Tag Archives: dot

Forget ‘Intel Inside’; It’s Now AI Inside

I am sure we are all familiar with the Intel slogan, “Intel inside.” This has been a very powerful tagline and one that has helped Intel become the dominant PC chip supplier. (I know I was very influenced by the slogan and very rarely bought a non-Intel PC as a consequence.)

But I believe that this slogan will be rapidly replaced by “AI inside” because I believe we are almost at the point when ALL future apps will include elements of AI. I also believe there is a very good chance that Amazon’s Alexa might become the de facto automatic speech recognition platform that will sit in front of (outside) every single app in the future.  (My rationale is here.)

Why do I say this?

First, you need to recognize that AI is not one singular, all-embracing technology. Rather, it is a set of technologies that hope to emulate the way a human interprets and acts upon information — albeit at the speed of light and (we hope) without error, on a 24/7 basis. As such, AI includes technologies such as natural language (voice) processing (NLP), semantic analysis and cognitive processing.

Second, these technologies have become pervasive. The CEO of IBM recently announced at Davos that Watson (a supercomputer and a collection of AI APIs) is now having a (positive) impact on the lives of some billion people (about 1/7th of the world’s  population). I don’t know how many Echo and Dot units have been sold by Amazon (it must be tens of millions, at least) but each unit gives you access to Alexa, which uses both voice recognition and processing.

See also: 10 Questions That Reveal AI’s Limits  

Third — and most important — you don’t need to have a degree in AI (any more) to deploy AI.

AI was notionally conceived by Alan Turing in 1936 (but, in one sense, you can trace the origins of AI all the way back to Archimedes!). I was taught elements of AI at university in the early 1970s, but I didn’t have a chance to develop an AI app until the mid-1990s when I was a consultant for the Nationwide Building Society. We had just finished a ground-breaking piece of work that involved the development and deployment of the world’s first touch-screen-driven, customer self-service system. This system was a huge success on all measures, so the client I was working for at the time asked me:

“How far can you take this idea? Could you, for example, develop a system that’s as good as — or even better than — our best sales person?”

Without knowing it at the time, he was asking me to develop our first AI system. Fortunately for me (because I am certainly not an AI expert), Accenture had just hired an authority on the subject. He was swiftly assigned to my project team, and we stepped once more into the unknown world of innovation.

We started by gathering a team of the client’s top sales people. We then sat them down with our AI expert, who had been carefully briefed on the rules governing the sale of regulated products. We also called in the services of a user experience designer to obtain a better understanding of people’s risk appetites and option requirements. Last, but certainly not least, we asked a group of customers to help us develop the system that would be designed for their stand-alone use.

The result blew everyone away.

It even won the support of the U.K. Financial Services Authority (FSA), which agreed to assess the system for compliance. The FSA tested and analyzed every aspect of the new application — and then signed off. It was the first time the FSA had ever approved a sales platform that removed the need for a sales person.

Remember, this happened in the early ’90s — long before Java, Windows 95 and the first PlayStation were launched. Our system is a tribute to a client who not only had the vision to see the possibilities but also had the courage to take on the challenge — as well as the very real risk of failure.

However, there is a sad but rather revealing postscript to this story.

What happened to this ground-breaking system? Well, it was lauded, feted and widely acclaimed — and then quietly shelved. The building society decided to focus on building its Systems of Record (SoR) rather than its Systems of Engagement (SoE). And, sad to say, that was not an uncommon fate back then. Real innovation is often too radical for most risk-averse management to stomach. Sometimes it takes time to build an appetite for the truly ground-breaking. And maybe — just maybe — 20 years later, that time has come.

There was another problem: I only had one AI programmer at my disposal, and there weren’t that many more in the U.K. at the time. Given this, it would have taken a considerable amount of time to build an industrial-strength application that could have been put into the hands of any customer. But now we don’t have that problem.

One of the firms we at Clustre represent is an AI consultancy that is AI-technology-agnostic. It conceives, designs and builds AI-driven customer and employee apps that use a variety of AI technologies — as appropriate. It was recently asked by a loyalty card operator to show how AI could be used to allow a card holder to get an answer to a query without talking to a human or having to scour through FAQs (which I think are generally pretty useless). The firm created a web-based chat bot that used Watson to help recognize and understand the question and used another product to drive the Q&A process and, ultimately, answer the question.

