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Labor Alliance Officers Sentenced For WC and Pension Fraud

Fresno residents Marcus Asay, 69, and Antonio Gastelum, 53, were sentenced to five years in prison and two years in prison, respectively, for committing a long-running pension fraud scheme through their company, Agricultural Contracting Services Association dba American Labor Alliance. ALA also received a corporate fine of $2.5 million. Asay and ALA were each ordered to pay $69,250 in restitution.

On June 18, 2024, Asay, Gastelum, and ALA were convicted of the pension fraud scheme following a five-week jury trial. Asay and ALA were also convicted of committing a worker’s compensation fraud scheme, a hardship exemption fraud scheme, and money laundering. The hardship exemption fraud scheme involved a supposed exemption from the Affordable Care Act’s requirement that people obtain health insurance or pay a significant shared responsibility payment when they file their taxes.

According to court documents and evidence presented at trial, Asay was the founder and chairman of ALA, and Gastelum was the company’s Chief Operating Officer, Chief Financial Officer, and Compliance Officer. From 2011 through 2019, the defendants offered three sham products: retirement plan, worker’s compensation coverage, and hardship exemption.

For the worker’s compensation fraud scheme, Asay and ALA falsely represented that national insurers backed the worker’s compensation coverage that the company offered in several states, including California. Asay and ALA did so by listing the national insurers on the certificates of insurance and policy declarations that the company issued to customers. The accuracy of the certificates of insurance and policy declarations was important to the customers because they needed to present these items to their own customers and regulators as proof of having worker’s compensation coverage in order to continue doing business. When government authorities began investigating the workers’ compensation fraud scheme, Asay and ALA sent letters to customers telling them not to cooperate. The worker’s compensation fraud scheme generated $2.25 million in premiums.

For the pension fraud scheme, Asay, Gastelum, and ALA falsely represented to more than 3,000 people that they would protect and invest their retirement money through a 401(k) Plan when, in fact, they used the money for improper business and personal expenses. The improper expenses included restaurants, travel, credit cards, rare coins, transfers to Asay’s personal retirement account, online companion websites, and rent for Asay’s lakefront mansion in Fresno. Asay, Gastelum, and ALA then covered up the fact that the retirement money was gone by taking money the company received from the worker’s compensation fraud scheme and holding those funds out as pension funds. The loss caused by the pension fraud scheme was more than $620,000.

Asay’s money laundering conviction resulted from this scheme because he moved pension funds through multiple bank accounts to conceal the source of the funds before using them for improper expenses.

For the hardship exemption fraud scheme, Asay and ALA falsely represented that for a few hundred dollars they could provide people with an exemption that would protect them from the Affordable Care Act’s shared responsibility payment for not having health insurance when, in fact, only government agencies could issue such exemptions. Moreover, the exemptions were free to those who qualified.

Asay and Gastelum received enhanced sentences because they both testified in their own defense at trial and were found to have perjured themselves.

This case was the product of an investigation by the U.S. Department of Labor’s Employee Benefits Security Administration and Office of Labor-Management Standards, Federal Bureau of Investigation, the IRS Criminal Investigation, and the Social Security Administration Office of Inspector General. Assistant U.S. Attorneys Michael Tierney, Joseph Barton, and Stephanie Stokman prosecuted the case.

Community Colleges Face Massive “Pell Runner” Financial Aid Fraud

California’s community colleges are reporting a rise in financial aid fraud. In January, suspected bots represented 1 in 4 college applicants. Schools have given away millions to these scams, and college officials say fraudsters are getting smarter with the help of AI.

They’re called “Pell runners.” “Pell Running” in this context refers to a type of financial aid fraud where individuals enroll in colleges, apply for federal Pell Grants (intended for low-income students to cover education costs), collect the funds – up to $7,395 per year as of recent award years – and then drop out without completing courses. These individuals, called “Pell Runners,” exploit the system for personal profit, as Pell Grants don’t require repayment under normal circumstances

Estimates suggest Pell Grant fraud costs taxpayers over $1 billion annually, with some experts citing 3.6% of disbursements as fraudulent. In 2003, the U.S. General Accounting Office (GAO) estimated that Pell grant fraud accounted for about $300 million in grants per year – about 3 percent of total money handed out. A decade later, the program has more than tripled in scope (roughly doubling between 2008 and 2010), and fraud seems to be as bad as ever.

