Author: WorkCompAcademy

A doctor who operated a medical clinic in Lynwood has been found guilty of drug-trafficking charges after a federal jury found that he issued prescriptions for powerful narcotics and sedatives without a medical purpose for mostly young “patients” who sometimes traveled more than 100 miles to get prescriptions.

Dr. Edward Ridgill, 65, who has residences in Whittier and Newbury Park, was found guilty of 26 felony counts of illegally distributing controlled substances.

The evidence presented during a one-week trial showed that Ridgill illegally prescribed the opioid painkiller hydrocodone, which is often sold under the brand name Norco; alprazolam, best known by the brand name Xanax; and carisoprodol, a muscle relaxer often sold under the brand name Soma.

Prosecutors presented evidence at trial from a California database that tracks prescriptions and “confirms [Ridgill]’s predatory prescribing,” according to court documents that describe young “patients” traveling from Victorville, Palmdale and Desert Hot Springs to obtain prescriptions.

The jury heard that, in 2014 alone, Ridgill wrote nearly 9,000 prescriptions, and 95 percent of those prescriptions were for hydrocodone, alprazolam and carisoprodol, typically for the maximum strength. “The combination of these three drugs is the most sought-after drug cocktail on the black market, and one for which there is no legitimate medical purpose,” prosecutors said in a court filing.

Jurors in the case heard testimony about undercover DEA operatives who received prescriptions from Ridgill in exchange for cash. According to court documents, the testimony showed that Ridgill’s “initial physical exams were cursory, and far from the type of exam required to justify prescribing high doses of controlled substances.”

Law enforcement authorities executed federal search warrants on Ridgill’s residences and medical office in March 2015. At that time, authorities recovered multiple pre-written prescriptions for controlled substances, as well as cash found lining patient files and stuffed in the drawers containing those files, which prosecutors argued demonstrated that Ridgill operated a cash-for-drugs business.

The jury deliberated for about 30 minutes before finding Ridgill guilty of 26 counts of distributing controlled substances outside the course of professional practice and without a legitimate medical purpose. Specifically, Ridgill was convicted of 13 counts of distributing hydrocodone, nine counts of distributing alprazolam, and four counts of distributing carisoprodol.

Ridgill is scheduled to be sentenced on March 19 by United States District Judge S. James Otero. Ridgill faces decades in federal prison, including up to 20 years in prison for six of the counts related to distributing hydrocodone.

This was not his first run-in with the law. He was convicted by a jury in 1998 of the federal crime of mail fraud. State records reflect that “respondent devised a scheme to defraud the Employment Development Department (“EDD”) in which he would falsely certify that various individuals were disabled, and hat he had medically examined them prior to reaching such determination,when in fact respondent knew full well those individuals were not disabled.”

As a result of the 1998 conviction, his license was revoked, but the revocation was stayed and he was placed on probation for five years. In 2004 the Medical Board granted early relief from his probation. He is currently still licensed to practice.

The current investigation into Ridgill was conducted by the Drug Enforcement Administration’s Tactical Diversion Squad, HIDTA (the Los Angeles High Intensity Drug Trafficking Area), the Los Angeles Police Department, the Torrance Police Department and IRS-Criminal Investigation.

A former NBA player known for an infamous on-court punch that nearly killed another player has pleaded guilty to fraudulently taking money meant for an African charity he ran. The Kansas City Star reports that Kermit Washington, who was scheduled to go to trial Monday in U.S. District Court in Kansas City, instead pleaded guilty to two counts of making a false statement in a tax return and one count of aggravated identity theft.

Washington, 66, of Las Vegas, referred professional athletes to San Diego attorney Ronald Jack Mix so that Mix could file workers’ compensation claims in California on behalf of the athletes, according to federal prosecutors. Washington used his position as a regional representative for the National Basketball Players Association to refer clients to Mix.

Mix then agreed to make donations to Washington’s charity, The Sixth Man Foundation, which did business as Project Contact Africa. Washington accepted about $155,000 in donations to his charity, which were actually illegal referral payments from Mix and his law firm, prosecutors said.

Washington then diverted money from the charity’s bank account to pay himself or for personal spending. Washington admitted that he failed to account for this income to the charity on Project Contact Africa’s IRS filings during those years.

Mix, 78, a member of the NFL Hall of Fame, pleaded guilty last year to filing a false tax return. The California State Bar suspended Mix from the practice of law in September 2016 pending the outcome of disciplinary proceeding it filed against him.

