Author: WorkCompAcademy

A former insurance agent was sentenced to three years of formal probation and time served, and ordered to pay restitution after pleading guilty to one felony count of insurance fraud for embezzling from his employer.

Zachary Dale Jackson, 31, of Santa Maria must pay back $4,389 under the terms of the deal.

An insurance company alerted California Department of Insurance investigators, who determined that while Jackson worked as an agent for the firm, he falsified insurance documents related to his own personal insurance claim.

He also embezzled funds from the insurance company by writing multiple checks, adding up to $4,388 to himself from the company’s account.

“I have zero tolerance for agents who violate the principles of their license and rip off insurers or consumers for their own financial gain,” said Insurance Commissioner Dave Jones. “Dishonest agents reflect poorly on the more than 350,000 licensed agents and brokers, most of whom do their best to be honest and professional in their business practices in California.”

The department’s investigation led to Jackson’s arrest in November 2017, and he initially faced five felony charges, according to Santa Barbara County Superior Court records. Jackson was sentenced in June.

The state revoked Jackson’s agent license and barred him from transacting the business of insurance.

The case was prosecuted by the Santa Barbara County District Attorney’s Office, and he was represented by the Santa Barbara County Public Defender’s Office.

A pharmacy in Lakeside, California and its owners have paid $75,000 to resolve allegations that they failed to properly account for highly addictive and frequently abused opioids, including fentanyl.

The settlement is with Archana Corporation and its owners Rajeshbhai Zalavadiya and Ramesh Rakholia. The Archana Corporation, Zalavadiya, and Rakholia do business as Leo’s Lakeside Pharmacy.

This settlement arises from a Drug Enforcement Administration (DEA) investigation into Leo’s Lakeside Pharmacy’s opioid dispensing practices. In response to the Justice Department’s focus on combatting the opioid epidemic, the DEA has continued to conduct inspections and audits at pharmacies throughout the Southern District of California. Leo’s Lakeside Pharmacy was one of those pharmacies. Based on the DEA’s inventory audits, inspections, and other investigative activities, the United States asserts that Leo’s Lakeside Pharmacy violated the Controlled Substances Act (CSA).

The CSA applies to all registered controlled substances handlers, including pharmacies. The CSA also subjects registered pharmacies to strict requirements regarding inventory control and recordkeeping. These requirements ensure that pharmacies account for controlled substances from the time of purchase until they are dispensed to patients. The alleged violations include failure to keep accurate records associated with pharmaceutical fentanyl, oxycodone, and hydrocodone

In addition to paying $75,000 in settlement to the government, Leo’s Lakeside Pharmacy has committed to implementing new inventory control procedures to assure full accountability of all controlled substances. .

“This investigation is a reminder to the pharmacy community that lax recordkeeping opens the door to the diversion of highly addictive pharmaceuticals,” states Drug Enforcement Administration San Diego Field Division Special Agent in Charge Karen Flowers. “These pills can and do make their way into the illegal distribution stream of narcotics which continue to fuel the opioid epidemic.”

This matter was handled by Assistant U.S. Attorney Dylan M. Aste of the U.S. Attorney’s Office for the Southern District of California and the Drug Enforcement Administration.

An artificial intelligence (AI) system scored 2:0 against elite human physicians in two rounds of competitions in diagnosing brain tumors and predicting hematoma expansion.

The BioMind AI system, developed by the Artificial Intelligence Research Centre for Neurological Disorders at the Beijing Tiantan Hospital and a research team from the Capital Medical University, made correct diagnoses in 87 percent of 225 cases in about 15 minutes, while a team of 15 senior doctors only achieved 66-percent accuracy.

The AI also gave correct predictions in 83 percent of brain hematoma expansion cases, outperforming the 63-percent accuracy among a group of physicians from renowned hospitals across the country.

