Breaking News

Two Arrests in $20 Million Workers’ Compensation Insurance Fraud Scheme

California’s Department of Insurance has announced that two men have been arrested on multiple felony charges after self-surrendering in Orange County. The two men’s alleged conspiracy resulted in billings to insurers of over $20 million between 2014 and 2017.

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IRS Reduces Mileage Reimbursement Rate for 2020

The IRS mileage reimbursement rate for medical care and evaluations has been updated for 2020. The rate has been reduced by half a cent, from $.58 to $.575 per mile. The new rate will apply to all mileage incurred in 2020, regardless of the original date of injury.

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Southern California Attorney Sentenced to 14 Months in $22 Million Kickback Scheme

Attorney Lee Mathis was sentenced to 14 months in federal prison for honest services mail fraud as a result of his role in a scheme that saw Mathis and another man, Fernando Valdes, pay kickbacks to providers for patient referrals to a company they co-owned, Los Angeles-based Foremost Shockwave Solutions.

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Southern California Surgeon Sentenced to 30 Months For Kickbacks Scheme

Dr. Daniel Capen, a spinal surgeon in Huntington Beach, CA, was sentenced on Friday to 30 months in federal prison for conspiring to commit honest services fraud. He had received at least $5 million in kickbacks for performing surgeries at Pacific Hospital of Long Beach in a scheme coordinated by former Pacific Hospital owner Michael Drobot, and for referring patients for other medical services.

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WCAB en banc Decision in Colamonico v. Secure Transportation Places Burden of Proof on Lien Claimant/Provider

The WCAB has held en banc in Colamonico v. Secure Transportation that it is the lien claimant/provider’s (in this case a photocopy service) burden to prove that its services were both reasonable and necessary and that the defendant’s failure to cite reasonableness or necessity in its objection to a med-legal bill doesn’t act as waiver of those defenses at the time of the lien conference. 

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Vocational School Owner Charged with Workers’ Compensation Fraud

The owner of San Jose-based Advanced Vocational Institute (AVi), Rashad Said, has been charged with 11 felony counts involving workers’ comp fraud and kickbacks. Said, a former member of the San Jose Regional Workforce Development Board, is accused of illegally diverting over $650,000 in workers’ compensation insurance funds.

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Doctor Charged in $150 Million Healthcare Fraud Scheme Pleads Guilty to Conspiracy

An anesthesiologist charged along with 24 other entities in a massive fraud scheme has pleaded guilty to one count of conspiracy to commit honest services mail fraud. Amir Friedman’s plea agreement was accepted by the Centra District of California federal court on October 21, and will see him return for sentencing on April 6th.

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25 Face Federal Charges in Alleged Fraud Scheme

On Wednesday September 18th, the U.S. Attorney’s Office for Central California announced charges against 25 entities, including 24 individuals and a pharmaceutical company for an alleged scheme to defraud Medicare, Medicaid, and private insurers and union health plans out of over $150 million.

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Governor Gavin Newsom Signs Sabor Bill AB5

On Wednesday September 18, Governor Gavin Newsom signed into law Assembly Bill 5, a sweeping new labor law re-defining the distinction between “employees” and “independent contractors.”

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Division of Workers’ Compensation announces 2020 rates for Temporary Total Disability

The California Division of Workers’ Compensation (DWC) has announced an increase in the minimum and maximum temporary total disability (TTD) rates. The increase will go into effect on January 1, 2020.

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Workplace Fatigue Injuries on the Rise

The U.S. Department of Labor cites worker fatigue as a major factor in some of the world’s most tragic workplace disasters – and levels of worker fatigue seem to be drastically climbing.

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Another Conviction From Kickback Scheme

Gonzalo Parades, the former office manager of Advanced Radiology in Beverly Hills, was recently convicted of 51 felony counts and sentenced to five years in prison.

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Medical Marketer Forfeits $126,808 in Conspiracy Case

John Pangelinan, a medical marketer and president of Board Med Inc., was ordered to forfeit $126,808 after pleading guilty to conspiracy to commit honest services mail fraud and health care fraud.

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Two Busted In Workers’ Compensation Voucher Scheme

On May 24, Salvador Franco Jr. and Mirella Flores were found guilty of 37 felony counts for fraud charges involving the Supplemental Job Displacement Benefit voucher. Franco was the CFO of Graduates Do Succeed Institute and a 20% owner of Technical School Inc., where he was also Director and CFO. Flores was also an employee for both schools.