So clever is the bot that it can easily handle misspellings and allow the questions to be phrased in a variety of ways and still operate properly. I would hazard a guess that this tool could handle at least 50% of all customer queries (the rest would be handed off to a human to resolve). That’s a lot fewer calls that need to be routed through to a human.

See also: Why 2017 Is the Year of the Bot  

So, you may ask, how many days did it take our AI consultancy to design and build this AI-driven chat bot? Just five.

Five days to design and build a tool that could potentially reduce call center volumes by around 50%!!!

AI has truly arrived, and everyone should be looking at how you are going to deploy it NOW!

Yes, OSHA Is Now a Friend to Insurers

The HR/safety director at a large national construction company, who was the first to use OSHA-sanctioned medical exams conducted outside the workers’ comp system, said the program is “extremely successful” and may have saved the company as much as $1 million in workers’ comp expenses over the past few years.

The company, which has asked not to be named, has had employees sign contracts agreeing to diagnostic tests based on OSHA medical exam regulations. But when the company wanted to us a test result in front of the New York State Workers’ Comp Commission, the company’s insurance lawyer strongly advised against doing so — the insurance lawyer told the company lawyer she might go to jail!

The company contacted Ted Ronca, a leading workers’ comp and disability attorney and author based in New York. Ronca said a section in OSHA record keeping regulations (attached below) allowed an employer to schedule a contemporaneous exam with a medical provider of its choice, at the same time a worker was being examined as part of the workers’ comp process. The employer could then request a release of HIPAA-protected medical records from the worker. Ronca made a written request to OSHA and received an official letter of clarification and refinement, which was noted in my ITL article in October, Has OSHA Become a Friend to Insurers?

Both Ronca (reachable at medsearch7@optonline.net) and I were very surprised to learn of these regulations, which can help an employer push back against any overstatement of the injury done to the worker. But as anyone who has worked in the HR/disability world knows, there is a whole alphabet soup of federal regulations involving both occupational and non-occupational disability programs, including ERISA, SSDI, ADA, FMLA, EEOC, OSHA, DOT and both federal and state workers’ comp laws, not to mention scores of management/union-negotiated disability benefit programs. None of these programs are actually aligned with one another. Most are run independently from each other by different federal agencies. And most large employers have different internal staffs and outside vendors or insurance companies that administer these various disability/paid-time-off programs.

A retired New York workers’ compensation judge said that uncovering the OSHA regulations was “brilliant” and that state courts wouldn’t override them. He said the first thing judges are trained to do is “not touch” any other laws in workers’ comp cases. A workers’ comp judge would have no authority whatsoever on federal OSHA regulations.

An employer has an unequivocal right to schedule a contemporaneous exam under OSHA record keeping regulations, outside of state workers’ comp systems. How and when to use these exams is a whole other matter. Their use is not based on any case law. Case law does not exist here. Usage is based on what Ronca has done with the major construction company and other clients. In fact, OSHA exams are now formerly a part of the construction company’s employee contract protocol as a union contractor.

The new employment contract includes all the typical rules and regulations but also contains a provision on how to report all work-related injuries and the requirement that the injured worker must go to a company-provided medical/diagnostic exam, paid for 100% by the employer. In addition, new employees or contractors must undergo a confidential post-hire baseline range-of-motion medical exam, which is not read but kept in a private file and used only if there is a subsequent, work-related injury reported.

Ronca and the company have headed off potentially difficult or fraudulent claims, often without ever going to court, since implementing their program in late 2011. It would typically take as long as 18 months to schedule a hearing or independent medical exam (IME) through the state work comp system. Now, the company can take a very active role from the time of injury.

Among the first test cases was a classic type involving an employee who filed a work comp claim, after being fired, for aggravation of a pre-existing back condition. The OSHA-sanctioned medical exam confirmed there was no aggravation of a pre-existing condition. Furthermore, it was discovered that the employee was working a second job “under the table.”  No claim was filed.

Ronca says that, depending on results of the OSHA-sanctioned exams, he may be able to tell the employee’s work comp attorney, “Your client is a liar.” The client and attorney will not show up for a hearing.