Mix made donations ranging ranging from $5,000 to $25,000 for referrals of athletes, some of whom lived in the Western District of Missouri. Mix then claimed those payments as charitable contributions on his individual tax returns from 2010 to 2013.

The case against Washington also involved a Maryland man, Reza Davachi, who was once prosecuted in a separate case in one of the largest software piracy crimes ever handled by U.S. authorities. Washington accepted about $82,000 in contributions to his charity from Davachi, and also diverted those funds from the charity’s bank account to pay himself or for personal spending.

In 1977, Washington was involved in one of the ugliest on-court incidents in NBA history. During a game between the Los Angeles Lakers and Houston Rockets, Washington punched Rudy Tomjanovich, shattering bones in a his face and nearly killing Tomjanovich.

A sentencing date for Washington has not been set.

Patriot National Inc., provides technology, outsourcing and underwriting services to the workers’ compensation insurance industry with several offices in California.

According to a report in the Insurance Journal, it has announced a plan of reorganization as part of a restructuring support agreement (RSA) with its lenders, Cerberus Business Finance, LLC and its affiliates, and TCW Asset Management Co. LLC., which have agreed to acquire the financially troubled firm.

Under the transaction, announced Nov. 28, Patriot National will be acquired by certain funds and accounts managed by the investment management firms, and its direct and indirect U.S.-based subsidiaries will file voluntary petitions for relief under Chapter 11 of the U.S. Bankruptcy Code.

Cerberus and TCW will convert a portion of their claims under the financing agreement in consideration for 100 percent of the new equity to be issued in Patriot National and the subsidiaries under the plan. All existing equity interests in Patriot National and its subsidiaries will be extinguished, and Patriot National will no longer have any affiliation with its founder and former CEO Steven Mariano, who resigned earlier this year.

The company, headquartered in Fort Lauderdale, Fla., expects the reorganization, which is subject to regulatory approval, will be completed early in the second quarter of 2018.

Patriot National said in a statement that it will “continue to operate its business in the ordinary course and the Chapter 11 filing is not expected to have a meaningful impact on its day-to-day operations.”

Patriot National provides general agency services, technology outsourcing, software, specialty underwriting and policyholder services, claims administration services and self-funded health plans to insurance carriers, employers and other clients. While it does not bear underwriting risk, it works with insurance carriers to design workers’ compensation and other multi-line programs that are marketed through more than 4,000 independent retail agencies.

In its announcement, Patriot National said it intends to continue to provide service to all of its carrier customers in accordance with the terms of current agreements. Furthermore, it anticipates all commissions due to brokers who commit to continue their business relationships with Patriot National will be paid “in the ordinary course of business or in full under the [reorganization] Plan,” the statement says.

The move is not unexpected after a tumultuous year for the company that came to a head in mid-November with the announcement that its largest workers’ compensation customer, Guaranteed Insurance Co. (GIC), would be placed in receivership by Florida regulators. The companies were mutually owned by Mariano, who resigned from Patriot National last summer. GIC held an estimated 10 percent of Patriot National’s stock and accounted for 60 to 70 percent of its business.

GIC provided alternative market workers’ compensation insurance in 31 states, with 8,600 active polices in force as of Nov. 13, including 1,250 in Florida. Its liquidation was approved by Florida regulators on Monday. Under the liquidation order, all GIC policies are canceled effective Dec. 27, unless otherwise terminated prior to that date.

Another subsidiary, Patriot Underwriters Inc., is a national program administrator that underwrites and services workers’ compensation insurance for insurance companies. Shortly after Florida regulators took over GIC, Patriot National filed a forbearance agreement with the Securities and Exchange Commission that said it would be laying off 250 employees, representing approximately one-third of its workforce.

Another affiliate of Patriot National, Ashmere Insurance Co., announced last week it would be acquired by New York-based Bedrock Insurance Group Holdings. Ashmere is a workers’ compensation insurance carrier licensed in 15 states.

Reserving a claim for lifetime workers’ compensation benefits can be tricky business. How do you “guess” a good number for life expectancy? For most of the last several decades, life expectancy has been increasing as a result of new medical discoveries. But now, antibiotic resistance has caused a fall in life expectancy for the first time.

The U.K. Office for National Statistics said that life expectancy in future years has been revised down after the statistics authority said that “less optimistic views” about the future had to be taken into account.