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Kickback Scheme Conspirator Carlos Arguello Will Serve Four Years in Prison

Carlos Arguello will serve 48 months in prison and give up $1.2 million in proceeds for participating in a $5 million kickback scheme. He and co-defendant Fermin Iglesias used a company called Providence Scheduling to steer patients to providers, which were required to meet quotas for services that were provided by other participants in the cross-referral scheme. Arguello pleaded guilty to a federal conspiracy charge back in August 2016.

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15 SoCal Chiropractors Busted in Huge Insurance Fraud Scheme

The Los Angeles County district attorney’s office announced that 15 Southern California chiropractors were arrested on Thursday, May, 2, 2019 in a multimillion-dollar insurance fraud scheme.

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Judge Jacqueline Duncan of SF WCAB to Retire

BREAKING: Just learned that presiding Judge Jacqueline Duncan of the San Francisco Workers’ Compensation Appeals Board is set to retire 7/1/19.

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DWC Posts Changes to Official Medical Fee Schedule

The California DWC) has posted changes to the Official Medical Fee Schedule, specifically for Physicians and Non-Physician Practitioners.

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Division of Workers’ Compensation Suspends Five More Providers

The Division of Workers’ Compensation (DWC) suspended Paul Turley, Francisco Gomez, Angela Rehmann, Tomas Rios and Joseph E. Long for a swath of improprieties.

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Four More Charged in Elaborate Capping Scheme

Four more people have been charged in a capping scheme, including two QMEs accused of running a clinic that paid $1.8 million+ for patient referrals.

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Mileage Reimbursement for Injured Workers to Increase

The California Workers’ Compensation Institute has announced that reimbursement for injured workers traveling to medical appointments will increase from 54.5 cents/mile to 58 cents/mile.

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California WCAB Issues En Banc Decision in Suon v. California Dairies

Yesterday, the California Workers’ Compensation Appeals Board (WCAB) issued an important decision in the case of Sandab Suon v. California Dairies.

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Head of Numerous California Imaging Centers Indicted for Fraud

The U.S. Attorney for the Southern District of California has issued an indictment and arrest warrant against Sam Solakyan, who headed numerous imaging centers in the state tied to fraud allegations. Solakyan allegedly paid $8.8 million in kickbacks for referrals, which were used to bill workers’ compensation payers for $284 million.

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DWC Dismisses over 4,000 Liens Connected to Drobot Conspiracy

The California Division of Workers’ Compensation has dismissed almost 5,000 liens filed by companies associated with Michael R. Drobot, including Industrial Pharmacy Management and California Pharmacy Management. This marks the first major case involving a provision in AB 1244 which requires the DWC to dismiss liens held by individuals convicted of fraud.

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Federal CA Officials Secure Restitution and Guilty Plea in Two Fraud Cases

On Thursday, a federal judge in Northern California ordered Pain Free Diagnostics Inc. to deposit the $1.2 million it owes in restitution to over 24 defrauded carriers. In an unrelated case, the U.S. Attorney’s Office for Southern California obtained a guilty plea from a doctor for accepting kickbacks for prescriptions and therapy.

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BREAKING: CA Supreme Court Rules Workers’ Comp Law Exclusive Remedy In King v. CompPartners

Today, the California Supreme Court decided in King v. CompPartners that an injured worker’s claims against a utilization review (UR) doctor are exclusively compensable as part of the workers’ compensation system.

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California DWC Suspends 11 More Medical Providers

The California Division of Workers’ Compensation (DWC) has suspended 11 more medical providers from participation in the California workers’ compensation system. 274 total providers have been suspended thus far in 2018.

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Two More Providers Indicted in Pacific Hospital Kickback Scheme

Dr. Jacob Tauber of Beverly Hills and Dr. Serge Obukhoff of Malibu have been indicted by a federal grand jury for participating in a kickback scheme involving referrals to Pacific Hospital of Long Beach, bringing the total cost of the scheme to almost $1 billion.

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DWC Establishes Pharmacy & Therapeutics Committee

The California Division of Workers’ Compensation has announced the formation of the Pharmacy & Therapeutics Committee, which will consult with and advise the DWC on updates to the Medical Treatment Utilization Schedule Drug Formulary.

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California Department of Insurance Orders Workers’ Comp Insurers to Report Tax Savings

The California Department of Insurance has ordered that every insurer licensed to write workers’ compensation insurance in the state is required to report their yearly tax savings due to the tax Jobs and Cuts Act of 2017, beginning in 2018.

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More Providers Charged in Pacific Hospital Fraud Scheme, Compounded Drugs Kickback Scheme

This week, federal prosecutors in Los Angeles indicted several medical providers, as well as an attorney, in numerous scams to defraud Medicare, private health insurers, workers’ compensation insurers and programs, and a military health insurance program.

