Author: WorkCompAcademy

Felony charges have been filed against Ghada Kalsho Kassab M.D, a 57 year old San Diego dermatologist, for a $1.3 million Medi-Cal fraud scheme. The investigation uncovered that the dermatologist charged Medi-Cal $1,386,995 for services that were never rendered.

According to the Medical Board of California, Kassab currently holds a Physician and Surgeon license (A 114457). The physician is reportedly a 1999 graduate of the University of Baghdad College of Medicine. Kassab practices dermatology at GK Dermatology of San Diego, located at 3737 Moraga Ave, Ste A206, San Diego, CA 92117.

A complaint was filed in San Diego County Superior Court charging the dermatologist with 22 counts of healthcare insurance fraud, one count of Medi-Cal fraud, the white-collar crime enhancement, and the excessive takings enhancement.

Prosecutors alleged that the dermatologist was invoicing for as many as 233 patients on a daily basis, averaging between 60 to 70 patients per day for identical or comparable services.

Furthermore, it was found that all patients were undergoing light therapy, with the majority using non-medical lamps.

It was further alleged that the crimes committed by defendant Ghada Kassab involved a pattern of related felony conduct, and the pattern of related felony conduct involving the taking of, and resulted in the loss of more than five hundred thousand dollars ($500,000), within the meaning of Penal Code §186.11 (a)(2). This enhancement is known as the aggravated white collar crime enhancement

Pursuant to Penal Code §1170(h), prison custody time is to be served in state prison if the enhancement pursuant to Penal Code §186.11(a)(2) is imposed as part of a sentence for the offenses.

Edgar Osuna worked for Spectrum Security Services, Inc., from October 2011 to February 2022. During his tenure Spectrum allegedly committed Labor Code violations against Osuna and other employees. The violations against other employees purportedly continued after Osuna’s employment terminated.

In August 2023, Osuna notified the Labor and Workforce Development Agency (LWDA) of Spectrum’s alleged failure to comply with the Labor Code. After the LWDA failed to respond within the statutory period Osuna filed a representative PAGA claim based on the underlying violations identified in Osuna’s LWDA notice, and individual and class claims based on the same allegedly unlawful conduct.

Spectrum demurred to the PAGA claim. It argued the applicable one-year statute of limitations bars the claim because Osuna did not provide the LWDA with notice of the alleged Labor Code violations until 18 months after his employment ended. Spectrum also argued Osuna lacks standing to bring his PAGA claim because he was not employed during the time he sought to represent other aggrieved employees. (Citing Robinson v. Southern Counties Oil Co. (2020) 53 Cal.App.5th 476 (Robinson).) It urged the trial court to sustain the demurrer without granting leave to amend.

The trial court agreed with Spectrum’s argument and dismissed Osuna’s class claims, sent his individual claims to arbitration, and sustained Spectrum’s demurrer to his representative PAGA claim without granting leave to amend. It concluded that Osuna lacked standing to bring the PAGA claim because he did not suffer a Labor Code violation during the one-year statute of limitations period for recovering civil penalties.

The Court of Appeal reversed the portion of the order sustaining Spectrum’s demurrer to Osuna’s representative PAGA claim in the published case of Osuna v. Spectrum Security Services, Inc. CA2/6 – B338047 – (May 2025).

Before turning to the issue of representative PAGA standing, the Court of Appeal resolve the threshold issue of appealability. Spectrum contended that it should dismiss Osuna’s appeal because “an order sustaining a demurrer to [fewer] than all of the [claims in a complaint is not immediately appealable.” It also contends the “death knell” doctrine – an exception to this general rule – is inapplicable here because Osuna has not shown that the trial court’s order was “a de facto final judgment for absent plaintiffs.”

The Court of Appeal concluded “the Miranda rule applies here.” (citing Miranda v. Anderson Enterprises, Inc. (2015) 241 Cal.App.4th 196) The order dismissing the representative PAGA claim without leave to amend operates as “a de facto final judgment for absent plaintiffs” (In re Baycol Cases I & II (2011) 51 Cal.4th 751, 759) and is appealable”

Due to the systemic underenforcement of the Labor Code, the Labor Code Private Attorneys General Act of 2004 (Labor Code,1 § 2698 et seq.; PAGA) deputizes employees to stand in the shoes of the state to pursue civil penalties on behalf of themselves and other “aggrieved employees.” (Arias v. Superior Court (2009) 46 Cal.4th 969, 980 (Arias).) So long as they were employed by the alleged violator and personally suffered at least one Labor Code violation, aggrieved employees have standing to bring representative PAGA actions.

