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Landscaping Worker Sentenced For Worker’s Compensation Insurance Fraud After Lying About Injury

Angel Luis Maces, 24, of San Jacinto, pleaded guilty to one count of felony workers’ compensation insurance fraud after a months-long investigation by the Department of Insurance (DOI). Maces had been employed by a landscaping company in Temecula, and claimed to have injured his knee when he slipped and fell, subsequently needing a cane or crutches 100% of the time.

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Liens From Vital Imaging And Others Stayed Pending Workers’ Compensation Kickback Fraud Trial

Liens filed by Vital Imaging, San Diego MRI Institute, and Empire Radiology are stayed pursuant to section 4615 of the Labor Code, which places an automatic stay on liens filed by the associated entities charged with fraud. Federal prosecutors are pursuing charges of conspiracy to commit healthcare fraud, and multiple counts of honest services mail fraud, in a kickback scheme that they allege to have generated almost $300 million in charges stemming from illegal referrals and kickbacks.

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Law Firm Employees, Vocational School Owners Among Seven Indicted In Workers’ Compensation Insurance Fraud Case

The defendants, including two law firm employees, face allegations that they conspired to misuse and misappropriate Supplemental Job Displacement Benefit vouchers, defrauding 20 separate insurers of over $330,000, in part with illegal kickbacks.

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Insurance Fraud Charges in Referral Conspiracy Block Liens From Multiple Providers Under Labor Code 4615

The charges include conspiracy to commit a crime, insurance fraud, and referral of clients in return for compensation, and activate section 4615 of the Labor Code, which places an automatic stay on liens filed by the associated entities charged with fraud.

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15-Month Sentence For Surgeon Involved In Pacific Hospital Workers’ Compensation Insurance Fraud Case

A Federal Judge has handed down a 15-month prison sentence for Dr. Jeffery David Gross for his role in the Pacific Hospital kickback scheme. In addition to the prison term, Dr. Gross will forfeit over $600,000 as part of his plea deal for conspiracy and fraud charges.

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California Rice Mill Worker Sentenced To Probation And Fined in Workers’ Compensation Fraud Case

A rice mill worker who claimed an abdominal injury from lifting bags of rice has been found guilty of misrepresenting her symptoms and receiving almost $7,000 in undeserved workers’ compensation benefits. The employer’s insurer is said to have paid out $6,893 in undeserved benefits, and lost an additional $8,992 in costs stemming from the investigation and legal proceedings.

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California Tradesman Arraigned on Felony Charges in Workers’ Compensation Fraud Case

The California Department of Insurance (DOI) announced today that Ahmad Zaki Noori, a 41-year old welder from Sacramento, has been arraigned on two felony counts of workers’ compensation insurance fraud. Noori allegedly misrepresented symptoms after a work injury and collected over $20,000 in benefits to which he should not be entitled.

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Melamed, Pharmacist in Workers’ Compensation Kickback Fraud Scheme, Sentenced to 6 Months, $1.4M Forfeiture

Hootan Melamed, the pharmacist whose kickback scheme resulted in losses to insurance carriers of between $9 million and $20 million, has been sentenced to a 6 month jail term, and must repay $1.4 million in an asset forfeiture. The judgment requires Melamed, who entered a plea agreement in November of 2020, to turn himself in and serve his sentence by October 1st, 2021.

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California Legislature Passes SB 95, Providing Supplemental Paid Sick Leave for COVID-19

On March 18, 2021, the California Legislature passed SB 95, which reestablishes and expands supplemental paid sick leave for reasons related to COVID-19.

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Landscaper in San Jancinto Charged with Workers’ Compensation Insurance Fraud

The California Department of Insurance (DOI) has announced that Angel Maces, a San Jacinto landscaper, has been arraigned for felony insurance fraud for falsifying symptoms following a work-related injury. Mr. Maces received over $42,000 in workers’ compensation benefits that he did not deserve.

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Former City of Hollister Employee Faces Four Felony Counts in Workers’ Compensation Insurance Fraud Case

The California Department of Insurance (DOI) has announced that Daniel Clampitt, a former Hollister firefighter, was charged with four felony counts including workers’ compensation insurance fraud, grand theft and perjury. He claimed to be too injured to work and collected over $94,000 in workers’ compensation benefits while continuing to work for another company.

