Author: WorkCompAcademy

Los Angeles Union Station is the largest railroad passenger terminal in the Western United States. The station, which opened in 1939 and serves as a major transportation hub for Southern California, was found to have a series of accessibility issues, including wide gaps in walkways, a passenger loading zone that did not have a compliant curb ramp, various signage issues, and other ADA violations.

Following an investigation that found Los Angeles Union Station was not accessible to persons with disabilities, the Los Angeles County Metropolitan Transportation Authority entered into a settlement agreement that requires the transit agency to remedy violations of the Americans with Disabilities Act.

The investigation revealed that Metro, which is responsible for Union Station, failed to make the facility readily accessible to and usable by individuals with disabilities, including individuals who use wheelchairs. Station facilities include the station structure, the platform and any parking facility.

Title II of the ADA prohibits public entities from discriminating against any individual on the basis of disability, including by excluding such individual from participation in or denying such individual the benefits of the services, programs or activities of the public entity.

While the government’s investigation revealed certain ADA violations, the settlement agreement requires Metro to hire an independent licensed architect to conduct an initial survey and annual inspections of Union Station, provide the United States Attorney’s Office with a list of all the violations identified by the independent licensed architect, and remedy all the violations identified.

With the Union Station agreement, the United States Attorney’s Office has resolved a total of 17 ADA investigations of rail stations in Southern California, including with cities and agencies responsible for stations in Anaheim, Barstow, Camarillo, Chatsworth, Fullerton, Glendale, Moorpark, Ontario, Oxnard, Palm Springs, Pomona, San Juan Capistrano, Santa Ana, Santa Barbara, Simi Valley and Van Nuys.

The relief provided in the agreements includes the remediation of violations so that the rail stations are accessible to individuals with disabilities, including those who use wheelchairs. Some examples of violations include insufficient directional signage indicating the location of accessible entrances or paths of travel, paths that are inaccessible due to sloping issues and abrupt elevation changes, non-compliant accessible parking spaces and access aisles, and non-compliant elements in restrooms.

“The Union Station agreement caps a long list of rail station matters my office resolved over the past several years to ensure full access for every transit user,” said United States Attorney Martin Estrada. “Our office is committed to enforcing the rights of persons with disabilities, and I am pleased that the operators of the rail stations in this district have recognized the importance of complying with federal law and ensuring complete access. We thank the various entities, such as Metro, for fully cooperating in our investigations.”

18 arrests were announced in nine federal districts across the United States in a nationwide coordinated law enforcement action to combat health care fraud. Two of the most significant criminal cases in this sweep were filed in the Central District of California.

One of the cases involved 63 year old Dr. Anthony Hao Dinh, who lives in Newport Coast – a community south of Los Angeles – who was allegedly the second highest biller to the Health Resources and Services Administration’s Covid-19 Uninsured Program in the country. Dinh currently holds license 7642 as an Osteopathic Physician and Surgeon issued by the California Osteopathic Medical Board.  There are currently no disciplinary charges pending against him.  His address of record is 13132 Magnolia Street in Garden Grove.

As a result of the scheme Dr. Dinh and his companies allegedly were paid more than $153 million, and he used fraud proceeds for high-risk options trading in securities markets, losing over $100 million from November 2020 through February 2022.

Dr. Dinh allegedly submitted fraudulent claims for treatment of patients who were insured, billed for services that were not rendered, and billed for services that were not medically necessary, according to a criminal complaint filed on April 10. Prosecutors say one witness was a commander in the National Guard who brought an entire 60-person unit for testing. The witness denied getting any treatment, even though Dr. Dinh‘s clinic billed the Uninsured Program for a biopsy and control of a nosebleed.

Dr. Dinh is also charged with two other individuals for allegedly submitting over 70 fraudulent loan applications under the Paycheck Protection Program (PPP) and Economic Injury Disaster Loan (EIDL) Program and fraudulently obtaining over $3 million in loan funds.

The other defendants named in this scheme are Dr. Dinh’s sister – Hang Trinh Dinh, 64, of Lake Forest, who is currently a fugitive being sought by federal authorities – and Matthew Hoang Ho, 65, of Melbourne, Florida, who also was arrested on April 12.

Dr. Dinh is charged in the complaint with health care fraud and two counts of wire fraud. Hang Dinh and Matthew Ho are each charged with one count of wire fraud.