The Legislature recently adopted Assembly Bill No. 2288 (2023-2024 Reg. Sess.), which amended portions of Labor Code § 2699. Among other changes, Assembly Bill No. 2288 “requir[es] an aggrieved employee to have personally suffered the alleged violations within [PAGA’s] one-year statute of limitations.” (Sen. Com. on Judiciary, Rep. on Assem. Bill No. 2288 (2023-2024 Reg. Sess.) as amended June 21, 2024, pp. 15-16.) Because those amendments apply only to lawsuits filed on or after June 19, 2024, they are inapplicable here. (See Stats. 2024, ch. 44, § 1.)

If after notification the LWDA does not investigate, does not issue a citation, or fails to respond to the notice within 65 days, the employee may sue. But not every private citizen can maintain such a suit. Only an “aggrieved employee” has PAGA standing.The Labor Code defines such an employee as “any person who was employed by the alleged violator and against whom one or more of the alleged violations was committed.” The issue here is whether Osuna meets that definition. The Court of Appeal concluded that he did.

“The words of section 2699, former subdivision (c) are clear and unambiguous: To have standing to bring a PAGA action, “[t]he plaintiff must be an aggrieved employee, that is, someone ‘who was employed by the alleged violator’ and ‘against whom one or more of the alleged violations was committed.”

Beckers Hospital Review just reported that in May 2025, a federal jury in the U.S. District Court for the Central District of California awarded $147 million in damages to Scottsdale, Arizona–based Innovative Health, a medical device reprocessor, in a lawsuit filed in 2019 against Johnson & Johnson’s subsidiary, Biosense Webster.

The jury found that Biosense Webster violated federal antitrust laws (Sherman Antitrust Act, Sections 1 and 2 and California Cartwright Act) by engaging in anticompetitive practices, specifically by withholding clinical support from hospitals that used reprocessed catheters instead of purchasing new ones from Biosense.

The lawsuit centered on Biosense Webster’s policy of tying access to clinical support for its CARTO 3 cardiac mapping system to the exclusive purchase of its high-density mapping and ultrasound catheters.

Innovative Health alleged that this policy, implemented after they received FDA clearance in 2016 to reprocess Biosense’s catheters, pressured hospitals to buy new devices, stifling competition and maintaining Biosense’s monopoly in the cardiac mapping catheter market.

Internal emails presented during the trial showed hospitals expressing interest in Innovative’s cost-effective reprocessed catheters but facing warnings from Biosense about discontinued support.

Biosense defended the policy, arguing it was necessary to ensure service quality and prevent competitors from “free-riding” on their clinical support infrastructure.

However, the jury sided with Innovative Health, determining that the tying arrangement and monopolistic practices were illegal.

The case was initially dismissed in 2022 but revived by the Ninth Circuit Court of Appeals in 2023, leading to the trial that began in April 2025.

Association of Medical Device Reprocessors issued the following statement: “Friday’s unanimous verdict by a federal jury in Santa Ana, California for Innovative Health against Johnson & Johnson (NYSE: JNJ) is a victory for America’s hospitals, providers, patients, and the environment. The jury found that Biosense Webster violated federal and state antitrust laws by withholding clinical support to hospitals using Innovative Health’s FDA regulated, reprocessed catheters.”

“For too long, Johnson & Johnson has used tying arrangements and other tactics to interfere with fair competition from lower-cost, FDA-regulated, reprocessed ‘single-use’ devices (SUDs),” the association’s CEO Daniel J. Vukelich said in a news release. “We hope this jury’s message will be heard loud and clear: Hospitals want to reduce costs and greenhouse gas emissions by using more reprocessed SUDs without fear of retribution by their original equipment manufacturers (OEMs).”

The verdict is seen as a significant win for reprocessors and hospitals seeking cost-effective, FDA-regulated reprocessed devices to reduce costs and environmental impact.

Deborah Hemsted’s workers’ compensation claim is based on an injury she sustained on September 24, 2014, when she was a Medical Assistant III for United Indian Health Service at Arcata, California.

The history of the United Indian Health Services began in 1968. It was a time when Native activism coincided with the nation-wide Civil Rights Movement and the Office of Economic Opportunity programs. Together these factors helped create a new era of self-determination for Indian peoples.