The outcomes for human physicians were quite normal and even better than the average accuracy in ordinary hospitals, said Gao Peiyi, head of the radiology department at Tiantan Hospital, a leading institution on neurology and neurosurgery.

To train the AI, developers fed it tens of thousands of images of nervous system-related diseases that the Tiantan Hospital has archived over the past 10 years, making it capable of diagnosing common neurological diseases such as meningioma and glioma with an accuracy rate of over 90 percent, comparable to that of a senior doctor.

All the cases were real and contributed by the hospital, but never used as training material for the AI, according to the organizer.

AI will not only reduce the workload but also push doctors to keep learning and improve their skills, said Lin.

Bian Xiuwu, an academician with the Chinese Academy of Science and a member of the competition’s jury, said there has never been an absolute standard correct answer in diagnosing developing diseases, and the AI would only serve as an assistant to doctors in giving preliminary results.

Dr. Paul Parizel, former president of the European Society of Radiology and another member of the jury, also agreed that AI will not replace doctors, but will instead function similar to how GPS does for drivers.

Dr. Gauden Galea, representative of the World Health Organization in China, said AI is an exciting tool for healthcare but still in the primitive stages.

China has introduced a series of plans in developing AI applications in recent years.

In 2017, the State Council issued a development plan on the new generation of Artificial Intelligence and the Ministry of Industry and Information Technology also issued the “Three-Year Action Plan for Promoting the Development of a New Generation of Artificial Intelligence (2018-2020).”

The Action Plan proposed developing medical image-assisted diagnostic systems to support medicine in various fields.

The Labor Commissioner’s Office has issued wage theft citations to a large farm labor contracting operation for failing to timely provide 1,374 seasonal farm workers their final pay.

Vista Santa Rosa Inc. did not pay discharged workers on the last day of work as required by law, and the company consistently issued final paychecks at least 72 hours late. Both client employers and their labor suppliers are accountable for workplace labor law violations in California.

An investigation was launched in August 2016 after workers reported violations of late pay to California Rural Legal Assistance, a nonprofit that provides free legal services. The investigation identified $646,875 in waiting time penalties, of which $323,729 is due to 867 affected workers in 2016, and $323,145 is due to 864 workers in 2017.

Vista Santa Rosa Inc. hires and provides farm workers to growers in the Coachella Valley region. In 2016, Vista was a sole-proprietorship owned and operated by Jose Luis Gomez Jr. In 2017 Gomez began doing business as Vista Santa Rosa Inc. Both Gomez and his successor company Vista share joint and several liability for the $646,875 in waiting time penalties.

California Labor Code section 2810.3 holds client employers – those that obtain or are provided workers from a subcontractor – responsible for their subcontractor’s workplace violations. Client employers also liable for Vista’s violations include:

— Brighton Distributing, Inc.
— Alexandra Dates, Inc.
— Coachella Valley Ranch Development, Inc.
— MICA, LLC
— The Wildwood Group, Inc.
— East-West Unlimited, LLC
— Anthony Vineyards, Inc.
— Sun World International, LLC

If a worker quits, final wages are due within 72 hours of the notice. Waiting time penalties are imposed when the employer intentionally fails to pay all wages due to the employee at the time of separation. This penalty is calculated by taking the employee’s daily rate of pay and multiplying it by the number of days the employee was not paid, up to a maximum of 30 days.

Enforcement investigations typically include a payroll audit of the previous three years to determine minimum wage, overtime and other labor law violations, and any payments owed and penalties due are calculated.

Federal officials are charging 601 people in the largest bust of health care fraud in U.S. history. Southern California criminal cases named a total of 33 defendants. Nine new defendants being charged as part of Operation “Spinal Cap.” The scheme was spearheaded by Michael Drobot, the former owner of Pacific Hospital in Long Beach.

In the cases announced in Operation Spinal Cap Daniel Capen, 68, of Manhattan Beach, an orthopedic surgeon, has agreed to plead guilty to conspiracy and illegal kickback charges. Capen accounted for approximately $142 million of Pacific Hospital’s claims to insurers, on which the hospital was paid approximately $56 million.