After being arrested on April 12 and subsequently released on a $7 million bond, Dr. Dinh is scheduled to be arraigned in United States District Court on May 22. If he were to be convicted of the three charges, Dr. Dinh would face a statutory maximum sentence of 50 years in federal prison.

In another case filed the Central District of California a clinical lab owner was charged for allegedly submitting over $358 million in false and fraudulent claims to Medicare, HRSA, and a private insurance company for laboratory testing.

The indictment alleges that the defendant’s lab performed COVID-19 screening testing for nursing homes and other facilities with vulnerable elderly populations, as well as primary and secondary schools. But to increase its reimbursements, the defendant allegedly fraudulently added claims for respiratory pathogen panel tests even though ordering providers and facility administrators did not want or need them.

Lourdes Navarro, 64, of Glendale, was charged with conspiracy to commit health care fraud and wire fraud, health care fraud, conspiracy to commit money laundering, and making false statements, in connection with the operation of Matias Clinical Laboratory, Inc., also known as Health Care Providers Laboratory, a laboratory she operated with her husband Imran Shams at 14411 Palmrose St, Baldwin Park, California.

Prosecutors say the two carried out a scheme to submit false and fraudulent claims to Medicare, the HRSA’s COVID-19 Uninsured Program, and an insurance company for respiratory pathogen panel (RPP) testing that was not ordered, medically unnecessary, procured through illegal kickbacks and bribes, and ineligible for reimbursement.

The superseding indictment alleges approximately $241 million in billed claims.

Drickey Jackson is a driver for Amazon’s delivery program known as Amazon Flex. Amazon engages these individuals to make deliveries in their own cars. Amazon describes them as “delivery partners” who sign up through the Amazon Flex app on a smartphone and deliver food and grocery orders from Whole Foods Market stores, Amazon Fresh locations, and other local stores, as well as packages and orders of goods from Amazon Delivery Stations, using their personal vehicles.

When Jackson signed up for the Flex program in December 2016, he accepted the 2016 TOS. It contained an arbitration clause that applied to disputes related to that agreement: The 2016 TOS stated that Flex participants were “responsible for reviewing this Agreement regularly to stay informed of any modifications.”

Amazon emailed a new TOS to Amazon Flex drivers in 2019, which contained a broader arbitration provision that made the issue of arbitrability itself subject to arbitration. Jackson continued in the program after 2019.

In February 2021, Jackson filed a class action lawsuit against Amazon in the United States District Court for the Southern District of California, alleging that it wiretapped Flex drivers’ communications and invaded their privacy by monitoring their closed Facebook groups. Jackson sought to represent a class of all Flex drivers in the United States who were members of the closed Facebook groups and allegedly had communications intercepted by Amazon without their consent. He also sought to represent a subclass of members in California.

The complaint alleged that during times when they were not working, the members of these groups communicated about matters of mutual interest. These included “planned strikes or protests, pay, benefits, deliveries, driving and warehouse conditions, unionizing efforts, and whether workers had been approached by researchers examining Amazon’s workforce.“

Jackson contends that Amazon monitored and wiretapped the drivers’ conversations when they communicated during off hours in closed Facebook groups. He claimed damages. And injunctive relief for alleged privacy violations of state and federal laws: the California Invasion of Privacy Act (Cal. Penal Code §§ 631, 635); invasion of privacy under California’s Constitution; the Federal Wiretap Act for the interception and disclosure of wire, oral, or electronic communications (18 U.S.C. §§ 2510, et seq.) and for the manufacture, distribution, possession, and advertising of wire, oral, or electronic communication (18 U.S.C. § 2512); and the Stored Communications Act (18 U.S.C. §§ 2701, et seq.).

Amazon moved to compel arbitration pursuant to the arbitration clause of the 2019 TOS under California law. The district court denied Amazon’s motion to compel. The court ruled that under California law, the 2016 TOS applied because Amazon had not shown that it provided individualized notice to Jackson of a 2019 TOS, and such individualized notice was necessary to establish mutual assent to the 2019 arbitration provision.

The district court further concluded that the claims of Amazon’s unlawful conduct fell outside the scope of the arbitration clause in the 2016 TOS because the claims were not related to the parties’ performance under the agreement.

The 9th Circuit Court of Appeals affirmed (with Judge Graber dissenting) in the published case of Jackson v Amazon – 3:20-cv-02365-WQH-BGS (April 2023).

Under California law and generally applicable principles of contract law, the burden is on Amazon as the party seeking arbitration to show that it provided notice of a new TOS and that there was mutual assent to the contractual agreement to arbitrate. Mutual assent requires, at a minimum, that the party relying on the contractual provision establish that the other party had notice and gave some indication of assent to the contract.