One expert, Mark Kantrowitz of FinAid.org, believes that Pell grant fraud still runs at about 3.6 percent or more than $1 billion a year. The Obama administration reported that “improper payments” – money distributed erroneously due either to fraud or mistakes – to Pell recipients totaled 2.7 percent of disbursements in 2011. Kantrowitz’s higher number is based on the number of students who receive grants but never obtain degrees. Considering that the Education Department doesn’t have the manpower to track down all fraudsters, Kantrowitz’s estimate may be closer to reality.

Since fall 2021, California’s community colleges have given more than $5 million to Pell runners, according to monthly reports they sent to the California Community Colleges Chancellor’s Office. Colleges also report they’ve given nearly $1.5 million in state and local aid to these scammers. The chancellor’s office began requiring the state’s 116 community colleges to submit these reports three years ago, after fraud cases surged.

The California Student Aid Commission told the Los Angeles Times it had identified more than 65,000 applications for aid from purported community college students that appear to be fake, lending credence to the idea that scammers are seeking to get their hands on state grants.

A 2024 IntelliBoard article estimates 460,000 fraudulent applications in California alone, clogging enrollment and wasting funds. Nationally, fraud spiked post-COVID due to online learning and stimulus funds – $40 billion in emergency aid was a magnet for scammers. A 2011 Chronicle of Higher Education piece (older but relevant) notes the Education Department investigating 74 fraud rings back then, suggesting this isn’t new, just evolved. Community colleges remain prime targets due to low tuition, leaving more grant money for fraudsters to pocket.

There are two primary ways in federal student aid is abused. One is the Pell runner described above. Students obtain grants, receiving directly whatever money is left over after tuition and fees are paid. Then they drop out of school without finishing any courses.

Federal law makes this scam possible. Grantees are allowed to attend school for 12 semesters (six years) in total before they lose eligibility for more money. There are no academic requirements to obtain a Pell grant; the only requirements are based on income and the cost of attending school. And there is no graduation requirement.

The other form of student aid abuse is more complex. It tends to be aimed at online education and is designed to make off with Pell grants and federal student loans as well. Criminals form rings, in which the leader recruits multiple “straw students” who apply for the grants and loans, then shares the haul with them.

Such fraud has lately become easier to commit due to the rise of online education, since students don’t even have to appear in person. In 2011, the Education Department reported a “dramatic” increase in financial aid scams involving online education, opening 100 investigations in the first 8 months of 2011, compared to just 16 investigations in 2005.  The report found that “straw students drop or withdraw from programs after they receive their credit balance payments and then kick back a portion of the funds to the ringleader and, if applicable, a recruiter.”

According to the FBI website, Pell Grant fraud is widespread. Technological advances and changes to the administration of higher education present new opportunities for criminals and greater challenges for law enforcement. Federal law is reactive, but colleges and universities must be proactive by extending orientation periods, mandating in-person orientations, assigning more coursework during the first weeks of class, reporting nonattending students, and delaying or compartmentalizing financial aid disbursements to help eliminate this white-collar crime.

April 7, 2025 – News Podcast


Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Cigna Faces Class Action for Use of PxDx Algorithm to Deny Claims. Legal Aid Lawsuit Forces EDD to Fix Broken UI Notification System. UIM Arbitration is Not a “Civil Action” Protected by Covid Rules. Old Arbitration Agreements Need Clear Wording After Viking River. After Supreme Ct. Remand, CSU Need Not Reimburse Employees. LA Couple Sentenced for $2.3M WC Premium Fraud. San Diego Plumbing Contractor Sentenced for SCIF Premium Fraud. EDD Employee to Serve 66 Months for Fraud and Bribery Scheme.

2024 Developments in Orthopedic Surgical and Non-Surgical Care

According to a new report by the The Kettering Joint Center, 2024 has ushered in a new era for orthopedic research, with the field experiencing a surge of innovation and advancement in the way physicians approach musculoskeletal health.

One of the most significant shifts in orthopedic medicine has been the move towards personalized medicine. Advances in genetic testing and the understanding of individual patient’s unique biology have paved the way for treatments that are tailored to the specific needs of each patient. This personalized approach has the potential to significantly improve the efficacy of treatments and reduce the risk of complications.

Technology has played a pivotal role in shaping these new therapies. From the use of 3D printing to create custom implants to the development of advanced imaging techniques that provide detailed insights into joint health, technology has enabled orthopedic surgeons to perform procedures with unprecedented precision and accuracy. Moreover, the integration of wearable sensors and mobile health applications has allowed for continuous monitoring of patients’ recovery, enabling real-time adjustments to treatment plans.

