Category: Daily News

The Los Angeles Times recently ran a feature story about how the California Medical Board protects negligent doctors. The Times cited at least ten California physicians as examples.

One of the ten examples described in the article was Lokesh Tantuwaya, a San Diego spinal surgeon whose license has been revoked three times by the board, which placed him on probation each time. His license remains valid as he sits in jail awaiting trial on charges that he took more than $3 million in illegal kickbacks for surgeries in one of the biggest insurance scams in state history.

Tantuwaya, is a spinal surgeon who performed so many surgeries at a now-shuttered hospital in Long Beach that he was offered a private jet to commute to the facility, has become the subject of multiple malpractice lawsuits and a federal prosecution for his fraudulent healthcare schemes.

The kickback scheme came to light in 2018 and centered on Pacific Hospital of Long Beach which specialized in spinal and orthopedic procedures. The owner of Pacific Hospital, Michael D. Drobot, “conspired with doctors, chiropractors, and marketers to pay kickbacks in return for the referral of thousands of patients for spinal surgeries and other medical services paid for primarily through the California workers’ compensation system,” according to the Department of Justice. During the last five years of its operation, there were more than $500 million in fraudulent medical bills associated with the hospital, and Drobot eventually went to federal prison.

One of Tantuwaya’s patients sued him for malpractice after she went in for a routine back surgery and it went so badly her leg had to be amputated. He was also charged with accepting millions in bribes to perform these surgeries. Yet, despite all of this on his record, the doctor remains licensed.

Tantuwaya was charged with accepting $3.2 million in bribes and was ordered to hand over his passport, a million dollars and the jet. However, he has not yet gone to trial, and has pleaded not guilty. In June of this year, a judge finally ruled he was a flight risk and confined him to Santa Ana jail only after federal agents learned he’d purchased his own private plane and had discussed “fitting it with an extended fuel tank, just in case he needed to go far away,” according to a motion to revoke bond.

“If he were in any other profession, his license would be yanked,” said Marian Hollingsworth, co-founder of the Patient Safety League, “Any reasonable person would ask, ‘Why does he still have his license?’”

His organization claims that as the battle between would-be reformers and the physicians’ professional association rages regularly in Sacramento. It gained fresh momentum this week in the wake of the Times investigation. “As injured patients and consumer rights groups fight for tougher penalties on grossly negligent doctors, California’s powerful physicians lobby is working hard behind the scenes to water down any proposed reforms. So far, the lobbyists seem to be winning.”

For years, reformers have been demanding significant medical license fee increases to beef up enforcement and to alter the balance of the oversight board – from a physician majority to a public member majority – in the hope of getting more patient-friendly decisions in disciplinary cases.

Robert Fellmeth, executive director of the Center for Public Interest Law at the University of San Diego, called the California Medical Assn. a “pernicious cartel” that consistently fights to starve the state medical board of the funds needed to investigate doctors.

The political ties of the medical association have been well documented, particularly since Newsom’s well-publicized blunder sitting next to CMA’s chief executive and top lobbyist at an upscale Napa Valley restaurant last year, seeming to flout COVID-19 safety guidelines the governor had set.

State Senator Richard Roth (D-Riverside) said his bill, SB 806, has strong reforms, such as allowing the board to seek reimbursement from disciplined doctors for investigation and legal costs. The measure is crucial because, with no fee increases in 15 years, the board is “insolvent,” Roth noted.

But in a message to members last June, the doctors’ lobbyists – the California Medical Association – claimed they got the ear of the senator sponsoring those reforms.

Gavin Newsom, whose office is responsible for appointing most of the board members, refused to be interviewed about The Times’ findings or to offer comment.

The United States has intervened in six complaints pending in Northern California federal court, alleging that members of the Kaiser Permanente consortium violated the False Claims Act by submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees in order to receive higher reimbursements.

The Kaiser Permanente consortium members (collectively Kaiser) are Kaiser Foundation Health Plan Inc., Kaiser Foundation Health Plan of Colorado, The Permanente Medical Group Inc., Southern California Permanente Medical Group Inc. and Colorado Permanente Medical Group P.C. Kaiser is headquartered in Oakland, California.

