Author: WorkCompAcademy

Lawrence J. Gerrans was convicted by a federal jury of wire fraud and money laundering in connection with a scheme to defraud the medical device company he ran. The verdict issued following a two-week trial.

“The defendant siphoned millions of dollars from the medical device company he was entrusted to run, and then tried to cover up that crime,” stated U.S. Attorney Anderson.

Evidence at trial showed that Gerrans, the president and chief executive officer of San Rafael-based medical device company Sanovas, employed a number of fraudulent methods to siphon funds out of Sanovas.

From January 12, 2015, through March 16, 2015, Gerrans systematically transferred more than $2.6 million from Sanovas to himself and two shell companies he controlled, Halo Management Group and Hartford Legend Capital Enterprises. That money was then used for an all-cash purchase of a luxury home in San Anselmo, at a purchase price of $2,570,000. At least $2.3 million of this money was laundered through Hartford Legend before being paid to the escrow account to purchase the house.

Evidence at trial also showed that Gerrans made false statements to a newly-created board of directors to seek their approval for a lucrative compensation plan and for reimbursement of retirement account funds that Gerrans had liquidated in 2013 and 2014. Evidence at trial showed that Gerrans had used the retirement account funds for personal expenditures, including a Maserati, a diamond ring, and rent on his personal residence, but he told the board of directors he had used the retirement account funds to benefit Sanovas. In another part of the scheme to defraud, evidence also showed that in 2017 Gerrans used a Sanovas corporate credit card for lavish personal expenditures, including a $44,000 vacation timeshare, $12,500 for high-end carpets for his home, and $32,000 to pay the property taxes on his personal residence.

Evidence at trial further showed that Gerrans provided false documents to the FBI during the criminal investigation, and that after he was first charged in the case he violated a court-ordered bond condition, attempted to tamper with a witness, and obstructed justice.

Judge Chen scheduled the defendant’s sentencing hearing for May 20, 2020.

Jay Brome began his employment at the California Highway Patrol in 1996. During his nearly 20-year career he was openly gay. He claims that other officers subjected him to derogatory, homophobic comments; singled him out for pranks; repeatedly defaced his mailbox; and refused to provide him with backup assistance during enforcement stops in the field.

As a result, Brome feared for his life during enforcement stops, experienced headaches, muscle pain, stomach issues, anxiety and stress, and became suicidal by early 2015. In January 2015, he went on medical leave and filed a workers’ compensation claim based on work-related stress.

Brome’s workers’ compensation claim was resolved in his favor on October 27, 2015. He took industrial disability retirement on February 29, 2016, ending his employment with the Patrol.

On September 15, 2016, Brome filed an administrative complaint with the Department of Fair Employment and Housing. He filed a lawsuit the next day, asserting four claims under the Fair Employment and Housing Act for the conduct he alleged in his workers’ compensation claim.

The CHP sought summary judgment, contending Brome’s claims were untimely because he did not file his administrative complaint within one year of the challenged actions, as required under former section 12960, subdivision (d).

However, because the crux of his case concerns circumstances that occurred before his medical leave began in January 2015, he asserted that exceptions to the one-year deadline were applicable. He argued that the filing of his workers’ compensation claim should stop the clock on his one-year filing deadline during the pendency of his compensation claim. The legal doctrine is known as “equitable tolling.”

The trial court granted summary judgment in favor of the Patrol, holding that Brome’s claims were filed after the statute of limitations expired and a reasonable jury could not have concluded they were timely based on an exception to the deadline.

The Court of Appeal reversed in the published case of Brome v California Highway Patrol.

The equitable tolling doctrine operates to suspend or extend a statute of limitations as necessary to ensure fundamental practicality and fairness. In the case of McDonald v. Antelope Valley Community College Dist. (2008) 45 Cal.4th 88, the California Supreme Court held that the deadline for filing an administrative claim under the Act could be tolled while a plaintiff is voluntarily pursuing alternate remedies.

The time for filing a claim pursuant to the Act may be tolled where the plaintiff can establish three elements: timely notice, and lack of prejudice, to the defendant, and reasonable and good faith conduct on the part of the plaintiff.

It will be the jury’s job to reconcile the evidence at trial, and summary judgment was not justified.

Bradley Dean Groscost, 59, of Westminster, and Felix Koltsov, 57, of Beverly Hills, self-surrendered last week to the Orange County Central Justice Center after being charged with multiple felony counts of insurance fraud, money laundering, and unlawful referrals for allegedly conspiring to bill insurers in excess of $20 million as part of a kickback referral scheme.

From 2014 to 2017, Groscost operated five workers’ compensation clinics in Southern California. Doing business as DSJ MGT, Inc. in Fountain Valley, Groscost controlled treatments, referrals, and medical and financial records at the clinics even though he was not licensed to practice medicine.

