Author: WorkCompAcademy

Castro Valley orthopedic surgeon, Douglas J. Abeles, M.D., surrendered on an arrest warrant obtained by the Alameda County District Attorney’s Office for his role in an insurance fraud scheme occurring out of his East Bay business office. He has been charged with 31 felony offenses following an investigation that was conducted jointly by the Alameda County District Attorney’s Office and the California Department of Insurance.

Medical Board records do not show any disciplinary actions against him and also do not reflect that he is board certified in any specialty. He currently has unfettered rights to practice medicine. According to his website drabeles.com, “Abeles specializes in Sports Medicine, Spine Surgery, and General Orthopaedics. He completed fellowships at Georgetown University-Virginia Sports Medicine Institute and also USC-Rancho Los Amigos Spine Surgery in 1995. His residency was completed in 1993 at the prestigious New York Medical College-Brooklyn-Queens (previously known as Catholic Medical Center). He also rotated on the spine and pediatric services at the Hospital for Joint Disease in 1992”.

The Criminal Complaint filed by authorities against Abeles and his office manager, Gabriela Cuevas, alleges that for several years he falsely and fraudulently billed insurance companies for medical services that were not provided. While Abeles, had an orthopedic medical practice in Castro Valley, he also owned and operated at least four medically-related businesses from an office located at the Castro Valley-Hayward border. These businesses included drug testing urine analysis for medical offices that contracted with him. It was through this business that he allegedly fraudulently billed insurance companies for lab reports.

Abeles allegedly formed Physicians RX Network, Inc. (“PRXN”) in 2005 in a location other than his medical office. PRXN contracted with physicians in regards to the dispensing of prescribed drugs, including prescription compound creams, billing the insurance companies on behalf of the physicians for these drugs. In late 2010, Abeles went into the Urine Analysis (“UA”) business, forming Redwood Laboratory Management, LP and Redwood Laboratory Associates, LLC (“RLM”). RLM contracted with physicians in regards to urine drug testing of patients and billing insurance companies on behalf of the physicians for this drug testing.PRXN and RLM operated in the same office and the two businesses overlapped and shared. In May of 2011, Abeles formed another business, PRXN Toxicology, LLC.

Abeles hired Gregg Gorski to be a sales representative, Roxanne Cecot to be the billing supervisor and Larry Davis to be the Chief Operating Officer of PRXN. All three had complained about improprieties in PRXN billings, particularly about over-billing insurance companies for prescription drug compounds. Roxanne Cecot learned that Douglas Abeles told the receptionist at PRXN and another PRXN employee to over-ride the billing software at PRXN and manually increase the prices When Roxanne Cecot complained to Abe!es about the billing improprieties Abeles allegedly replied “Screw them until they catch on.” Abeles allegedly sent an email that said “if any employee further implies any wrong doing to anyone they are to be let go immediately on grounds of insubordination and liable. We cannot operate a successful company with this kind of mutiny …. “‘

One document allegedly sent to insurance companies was was called a “Urine Toxicology Review” report and it purported that the physician that ordered the urine test spent forty-five minutes reviewing medical records that had been submitted for the physician’s review by PRXN. This activity allegedly did not take place and the billing was fraudulent  In March of 2013, Gabrieia Cuevas’ work computer was seized pursuant to a court ordered search. There were over 10,200 of these UTR’s stored in her computer.

Abeles posted $355,000 bail and Gabriela Cuevas was released on her own recognizance. Arraignment is scheduled for Monday, November 3, 2014.

.Any medical professional or insurance company that believes it may have been a victim to this fraud is asked to contact the Alameda County District Attorney’s Office, Alameda ADA Teresa Drenick: Teresa.drenick@acgov.org Facebook Twitter @AlamedaCountyDA. Phone: 510-272-6280.