The field of orthopedics has also seen a rise in the use of regenerative medicine, with stem cell therapy and platelet-rich plasma treatments gaining traction as viable alternatives to traditional surgical interventions. These therapies harness the body’s natural healing mechanisms to repair damaged tissues, offering hope to patients suffering from a range of orthopedic conditions.

Robotic-assisted surgery represents a significant leap forward in orthopedic surgical precision. Surgeons are now able to leverage robotic systems that provide unparalleled accuracy and control during operations. These systems, often guided by pre-operative imaging and real-time intraoperative data, allow for the precise placement of implants and the meticulous execution of bone cuts. The benefits are clear: reduced risk of complications, improved surgical outcomes, and a more predictable recovery process for patients. The integration of robotics has particularly revolutionized joint replacement surgeries, where the alignment and positioning of implants are critical to long-term success.

The advent of 3D printing technology has ushered in an era of personalized orthopedic care. Custom implants, tailored to the exact anatomical specifications of an individual patient, can now be manufactured with remarkable speed and precision. This technology has been particularly beneficial for patients with complex bone deformities or unique anatomical structures, where off-the-shelf implants may not provide the best fit.

Orthopedic care in 2024 has seen a significant shift towards non-surgical therapies that offer alternatives to traditional invasive procedures. These emerging treatments have the potential to revolutionize the way we address musculoskeletal conditions, providing patients with less invasive options that can yield impressive results.

Regenerative medicine has taken center stage in orthopedic non-surgical treatments. Two of the most promising therapies within this field are stem cell therapy and platelet-rich plasma (PRP) injections.

Targeted drug delivery systems have become increasingly sophisticated, allowing for the precise administration of medications directly to the site of injury or disease. This approach minimizes systemic side effects and maximizes the therapeutic impact.

The identification of specific biomarkers has revolutionized the diagnosis of orthopedic conditions. Through advanced laboratory techniques, healthcare professionals can now detect and measure biological indicators of inflammation, tissue damage, and disease progression. This has led to more objective and quantifiable diagnoses, paving the way for targeted therapies.

One of the most anticipated developments is the potential for bioabsorbable implants, which offer the advantage of eliminating the need for a second surgery to remove permanent implants. These implants are designed to break down over time, allowing the body to heal naturally without foreign objects remaining.

Despite the technological advancements, the orthopedic community faces the critical challenge of conducting robust clinical trials to validate new treatments. The high cost and complexity of these trials can be a barrier to progress, and there is a pressing need for more efficient and collaborative approaches to research.

ASHP Reports AI Helps Pharmacists Streamline Routine Tasks

The American Society of Health-System Pharmacists (ASHP), is the largest association of pharmacy professionals in the United States, representing 60,000 pharmacists, student pharmacists, and pharmacy technicians in all patient care settings, including hospitals, ambulatory clinics, and health-system community pharmacies. For over 80 years, ASHP has championed innovation in pharmacy practice, advanced education and professional development, and served as a steadfast advocate for members and patients.

According to an ASHP new report this month, Pharmacy informaticists say that although they’re optimistic about the potential for artificial intelligence (AI) to improve patient care, some of the best current uses of the technology target nonclinical tasks that help keep the pharmacy running.

“I think AI is going to revolutionize a lot of the things that we do and free us up to do other things. But it’s just a tool,” said Kendall Gross, manager of the pharmacy informatics team for University of California, San Francisco (UCSF) Health. “What we have really focused on as we build trust is things like administrative tasks, or pain points, where we can leverage AI and then use the human to validate, rather than having the human mine data or do manual transcription work.”

What that means in practice is that a UCSF-developed large language model platform sorts incoming faxes, reads invoices, and identifies documentation and billing opportunities – common administrative tasks that used to be performed manually by the pharmacy staff.

Gross said additional areas under exploration include integrating AI into prior authorizations, prescribing, and dose adjustments and using the technology to make audits more efficient.

“We have a really talented pharmacy analytics team,” she said. “They have been identifying problems and potential use cases and then leveraging this internal large language model tool to build things ourselves to solve problems.”

Arlene Johnstone, pharmacy director for MarinHealth Medical Center, a 327-bed facility in the North Bay region of San Francisco, said her department uses AI technology to manage the facility’s automated dispensing cabinets (ADCs), replacing a tedious manual process for assessing and maintaining stock levels in the cabinets.