The Department of Insurance’s investigation, with the assistance of the National Insurance Crime Bureau, discovered that Groscost allegedly received approximately $2.1 million in kickbacks from Koltsov, owner of LFPS Inc. and Resource Pharmacy Inc., for patient referrals for urine drug screenings and compound cream prescriptions. Koltsov’s companies billed workers’ compensation insurance carriers over $20 million for these claims.

The investigation also revealed that Groscost allegedly failed to report employees to the Employment Development Department (EDD) and paid them as independent contractors. He failed to report over $5.1 million in wages to EDD and as a result, avoided paying over $510,000 in taxes. As of July 5, 2019, Groscost owed EDD over $1.6 million in taxes, penalties, and interest.

“These fraudulent workers’ compensation claims funnel resources away from injured workers and make it more difficult to provide the treatment to those workers who truly need it,” said District Attorney Todd Spitzer. “The Orange County District Attorney’s Office is collaborating with the California Department of Insurance to crack down on workers’ compensation fraud and preserve resources for the truly injured.”

“These co-conspirators allegedly ordered screenings and prescriptions for patients in order to enrich themselves, as part of a kickback referral scheme,” said Insurance Commissioner Ricardo Lara. “By investigating health care fraud, my department is helping keep insurance costs down for all California consumers and businesses.”

This case is being prosecuted by Deputy District Attorney Christine Oh of the Insurance Fraud Unit of the Orange County District Attorney’s Office. Koltsov surrendered to the court on January 22, 2020, and posted bail of $500,000. Groscost surrendered to the court on January 24, 2020, and remains in custody. His bail is set at $500,000.

Luisa Rodriguez was employed by Kelly Services, and injured her low back, and claimed to have injured her neck, left leg, left hip, psyche, head, bilateral shoulders, and suffered a sleep disorder. Some of her treatment was provided on a lien basis.

Mr. Patrick Christoff executed a section 4903.S(d) declaration on behalf of lien claimants Comprehensive Outpatient Surgery Center (COSC) and Technical Surgery Support (TSS). In both declarations, Mr. Christoff declared under penalty of perjury that “the services or products described in the bill for services or products were actually provided to the injured employee”; and that “the billing statement . . . truly and accurately describes the services and products that were provided to the injured employee.”

At trial the employer objected to the liens and claimed that Mr. Christoff did not have personal knowledge of the facts set forth in the declarations to sign them on behalf of lien claimants.

Christoff testified that he has worked for COSC since 2003 as an attorney, and he collects liens for COSC and TSS. His job duties included understanding billing procedures and codes, reviewing and negotiating bills, and reviewing surgical and medical reports, which includes over 10,000 operative reports. He reviewed these reports to have an understanding of what was billed for what service for each case. He also spoke to pain management doctors to get an understanding of the medical services that had been provided and billed to negotiate billing.

Christoff stated that he reviewed the operative reports to ensure that the description of the services in the operative reports matched the services that were billed in the invoice. Mr. Christoff testified that he relied on the information in the operative reports to determine the accuracy and specificity of the actual billing to ensure that they were the same and matched each other. Mr. Christoff explained that he received education on decompression procedures as well as training on bill review practices; he has reviewed over 10,000 bills. Mr. Christoff testified that he reviewed medical and surgical reports prior to signing his section 4903 .8( d) declarations on September 1, 2017.

On cross-examination, Mr. Christoff testified that he did not have any formal training or classroom instruction on CPT coding; did not attend any seminars in bill review; and did not recall being in the operating room for any of the procedures that were billed. Mr. Christoff testified that he based his declaration on the doctor’s chart notes, and the doctor declared under penalty of perjury that the services were provided on that date.

The WCJ found that Christoff was competent to sign Labor Code section 4903.8(d) declarations on behalf of lien claimants Comprehensive Outpatient Surgery Center (COSC) and Technical Surgery Support (TSS). The decision was affirmed in the panel decision of Rodriguez v Kelly Services.

Here, Mr. Christoff s section 4903.S(d) declarations comply with section 4903.8(d) in that he declared under penalty of perjury the facts found in subsections (d)(l) and (d)(2). Therefore, the burden shifted to defendant to prove that Mr. Christoff’s section 4903.S(d) declarations were invalid.

Defendant argues that lien claimants’ 4903.S(d) declarations are invalid because Mr. Christoff is not competent to testify to the facts in his declarations; in particular, Mr. Christoff does not have “personal knowledge that the billing statement accurately describes the products/services provided to the injured employee and that those products/services were actually performed.”

Although section 4903.8(d) does not define exactly what is meant by the phrase, “competent to testify,” there guidance in Evidence Code section 702, which provides: “A witness’ personal knowledge of a matter may be shown by any otherwise admissible evidence, including his own testimony.”

