Category: Daily News

Sanjoy Banerjee M.D.provided billings and doctor’s reports concerned medical services to workers’ compensation patients through three entities that Banerjee owned and operated from a single location in Wildomar California: (1) Sanjoy Banerjee, M.D., Inc., doing business as Pacific Pain Care Consultants (PPCC); (2) Kensington Diagnostics, LLC (Kensington); and (3) Rochester Imperial Surgical Center, LLC (Rochester).

Banerjee presented billings totaling $157,797.01 to Berkshire Hathaway Homestate Companies payable pursuant to the state’s workers’ compensation system, through Kensington and Rochester, for services that Banerjee provided to patients between 2014 and 2016. BHHC paid less than 10 percent of the $157,797.01 amount billed.

Each doctor’s report included the following attestation near the end of the report: “I have not violated Labor Code section 139.3, and the contents of this report and bill are . . . true and correct to the best of my knowledge. This statement is made under penalty of perjury.”

Banerjee was charged with two counts of insurance fraud and three counts of perjury. The charges are based on Banerjee’s alleged violations of Labor Code section 139.3(a), which prohibits physician self referrals to entities where the physician owns a specified financial interest.

According to a BHHC investigator who testified as the only witness at his preliminary hearing, Banerjee was obligated to disclose his financial interests in Kensington and Rochester to BHHC, and BHHC had no business records indicating that Banerjee had made this disclosure.

The superior court denied Banerjee’s motion to dismiss the information as unsupported by reasonable or probable and set a trial on the merits. The Court of Appeal granted his petitions for a writ of prohibition and dismissed the perjury charges, but rejected the petition to the fraud charges (for overbilling) in the published case of Banerjee v. Superior Court.

To date, no published court decision has interpreted Labor Code sections 139.3 or 139.31. The statutes were enacted in 1993 as part of Assembly Bill No. 110, part of a comprehensive package of legislation that reformed the state’s workers’ compensation laws. It was intended to reduce costs and strengthen conflict of interest rules in the workers’ compensation system.

Section 139.3(a) makes it unlawful for a physician to refer a person for specified services “if the physician or his or her immediate family has a financial interes with the person or in, the entity that receives the referral.” A violation of section 139.3(a) is a misdemeanor.

Section 139.31(e) provides: “The prohibition of section 139.3 shall not apply to any service for a specific patient that is performed within, or goods that are that are supplied by, a physician’s office, or the office of a group practice. . . .”  The Court’s interpretation of section 139.31(e) means that the physician’s office exception applies to Banerjee’s financially interested “self-referrals” to his two other legal entities since they are both located in his same Widomar office. Since his alleged violations of section 139.3(a) was the only basis to support the perjury charges, the perjury charges must be dismissed.

The record also supports a strong suspicion that Kensington and Rochester were sham entities, and that Banerjee formed Kensington and Rochester with the specific intent to defraud BHHC through his Kensington and Rochester billings. The Kensington and Rochester billings gave the appearance that the entities were not part of Banerjee’s medical practice but were stand alone, diagnostic testing and surgical centers, operating independently of any physician’s office.

Even though the evidence does not show that Banerjee violated section 139.3(a), the evidence supports a strong suspicion that Banerjee specifically intended to present false and fraudulent claims for health care benefits, in violation of Penal Code section 550, subdivision (a)(6), by billing the workers’ compensation insurer substantially higher amounts through his two other legal entities, between 2014 and 2016, than he previously and customarily billed the insurer for the same services he formerly rendered through his professional corporation and his former group practice.

Thus, the Court granted the writ as to the perjury charges but denied it as to the insurance fraud charges.

The Los Angeles Times reports that a group of 500 Los Angeles firefighters filed a lawsuit Friday against the city over its requirement that L.A. employees be vaccinated against COVID-19.

The lawsuit, filed in Los Angeles County Superior Court, claims the city’s mandate is a violation of employees’ constitutionally protected autonomous privacy rights.

The lawsuit was filed on behalf of the Firefighters 4 Freedom Foundation, a nonprofit representing 529 members, said Kevin McBride, the group’s attorney.

The firefighters are “pawns in a political chess match, ordered by thirteen politicians on the Los Angeles City Council to inject themselves with an experimental vaccine – over their objections – or lose their jobs,” the lawsuit states.

A group of employees in the Los Angeles Police Department also sued last week over the vaccination mandate.

The city of L.A. moved to require city employees to be fully vaccinated against COVID-19 by early October, while granting exemptions to employees with medical conditions or “sincerely held religious beliefs.”

More than 460 exemption requests have been submitted by LAFD employees, according to city data – a number equal to 12.5% of the department workforce. However, it is possible that some employees may have turned in multiple requests.