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California DWC Extends Emergency Regulations for Medical-Legal Evaluations and Reporting Through October 12, 2021

California’s Division of Workers’ Compensation (DWC) announced today that its emergency regulations 36.7 and 46.2 for medical-legal evaluations and reporting, which went into effect on May 14, 2020 and were set to expire in January 2021, have been extended until October 12, 2021.

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Nutrition Assistant Arraigned on Four Workers’ Compensation Insurance Fraud Charges in Merced

The California Department of Insurance (DOI) announced on Thursday, March 4, 2021, that Kia Lor, 54, of Merced has been arraigned on multiple counts of workers’ compensation insurance fraud. Lor, a Nutrition Assistant at the Merced Community Action Agency, suffered a back injury at a company picnic in 2018, while lifting a cooler.

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Long Beach Division of Workers’ Compensation (DWC) Office Moves to New Location

The California Department of Industrial Relations (DIR) Division of Workers’ Compensation announced on February 25th that the Long Beach office has moved to a new location, effective immediately.

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School District Employee Faces Charges of Workers’ Compensation Insurance Fraud, Grand Theft in COVID-19 case

The California Department of Insurance (DOI) announced in a bulletin today that Stephanie Medrano, 33, of West Covina, was arraigned on multiple charges of workers’ compensation insurance fraud and grand theft after making false statements about her condition.

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Workers’ Compensation Fraud Conviction Upheld in Illegal Kickback Scheme Case People v. Paredes

California’s Court of Appeal for the 4th District has upheld the workers’ compensation fraud conviction of Gonzalo Ernesto Paredes, the former Office Administrator for Advanced Radiology. Paredes had been found guilty of 35 counts of “offering or delivering compensation for workers’ compensation patient referrals” in the illegal kickback scheme.

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Fusion Rx Pharmacy Owner Enters Guilty Plea in Healthcare Fraud Conspiracy Case

Navid Vahedi, owner of Fusion Rx Compounding Pharmacy in Los Angeles, stood accused of conspiring with marketers to commit healthcare fraud and pay kickbacks. Vahedi, 41, pleaded guilty on behalf of himself and his business, and will be sentenced on June 28.

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Buttonwillow Worker Faces Felony Charges in Workers’ Compensation Insurance Fraud Case

The California Department of Insurance has announced that a warehouse worker in Buttonwillow has been arraigned on multiple felony counts, and will be prosecuted by the Kern County District Attorney’s office.

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Fresno Man Faces Felony Workers’ Compensation Insurance Fraud Charges

The California Department of Insurance (DOI) has announced the self-surrender to the Fresno County Jail of a man accused of perjury and workers’ compensation insurance fraud. Jose Zepeda, 45, of Fresno, faces multiple charges stemming from a claim filed after a 2017 injury.

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WCAB Decision Addresses Remote Testimony In Response to the COVID Pandemic

In a significant panel decision (PDF) issued Tuesday, January 12, 2021, the California Workers’ Compensation Appeals Board (WCAB) ruled that continuing a trial indefinitely to get in-person testimony was inappropriate.

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California DIR, Division of Workers’ Compensation Expand District Office Services Effective January 11, 2021

The Department of Industrial Relations (DIR) Division of Workers’ Compensation (DWC) announced on Thursday that beginning Monday, January 11th, walk-through appointments would be made available at District Offices, using the LifeSize video platform.

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Ventura Man Pleads Guilty to Felony Workers Compensation Fraud

Ventura County District Attorney Gregory D. Trotten announced that a sentence of 120 days in jail has been handed down in a case involving a violation of Insurance Code section 1871.4(a). Sergio Ordonez of Ventura pled guilty to making a “false and fraudulent material statement” in order to obtain workers’ compensation benefits.

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Firefighter Pleads Guilty to Felony Workers’ Compensation Fraud

Perry Adam Lieber, 34, has pled guilty in a workers’ compensation fraud case that saw the former Ventura County firefighter receive more than $145,000 in workers’ comp benefits. In June, Lieber had been charged with three felony counts, including workers’ compensation fraud and perjury.