In another case, the HR/safety director at the construction company said an attorney at her work comp carrier read the OSHA medical exam report and said, “I have never been so prepared for a hearing.”  This was another complicated claim involving aggravation of a pre-existing shoulder and neck condition. The carrier was going to settle for $80,000. Instead, the case was settled for $12,000 when it was determined there was no aggravation of the shoulder injury, only of the neck.

Another case in California involved aggravation of a pre-existing condition, where the claimant claimed total disability as a result. The medical exam found a slight aggravation, but the employee refused to return to work. The company went as far to arrange a modified-duty job with the nonprofit Habitat for Humanity, at full pay and benefits, but the employee refused. The company pointed out the situation to the company union. After a 5 1/2-month stand- off, the employee returned to full duty and dropped his work comp claim.

Ronca feels the strongest tool offered by the OSHA regulation is the ability to obtain prior medical records. He also stressed that the whole goal is to get the employer involved in workers’ comp claims from the moment of injury.  Early intervention is a well-known standard and best practice in workers’ comp. An OSHA exam is tool employers may use in selected cases.

The construction company is trying to do the right thing — that is, get the injured worker an early exam to help determine the correct diagnosis and treatment, which is in the best interest of both the employee and the employer. The OSHA exam should also be used if the employer suspects fraud or abuse, pre-existing conditions, employees working second jobs, etc.

Bob “Red” Hollingsworth, CEO of CompMinder in Salt Lake City, is now using this approach and has updated the CompMinder injury reporting tool he offers to employers. There is now a section that asks the employer if it wants to schedule an OSHA exam? If yes, Hollingsworth (reachable at Bob@buckner.com) has arrangements with a highly qualified occupational medical director to set-up a pre-planned program. It is critical that the employer do this directly with medical providers. The work comp carrier or TPA cannot pay for or schedule such an exam.

The work comp folks can’t be involved, so non-believers need not apply. But the employer can!

ADDENDUM — OSHA REGULATIONS UNDER SECTION 1904

“OSHA record keeping regulations permit an employer to request a prompt medical exam and release of HIPPA protected prior medical records outside the workers’ compensation system in order to help understand the link between workplace factors and injuries and illnesses in particular cases.”

Key Points

The medical exam must be paid 100% by the employer with the provider of its choice outside the workers’ compensation system.

An insurance company or third party administrator cannot schedule or pay for such exams because they cannot act outside the state workers’ comp system.

The costs of such medical exams are not included in a company’s workers’ comp costs nor experience modification calculation.

The employer can choose what medical provider’s opinion they consider to be the most authoritative for record keeping purposes.

Employee must submit to a prompt medical exam when requested by the employer and release of HIPAA-protected medical records.

Medical information and records obtained through this process can be discoverable with proper procedure and subpoena in workers’ comp cases.

OSHA 300 LOG Recordable Rules-1904

Key Language

In certain circumstances, OSHA record keeping requirements permit an employer to choose between two conflicting medical opinions. When an employer receives contemporaneous recommendations from two or more physicians or licensed health care professionals about the need for medical treatment, the employer may decide which recommendation is the most authoritative and record case based on that recommendation.

1904 Frequently Asked Questions

If a physician or licensed health care professional recommends medical treatment, days away from work or restricted activity as a result of a work-related injury or illness, can the employer decline to record the case based on a contemporaneous second provider’s opinion that the recommended medical treatment, days away from work or work restrictions are unnecessary, if the employer believes the second opinion is more authoritative?

OSHA ANSWER IS YES

HOWEVER,  

Once medical treatment is provided for a work-related injury or illness, or days away from work or restricted work activity has taken place, the case is recordable.

“If there are conflicting contemporaneous recommendations regarding medical treatment or the need for days away from work or restricted work activity but the medical treatment is not actually provided and no days away from work or work restrictions have occurred, then the employer may determine which recommendation is the most authoritative and record on that basis.”

OSHA considers that medical treatment is provided once a prescription is issued.

Key Definitions

Lost-Time: Work day (other than day of injury) when the worker is unable to return to their job.

Contemporaneous: Medical recommendations provided with no change in condition.

Most Authoritative: Best documented, best reasoned and most persuasive

Section 1904.5

Wide variety of issues do not need to be reported on OSHA log 300 but require a medical exam with prior medical records.