Under Medicare Advantage, also known as the Medicare Part C program, Medicare beneficiaries have the option of enrolling in managed care insurance plans called Medicare Advantage Plans (MA Plans). MA Plans are paid a per-person amount to provide Medicare-covered benefits to beneficiaries who enroll in one of their plans.

The Centers for Medicare and Medicaid Services (CMS), which oversees the Medicare program, adjusts the payments to MA Plans based on demographic information and the diagnoses of each plan beneficiary. The adjustments are commonly referred to as “risk scores.” In general, a beneficiary with more severe diagnoses will have a higher risk score, and CMS will make a larger risk-adjusted payment to the MA Plan for that beneficiary.

Medicare requires that, for outpatient medical encounters, MA Plans submit diagnoses to CMS only for conditions that required or affected patient care, treatment or management during an in-person encounter in the service year.

In order to increase its Medicare reimbursements, Kaiser allegedly pressured its physicians to create addenda to medical records after the patient encounter, often months or over a year later, to add risk-adjusting diagnoses that patients did not actually have and/or were not actually considered or addressed during the encounter, in violation of Medicare requirements.

The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to receive a share of any recovery.

The False Claims Act also permits the government to intervene in such lawsuits, as it has done, in part, in these cases. The cases are consolidated in the Northern District of California and captioned United States ex rel. Osinek v. Kaiser Permanente, 3:13-cv-03891 (N.D. Cal.); United States ex rel. Taylor v. Kaiser Permanente, et al., 3:21-cv-03894 (N.D. Cal.); United States ex rel. Arefi, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-01558 (N.D. Cal.); United States ex rel. Stein, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-05337 (N.D. Cal.); United States ex rel. Bryant v. Kaiser Permanente, et al., 3:18-cv-01347 (N.D. Cal.); and United States ex rel. Bicocca v. Permanente Med. Group, Inc., et al., No. 3:21-cv-03124 (N.D. Cal.).

This matter was investigated by the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Offices for the Northern District of California and the District of Colorado, with assistance from HHS-OIG.

The claims in which the United States has intervened are allegations only, and there has been no determination of liability.

Hundreds of staffers at two major hospitals in San Francisco have tested positive for coronavirus in July, with most of them being breakthrough cases of the highly infectious Delta variant, The New York Times reported Saturday evening.

By the CDC’s definition, a breakthrough infection is a COVID case that occurs in someone who is fully vaccinated, meaning 14 or more days after completing the recommended doses of an authorized vaccine. Some say the word “breakthrough” is a euphemism for a vaccine failure.

The University of California, San Francisco Medical Center told media outlets that 183 of its 35,000 staffers tested positive. Of those infected, 84% were fully vaccinated, and just two vaccinated staff members required hospitalization for their symptoms.

At Zuckerberg San Francisco General Hospital, at least 50 members out of the total 7,500 hospital staff were infected, with 75-80% of them vaccinated. None of those staffers required hospitalization.

UCSF’s chief medical officer, Dr. Lukejohn Day, told The Times the numbers from his hospital showed just how important and effective vaccinations are.

“What we’re seeing is very much what the data from the vaccines showed us: You can still get COVID, potentially. But if you do get it, it’s not severe at all,” Day said.

Day also told ABC7 News that at least 99% of the cases at UCSF were traced back to community spread, but that hospital officials are still investigating and conducting contact tracing.

He added that most of the cases presented mild to moderate symptoms, and some were completely asymptomatic. He said the cases were spread among doctors, nurses, and ancillary staff.

“We sort of are seeing that across the board,” he said. “We have so far not detected any patient-to-staff or staff-to-patient transmission right now.”

The highly infectious Delta variant has been deemed more transmissible than the viruses that cause the common cold, Ebola, and smallpox, and is equally as contagious as chickenpox, the US Centers for Disease Control and Prevention said in internal documents.

The Delta variant has also been known to spread among vaccinated people in breakthrough cases, prompting the recommendation, if not requirement,that even fully vaccinated people wear masks indoors in areas with high transmission rates.