Here there was “no evidence that the email allegedly sent to drivers adequately notified drivers of the update. The district court did not have the email, so it could not evaluate whether the email (assuming it was received at all) sufficed to provide individualized notice.”

Jackson’s claims do not depend on any terms of his contract as a driver for Amazon Flex. And the harm Jackson alleges “is not measured by or dependent on the terms of” his work for Flex; rather, it involves Amazon’s alleged breach of wiretapping statutes and invasion of privacy.

“In this case, the allegations underlying Jackson’s claims involve employer misconduct wholly unrelated to the parties’ agreement.”

Brent Reynolds, sustained an injury on October 16, 2012 to his shoulder and wrist that arose out of and in the course of his employment as a sales representative for Hostess Brands.

The parties agreed to use Dr. Robert Fenton as an Agreed Medical Evaluator in Orthopedic Surgery. Defense counsel scheduled Dr. Fenton’s cross-examination to take place on August 15, 2016.

In May, Dr. Fenton transmitted a proposed deposition fee agreement to Defense counsel’s office, seeking Defendant’s acknowledgment and agreement to pay a $781.25 non-refundable deposit for the schedule cross-examination. Defense counsel executed this agreement on May 6, 2016, but did not copy opposing counsel when transmitting this now fully executed agreement back to Dr. Fenton. The deposition was eventually re-scheduled to October 31, 2016. The Defendant would ultimately pay the requested deposit, which Dr. Fenton would receive on or around October 19, 2016.

Applicant counsel requested that the October 31, 2016 cross-examination be re-scheduled. Dr. Fenton refused to waive his non-refundable deposit policy, and intended to charge the parties with an additional $781.25 for any re-scheduled deposition.

Around this time, Applicant counsel learned of the Defendant’s payment of a $781.25 non-refundable deposit, which he then objected to as being in excess of fee schedule. Applicant counsel then wrote a letter directly to Dr. Fenton on October 27, 2016, objecting to the cross-examination in its entirety, contending that Dr. Fenton was paid in excess of the fee schedule.

He further filed a Request to Strike Dr. Fenton and Petition for Costs, Sanctions, and Attorney’s Fees for Bad Faith Tactics, which in no uncertain terms accused Defendant of paying fees in excess of the fee schedule to attempt to sway Dr. Fenton to provide a more favorable opinion; Dr. Fenton was copied on this Petition.

In response, Defendant filed its own Petition for Costs and Sanctions on October 31, 2016 and its own Petition to Strike Dr. Fenton on November 2, 2016.

The WCJ ultimately ordered that Dr. Fenton be stricken as the agreed medical evaluator, but deferred action on the competing Petitions for Fees and Costs. The parties eventually settled the case via Stipulations with Request for Award based on a newly selected QME  reporting.

After a trial on the unresolved issue of the competing Petitions for Sanctions, the WCJ concluded that Applicant counsel’s challenge of the AME Dr. Fenton’s cross-examination fees was not bad faith as he possessed the statutory right to challenge the same. However, the Applicant’s conduct in communicating his objections to Dr. Fenton were in violation of Labor Code section 4062.3.

The WCJ further found that the Defendant’s payment of the $781.25 deposit was not done in bad faith as the fee was not in excess of the medical-legal fee schedule. However, Defendant also violated Labor Code section 4062.3 for failing to serve opposing party with the cross-examination fee agreement.

As a result the WCJ ruled that “neither party acted with clean hands, and that both Defendant and Applicant’s respective Petitions for Costs and Fees are denied.” A Petition for Reconsideration filed by the Defendant was denied in the panel decision of Reynolds v Hostess Brands – ADJ9714303 (February 2023).

The Defendant challenged the finding that their May 6, 2016 communication with Dr. Fenton was ex parte. as being a nonsubstantial communication. They argued it was just administrative, and therefore did not violate Labor Code section 4062.3(f).

In support of this position Defendant argued that the communication about the QME fees is “currently part of the CA workers’ compensation culture,” and that a finding from the WCAB that these communications “must be copied on all parties would essentially require a re-ordering of our whole workers’ compensation system.”

However, in the WCJs view, a fee agreement for a scheduled cross-examination goes beyond what the Petitioner characterized as “simple messages or administrative tasks.”

