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Former Attorney Tom Girardi Gets 7 Years for Defrauding Clients

Disbarred plaintiffs’ personal injury attorney Thomas Vincent Girardi was sentenced to 87 months in federal prison for leading a years-long scheme in which he embezzled tens of millions of dollars of settlement money that belonged to his clients, some of whom awaited payment for treatment of severe physical injuries.

Girardi, 86, formerly of Pasadena and who now resides in Seal Beach, was sentenced by United States District Judge Josephine L. Staton also ordered Girardi to pay a $35,000 fine and $2,310,247 in restitution. Judge Staton ordered Girardi to surrender to federal authorities no later than July 17.

Girardi was found guilty by a jury in August 2024 of four counts of wire fraud.

A once-powerful figure in California’s legal community, Girardi ran the now-defunct downtown Los Angeles law firm Girardi Keese. For years, Girardi misappropriated and embezzled millions of dollars from client trust accounts at his law firm. The scheme involved defendant Girardi stealing millions of dollars in client settlement funds and failing to pay Girardi Keese clients – some of whom had suffered serious injuries in accidents – the money they were owed.

In carrying out his criminal conduct, from October 2010 to late 2020, Girardi operated Girardi Keese like a Ponzi-scheme by providing a litany of lies for failure to pay clients and directing law firm employees, including co-defendant and former Girardi Keese CFO Christopher Kazuo Kamon, to make incremental payments of newly obtained settlement funds to previously defrauded clients or using the new funds to pay other unrelated expenditures.

Girardi sent lulling communications to the defrauded clients that, among other things, falsely denied that the settlement proceeds had been paid and falsely claimed that Girardi Keese could not pay the settlement proceeds to clients until certain purported requirements had been met. These bogus requirements included addressing supposed tax obligations, settling bankruptcy claims, obtaining supposedly necessary authorizations from judges, and satisfying other debts.

Girardi also diverted tens of millions of dollars from his law firm’s operating account to pay illegitimate expenses, including more than $25 million to pay the expenses of EJ Global, a company formed by his wife related to her entertainment career, as well as spent millions of dollars of Girardi Keese funds on private jet travel, jewelry, luxury cars, and exclusive golf and social clubs.

At the end of 2020, as Girardi and his law firm faced mounting legal problems related to his years-long theft of client funds, Girardi Keese was forced into involuntary bankruptcy. The State Bar of California disbarred Girardi in July 2022.

Relatedly, co-defendant Kamon, 51, formerly of Encino and Palos Verdes and who was residing in The Bahamas at the time of his November 2022 arrest on a federal criminal complaint, pleaded guilty in October 2024 to two counts of wire fraud. Kamon, the long-time head of the accounting department at Girardi Keese, aided and abetted Girardi’s fraud scheme and embezzled millions of dollars from Girardi Keese itself for his own benefit.

On April 11, Kamon was sentenced to 121 months in custody and ordered to pay $8,903,324 in restitution. Kamon has been in federal custody since November 2022.

Kamon has agreed to plead guilty to federal fraud charges in Chicago where he is charged along with former Girardi Keese lawyer David R. Lira, Girardi’s son-in-law. Trial in that case is scheduled to start on July 14. Girardi was dismissed from the Chicago case because of his conviction and sentencing in this case.

IRS Criminal Investigation and the FBI investigated this matter. The Office of the United States Trustee provided assistance.Assistant United States Attorney Scott Paetty of the Major Frauds Section prosecuted this case.

Home Depot Settles Overnight Overtime Wages Case for $3.35M

A class action lawsuit was filed by Sandy Bell and Martin Gama against Home Depot U.S.A. in 2012 in California state court. The lawsuit alleged that Home Depot violated California labor laws by designing its workday to evade overtime obligations, specifically for employees working overnight shifts.

The plaintiffs claimed Home Depot structured its workday (defined as 12 a.m. to 11:59 p.m.) to avoid paying proper overtime wages for shifts crossing midnight. California law requires overtime pay (1.5 times the regular rate) for hours worked beyond 8 in a single workday or 40 in a workweek, and double time for hours exceeding 12 in a workday. By splitting overnight shifts across two calendar days, Home Depot allegedly avoided paying overtime for hours worked past midnight, even if part of a single shift.