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Orange County Attorney Faces 20 Felony Charges in Workers Compensation Insurance Scheme

The California Department of Insurance announced today that Moses Luna, 73, of Newport Beach was arrested on 20 felony counts after an investigation into his business found that he had fraudulently billed multiple insurance carriers for translation and interpreting services, generating over $300,000 in fraudulent billings.

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13 charged in $20M Supplemental Job Displacement Benefits Fraud Conspiracy

Riverside County prosecutors announced Monday that the first of 13 defendants across three criminal cases have been arraigned, facing a range of charges that include conspiracy, workers’ compensation insurance fraud, caping, and receiving kickbacks.

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Plea Agreement Filed in Melamed Workers’ Compensation Fraud Criminal Case

The criminal case against Hootan Melamed, the former owner of several pharmacies, appears to be coming to a close. A plea agreement for Melamed was filed in the U.S. District Court for Southern California in early November, at the same time that prosecutors filed superseding information that outlines a conspiracy charge and a plan to recover assets in a forfeiture plan.

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Canoga Park Man Arraigned on Three Felony Charges in California Workers’ Compensation Insurance Fraud Case

The California Department of Insurance (DOI) has announced that Alexander Cody Smith, 30, has been arraigned on three felony charges for worker’s compensation insurance fraud stemming from a claim made while working for Engen Enterprises Inc.

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30 Month Prison Sentence in California Disability Fraud Scheme

Angela Stubblefield, 49, of Tacoma Washington was sentenced on Monday to two and half years in prison for disability fraud and identity theft. She and Katherine Decker, who worked for the California Employment Development Department, filed multiple fraudulent diability claims, and illegally extended benefits for existing claims, using real identities.

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California Workers’ Compensation Appeals Board Reinstates Rules Previously Suspended During COVID-19 Pandemic

On Tuesday, the California Department of Industrial Relations Workers’ Compensation Appeals Board (WCAB) issued two en banc decisions which lift the suspensions of rules on lien claims and documentary trial exhibits.

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Emergency COVID-19 Medical-Legal Reporting Regulations To Expire March 12, 2021

California Division of Workers’ Compensation has announced that Emergency Regulations 36.7 and 46.2, which took effect on May 14, 2020 in response to the COVID-19 pandemic, will expire in March, in accordance with Governor Newsom’s Executive Orders.

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$18 Million in Liens Dismissed in Case Involving Workers Compensation Fraud

A judge has dismissed liens totaling over $18 million in the case of Michael E. Barri, who pled guilty in 2016 to multiple federal charges, including conspiracy and receiving illegal kickbacks from Pacific Hospital.

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Gov. Newsom Signs SB1159 Into Law, Creating COVID-19 Presumption for Workers’ Compensation

Governor Newsom has now signed SB1159 into law, as anticipated, creating a rebuttable presumption of compensability for COVID-19 cases. An urgency measure, the law goes into effect immediately.

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California DWC and WCAB Further Expand Hearing Options to Include Lien Trials

California’s Department of Industrial Relations announced today that judges will resume hearing a limited number of lien trials beginning on September 14th.

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California Senate Sends SB 1159 Coronavirus Presumption Bill to Governor Newsom for Signature

The legislature’s passage of the bill through both houses in the final hours of the legislative session sends the urgency measure to the governor’s desk, where it will take effect upon his signature.

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California Division of Workers’ Compensation Suspends Three Doctors, Three Nurses

Among the grounds for suspension were a failure to respond to allegations from Florida regulators that the nurse in question was diverting Fentanyl, and a failure to report that the physician in question was seeing patients seeking medical marijuana recommendations (the physician was already on probation).

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Three Bills on COVID-19 Workers’ Compensation Presumptions Under Review by Appropriations Committees

The California legislature will hear testimony today on the costs for the three California bills under consideration to create workers’ compensation compensability presumptions for coronavirus (COVID-19) cases.

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California DWC and WCAB Further Expand Workers’ Compensation Hearing Options to Include Video

In a statement released today, the California Department of Industrial Relations announced that the Division of Workers’ Compensation (DWC) and the Workers’ Compensation Appeals Board (WCAB) will expand their capabilities for remote hearings with a video option.

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Federal Charges Brought in Opioid Trafficking and Fraud Case

Ten individuals, including Dr. John Michael Korzelius of Camarillo, face federal drug trafficking and fraud charges after a two-year investigation by DEA and IRS agents resulted in two federal grand jury indictments. The charges allege that the individuals were part of a narcotics scam that sold illegal opioids for cash through fraudulent pain clinics.