It looks at all the movement, expiration dates, and volumes,” Johnstone said. “It basically is telling us things like, ‘Move that product that’s about to expire over to this other unit where you’re using it more.’ And it’s really improved our efficiency tremendously.” Previously, she said, the pharmacy team spent a lot of time on the phone with nursing “chasing complaints” about ADC stock levels.

“I don’t think we were completely aware that this was really a problem,” Johnstone recalled. “It was just kind of way it was.”

After the ADC vendor’s AI product was fully implemented a couple years ago, the number of complaints declined substantially. The technology also cut by half the number of trips pharmacy and nursing staff made to the ADCs looking for products that weren’t there and then restocking and retrieving those items.

It really reduced the stress on our staff,” Johnstone said. She added that with the more efficient process in place, the department has redeployed some pharmacy technicians to better support clinical care.

The pharmacy team’s experience with this AI tool underscored the need for human oversight of both the AI system and the people who use it.

Johnstone said that after a smooth initial deployment, the pharmacy suddenly began fielding an influx of complaints about the ADCs. The problem was traced to a system user who was inadvertently silencing some of the AI tool’s alerts – an issue that was readily resolved through training.

The medical center also uses an AI product to strengthen its diversion prevention program. The tool, which was implemented as part of an electronic health record (EHR) system replacement, analyzes all ADC transactions to track the movement of controlled substances throughout the facility.

Critic of Medi-Cal Crisis Launches SoCal Fraud and Corruption Task Force

In early 2025, California Governor Gavin Newsom requested a $6.2 billion emergency bailout for Medi-Cal, the state’s Medicaid program, to address a significant funding shortfall. This request was broken into two parts: a $3.4 billion loan from the general fund to cover costs through March 2025, followed by an additional $2.8 billion to sustain the program through June 2025. The shortfall stemmed from higher-than-expected costs, with total Medi-Cal spending projected to reach $188.1 billion for the 2025-26 fiscal year, an 84% increase over six years.

Several factors contributed to the overrun. Enrollment surged beyond projections, partly due to expanded eligibility for undocumented immigrants, which began in 2024 and cost an estimated $9.5 billion in 2024 alone, including $2.8 billion in unanticipated expenses. Other drivers included rising pharmacy costs and higher overall enrollment, partly due to pandemic-era policies that delayed eligibility reviews. About 15 million Californians, roughly half the state’s children, rely on Medi-Cal for healthcare.

The request sparked debate. Republicans, including Assembly Minority Leader James Gallagher and Senator Brian Jones, criticized the expansion to undocumented immigrants, arguing it strained the system and reduced access for legal residents. They called for an audit to investigate cost spikes, with some, like Assemblyman Bill Essayli, claiming the program was insolvent. Democrats, however, defended the expansion as a step toward universal healthcare, with Newsom himself stating it was “partially” responsible for the shortfall but aligning with his belief in universal coverage. He expressed openness to adjustments but ruled out reversing the expansion.

Bill Essayli is now currently serving as the interim United States attorney for the Central District of California, having been appointed to the position in April 2025. He previously served as a member of the California State Assembly from 2022–2025 until his appointment as interim U.S. attorney. On April 8, 2025, as United States Attorney, Essayli announced the formation of the Homelessness Fraud and Corruption Task Force, which will investigate fraud, waste, abuse, and corruption involving funds allocated toward the eradication of homelessness within the seven-county jurisdiction of the Central District of California. The Central District of California is comprised of approximately 20 million residents within the counties of Los Angeles, Orange, Riverside, San Bernardino, San Luis Obispo, Santa Barbara, and Ventura.

This task force will be comprised of federal prosecutors from the Major Frauds Section, the Public Corruption and Civil Rights Section, and the Civil Division’s Civil Fraud Section of the United States Attorney’s Office for the Central District of California. Assisting the U.S. Attorney’s Office will be the FBI, the United States Department of Housing and Urban Development Office of Inspector General (HUD-OIG), and IRS Criminal Investigation.

Despite voter-approved initiatives and billions of dollars spent on tackling this issue, homelessness remains a crisis, especially in Los Angeles County. Last month, a court-ordered audit found that homelessness services provided by the city and county of Los Angeles were “disjointed” and contained “poor data quality and integration” and lacked financial controls to monitor contracts for compliance and performance.

Newsom’s administration noted that tax revenues were holding up, with February 2025 collections $4.6 billion above projections, providing some fiscal cushion. However, the bailout adds pressure to California’s budget, already facing a proposed $7 billion reserve withdrawal for 2025-26. Critics worry about long-term sustainability, especially with potential federal Medicaid cuts looming under the Trump administration. Democrats, like Assemblymember Pilar Schiavo, argued the increased enrollment reflects successful coverage efforts, while Newsom’s team pledged to work with legislative leaders to curb long-term spending without gutting core services.