The Department of Industrial Relations (DIR) has posted proposed changes to the California Code of Regulations to implement the Return-to-Work Supplement Program, one of the workers’ compensation reforms mandated by SB 863. This program is intended to provide supplemental payments to workers whose permanent disability benefits are disproportionately low in comparison to their earnings loss. Public hearings on the proposed regulations have been scheduled on December 8, 2014 from 10 a.m. to 3 p.m. at 1515 Clay Street in Oakland and on December 9, 2014 from 1:30 p.m. to 4:30 p.m. at 320 West 4th Street, Suite 500 in Los Angeles. Members of the public may also submit written comment on the regulations until 5 p.m. on December 9, 2014. The notice, initial statement of reasons, and text of the proposed regulations can be found on the DIR website.

Under the proposed regulation, to be eligible for the benefit, an individual must have a work related injury that results in an inability to return to the work they were doing at the time of the injury. The regulation further requires that an individual who receives the Return-to-Work Supplement may not receive a second Return-to-Work Supplement unless that individual returns to the work force and suffers an additional injury that prevents that individual from continuing in that job. The Supplemental Job Displacement Benefit voucher triggers the application process for the Return-to-Work Supplement Program.

An individual who receives the Supplemental Job Displacement Benefit under Labor Code section 4658.7 because that individual cannot return to the job they were performing when they were injured receives a voucher evidencing the promise to make payments under section 4658.7. That voucher is on a form mandated by 8 C.C.R. § 10133.32. Section 25104 of the proposed regulations requires that the voucher include a notice that the individual may be eligible for the Return-to-Work Supplement and is intended to advise those individuals who may wish to apply for the Return-to-Work Supplement about the program and how to get additional information. The section also provides that the Director will arrange for publication of this notice targeted at those who have already received a voucher. Claim adjusters will have to use the new voucher 30 days after the regulations become effective.

An application for the Return-to-Work Supplement must be received by the Return-to-Work Supplement Program within one year from the date the Voucher was served on the individual or within one year from the effective date of these regulations, whichever is later. The application shall be made on the electronic form on the Department of Industrial Relations web site and shall include a declaration under penalty of perjury that the information provided is true and correct. Section.25l08 establishes a time frame of 60 days for reviewing applications and for making a decision on an application. It also provides for the method of notifying applicants of the decision.

The Return-to-Work Supplement Program will provide a supplement of $5,000.00 to each eligible individual who submits a complete application by the deadline. The payment will be made within 25 days of the date the decision of the Director on the application and will be paid in one lump sum. Payment shall be made directly to the individual and is not assignable before payment. The amount of this supplement may be adjusted by the Director from time to time based on further studies conducted by the Director in accordance with Labor Code section 139.48 and or based on consideration of the number of anticipated recipients.

Labor Code section 13 9.48 requires that appeals of decisions concerning the Return-to-Work Supplement be handled at the Workers’ Compensation Appeals Board trial level. Section 25110 establishes a time frame for such appeals and allows the Return-to-Work Supplement Program to correct errors or otherwise modify decisions.

Michael D. Drobot, Chief Executive Officer of Pacific Hospital of Long Beach, filed a $50 million dollar defamation lawsuit against a group of plaintiff’s attorneys who he alleges have falsely claimed in broadcast comments that he and Pacific Hospital of Long Beach directed surgeons to install “counterfeit” screws in “thousands” of spinal-surgery patients.

The lawsuit, filed in Orange County Superior Court alleges that lawyers Brian Kabatek and Robert Hutchinson and the law firms of Kabateck Brown Kellner, Cotchett Pitre and McCarthy and Knox Ricksen made false claims in press statements “in an effort to disparage Michael D. Drobot and Pacific Hospital of Long Beach’s good name and reputation, and disrupt business operations for their own personal benefit.”

According to his press release Drobot claims “I never envisioned filing a lawsuit against a group of attorneys,,” said Drobot. “But these allegations are malicious and, most importantly, patently false. Not only do they portray me as someone I am not, but they needlessly create incredible anxiety for hundreds of former patients at Pacific Hospital. We did not compromise patient care at PHLB.”