Hemsted first received benefits and treatment for her injury through United Indian’s tribal workers’ compensation system. After a dispute arose, Hemsted filed a claim with the state workers’ compensation system. United Indian took the position that, in light of its tribal immunity, California’s workers’ compensation system lacked jurisdiction to adjudicate the claim.

In a March 2024 decision, the workers’ compensation administrative law judge (ALJ) rejected United Indian’s claim of sovereign immunity after applying the California Supreme Court Miami Nation’s five-factor arm-of-the-tribe test. (People v. Miami Nation Enterprises (2016) 2 Cal.5th 222.)

With respect to United Indian’s method of creation, the ALJ found that it was a California non-profit created through the Indian Health Board and authorized by several tribes, including federally recognized tribes, to provide health services to their members. The ALJ observed that eight or nine tribes have sanctioned United Indian as their health provider. The ALJ noted that most of the tribal resolutions did not specifically designate United Indian as a tribal organization. Based on these circumstances, the ALJ concluded that United Indian’s method of creation weighed against sovereign immunity.

As to the question of intent, the ALJ found no evidence that the tribes intended to share their sovereign immunity with United Indian. The ALJ held that United Indian’s purpose – to serve the health needs of Indians in Humboldt and Del Norte Counties – weighed in favor of sovereign immunity.

As for control, the ALJ concluded that “[c]ontrol weighs against sovereign immunity because the Board [of Directors of United Indian] consisted of tribal members and others who may or may not be tribal members.”

With respect to the financial relationship between United Indian and the tribes, the ALJ found United Indian was not funded by the tribes, but instead by grants obtained by the Indian Health Board and distributed to United Indian. The ALJ reasoned that, because United Indian is incorporated separately from the tribes, “any action against [United Indian] would not threaten the tribes’ resources, nor the resources of the members of the board.” The judge therefore concluded that this factor weighed against immunity.

In her report on reconsideration, the ALJ recommended that the Board deny United Indian’s request for reconsideration. The ALJ appeared to change her view on the funding factor, stating: “Defendant’s argument on Reconsideration with regard to funding is well made. The[ir] point [that] any monies lost through suit would not be available to [United Indian] to provide medical treatment to the tribes weighs in favor of sovereign immunity.” However, the ALJ’s overall assessment remained that United Indian had failed to establish its entitlement to sovereign immunity.

Denying United Indian’s reconsideration request, the Board adopted and incorporated the ALJ’s report on reconsideration. The Board found no abuse of discretion in the ALJ’s rejection of United Indian’s claim of sovereign immunity.

The Court of Appeal granted a petition for writ of review, and reversed the Boards decision in the unpublished case of United Indian Health etc. v. Workers’ Comp. Appeals Bd. – A170950 – (May 2025).

“No one Miami Nation factor of the five-factor test is dispositive.” Whether sovereign immunity applies to an entity is a question of law reviewed de novo. (Miami Nation, supra, 2 Cal.5th at p. 250.) the Court of Appeal also applid the de novo standard when interpreting written instruments, except to the extent that the interpretation turns on conflicting extrinsic evidence.

Considering both the law and the circumstances under which United Indian was formed (Miami Nation, supra, 2 Cal.5th at pp. 245-246), the method of creation factor weighs somewhat in favor of sovereign immunity.

The ALJ concluded the tribes had no intent to share their sovereign immunity with United Indian. The record contained no tribal documents stating the tribes’ intent to extend sovereign immunity to United Indian. “However, that even absent express statements of a tribe’s intent, tribal intent may be inferred from the tribe’s actions or other circumstances.” And as United Indian asserts, it may be possible to infer the intent to share tribal immunity based on the fact that the tribes established and sanctioned United Indian to provide healthcare services to tribe members under a federal system intended to further tribal self-governance.

The Court of Appeal agreed with the ALJ that United Indian’s provision of health care serves a purpose central to tribal self-sufficiency and self-governance, weighing in favor of sovereign immunity

The control factor also weighs in favor of sovereign immunity. The tribes participate in the management and control of United Indian in at least three respects.

Finally, the financial relationship factor likewise weighs in favor of immunity. Miami Nation makes clear that where a judgment against the tribal entity would significantly reduce tribal resources, sovereign immunity is appropriate, even if the tribe’s treasury is not directly affected.

“In sum, although there is no express evidence that United Indian’s participating tribes intended to share their immunity, the remaining factors reflect that United Indian is an arm of the tribes that it serves.”