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COVID19 Compensability Presumption Could Extend to 2024 For Some Workers

A new amendment to Senate Bill 1159 by Sen. Jerry Hill of San Mateo would extend the presumption that COVID-19 is compensable, through July 1, 2024, for certain workers, including those on the front line of the pandemic.

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California DIR, WCAB Rescind COVID-19 Rules Suspension of Timeframes for Reconsiderations, Effective 9/1

The California Department of Industrial Relations Workers’ Compensation Appeals Board has issued an en banc ruling, reinstating the requirements and time frames for the WCJ’s Report and Recommendation on a party’s Petition for Reconsideration, effective 9/1.

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California Division of Workers’ Compensation and WCAB Expand Hearing Schedule to Include Lien Conferences, Effective June 8

California’s Department of Industrial Relations (DIR) Division of Workers’ Compensation (DWC) and Workers’ Compensation Appeals Board (WCAB) have announced updated hearing procedures, effective June 8th, in an effort to improve operations during the coronavirus (COVID-19) pandemic. 

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New Emergency Workers’ Compensation Rules Allow Remote Med-Legal Evaluations By AMEs or PQMEs During Stay-At-Home Orders Due to COVID19 Pandemic

Emergency rules have been passed due to the COVID-19 pandemic to allow remote med-legal evaluation by AMEs or PQMEs while the stay at home orders are in effect. This emergency regulation may have the effect of speeding up the med-legal process which has been stalled somewhat under the stay at home orders.

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Executive Order from Governor Newsom Establishes Presumption That Workers Infected With COVID-19 Contracted Virus At Work

California Governor Gavin Newsom announced an Executive Order in response to the Coronavirus COVID-19 outbreak, establishing a rebuttable presumption that a worker who tests positive for the virus contracted it arising out of and during the course of employment.

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California DWC, WCAB Expand District Office Hearing Schedule, Suspend Exhibit Filing Requirement

Case-in-chief trials will now be heard by the DWC, beginning May 4, via the judges’ individually assigned conference lines. An en banc order by the WCAB also suspended the 20-day requirements laid out in WCAB Rules 10620 and 10670(b)(3).

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WCAB Issues En Banc Decision in Anthony Dennis v. State of California – Department of Corrections and Rehabilitation

On Monday April 13, 2020, the California Workers’ Compensation Adjudication Board (WCAB) issued an en banc decision affirming it’s July 31, 2018 decision in the case of Anthony Dennis v. State of California – Department of Corrections and Rehabilitation 2020 Cal. Wrk. Comp. LEXIS 19, W.C.A.B. Case No. ADJ9346293.

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California Department of Industrial Relations to Require Certain Appearances by Phone

California’s Department of Industrial Relations (DIR) will require MSCs, status conferences, and priority conferences to occur by phone beginning Monday, 4/13/2020.

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California DIR, DWC, WCAB Announce Updated Procedures for Hearings and Filings Due to COVID-19

California’s Department of Industrial Relations (DIR) announced today that the Division of Workers’ Compensation (DWC) and Workers’ Compensation Appeals Board (WCAB) have released updated procedures through April 10th to prevent the spread of COVID-19.

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California DIR, DWC Announces Updates For QME Med-Legal Exams Due To COVID-19

California’s Department of Industrial Relations (DIR) announced today that the Division of Workers’ Compensation (DWC) is taking further steps to ensure public safety, evaluating the viability of telemedicine for Qualified Medical Examiner (QME) evaluations.

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WCAB Issues En Banc Order, Suspends Some Rules of Practice & Procedure

The California Department of Industrial Relations (DIR) Workers’ Compensation Appeals Board (WCAB) issued an en banc order today in response to the continuing threat of the novel Coronavirus COVID-19. The order suspends “specific WCAB Rules of Practice and Procedure contained in Title 8 of the California Code of Regulations.”

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California DWC Announces Temporary Office Closures

California’s DIR announced today that the Division of Workers’s Compensation (DWC) will temporarily close its district offices in San Jose, Oakland and San Francisco to comply with shelter-in-place orders intended to protect the health and safety of the public as well as DWC staff.

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