Novo Nordisk and Others Challenge Medicare Drug Price Negotiations

Novo Nordisk, a major pharmaceutical company known for its diabetes and weight-loss drugs like NovoLog, Ozempic, and Wegovy, has been pushing back against a U.S. government program that allows Medicare to negotiate prices for certain high-cost prescription drugs. This program, part of the Inflation Reduction Act passed in 2022, aims to lower the cost of medications for millions of Americans, particularly seniors, by enabling Medicare to directly bargain with drugmakers for better prices. The first round of negotiations, which included some of Novo Nordisk’s insulin products, set new prices to take effect in 2026, while a second round targeting Ozempic and Wegovy is underway for 2027.

The company’s challenge stems from its belief that the negotiation process is unfair and oversteps legal boundaries. Novo Nordisk argues that the program forces them to accept lower prices under threat of hefty penalties, like steep taxes or losing access to Medicare and Medicaid markets, which they see as coercive rather than voluntary. They’ve raised concerns about the program violating constitutional protections, claiming it compels them to agree to prices that imply their drugs were overpriced before, which they argue infringes on free speech and due process. They also worry that lower prices could hurt their ability to fund research and development for new treatments.

On the other side, supporters of the program, including lawmakers and patient advocates, argue it’s a long-overdue step to make life-saving drugs more affordable. Medicare spends billions annually on medications like Novo Nordisk’s, with semaglutide-based drugs alone costing over $14 billion in a recent year. High drug prices can leave patients struggling to afford treatments, sometimes forcing tough choices between medicine and other essentials. The government contends that negotiating prices is a standard practice in other industries and countries, and the program is designed to balance affordability with innovation.

Novo Nordisk initially filed a lawsuit in 2023, challenging the program’s legality in a New Jersey federal court, but lost when a judge ruled participation was voluntary and didn’t violate their rights. They’ve since appealed to a higher court, arguing the program gives the government too much unchecked power. Meanwhile, they’ve reluctantly agreed to participate in both rounds of negotiations, likely to avoid penalties while their legal fight continues. The outcome of this challenge could shape how the U.S. tackles drug pricing, affecting patients, taxpayers, and the pharmaceutical industry for years to come.

Several other drugmakers have filed lawsuits challenging the Medicare drug price negotiation program under the Inflation Reduction Act, echoing concerns similar to Novo Nordisk’s about its legality and fairness. Companies like Merck, Bristol Myers Squibb, Johnson & Johnson, AstraZeneca, and Boehringer Ingelheim have all taken legal action, arguing the program violates constitutional protections, such as property rights and free speech, by forcing them to accept government-set prices under threat of penalties.

The pharmaceutical industry’s main trade group, PhRMA, along with organizations like the U.S. Chamber of Commerce, have also sued, claiming the program oversteps federal authority and could harm innovation. These cases, filed across various federal courts, have mostly been unsuccessful so far, with judges ruling that participation is voluntary since companies can opt out of Medicare entirely.

However, appeals are ongoing, and some companies hope conflicting rulings might push the issue to the Supreme Court. Despite the lawsuits, all affected drugmakers have participated in negotiations to avoid steep fines or losing access to Medicare’s massive market.

L.A. Judge Disqualified Post Trial and $10M FEHA Verdict Reversed

Plaintiff Sabrena Odom was and still is a tenured professor at Southwest College. She began as an adjunct, and in 2005 was hired full time, working 50/50 as an English instructor and as director of the Student Success Center, which offered tutoring and workshops to enable student learning.

Defendants are the District and Dr. Irvin, the alleged harasser. Dr. Irvin joined Southwest College in 2016 as vice president of student services. He had been an officer with the Los Angeles Police Department for 13 years, until he retired in 1998, 18 years before he joined Southwest College. After leaving the police department, he began a career in community counseling and worked at several community colleges in southern California. He earned his Ph.D. in 2007.

In October 2018, Odom filed a complaint for damages, alleging sexual harassment; failure to investigate and prevent sexual harassment; retaliation; and negligent hiring, supervision and retention, in violation of the Fair Employment and Housing Act (FEHA; Gov. Code, § 12940 et seq.), against defendants Los Angeles Community College District and Howard Irvin, then the vice president of student services at Los Angeles Southwest College, a community college in the District.