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Heat Warnings in California Prompt Safety Precautions

The National Weather Service has announced heat warnings across California; employers should follow certain steps in order to protect their employees working outdoors from heat illness.

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Senate Bill 189 Provisions May Affect Workers’ Compensation Policies

Beginning July 1, 2018, provisions in Senate Bill 189 governing changes in employee and waiver status for the purpose of workers’ compensation coverage will become effective, and may impact coverage.

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TTD Min. and Max. Rates Increase for 2019

The California Division of Workers’ Compensation (DWC) has announced the 2019 minimum and maximum temporary total disability (TTD) rates.

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California Supreme Court Denies Review of Ruling on TD Benefit Statutory Cap

The California Supreme Court has decided not to review a 4th District Court of Appeal decision placing a five-year statutory cap on temporary disability benefit duration.

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Southern California Surgeons Charged in Pacific Hospital Kickback Scheme

Drs. Jeffrey Gross, David Payne, and Lokesh Tantuwaya have been charged with conspiracy and fraud for collectively receiving over $4 million in kickbacks for surgeries and referrals at Pacific Hospital in Southern California.

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California DWC Suspends 18 Medical Providers

The Division of Workers’ Compensation (DWC) has suspended 18 more medical providers from  California’s workers’ compensation system, bringing the total number of providers suspended in 2018 to 263.

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California District Court Rules in DIR Lien Stay Case

A California District Court ruled in favor of the Department of Industrial Relations, allowing the granting of lien stays to criminally charged providers.

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California Supreme Court Rules in Independent Contractor Case

The Supreme Court of California made a key decision in distinguishing between independent contractors and employees that sets an important precedent in employer-worker relations.

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California DIR Director Christine Baker Retires

Christine Baker, director of the California Department of Industrial Relations, announced her immediate retirement this past weekend.

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California DWC Suspends 27 Medical Providers

The Division of Workers’ Compensation (DWC) has suspended 27 more medical providers from  California’s workers’ compensation system, bringing the total number of providers suspended in 2018 to 234.

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20 More Medical Providers Suspended by California DWC

The California Division of Workers’ Compensation (DWC) has suspended 20 more medical providers from the state’s workers’ compensation system for fraud and related criminal actions, or for loss of license.

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California DWC Suspends 7 More Medical Providers

In the first suspension announcement of 2018, the California Department of Workers’ Compensation has suspended 7 more medical providers from the state’s workers’ comp system. 

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21 More Medical Providers Suspended by California DWC

The California Division of Workers’ Compensation (DWC) has suspended 21 more medical providers from the state’s workers’ compensation system for fraud and related criminal action. 

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9 More Medical Providers Suspended

The California Division of Workers’ Compensation (DWC) has suspended 9 more medical providers from the state’s workers’ compensation system.

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1st DCA Accepts Appeal of SCIF v. WCAB (Stevens) Ruling

The California 1st District Court of Appeal has accepted a petition for review of the WCAB’s decision in the well known Stevens case.

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California DIR Suspends Another 12 Medical Providers

The Division of Workers’ Compensation (DWC) announced that it has suspended 12 more medical providers from the state’s workers’ compensation system. Nine of these providers were suspended for fraud or criminal actions, while three were suspended for administrative reasons. These suspensions bring the total number of medical providers suspended in California this year to 85.  The following providers were suspended: Paul … Continued

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California DWC Suspends 21 More Medical Providers

The Division of Workers’ Compensation (DWC) announced that it has suspended another 21 medical providers from the state’s workers’ compensation system. A total of 73 medical providers have been suspended in California this year. 

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WCAB Issues En Banc Decision in Jose Guillermina Rodriguez and Consolidated Cases

On September 14, 2017, 1200 Petitions for Reconsideration were filed by and through lien claimant Maximum Medical. These Petitions requested reconsideration of the enforcement of new lien assignment statutes, challenging an administrative action in the DWC’s Electronic Adjudication Management System (EAMS) that would have resulted in the automatic dismissal of liens due to an alleged failure to timely file declarations. The Appeals Board has consolidated the cases in its decision.

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Eight Medical Providers Suspended for Fraud by Division of Workers’ Compensation

The California DIR’s Department of Workers’ Compensation (DWC) has suspended an additional 8 medical providers who were found guilty of fraud. Orders of Suspension from California’s workers’ compensation system were filed against the following medical providers: Abraham Khorshad – This Beverly Hills investor in Aspen Medical Resources was also a co-conspirator with providers Jeffrey Campau and … Continued

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