Opinions on “improvements in medical science” had declined, it said, and fears of the “re-emergence of existing diseases and increases in anti-microbial resistance” meant people would not live as long as was previously expected.

The ONS uses predictions about how medicine and science will improve to model how life expectancy will change. Under the projection made in 2010, a baby girl born in 2016 could expect to live 83.7 years. This has now been revised down to 82.9.

Life expectancy for babies born in 2060, the latest year which appears in both models, is now two years shorter than it was in the 2010 data. Baby girls born in that year were previously expected to live to 90.1 – this has now fallen to 88.3.

Baby boys are also set to live less long, with children born in 2016 expected to live to 79.2, instead of 79.9, and those born in 2060 expected to live to 85.7 instead of 86.8.

The expectancies have been revised down before but this is the first time the ONS has said it believes antibiotic resistance plays a part. Experts have repeatedly warned of the dangers of antibiotic resistance, which could cause hundreds of diseases which are currently easily curable to become killers.

Anti-microbial resistance also includes the issue of viruses and funguses becoming resistance to antiviral and antifungal medication. An increasing number of people with HIV have a version of the condition which is resistant to antiretroviral medication.

The World Health Organisation has said that the phenomenon is “one of the biggest threats to global health”. Earlier this month it told farmers and the food industry to stop giving the medicines to healthy animals. It is also asking farmers to avoid using the varieties which are seen as the “last line of defence” because they are among the few medicines which treat certain diseases in humans.

According to a paper published earlier this month by the European Consumer Organisation, antibiotic resistance is set to become a bigger killer than cancer by 2050, and routine infections could become deadly in as little as 20 years.

A former employee of a Southern California ambulance company and a former employee of a Los Angeles dialysis treatment center both pleaded guilty today to fraud charges for their roles in a fraud scheme that resulted in more than $6.6 million in fraudulent claims to Medicare.  Three other individuals charged in the case previously pleaded guilty.

Aharon Aron Krkasharyan, 53, of Los Angeles, California, pleaded guilty in federal court in Los Angeles to one count of conspiracy to commit health care fraud.  Maria Espinoza, 47, also of Los Angeles, pleaded guilty to one count of conspiracy to pay and receive kickbacks for health care referrals.  U.S. District Judge George H. Wu of the Central District of California accepted the guilty pleas.  Krkasharyan is scheduled to be sentenced on March 29, 2018, and Espinoza is scheduled to be sentenced on April 2, 2018.

Krkasharyan was employed as the Quality Improvement Coordinator for Mauran Ambulance Inc., an ambulance transportation company operating in the greater Los Angeles area that provided non-emergency services to Medicare beneficiaries, many of whom were dialysis patients.  According to admissions made in connection with his plea, between June 2011 and April 2012, Krkasharyan conspired with other Mauran employees to submit claims to Medicare for ambulance transportation services for individuals who did not need such services.  Krkasharyan also admitted that he and his co-conspirators instructed Mauran emergency medical technicians to conceal the patients’ true medical conditions by altering paperwork and creating fraudulent reasons to justify the ambulance services.

Espinoza was an administrative assistant at DaVita Doctors Dialysis of East Los Angeles.  As part of her guilty plea, Espinoza admitted that she conspired with an employee of Mauran to receive cash kickbacks in return for referrals of dialysis patients to Mauran for whom Mauran submitted claims to Medicare for non-emergency ambulance transportation services.

Earlier this month, Toros Onik Yeranosian, 55, the former owner of Mauran, and Oxana Loutseiko 57, the former general manager of Mauran, each pleaded guilty before Judge Wu to one count of conspiracy to commit health care fraud for their roles in the fraud scheme.  The former Dispatch Supervisor at Mauran, Christian Hernandez, 36, pleaded guilty to one count of conspiracy to commit health care fraud in December 2015.

In connection with his guilty plea, Yeranosian admitted that during the course of the conspiracy, Mauran submitted to Medicare at least $6.6 million in false and fraudulent claims for medically unnecessary transportation services, of which Medicare paid at least $3.1 million.  As part of their plea agreements, all five defendants agreed to pay restitution to Medicare.

The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California.  Trial Attorneys Alexis D. Gregorian and Jeremy R. Sanders of the Fraud Section are prosecuting the case.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 3,500 defendants who have collectively billed the Medicare program for more than $12.5 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.