Here, Mr. Christoff s knowledge of lien claimants’ medical services was based, in part, on Dr. Williams’ medical reports, which Dr. Williams declared and signed under penalty of perjury.

Based on the facts of this case, the WCAB concluded that Mr. Christoff is competent to testify to the facts stated in his section 4903. 8( d) declarations.

A Nigerian American pathologist portrayed by Will Smith in the 2015 film, “Concussion,” Bennet Omalu M.D. is partly responsible for the most important sports story of the 21st century. He triggered thousands of claims against the NFL that have settled for around $1 billion, and hundreds of workers’ compensation claims filed, and now for the most part settled, in California.

Since 2005, when Omalu first reported finding widespread brain damage in a former NFL player, concerns about CTE have inspired a global revolution in concussion safety and fueled an ongoing existential crisis for America’s most popular sport. Omalu’s discovery – initially ignored and then attacked by NFL-allied doctors – inspired an avalanche of scientific research that forced the league to acknowledge a link between football and brain disease.

Nearly 15 years later, Omalu has withdrawn from the CTE research community and remade himself as an evangelist, traveling the world selling his frightening version of what scientists know about CTE and contact sports. In paid speaking engagements, expert witness testimony and in several books he has authored, Omalu portrays CTE as an epidemic and himself as a crusader, fighting against not just the NFL but also the medical science community, which he claims is too corrupted to acknowledge clear-cut evidence that contact sports destroy lives.

And since his discovery, Omalu told Sports Illustrated, researchers have uncovered evidence that shows adolescents who participate in football, hockey, wrestling and mixed martial arts are more likely to drop out of school, become addicted to drugs, struggle with mental illness, commit violent crimes and kill themselves.

But a new report from the Washington Post – “From scientist to Salesman How Bennet Omalu, Doctor of ‘Concussion’ Fame, Built a Career on Distorted Science” tells the other side of his story.

After more than a decade of intensive research by scientists from around the globe, the state of scientific knowledge of CTE remains one of uncertainty. Among CTE experts, many important aspects of the disease – from what symptoms it causes, to how prevalent or rare it is – remain the subject of research and debate.

But across the brain science community, there is wide consensus on one thing: Omalu, the man considered by many the public face of CTE research, routinely exaggerates his accomplishments and dramatically overstates the known risks of CTE and contact sports, fueling misconceptions about the disease, according to interviews with more than 50 experts in neurodegenerative disease and brain injuries, and a review of more than 100 papers from peer-reviewed medical journals.

Omalu did not discover CTE, nor did he name the disease. The alarming statistics he recites about contact sports are distorted, according to the author of the studies that produced those figures. And while Omalu cultivates a reputation as the global authority on CTE, it’s unclear whether he is diagnosing it correctly, according to several experts on the disease.

Omalu’s definition for CTE, as described in his published papers, is incredibly broad and all-encompassing, describing characteristics that can be found in normal, healthy brains, as well as in other diseases, according to experts including Ann McKee, lead neuropathologist for Boston University’s CTE Center. “His criteria don’t make sense to me,” McKee said. “I don’t know what he’s doing.”

McKee’s assessment was supported by three neuropathologists who worked with her to develop guidelines for diagnosing CTE used by researchers around the world.

McKee and other experts confirmed, in interviews, something that long has been an open secret in the CTE research community: Omalu’s paper on Mike Webster – the former Pittsburgh Steelers great who was the first NFL player discovered to have CTE – does not depict or describe the disease as the medical science community defines it. McKee and other experts believe Webster had CTE, based on his history of head trauma and his mental disorders. But the paper Omalu published shows images that are not CTE and could have come from the brain of a healthy 50-year-old man, they said.

“This is the problem,” McKee said. “People lump me with him, and they lump my work with him, and my work is nothing like this.” “My God, if people were actually following these [Omalu’s] criteria, the prevalence of this disease would be enormous, and there’s absolutely no evidence to support that.”

Omalu declined several requests for an interview and refused to answer any questions for this story. In an email, he dismissed questions raised by experts as coming from “a minority of doctors who are seeking very cheap and bogus popularity . . . who work directly or indirectly with these sports organizations.” “Your paper engaging in such bogus controversies will bolster some people’s allegations of ‘Fake News,’ ” Omalu wrote.

This is typically how Omalu responds to criticism: by claiming it comes from scientists corrupted by relationships with sports leagues. But his depiction of the science of CTE and his prominence in the CTE research community have yielded his own financial benefits.

Billing himself as the man who discovered CTE, Omalu has built a lucrative business as an expert witness for hire in lawsuits – including in the growing CTE-related litigation field – charging a minimum of $10,000 per case, according to his testimony. He also maintains a busy schedule of paid speaking engagements, charging $27,500 per appearance, records show, as he delivers his sermon against contact sports.