Plaintiff testified that the sexual harassment began in February 2017 and continued for about eight months. In early November 2017, plaintiff went to Denise Noldon, the interim president of Southwest College, and told her she was being sexually harassed by Dr. Irvin, had not complied with his wishes, and felt she was being retaliated against “with an attack against my program as well as my staff.” Plaintiff testified that nothing happened in response to her complaint.

During the summer of 2017, someone had slipped an article from The Los Angeles Times under her door, with the handwritten words, “Watch Out.” (There were actually two articles, one dated Feb. 25, 1998, and the other dated Oct. 30, 1997.) Plaintiff stated that the article “detailed Dr. Irvin’s past as an LAPD officer and his conviction of sexual assault. I was already uneasy around him, but after reading the article, I became frightened whenever he was around. I didn’t want to become a victim of his like the woman in the article. One day during a meeting with Dr. Irvin, I asked him if he carried a gun. His response was, ‘No, but I can get to it when I need it.’ Another time, I asked him the same question and he said, ‘Of course.’ “

During her trial testimony, plaintiff’s counsel asked plaintiff to explain more about The Times’s articles. Defense counsel objected on hearsay grounds. The court stated, “Well, the L.A. Times is not being admitted for the truth. What the L.A. Times article says is being admitted for her reaction, not admitted for the truth, so it’s overruled.”

Judge Robert S. Draper presided over a three-week trial in October 2022. There were more than 20 witnesses.Dr. Irvin’s criminal defense attorney testified Dr. Irvin was never convicted of any sex crime, and there was no evidence at trial to support plaintiff’s belief that he had been.

After deliberating for less than a day, the jury found in favor of plaintiff on each of her four claims. As to the District, the jury awarded plaintiff $8.5 million in noneconomic damages ($7 million for past mental suffering and emotional distress and $1.5 million for future mental suffering and emotional distress). As to Dr. Irvin, the jury awarded $1.5 million in noneconomic damages for past mental suffering and emotional distress. The jury found by clear and convincing evidence that Dr. Irvin acted with malice or oppression, but in the punitive damages phase of the trial, the jury declined to award any damages.

Defendants moved for partial judgment notwithstanding the verdict, or in the alternative for remittitur, based on excessive damages. “The hearing on defendants’ motions was held on February 15, 2023. The trial court made comments at the hearing, and later in chambers, reflecting his personal feelings and perspectives about societal and civil rights advances of Black Americans and the progress our society has made respecting women in the workplace since he was a college student and then a young attorney decades ago. At times during the hearing, Judge Draper appeared to become emotional and repeatedly described the personal effect the testimony had on him as a grandfather.”

The Court of Appeal reversed the judgment and ordered a new trial in the published case of Odom v L.A. Community College District – -B327997 (April 2025) “not for lack of substantial evidence, but for prejudicial errors in the admission of irrelevant and damaging “me-too” evidence from a witness who was not similarly situated to plaintiff, and for the equally prejudicial and erroneous admission of 20-year-old newspaper articles and other evidence of the alleged harasser’s misdemeanor convictions.”

The Court of Appeal also wrote “This is an unusual case, due to the significant arbitrary and prejudicial evidentiary rulings of the judge presiding over the trial. After the judgment was entered, defendants filed motions for a new trial (or in the alternative a remittitur) and for partial judgment notwithstanding the verdict (JNOV) (or in the alternative for remittitur). At the hearing on those motions, which were denied, the trial judge initiated extended, bizarre personal comments on racial matters with newly substituted defense counsel (the only Black woman in the courtroom), despite there being no racial issue of any kind in the case. Defendants filed a motion to disqualify the judge for cause and to void his rulings on the motions. After writ proceedings and referral to a neutral judge, the trial judge was disqualified and his rulings on the postjudgment motions were voided.”

“On this appeal from the judgment, we need not decide whether the trial judge’s prejudicially erroneous evidentiary rulings during the trial were motivated, in part, as defendants contend, by “persistent racial and gender bias.” It seems clear the judge’s rulings were motivated by personal opinions untethered to the rules of evidence. Whatever his motivations may have been, the judge admitted inflammatory evidence without consideration of the evidentiary rules, with undeniable prejudicial effect, thus preventing a fair trial. We accordingly reverse the judgment and order a new trial.”