Various statutory and regulatory protections are designed to prevent a provider from receiving excessive fees. They support the conclusion that communications with an agreed medical evaluator regarding the payment of or an agreement to pay fees/deposit for a cross-examination cannot be deemed a nonsubstantial matter, particularly in light of the parties’ statutory right to challenge such fees.

Dr. Fenton’s non-refundable deposit policy seemingly conflicts with Code of Civil Procedure section 2034.450(a). Despite this, Defendant paid the deposit, which Dr. Fenton received on October 19, 2016.

“It is unclear why Defendant did not challenge this restrictive deposit and cancellation policy given that the Code of Civil Procedure section 2034.450(a) allows parties to issue payment at the commencement of the cross-examination. And this further supports the importance of apprising the opposing party of any such fee agreement.”

A former California physician, 54 year old Julian Omidi who lives in West Hollywood, was sentenced Monday to seven years behind bars for using fabricated sleep studies to persuade insurance companies to pay out tens of millions of dollars for Lap-Band surgery. Fines and restitution are to be determined at a hearing in June.

The U.S. Attorney’s office reported that the former doctor and his company were found guilty in December 2021 by a federal jury of scheming to defraud private insurance companies and the Tricare health care program for military service members by fraudulently submitting an estimated $355 million in claims related to the 1-800-GET-THIN Lap-Band surgery business.

Julian Omidi, 53, of West Hollywood, and an Omidi-controlled Beverly Hills-based company, Surgery Center Management LLC (SCM), were found guilty of 28 counts of wire fraud and three counts of mail fraud. Omidi also was found guilty of two counts of making false statements relating to health care matters, one count of aggravated identity theft and two counts of money laundering. Omidi and SCM were found guilty of one count of conspiracy to commit money laundering.

According to evidence presented at his three-month trial, Omidi, a physician whose license was revoked in 2009, controlled, in part, the GET THIN network of entities, including SCM, that focused on the promotion and performance of Lap-Band weight-loss surgeries. Omidi established procedures requiring prospective Lap-Band patients – even those with insurance plans he knew would never cover Lap-Band surgery – to have at least one sleep study, and employees were incentivized with commissions to make sure the studies occurred.

Omidi used the sleep studies to find a reason – the “co-morbidity” of obstructive sleep apnea – that GET THIN would use to convince the patient’s insurance company to pre-approve the Lap-Band procedure.

After patients underwent sleep studies – irrespective of whether any doctor had ever determined the study was medically necessary – GET THIN employees, acting at Omidi’s direction, often falsified the results. Omidi then used the falsified sleep study results in support of GET THIN’s pre-authorization requests for Lap-Band surgery.

Relying on the false sleep studies – as well as other false information, including patients’ weights – insurance companies authorized payment for some of the proposed Lap-Band surgeries. GET THIN received an estimated $41 million for the Lap-Band procedures.

Even if the insurance company did not authorize the surgery, GET THIN still was able to submit bills for approximately $15,000 for each sleep study, receiving an estimated $27 million in payments for these claims. The insurance payments were deposited into bank accounts associated with the GET THIN entities.

Prosecutors estimate Omidi’s total fraudulent billings at approximately $355 million. The victim health care benefit programs include Tricare, Anthem Blue Cross, UnitedHealthcare, Aetna, Health Net, Operating Engineers Health and Welfare Trust Fund, and others. In 2014, the government seized more than $110 million in funds and securities from accounts held by individuals and entities involved in the criminal scheme, including Omidi.

According to Courthouse News, prosecutors had asked for a sentence of 22 years, even though under federal sentencing guidelines, Omidi could be sent to prison for life given the high amount of “intended” financial losses to his victims, including TRICARE, the U.S. military’s health care program.

The judge said she believed that the crimes Omidi had committed were serious but that the federal guidelines for fraud convictions were disproportionate.

“You could have earned a fine living without resorting to fraud,” she told Omidi, referring to his family background and education. “You should have known better.”

Omidi, before the judge imposed the sentence, told her that he was sorry and ashamed to be standing before the court.  “I live in constant remorse,” he said. “I worked hard all my life and tried to do the right thing. I didn’t want to harm anyone.”

Omidi’s lawyers had asked for a sentence of as low as 24 months in prison, arguing that the actual losses to the insurers were far less than the intended losses the government claimed and that two years incarceration would be sufficient punishment for a middle-aged man who has never been to prison before.

Omidi’s mother, Cindy, was sentenced to probation in 2015 after she was convicted of violating laws designed to prevent money laundering.