications.

One example of this is Patrick Jackson, a firefighter in North Carolina's Rocky Mountain fire department: This Firefighter Built His Own Google Glass App And It's Saving Lives.

Jackson is also a member of the Google Glass Explorer program and has developed an app that displays incoming emergency dispatches, shows maps of where incidents are, nearest fire hydrants, and even building plans. You can see a brief demo of Glass at work in the short clip, below. In addition, "Jackson is also working on a CPR assist app for Glass, measuring the speed of compressions, and whether you need to speed up or slow down based on sensors that detect head movement. He's teaming with a Michigan startup called team (evermed) during his days off from the department, where he spends 10 days per month working grueling 24-hour shifts."

The article also suggest another work safety application in DriveSafe, a Google Glass app that uses infrared sensors to detect when you doze off and to issue alarms to wake you and direct you to the next rest area.

PC World takes a look at other potential workplace applications for smartglasses , noting that, "The future of smartglasses will be realized by a factory worker operating a 3000-pound stamp press, not a gamer stomping on virtual-reality bad guys. Face computers will be all about scanning bar codes on cardboard boxes, not scanning tourist attractions for augmented reality overlays." They present a variety of work scenarios, from hands free scanning and troubleshooting to safety applications.

FierceCIO explores the topic further in Making wearables a good fit for workplace safety. They discuss potential safety applications and suggest that gaining optimal value from wearable devices will require IT departments to innovate with software applications, data management and administrative protocols and policies.

We're really just at the threshold of wearables in the workplace. To see more of the opportunities, this excellent Deloitte University Press primer by Shehryar Khan and Evangeline Marzec on Wearables is helpful in exploring the potential of everything from productivity, training and worker safety:

"Wearables' value comes from introducing technology into previously prohibitive environments--where safety, logistics, or even etiquette have constrained traditional technology solutions. Wearables can be the first seamless way to enable workers with digital information--especially where hands-free utility offers a clear advantage. For example, using wearables, workers in harsh environmental conditions can access data without removing gloves or create records without having to commit data to memory and then moving to a sheltered workstation."

Wearables are not without their HR and IT challenges. Susan Kuchinskas explores some of these issues in Forbes: How To Prepare Your Business For Wearable Technology. Also see:The Wearable Technology Revolution: Is your workplace prepared?

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April 3, 2014

 

Nancy Germond hosts a new edition of Cavalcade of Risk #205 at her blog. Check it out. You can also follow Nancy at Twitter: @insurancewriter

March 28, 2014

 

Chris Fleming has posted A March Madness Health Wonk Review at Health Affairs Blog. As might be expected, Obamacare is a big focus in the submissions, as well as some stellar entries on the healthcare scene in Massachusetts. There's also a grab bag of assorted topics. Health Affairs Blog and the parent publication Health Affairs is one of the nation's leading journals of health policy thought and research. If healthcare is a topic on your radar -- and if you are an employer, it should be -- it's worth dropping by to keep up to date.

Other notable news:

A bit of humor
You had one job: Funny on-the-job flubs

Bronze Age Orientation Day

The Electronic Morale Booster - How things have changed since 1951

Finally,
...if you missed the video of the dramatic rescue of a construction worker by the Dallas Fire Department, we've posted it below.

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March 27, 2014

 

We lost two firefighters in Boston, yesterday.

A 9-alarm fire on Beacon Street in Boston's Back Bay, aided by 45 to 50 mile per hour winds off the Charles River, took the lives of Lt. Edward J. Walsh and Firefighter Michael R. Kennedy. Walsh, 43, was married with three children; Kennedy, 33, was a Marine Corps veteran. They were trapped in the basement of the four story apartment building when a window blew out, the winds rushed in and part of the building exploded.

Deputy Chief Joseph Finn said, "In 30 years, I've never seen a fire travel that fast."

Once again, we are reminded that firefighting is a lot like combat, a lot of waiting for something to happen, and then the world falls in.

This, from today's Boston Globe, should give one a sense of the emotional trauma of the event:

After the seventh alarm sounded, all firefighters were ordered from the building through a haze of screams and sirens. But when word came that some firefighters were missing, some vowed to go back in.

"No companies should be going in anywhere; stay away from the building," firefighters were instructed in the mayday call.

"We are aware of the potential we see in front of us; we're going back inside the building," came the reply.

But the firefighters were told, "Stay out of the building."

It took five hours to recover Walsh's body. As he was carried out on a stretcher, all the firefighters formed an Honor Guard line. "Everyone saluted him, and Eddie was taken for his last ride," said Steve MacDonald, a Fire Department spokesperson. If that doesn't stir emotions inside you, then you have something other than blood coursing through your veins.

Reminiscent of the 1972 Hotel Vendome fire just a couple of blocks away that killed nine firefighters, and the 1999 Worcester Cold Storage Warehouse fire that took the lives of six, yesterday's inferno sledgehammers us with the understanding that firefighting is a deadly business.

Seeing the soot-covered, teary faces of the men and women who watched Lt. Walsh take his "last ride" made me think of the other end of the pole, the sometimes messy business of workers comp.

In most states, injured workers are given two-thirds of their average weekly salary (60% in Massachusetts), tax free, while they're recovering and unable to return to work. Police and firefighters, on the other hand, public sector employees, receive 100% of their average weekly salaries, also tax free. In essence, it's a promotion.

This different treatment can sometimes anger taxpayers, usually when abuse occurs. And abuse does occur, not often, but when it does it can make headlines. In Massachusetts, we vividly remember the case of Albert Arroyo, a 20-year veteran of the Fire Department, who, after being deemed "totally and permanently disabled," which allowed him to receive 100% of his salary, tax free, made the Boston Globe front page when he finished eighth in the 2008 Pro Natural American Bodybuilding Championship, with a picture to prove it.

Although Arroyo was acquitted of fraud charges in 2011 by a federal jury, the whole thing left a bit of a stink. US Attorney Carmen Ortiz, Boston Mayor Tom Menino and just about everyone else in authority complained loudly and in print that justice had not been done.

We all want our tax dollars spent well, but every once in a while, like yesterday, we come up against two truths that won't go away: First, protecting the citizenry can be a tragic and deadly business; and second, with the exception of soldiers, I don't know of any other occupations where people give their lives in the line of duty to protect others. Do you?

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March 20, 2014

 

Atty. Van Mayhall offers up a new roundup of risk-related matters in a fresh Cavalcade of Risk #204 posted at his Insurance Regulatory Law blog - check it out!

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