Timothy Hunt, 53, of Palos Verdes Estates, another orthopedic surgeon who referred spinal surgery patients to Capen and other doctors, has agreed to plead guilty to a conspiracy charge involving his receipt of illegal kickbacks stemming from various financial relationships with Pacific Hospital and related entities.

George William Hammer, 65, of Palm Desert, the former chief financial officer of the physician management arm of Pacific Hospital, has agreed to plead guilty to tax charges based on the fraudulent classification of illegal kickbacks in hospital-related corporate tax filings.

Lauren Papa, 52, of Tarzana, a chiropractor, has agreed to plead guilty to a conspiracy charge involving her receipt of illegal kickbacks to refer patients to a neurosurgeon with the understanding that the neurosurgeon would perform the surgeries at Pacific Hospital.

Tiffany Rogers, 53, of Palos Verdes Estates, an orthopedic surgeon, was named in an indictment unsealed Wednesday in connection with receiving illegal kickbacks to refer patients for spinal surgeries at Pacific Hospital.

Brian Carrico, 64, of Redondo Beach, a chiropractor – along with Performance Medical & Rehab Center, Inc., which was partially owned by Carrico; and One Accord Management, Inc., which Carrico wholly owned – were charged in connection with the receipt of illegal kickbacks to influence the referral of patients to Pacific Hospital. An indictment unsealed Wednesday alleges that these defendants and other co-conspirators were responsible for approximately $80 million in claims submitted to the federal workers’ compensation program and were paid approximately $56 million in connection with patients that Performance Medical referred to Pacific Hospital.

William Parker, 64, of Redondo Beach, was charged in a separate indictment unsealed on Wednesday in connection with the same kickback scheme involving Carrico and his companies.

In San Diego, the cases include Marco Antonio Chavez, a licensed medical doctor specializing in psychiatry, was charged with 30 counts of health care fraud in connection with over $928,000 in bills he submitted to TRICARE for services he never provided. He was also charged with five counts of aggravated identity theft and one count of obstruction of a federal audit..

Four defendants, including two chiropractors, a physical therapist and an acupuncturist, were charged with conspiracy to commit health care fraud and honest services fraud and to pay unlawful kickbacks stemming from their operation of R.I.S.E. Medical Center. According to the indictment, R.I.S.E. operated several “Wellness Centers” in San Diego County, including Bonita and Oceanside, and offering a range of services including physical therapy, diagnostic tests, massages, chiropractic treatments, and acupuncture..

Joserodel Zavala Candelario, a chiropractor and owner of R.I.S.E., imposed quotas for non-reimbursable services and treatments, allegedly telling staff that they were expected to provide a certain number of diagnostic tests, “no matter what”; to “grab patients in lobbies to put into provider schedules”; and to ply patients with complimentary treatments so R.I.S.E. could continue to fraudulently bill TRICARE and Medicare.  

In addition, Candelario was also charged with paying a patient recruiter over $18,000 to refer TRICARE patients to the R.I.S.E. clinic. The recruiter, Mariam Reyes, was charged separately with conspiring to solicit and receive kickbacks.

In a separate indictment, Candelario was charged with participating in a scheme to defraud California Workers’ Compensation insurers and R.I.S.E. patients by receiving illegal kickbacks and bribes to refer patients to certain providers. According to the indictment, Candelario paid kickbacks to his co-schemers through a front company in exchange for referrals of Workers’ Compensation patients, and then concealed these kickbacks through sham “marketing” agreements.

One of Candelario’s co-schemers, Boris Dadiomov, was charged separately for his role in the fraudulent conspiracy. As a result of their unlawful cross-referral kickback scheme, Candelario and the other schemers received over 500 illegal patient referrals and submitted over $6.6 million in false billings to insurance companies.