During the post trial hearing, “Judge Draper made many inappropriate remarks, including comments using racial terms. For example, Judge Draper stated that plaintiff and Dr. Irvin came from the same neighborhood: ‘And I use the term that my wife says is not politically acceptable. I think they are politically acceptable, because I use terms like coal black and light brown because I don’t think those are bad terms.’ ”

Judge Draper’s statements at the hearing led to a motion by defendants on March 3, 2023, to disqualify him for cause. Judge Draper issued a lengthy “recusal order” finding there were no legal grounds for disqualification for cause but recusing himself from further proceedings in the case.

Defendants sought writ review, and this court directed the superior court to refer the disqualification motion to a neutral judge. On October 16, 2023, Orange County Superior Court Judge Cheri Pham disqualified Judge Draper, stating that the evidence defendants submitted “establishes that during the February 15, 2023 hearing, Judge Robert S. Draper made several irrelevant and inappropriate comments about race and gender. Defendants’ attorney was the only African American person in the courtroom. Under these circumstances, and on the record presented, a person aware of the facts might reasonably entertain a doubt whether Judge Draper would be impartial.” Judge Pham also observed that, in response to our alternative writ, Judge Draper had vacated his recusal orders, and there was no verified answer to defendant’s disqualification motion; so the judge was deemed to have consented to his disqualification.

DWC Releases 2024 Independent Medical Review (IMR) Report

In September 2012, Governor Brown signed SB 863 into law. This reform of the workers’ compensation system in California included adoption of the IMR process, which went into effect on January 1, 2013, for injuries that occurred in 2013. On July 1, 2013, IMR was available to all injured workers regardless of their dates of injury.

The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have posted an annual report on the Department’s Independent Medical Review (IMR) program. IMR is the medical dispute resolution process for the state’s workers’ compensation system that resolves disputes over medical treatment for injured workers. The report describes IMR program activity in 2024, the twelfth year since the program was implemented.

The Independent Medical Review Organization (IMRO) administering the program, Maximus Federal Services, Inc., received 199,651 IMR applications, and issued 141,621 Final Determination Letters, each addressing one or more medical necessity disputes. Throughout the year, the IMRO issued decisions, on average, six to seven days after receipt of all medical records.

Some highlights of the report are as follows:

– – Nearly 90% of all unique IMR filings were deemed eligible for review, slightly less than the annual percentage for those filed in 2023.
– – Pharmaceutical requests accounted for 33% of all treatment requests sent for IMR, a slightly higher proportion of total service requests than in previous years.
– – Opioids comprised 24% of all pharmaceutical requests.
– – Treatment request denials were overturned at an overall rate of 12.7%, an increase from the previous year (10.2%). The denials that were overturned most often were for evaluation and management services, followed by other programs such as Functional Restoration program, Brain Injury program, Weight loss program, and behavioral and mental health service.
– – Guidelines contained in the Medical Treatment Utilization Schedule continue to serve as the primary resource for the determination of medical necessity.

Expert reviewers may hold licenses to practice in any of the 50 states. Reviewers licensed in California evaluated 81% of the decisions in 2024. This is a lesser proportion than in the previous years, when reviewers licensed in the state evaluated 83% of the decisions issued in 2023, and 87% of the decisions issued in 2022.

Filing Claim in Employers’ Bankruptcy Not Required for UEBTF Benefits

Adan Alvarez was employed on June 11, 2015 as a mover by Victor Manuel Martinez, individually and doing business as Bob Williams Moving, and Justine Marie Martinez, individually and doing business as Tristar Moving, and claimed to have suffered injury to multiple areas. It was stipulated by the parties that the employer was uninsured.

After a trial, the WCJ found applicant failed to file a proof of claim in the bankruptcy proceeding against alleged employers Victor Manuel Martinez and Justine Marie Martinez. Applicant did not strictly meet the statutory conditions that would render the Uninsured Employers Fund (UEF) liable for payment, and is now enjoined from obtaining an award in a workers’ compensation proceeding enforceable against Victor Manuel Martinez and Justine Marie Martinez personally or the UEF. Therefore, the undersigned WCJ found good cause to dismiss applicant’s claim with prejudice.

The WCAB granted reconsideration, and reversed in the panel decision of Alvarez-1 v Bob Williams Moving – ADJ10037291 (January 2025).

Applicant argued in Alvarez1 that the trial court’s reliance in Ortiz v. Workers’ Comp. Appeals Bd. (1992) 4 Cal.App.4th 392 is misplaced because the employee in Ortiz, unlike applicant here, had an award of temporary disability and reimbursement for medical treatment. Applicant further argues laches because UEBTF participated in discovery and was aware of the bankruptcy court’s lifting of the automatic stay and applicant’s failure to file a proof of claim in the bankruptcy proceedings. Applicant contends UEBTF should have alerted applicant of the requirements set forth in Ortiz.