The lawsuit filed Friday claims that the city mandate violates the firefighters’ right to privacy under the California Constitution. It seeks a temporary restraining order prohibiting the city’s vaccination mandate from going into effect until a preliminary injunction hearing and further order of the court.

The lawsuit alleges the city doesn’t have the power to “order forced vaccinations of its employees or residents” and that “the vaccine mandate is both unnecessary and ineffective in protecting the public.”

A LAFD spokesman told The Times on Friday that 58.5% of the sworn members have been fully vaccinated and 66% have received at least one dose.

The total number of LAFD employees who have tested positive for COVID-19 is 1,079, according to city data. A total of 1,056 LAFD employees have recovered and returned to duty. Two firefighters have died after contracting COVID-19.

City Atty. Mike Feuer said he was confident the city would prevail. “The U.S. Supreme Court and courts across the country have upheld vaccination mandates by government and they’ve done so because they said the greater good compels it,” Feuer said. “The greater good compels this right now.”

Federal prosecutors announced the indictment of 18 former professional basketball players and one spouse, who are accused of submitting fraudulent reimbursement claims for fictitious medical and dental expenses.

The alleged “ringleader” of the scheme was said to be Terrence Williams. He was drafted by the then-New Jersey Nets as their 11th overall pick in 2009. Williams allegedly recruited other NBA health plan participants into the scheme, providing them with falsified invoices to claim medical and dental services that were never rendered.

Terrence Williams, Alan Anderson, Anthony Allen, Desiree Allen (Alan’s wife), Shannon Brown, William Bynum, Ronald Glen Davis, Christopher Douglas-Roberts, a/k/a “Supreme Bey,” Melvin Ely (former Fresno State standout), Jamario Moon, Darius Miles, Milton Palacio, Ruben Pattierson, Eddie Robinson, Gregory Smith, Sebastian Telfair, Charles Watson Jr., Antoine Wright, and Anthony Wroten are each charged with one count of conspiracy to commit health care fraud and wire fraud, which carries a maximum sentence of 20 years in prison. Tennence Williams is also charged with one count of aggravated identity theft, which carries a mandatory minimum sentence of two years in prison.

Ronald Glen Davis will be prosecuted in the Central District of California. The other defendants will be prosecuted in other jurisdictions. Anthony Allen Douglas-Roberts, and Robinson remain at large. Milt Palacio, a current Trail Blazers assistant coach, was put on administrative leave by the team after being one of the 18 players arrested.

The indictment charges the defendants with conspiracy to commit health care fraud and wire fraud, in connection with a scheme to defraud the National Basketball Associations Health and Welfare Benefit Plan out of nearly $4,000,000.

The National Basketball Association Players’ Health and Welfare Benefit Plan is a health care plan providing benefits to eligible active and former players of the NBA.

From at least 2017, up to about 2020 the defendants engaged in a widespread scheme to defraud the Plan by submitting and causing to be submitted fraudulent claims for reimbursement of medical and dental services that were not actually rendered.  

Williams orchestrated the scheme to defraud the Plan. He recruited other Plan participants to defraud the Plan by offering to provide them with false invoices to support their fraudulent claims. Williams provided some of the other defendants with false provider invoices, which those defendants then submitted to the Plan for reimbursement of fraudulent claims. Several of the fake invoices stood out because, “they are not on letterhead, they contain unusual formatting, they have grammatical errors.”

Williams provided the other charged defendants fake invoices from a particular Chiropractic Office in California, which were created by individuals working with Williams. In addition, Williams obtained fraudulent invoices from a dentist affiliated with dental offices in Beverly Hills, California, and from a doctor at a Wellness Office in Washington State. The fraudulent invoices purported to document that some of the defendants,and, in some cases, members of their families, had been recipients of expensive medical and dental services.

But the defendants had not received the medical or dental services described in the invoices Williams provided them. In many instances, the defendants were not even located in the vicinity of the service providers on the dates the invoices stated they received medical or dental services. In particular, GPS location information and/or documents, such as flight records, show that the defendants were in locations other than the vicinity of the medical or dental offices falsely claimed as the providers of services.

In return for his provision of false supporting documentation for their fraudulent claims, many of the defendants paid Williams kickbacks, totaling at least $230,000. Williams also used the personal identifying information of an employee of the Administrative Manager, which managed the Plan, in the course of the fraud scheme.

The prosecution of this case is being overseen by the Office’s Complex Frauds and Cybercrime Unit. Assistant United States Attorneys Kristy J. Greenberg and Ryan B. Finkel are in charge of the prosecution.