The case is cited as Bell v. Home Depot U.S.A., Inc., No. 2:12-cv-02499-JAM-CKD, originally filed in Sacramento County Superior Court and later moved to federal court. It was consolidated with Henry v. Home Depot U.S.A., Inc., Case No. 3:14-cv-04858. The class currently includes 20,000 individual Class Members who worked more than eight hours and past midnight.

The Bell portion of this action covers the following certified class: All persons who worked for Home Depot in California as a non- exempt, hourly-paid supervisor during the period from August 14, 2009 through June 1, 2016, who worked at least one overnight shift that crossed midnight of more than eight hours, and who, as a result, was not paid overtime for the hours worked over eight hours during such overnight shift.

The Henry portion of the action covers the following certified class: All persons employed by Home Depot in hourly or non-exempt positions in California during the period from September 18, 2010 through May 3, 2016, who worked a shift past midnight in which the total aggregate number of hours for that shift exceeded eight hours.

After several rounds of summary judgment, the claims remaining for both the Bell and Henry classes were violations of California Labor Code sections 203 and 226, as well as claims under the UCL and FLSA, and PAGA claims. Plaintiffs’ claims were predicated on allegations that they did not receive adequate compensation for overnight overtime shifts.

Judge Tigar emphasized that Home Depot’s liability hinged on whether its workday designation had a legitimate business purpose or was intended to evade overtime pay. The court noted Home Depot’s detailed employee records in its Kronos time-tracking system could help determine class membership and assess claims.

Plaintiffs have now filed an unopposed motion in which they request preliminary approval of the class and PAGA settlements, approval of the Class Notice, and appointment of the Settlement Administrator.

Under the terms of the Settlement Agreement, the parties have agreed to settle Plaintiffs’ claims for a Gross Settlement Amount of $3,350,000. This is a non-reversionary settlement in which no portion of the Settlement can revert to Defendant. After review of the factors outlined in Federal Rule of Civil Procedure 23, Plaintiffs’ unopposed Motion for Preliminary Approval of Settlement was granted.

The Bell v. Home Depot case is distinct from other Home Depot wage and hour lawsuits, such as Utne v. Home Depot U.S.A., Inc., which addressed off-the-clock work and rounding practices and settled for $72.5 million in 2023, covering over 272,000 employees since March 2012. The Bell case is explicitly excluded from the Utne settlement’s scope.

California’s labor laws are among the strictest in the U.S., requiring precise compliance with overtime, meal, and rest break provisions. The Bell case highlights how workday definitions can impact overtime calculations, a tactic plaintiffs argued was exploitative.

Court of Appeal Declines to Apply Federal FEHA Attorney Fee Scrutiny

In 2017, Michael Cash worked as a captain in the Los Angeles County Fire Department and also served as a training captain for the Department’s training academies. When plaintiff complained to the Department’s battalion chief of training that the chief should have terminated a female recruit for failing a test that ordinarily results in automatic termination from a training academy, plaintiff was removed as a training captain in future academies.

Cash thereafter sued the County of Los Angeles (the County), alleging that his removal constituted (1) retaliation for reporting gender discrimination in violation of the Fair Employment and Housing Act (FEHA) (Gov. Code, § 12940 et seq.), (2) a failure to take reasonable steps to prevent such etaliation in violation of FEHA, and (3) retaliation for whistleblowing in violation of Labor Code section 1102.5.1

The matter proceeded to a 20-day jury trial in the spring of 2023. The jury found for plaintiff on all three claims and awarded him $450,000.

The County filed a motion for judgment notwithstanding the verdict (JNOV) or, alternatively, for a new trial. After a round of briefing, which included an opposition from plaintiff that included 28 exhibits encompassing 385 pages, the trial court denied the motion.

In August 2023, plaintiff filed a motion requesting $705,730 in attorney fees. In support of that motion, plaintiff’s attorney declared that the law firm’s hourly rates were (1) $600 for partners, (2) $400 for associates, and (3) $150 for paralegals; however, the invoices submitted in support of the $705,730 total reflected a higher hourly rate of $500 for associates and $200 for paralegals. In October 2023, plaintiff filed a supplemental request, seeking an additional $29,580 in attorney fees related to (1) additional hours opposing the County’s post-trial motions, (2) filing the motion for attorney fees, and (3) opposing the County’s motion to tax costs. This brought plaintiff’s request to a total of $735,310.