The Ortiz court stated: “Assuming the prerequisites to payment by the UEF have been met, if a findings and award in a workers’ compensation proceeding issues prior to a discharge of an employee’s claim in bankruptcy, the UEF would pay the award, become a creditor, and thus be able to file its own proof of claim in the bankruptcy proceeding.” And “The discharge in bankruptcy operates as an injunction prohibiting any proceeding against the employer for personal liability based on the award, however, including the UEF’s right to seek reimbursement pursuant to Labor Code section 3717.”

The WCAB panel noted “The Ortiz court, however, did not address whether an employee is required to file a proof of claim in the bankruptcy proceedings in this situation-when there is no workers’ compensation award before the discharge.” And it went on to find Slali v. Ruiz (2002) 282 B.R. 225 [67 Cal.Comp.Cases 634] instructive.

“In Ruiz, just as in this case, the employee did not file a proof of claim in the Chapter 7 bankruptcy proceedings of the employers. (Id. at p. 636.) The bankruptcy court entered discharges in favor of both employers as there were no assets to distribute. (Ibid.) The employee then petitioned for relief in the bankruptcy proceedings in order to pursue his workers’ compensation claims. (Ibid.) The bankruptcy court provided such relief and entered an order that (1) allowed the employee to pursue an award against the employers in his workers’ compensation case; (2) no personal liability on behalf of the employers to the employee would be created; (3) the employee would not be allowed to seek satisfaction of any award against the employers absent further orders from the bankruptcy court; (4) the employee’s claim remained open and pending before the WCAB and had not been resolved or decided; and (5) the employers’ participation in the litigation before the WCAB would not be affected by the bankruptcy order. (Ibid.)”

The bankruptcy court’s order was appealed to the United States District Court, which affirmed the bankruptcy court’s order.The District Court further explained that although it does not believe that the employee needed relief from the discharge injunction, it was prudent for the employee to seek such relief to serve as a clarification regarding the scope of the discharge injunction and avoid conflict between the workers’ compensation and bankruptcy proceedings. (Ruiz at p. 638.)

Ruiz instructs us that a failure to file a claim of proof in the bankruptcy proceedings when an employee does not yet have a compensation award from which to file a proof of claim is not fatal. We, therefore, conclude that the trial court’s finding that applicant here is enjoined from pursuing his workers’ compensation claim was in error.”

The Uninsured Employers Benefits Trust Fund (UEBTF) Petition for Reconsideration of Alvarez-1 was denied in In Alvarez-2 v Bob Williams Moving ADJ10037291 (April 2025),

In Alvarez-2 UEBTF contends that the WCAB failed to appreciate the difference between a Chapter 7 asset bankruptcy and a Chapter 7 no asset bankruptcy. According to UEBTF, in the former, a creditor such as applicant is required to file a proof of claim in a bankruptcy proceeding and failure to do so enjoins applicant from later seeking payment from UEBTF. In the latter, a failure to file a proof of claim is not fatal as demonstrated in In re Manuel D. Slali (Bankr. C.D.Cal. 2002) 282 B.R. 225 [67 Cal.Comp.Cases 634]. UEBTF contends that the underlying bankruptcy proceeding here was a Chapter 7 asset bankruptcy and, therefore, applicant was required to file a proof of claim in order to later seek payment from UEBTF.\

UEBFT cites to Duncan v. Workers Compensation Appeals Bd. (1998) 63 Cal. Comp. Cases 309 [1998 Cal. Wrk. Comp. LEXIS 4510] to support its argument. In Duncan, the WCJ found that in order to reinstate a workers’ compensation award, applicant “must obtain a modification of the discharge order in bankruptcy allowing a personal judgment to be entered against the uninsured employer.” (Duncan, at p. 310.)

After reviewing Duncan, the WCAB concluded in Alvarez-2 that the “Duncan court simply held that in a no asset case, it was not necessary to seek modification of the discharge injunctions in the bankruptcy court. Duncan does not stand for the proposition that a failure to file a proof of claim in the bankruptcy proceeding, whether it be an asset or no asset proceeding, enjoins the employee from later seeing payment from UEBTF. As such, we affirm our January 3, 2025 Opinion allowing applicant’s workers’ compensation claim to proceed despite his failure to file a proof of claim in the underlying bankruptcy proceeding.