The lawsuit alleges that Kabateck, during a July television interview with Fox 11, made multiple false and defamatory statements about “counterfeit” and “unsterilized” screws used on a patient during two 2010 surgeries. Several weeks later, attorney Hutchinson allegedly made many of the same defamatory remarks in a radio interview on CBS 2. The lawsuit alleges that the lawyers made the remarks as a solicitation for patients to join in their pending lawsuits against Drobot and Healthsmart Pacific, Inc. Among their claims: that Michael D. Drobot bribed government officials with money and prostitutes to sell and install the counterfeit screws into patients.

Drobot blasted the defamatory remarks in his defamation lawsuit, affirming under oath in a verified complaint that he and Pacific Hospital of Long Beach “never purchased or used any non-FDA-approved screws or other related parts made with non-FDA-approved materials for use in PHLB spinal surgeries.”

According to Drobot “Defendants made up the aforementioned false and defamatory statements broadcast on television, radio and Internet out of whole cloth,” the lawsuit alleges. “Ironically, Defendants’ false and defamatory statements likely will cause many PHLB spinal surgery patients to request and possibly undergo wholly unnecessary spinal surgeries simply to determine whether they, too, have received ‘counterfeit’ screws from PHLB.”

In February 2014, Drobot pled guilty to government allegations that he paid kickbacks to surgeons for referring patients to Pacific Hospital of Long Beach. The criminal case did not include allegations of providing counterfeit parts or devices to patients.

Hutchinson, in an interview with the Long Beach Press Telegram said the lawsuit is an attempt to intimidate him and other attorneys named, and to intimidate patients from coming forward in a pending lawsuit against Drobot and the company that previously owned Pacific Hospital. “(Drobot is) an admitted felon,” Hutchinson said. “This raises the issue of how can we defame someone when their own actions have tainted them far worse than any comments. He should know it’s not going to work.” The lawsuit is characteristic of a Strategic Lawsuit Against Public Participation, commonly known as SLAPP, used to try and censor, intimidate or silence critics by hampering them with legal costs until they abandon their criticism, Hutchinson said.

Drobot, 69, of Corona del Mar, was charged by the U.S. Attorney’s Office with orchestrating a conspiracy from 1997 to 2013 in which tens of millions of dollars in illegal kickbacks were paid to doctors, chiropractors, marketers and others who referred patients to the former Pacific Hospital for spinal surgery. Prosecutors said that Drobot also paid $28,000 in bribes to state Sen. Ron Calderon, D-Montebello, to support legislation delaying or limiting changes in workers’ compensation laws that would have directly affected Drobot’s scheme. The hospital submitted more than $500 million in fraudulent bills between 2008 and last year. Much of the total was paid by the California workers’ compensation system, according to the U.S. Attorney’s Office. Drobot pleaded guilty in April to counts of conspiracy and payment of kickbacks for his activities in the scheme, and he faces 10 years in prison when he is sentenced in October 2015.

In sweeping charges alleging public contract fraud, forged real estate deals and identity theft stretching from Alameda to Orange counties, authorities arrested a Black Muslim minister, his mother and five others, saying they ran a wide-ranging scam through a private security firm, known as Black Muslim Temple (BMT) International Security Services, that falsely claimed its guards were retired Navy SEALs and its leader a former FBI agent.

Alameda County District Attorney Nancy O’Malley said the charges involved “not only large-scale bid fraud victimizing local communities and cities and counties around the state, but also real estate fraud, insurance fraud, bankruptcy fraud, income tax evasion and the exploitation of workers by evading workers’ compensation insurance and payroll.” O’Malley said the group led “an organized and sophisticated criminal enterprise conducting an extraordinary variety of fraudulent activities.” The charges, detailed in a 118-page affidavit, allege the firm faked insurance and state license documents and made fanciful claims of expertise it did not possess.

O’Malley’s staff and the state Department of Consumer Affairs began investigating BMT in March.The Port of Oakland that month was in the final stages of agreeing to terms with the company when it terminated negotiations, citing reporting by the San Jose Mercury News on the bogus credentials. The city of Oakland also backed off on a proposal to award the firm part of a contract to guard City Hall. The Housing Authority of the city of Los Angeles rescinded a BMT contract after the investigation by the newspaper.The group sought and at times obtained lucrative contracts with Los Angeles agencies, Alameda County, Vallejo, Oakland, the Port of Oakland and Newport Beach.