A three-judge Ninth Circuit panel affirmed a federal court dismissal of a lawsuit filed by the American Society of Journalists and Authors and the National Press Photographers Association challenging the State’s passage of Assembly Bill 5 and its various amendments.

The American Society of Journalists and Authors and the National Press Photographers Association filed a federal lawsuit challenging, on First Amendment and Equal Protection grounds, California’s Assembly Bill 5 and its subsequent amendments, which codified the more expansive ABC test previously set forth in Dynamex Operations West, Inc. v. Superior Court of Los Angeles, 416 P.3d 1 (Cal. 2018), for ascertaining whether workers are classified as employees or independent contractors.

AB5 and its subsequent amendments, now codified at section 2778 of the California Labor Code, provides for certain occupational exemptions.

Because freelance writers, photographers and others received a narrower exemption than was offered to certain other professionals, plaintiffs sued, asserting that AB5 effectuates content-based preferences for certain kinds of speech, burdens journalism and burdens the right to film matters of public interest.

The panel in the published case of ASJA v Bonta held that section 2778 regulates economic activity rather than speech. It does not, on its face, limit what someone can or cannot communicate. Nor does it restrict when, where, or how someone can speak.

The statute is aimed at the employment relationship – a traditional sphere of state regulation. The panel further acknowledged that although the ABC classification may indeed impose greater costs on hiring entities, which in turn could mean fewer overall job opportunities for certain workers, such an indirect impact on speech does not necessarily rise to the level of a First Amendment violation.

The panel rejected plaintiffs’ assertion that the law singled out the press as an institution and was not generally applicable.

Addressing the Equal Protection challenge, the panel held that the legislature’s occupational distinctions were rationally related to a legitimate state purpose.

Amicus briefs were filed in this case by Cato Institute, Reason Foundation, Individual Rights Foundation, Goldwater Institute, Independent Institute and Liberty Justice Center.

Lion Farms, LLC owned and operated a dried-on-the-vine raisin vineyard in Madera County (Cottonwood Ranch), at which Lion’s employee Isaac Rey Barrientos worked.

On June 10, 2015, Barrientos was killed when he lost control of the Lion-owned ATV he was riding in the vineyard to service Lion’s portable toilets, and the ATV’s right front tire hit an eye ring grape stake, ejecting Barrientos off of the vehicle.

The June 12, 2015, Merced County Sheriff’s Office Report of Autopsy and the Madera County Certificate of Vital Record listed “blunt impact thoracospinal injuries” (not a head injury) as Barrientos’s cause of death. He was not wearing a helmet at the time of his fatal accident.

While Barrientos’s death was not due to the absence of head protection, Division Associate Safety Engineer Randy Chase found that wearing helmets while riding ATV’s would reduce the inherent risk of head injury. However, Chase also found that Lion had no written certification of having conducted a workplace hazard assessment and no requirement that its employees wear helmets as PPE while riding ATV’s.

Lion was therefore cited for violations of workplace safety regulations by the Division of Occupational Safety and Health.

Lion challenged the citations and the penalties by filing an appeal with the Board. Lion engaged the services of a retained industrial safety expert, who opined in his prepared report that a helmet would represent a hazard in itself and should never be worn while riding an ATV in and under the raisin vine “canopy” of hanging fruit and canes, as a helmet would “most probably become tangled within the vines and pull the rider off the vehicle, causing severe injury or death.”

Following the hearings, the ALJ upheld the citations, and reconsideration was denied. Lion filed its petition for writ of administrative mandate with the trial court, which was denied after a hearing on the merits. The Court of Appeal affirmed the citations in the unpublished case of Lion Farms v. Cal Occupational Safety and Health etc.

Among other issues, Lion claimed that section 3380 (particularly with respect to PPE required in the context of ATV usage in agricultural settings), as applied on the facts and circumstances of this case violated Lion’s substantive due process protections because the regulations were unconstitutionally vague and ambiguous. The Court of Appeal rejected this argument.

An administrative regulation violates due process of law if it forbids or requires the doing of an act in terms so vague that persons of common intelligence must necessarily guess at its meaning and differ as to its application. In considering a vagueness challenge to an administrative regulation, courts do not view the regulation in the abstract; rather they consider whether it is vague when applied to the complaining party’s conduct in light of the specific facts of the particular case. Standards under a regulation may be refined and developed on a case-by-case basis.

Section 3380(f)(1)(A)’s requirement that employers assess their workplaces to determine if hazards necessitating the use of PPE are present or likely to be present (and if such a determination is affirmatively made, select and make available the types of PPE that will protect affected employees from the hazards identified in the workplace assessment) is not impermissibly vague.