Five Things to Catch Up On: 6/24, Weekend Edition

Sarasota, FL (WorkersCompensation.com) - 

1) NJ: City Agrees to Pay More than $180K to Settle Four Work Comp Cases (FRIDAY)

The city of Paterson has settled four work comp cases, to the tune of $180,092, writes Jayed Rahman in the Paterson Times. Municipal court supervisor Joyce Dubose will receive $108K for alleged back and neck injuries from a box lifting accident in 2014, per city records. Firefighter Christopher Tiritilli will receive $34,635 after an alleged shoulder dislocation on the job in 2016; and another firefighter, Andre Lincoln, will receive $33,957 after allegedly hurting his shoulder as well the year prior. Lastly: “…$3,500 for Miguel Cepero. He allegedly injured his lower back and neck during an accident in a city SUV on May 2, 2016, according to city records,” writes Rahman.

2) OH: Employers Could See Work Comp Savings for Participation in BWC’s New Rebate Program (THURSDAY)

Ohio has rolled out a new program aiming to aid business owners in decreasing work comp costs this week, called the “Policy Activity Rebate Program,” according to an Occupational Health & Safety press release. “…Employers in the program earn credits for completing activities designed to improve workplace safety practices and encourage attentive management of their workers' comp policies. They receive a 50 percent premium rebate, up to $2,000; to be eligible for the rebate, they must select from among 33 available activities and earn 11 credits during the policy year that begins July 1,” per the article. Activities include, but are not limited to: Completion of a BWC website class, having a wellness program, attending the Ohio safety expo, and hosting an employee safety lunch.  

3) NY: Home Repair Co. Owner Busted for No Work Comp Coverage (WEDNESDAY)

Stephen Pollot of Auburn, in Cayuga County, NY, will have to pay more than $8G for failure to obtain work comp coverage for his company, D&S Home Improvements-Property Maintenance, writes Megan Blarr of auburnpub.com. The charge is a felony. Pollot was originally looked into for fraud and larceny, which led to discovery of the other allegations. With his plea, Pollot was able to avoid prison time but will instead serve “a three-year conditional discharge,” per the article. “…He was also ordered to pay $3,500 in restitution, which he paid Tuesday, and $5,000 in fines, which he will pay in installments of $450 per month.”

4) CA: Pair Takes Advantage Of Work Comp System; Receives Kickbacks of More than $100K (TUESDAY)

Santa Clara County resident and Interpreter Gabriela Pacheco has been charged with allegedly sending “unqualified family members” to aid insurance companies through translation services she had been paid for, and billing for services that hadn’t even been completed, writes Steven A. Meyerowitz for FC&S Legal, featured in Property Casualty 360. Dr. Tariq Mirza was charged with helping Pacheco and “receiving kickbacks,” according to the article. “…Dr. Mirza and Pacheco were charged with conspiracy to commit workers’ compensation billing fraud and unlawful kickbacks for patient referrals.” Dr. Mirza’s clinic has offices in San Jose and the Bay Area, treating mostly work comp patients. Pacheco owns One World Interpreting Services (for Spanish translation) out of San Francisco. “…The district attorney requested assistance from the Franchise Tax Board (FTB) and said that an FTB agent examined thousands of records, which uncovered over $100,000 of kickbacks from Pacheco to Dr. Mirza through payments made to third parties,” writes Meyerowitz. The pair was charged with “…conspiracy to commit workers’ compensation billing fraud and unlawful kickbacks for patient referrals.”

5) OH BWC Recruits New Rx Benefits Manager (MONDAY)

There is going to be a new pharmacy benefits manager in town for the Ohio Bureau of Workers’ Compensation. “…The bureau will contract with the Nashville-based Change Healthcare to manage its pharmaceutical program for injured workers starting Nov. 1, replacing Optum RX,” writes Catherine Candisky of the Columbus Dispatch. “The change is expected to provide significant savings. A recent audit by the Columbus-based Healthplan Data Solutions found Optum RX overcharged the bureau $5.6 million in 2017,” according to the article. “…The Dispatch reported in March that critics said CVS Caremark, one of the nation’s largest PBMs, was overcharging taxpayers and driving out its retail pharmacy competition by paying low reimbursement rates to pharmacists filling prescriptions for Medicaid managed care patients.” Optum didn’t return the outlet’s requests for comment by press time, and CVS denies involvement in the alleged activities.

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