Alameda County canceled its contract with the firm back in 2012 after a BMT guard beat up a guard from a rival company on the first day of the county contract to protect a public works building in Hayward. A lawsuit by the injured guard, Robert Chamberlin, helped expose the fraudulent credentials that government procurement officials had failed to vet when awarding the contracts. Upon learning that BMT was still listing it as its insurance carrier, the insurance company in that lawsuit contacted district attorney’s investigators to alert them to the discrepancy. The policy had been canceled in 2009 for non-payment of premiums, according to the complaint..

Those arrested include Black Muslim minister Dahood Sharieff Bey, 42, and his mother, Rory Parker, 63, Basheer Fard Muhammad, 62, Qadirah Najeebah Bey, 39, Jameelah Aasma Muhammad Bey, 39, Billie Latrice Poindexter, 33, and Ira Barnard Dickerson Jr., 53. among those who were arrested. District attorney’s inspector Patrick Johnson requested in an affidavit that the seven defendants be denied bail because he suspects their means of income for years has been fraudulent.

A spokesman for the state Department of Consumer Affairs said it should not be blamed. BMT had fraudulently taken over the security license of a retired Oakland police officer who had moved out of state. “We had no way of knowing the license had essentially been hijacked,” said the spokesman, Russ Heimerich.

The primary impact of the Ebola epidemic “crisis” on U.S. property and casualty insurers will be on companies writing workers compensation insurance, according to a new study by the Insurance Information Institute. In a paper written by Dr. Dr. Steven Weisbart, senior Institute vice president and chief economist, said the WC category will likely be most affected because health-care workers could be most directly exposed (as happened in Texas and in several African countries). Other possible effects might be on various liability insurance lines, such as general liability, directors and officers liability and medical malpractice liability, Weisbart said in his paper. Weisbart said that WC would be primarily impacted because it pays for the cost of medical care and lost income for people who become ill in the course of their work, and pays death benefits if they die from a work-related cause.

“As with life insurance, it is unlikely that many workers in the main affected African countries have workers compensation-type coverages,” he said. Citing the latest Swiss Re report, Weisbart said that the level of premiums per capita for all non-life insurance coverages combined (not just WC) in the three most-affected countries “is so low as to not be listed.”

In the United States, by contrast, Weisbart said, WC coverage is nearly universal, but the likelihood of claims is low, assuming that employers and their workers take CDC-recommended precautions. He also notes that, as with life insurance coverage, “reinsurance will help mitigate the financial effect of a surge in claims, which are likely to be very costly in the event of actual work-related infections.” In his report, Weisbart said that, “at this stage,” it is impossible to forecast the precise number of such claims or the amounts of damages that might be sought.

“That said, assuming the Center for Disease Control’s protocols are successfully followed, the number of Ebola cases should be small, thereby limiting the number and likelihood of tort actions that can impact various liability coverages,” Weisbart concluded.

As for the total world impact, Weisbart said that as of Oct. 10, the Ebola virus has infected at least 8,399 people and killed 4,035, according to the World Health Organization. This includes 4,762 confirmed cases, 2,196 probable cases and 1,652 suspected cases. He said that as of Oct. 10, all but four of the cases were in four countries in Africa (Guinea, Liberia, Sierra Leone, and Nigeria). One was in Senegal, one in Spain, and (as of Oct. 12) two in the United States.

There are five known strains of the Ebola virus, Weisbart said in his study. The one causing the illness and deaths noted above is the Zaire strain, which was identified in 1976, he said.Weisbart also said that there is currently no cure and no vaccine for this virus. Treatment is isolation (to prevent spread) and focus on symptoms—mainly dialysis and fluids to prevent dehydration and reduce fever. He also said that the mortality rate of infected people to date is roughly 50 percent.