Employer can schedule a prompt exam and request HIPAA release for prior medical records.

A carrier or TPA would NOT be permitted to schedule such an exam, because they cannot act outside the workers’ comp system.

Note the Department of Transportation (DOT) also has additional exams for drivers such as ability to load, drive etc.

These are known as intermediary exams.

In both cases, exam records and results are not part of the comp record.

Medical exam costs must be paid by employer and are not added in comp claims or the experience modifier. However, with proper procedure and use of subpoena, records may be released and used in the comp claim.

Who Makes the Determination?

OSHA agrees that medical opinions are a burden and impractical and not required in the majority of cases. “This does not mean that employers may not, if they choose, seek advice of a physician or other licensed health care professional to help understand the link between workplace factors and injuries and illness in particular cases. It simply means OSHA does not believe that most employers will need to avail themselves of such professional services in most cases.”

Accordingly, OSHA concluded in the final rule that the determination of work-relatedness is “best made by the employer.”

Minority-Contracting Compliance — Three Risks

On Jan. 13, 2014, the Department of Justice announced that two former executives of Schuylkill Products had been sentenced to two years in federal prison and forced to pay $119 million in restitution because of their role in what the FBI called the largest fraud involving the Department of Transportation’s Disadvantaged Business Enterprise (DBE) Program. A third individual, the owner of Marikina Construction, the firm that was used as a “front” in the scheme, received a prison sentence of nearly three years.

The sentencing of these individuals is not the result of an isolated incident. In recent years, federal prosecutors and the DOT inspector general have significantly stepped up enforcement of DBE and have brought several cases resulting in civil penalties and jail time. Some involved well-known international construction firms and their executives.

Here are three reasons why every contractor dealing with a federal, state or local minority contracting program needs to have proper compliance policies and procedures in place:

1.         Jail Time and Civil Fines

Contractors that do not comply with the DBE program’s rules and regulations face the very real threat of jail time and civil fines. According to the DOT, DBE fraud now represents more than one-third of the DOT inspector general’s open cases. From Oct. 1, 2003, through Sept. 30, 2008, investigations of DBE fraud allegations resulted in 49 indictments, 43 convictions, nearly $42 million in recoveries and fines and 419 months of jail sentences. From 2009 to 2010, the number of open investigations related to DBE fraud increased by almost 70%. The number of investigations shows no signs of slowing, as the DOT is aggressively hiring additional investigative agents.

Under several legal doctrines, a defendant can be held liable when the evidence shows that the defendant intentionally avoided confirming certain facts and learning the truth.

2.         Whistleblower Lawsuits

Under the Federal False Claims Act, every disgruntled employee is a bounty hunter. The act authorizes private individuals to bring a civil claim in the name of the U.S. against anyone who fraudulently obtained money or property from the government. The person who brings the action is entitled to 30% of the amount recovered for the government.

Contractors can become the target of a False Claims Act case if they submit payment applications to the government that falsely certify that a certain percentage of work was performed by DBE firms. Like in the criminal context, a contractor can still be liable even if it lacks actual knowledge of the DBE fraud. Reckless disregard for the truth or deliberate ignorance are sufficient.

3.         Bid Rejections and Challenges

Strict minority set asides or quotas are almost always unconstitutional. Disadvantaged business contracting programs, like the DOT’s DBE, are not quotas (a fact that DOT underlines in its regulations). Rather, they are goals that contractors must use “good-faith efforts” to achieve. In fact, many contractors would be surprised to know that a state transportation agency cannot reject a bid because it fails to include a commitment to subcontract work that meets or exceeds the stated DBE goal. However, for a bid to be accepted, the contractor must be able to demonstrate “good faith efforts” to meet the stated DBE contracting goal. Because most state procurement codes require the award of a contract to the lowest responsible and responsive bidder, failing to document adequate good-faith efforts is grounds for a state transportation agency to reject a bid or for challenge to be filed by a disgruntled bidder.

The risks that contractors face with not complying with minority contracting programs, particularly the DOT DBE program, literally cannot be ignored. At best, contractors that fail to comply with the program face significant financial ramifications in the form of fines, expensive lawsuits and lost projects. At worst, executives and employees can wind up in jail.