Breaking News

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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California DWC and WCAB Announce Hearing and Filing Updates in Response to Coronavirus

California’s DIR announced today that the DWC and WCAB will limit court appearances “to protect the health and safety of our staff and the community,” hearing only expedited hearings on a revised schedule. Filing deadlines have also been revised and extended. 

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Woman Charged With Fraud Over Workers’ Compensation Claims

52-year-old Maria Mendoza has been charged with multiple counts of fraud after filing workers’ compensation claims against four employers over four years.

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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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