Texas WC Agency Issues Network Report Card

• The Texas Department of Insurance, Division of Workers’ Compensation is out with its 2024 annual informational report card, which compares the performance of certified networks with each other, as well as with non-network claims, on a variety of healthcare metrics.
• Among the findings is that networks generally have lower overall healthcare costs per claim than non-network claims at six months and 12 months maturity.
• A higher percentage of network claims received professional services than non-network claims. A higher percentage of non-network claims received hospital services and pharmacy services.
• Networks provided non-emergency care sooner after an injury than non-network claims.
  FULL REPORT HERE

Zurich Joins Contractor in Seeking Reimbursement for Key Bridge Claims

• Zurich American Insurance Co. wants to be reimbursed for workers’ compensation and legal costs it incurs due to the deaths and injuries of the workers in the Key Bridge collapse earlier this year.
• The carrier joined its insured, road construction firm Brawner Builders, in seeking reimbursement for costs and reserving rights to any funds that the workers’ dependents may recover in litigation. Brawner and Zurich have filed claims against the owner and operator of the Dali cargo ship responsible for the accident.
• Brawner employed six men who were killed and another who was seriously injured in the collapse of Baltimore’s Key Bridge.
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Solakyan WC Kickback Case Sent Back to Lower Court 

• The U.S. 9th Circuit Court of Appeals said a Southern California judge failed to consider the fair market value of services provided when it ordered restitution or the criminal forfeiture in a workers’ compensation kickback case.
• Previously, a jury in July 2021 convicted Sam Solakyan, CEO of several Southern California medical imaging companies, of one count of conspiracy to commit honest services mail fraud and healthcare fraud and 11 counts of honest services mail fraud.
• Accused of paying kickbacks for patient referrals, he was sentenced to five years and ordered to pay $27.9 million in restitution in January 2022.
• The appeals court vacated the restitution order, ruling that the U.S. District Court for Southern California failed to explain why it didn’t give any credit for the amount insurers would have paid in the absence of the kickback scheme.
• “This court’s actual loss rule requires deducting from the total restitution amount the value of services for which insurers would have paid, absent Solakyan’s fraud,” the appeals court ruled.
  READ RULING HERE