The Division of Workers’ Compensation has issued a Notice of Public Hearing to amend the Copy Service Price Schedule. The Zoom public hearing is scheduled for Monday, August 30, 2021 at 10 a.m.

The proposed updates to the regulations include:

– – An increase of the flat rate for copy services from $180 to $225 for records up to 500 pages, and includes all associated services such as pagination, witness fees for delivery of records, and subpoena preparation.
– – Several provisions to address improper payments, such as a preclusion for medical providers to improperly charge for inspection of records, maximum witness fees from third party release of information services, and an increase for bills not paid within 30 days of billing.
– – A procedure to object to services provided within 30 days of a request by an injured worker to an employer, claims administrator or workers’ compensation insurer for copies of records in the employer’s possession that are relevant to the claim. It is not uncommon for an employee’s attorney to subpoena records even though they have been subpoenaed by defendant. The 30-day waiting period is triggered when the copy service advises the claims administrator of an intent to copy records from a specific location for a specific dispute. The parties would then have an opportunity to object within the waiting period. Once an objection is raised, the parties must meet and confer to resolve the objection.
– – DWC will also charge and collect retrieval costs for records requested under the Public Records Act.

The proposed amendments to the Copy Service Price Schedule are exempt from the rulemaking provisions of the Administrative Procedure Act. DWC is required to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period, and publish the order adopting the regulations online. Members of the public may review and comment on the proposal until August 30, 2021.

Members of the public may attend the public meeting:

Access Information
– – Join from PC, Mac, Linux, iOS or Android: https://dir-ca-gov.zoom.us/j/83062005767
– – Or Telephone:
– – Dial: USA 216 706 7005
– – USA 8664345269 (US Toll Free)
– – Conference code: 956474

Find local AT&T Numbers:

In June 2016, Kirk Hollingsworth was involved in a fatal accident while working for defendant Heavy Transport, Inc. (HT).

Hollingsworth’s wife and son, plaintiffs Leanne and Mark Hollingsworth, filed a wrongful death complaint in superior court against HT and Bragg Investment Company, Inc.

Plaintiffs alleged that HT lacked the required workers’ compensation insurance at the time of the incident, and therefore plaintiffs were entitled to sue Bragg/HT under Labor Code section 3706, which states, “If any employer fails to secure the payment of compensation, any injured employee or his dependents may bring an action at law against such employer for damages . . . .”

Bragg/HT then filed an application for adjudication of claim with the Workers’ Compensation Appeals Board. Only one of these tribunals could have exclusive jurisdiction over plaintiffs’ claims, and in a previous court of appeal opinion, Hollingsworth v. Superior Court (2019) 37 Cal.App.5th 927 (Hollingsworth I), the court held that the superior court, which had exercised jurisdiction first, should resolve the questions that would determine which tribunal had exclusive jurisdiction over plaintiffs’ claims.

Following remand, plaintiffs asserted they were entitled to a jury trial on the factual issues that would determine jurisdiction. The superior court denied plaintiffs’ request and held a hearing in which it received evidence and heard testimony regarding HT’s insurance status. The superior court determined that HT was insured by a workers’ compensation policy at the time of Hollingsworth’s death, and therefore the WCAB had exclusive jurisdiction over the matter. Plaintiffs appealed. The court of appeal affirmed the trial court in the published case of Hollingsworth v. Heavy Transport, Inc.

Plaintiffs assert on appeal, that they were entitled to a jury trial on the fact issues that would determine jurisdiction. The appellate court disagreed.

Although a jury may determine questions relevant to workers’ compensation exclusivity when the issue is raised as an affirmative defense to common law claims, jurisdiction under Labor Code section 3706 is an issue of law for the court to decide.

Citing numerous decisions, the court said that it is the general rule that “[i]n a civil case . . . personal and subject matter jurisdiction ordinarily are issues for the court, not the jury.”

Because plaintiffs asserted jurisdiction under Labor Code section 3706, it was appropriate for the court, not a jury, to determine the questions relevant to jurisdiction. Plaintiffs did not have a right to a jury trial on these facts.