Following a hearing, the trial court awarded plaintiff $455,546 in attorney fees. The court started from plaintiff’s originally proffered lodestar of $705,730, declining to include plaintiff’s supplemental request in the lodestar calculation. From that amount, the court deducted $54,950 to reflect the lower billing rates for associates and paralegals set forth in plaintiff’s attorney’s declaration. The court deducted a further $195,234—that is, an “across-the-board percentage cut” of 30 percent from the adjusted $650,780 lodestar – because the court’s “review of the billing records” indicated that “there has been unreasonable padding” because “[s]ome of the work appeared to have been duplicative” and because plaintiff’s attorneys unnecessarily prolonged trial with unnecessary prefatory statements during witness questioning. That resulted in the adjusted lodestar fee award of $455,546. The court declined to further reduce the award based on the County’s other arguments.

Also in August 2023, plaintiff filed a memorandum of costs seeking $132,445.32. The County moved to tax those costs, challenging several items including $4,300 associated with one of plaintiff’s expert witnesses, Donald Lassig (Lassig). Following a hearing, the trial court denied much of the County’s motion, but did tax $4,300 in plaintiff’s costs associated with Lassig.

Plaintiff timely appealed the attorney fees and costs orders. The Court of Appeal affirmed the reduced attorney fee award for the plaintiff in the published portion of the case in Cash v. County of Los Angeles CA2/5 – B336980 – (May 2025),and in the unpublished portion of this opinion also affirmed the trial court’s denial of a motion to tax the plaintiff’s costs.

Until recently, appellate courts in California uniformly “review[ed] attorney fee awards on an abuse of discretion standard” (Laffitte v. Robert Half Internat. Inc. (2016) 1 Cal.5th 480, 488 (Laffitte)), and would infer findings and defer to a trial court’s “general observation that an attorney overlitigated a case” or otherwise overcharged for fees (Karton v. Ari Design & Construction, Inc. (2021) 61 Cal.App.5th 734, 744; California Common Cause v. Duffy (1987) 200 Cal.App.3d 730, 754-755 (Duffy)).”

Recently, however, a handful of California courts have employed “heightened scrutiny” – imported from federal cases interpreting a federal civil rights statute (namely, 42 U.S.C. § 1988) – and on that basis have demanded that a trial court articulate “case-specific reasons for [any] percentage reduction,” including a “clear[]” “expla[nation of] its reasons for choosing the particular negative multiplier [or percentage] that it chose.” (Warren v. Kia Motors America, Inc. (2018) 30 Cal.App.5th 24, 37, 41 (Warren); Snoeck v. ExakTime Innovations, Inc. (2023) 96 Cal.App.5th 908, 921 (Snoeck); see Kerkeles v. City of San Jose (2015) 243 Cal.App.4th 88, 101-104 (Kerkeles)).”

Other courts have declined to employ this importation of federal law (Morris v. Hyundai Motor America (2019) 41 Cal.App.5th 24, 37 & fn. 6 (Morris)), and we join them in doing so.

“Importing the federal standard exceeds the federal courts’ rationale for employing heightened scrutiny of specific fee awards and is inconsistent with our State’s longstanding policy that “[t]he ‘experienced trial judge is the best judge of the value of professional services rendered in [their] court.’” (Serrano v. Priest (1977) 20 Cal.3d 25, 49 (Serrano).)”

Sutter Health Expands California Rural Health Care Access

In a move to expand access and advance care in some of Northern California’s most remote and rural communities, Sutter Health is making two strategic investments to expand primary care and behavioral health services in Del Norte and Lake counties. These enhancements are part of Sutter’s systemwide, not-for-profit commitment to help bridge gaps and deliver high-quality, innovative care closer to where patients live.

Sutter Coast Hospital just broke ground this June on its new Emergency Psychiatric Assessment, Treatment and Healing, or EmPATH, unit. The unit leverages a nationally recognized care model designed to provide a more supportive and calming environment for individuals experiencing acute psychiatric crises. The unit aims to stabilize patients in a more appropriate setting, reducing unnecessary inpatient stays. The EmPATH unit, set to open in early 2026, will also improve wait times within the hospital’s emergency department.

Sutter has also closed escrow on a 18,000 square-foot building across the street from the hospital that will expand access to primary care, urgent care and rehabilitation services. Construction is set to begin the first quarter of 2026 with plans to occupy the space by the first quarter of 2027.

Additionally, workforce recruitment and retention are essential to Sutter’s efforts to expand care access. Workforce housing is just one growing need for health care professionals, especially in rural areas. The Sutter system is committed to exploring affordable housing initiatives, starting in Crescent City, as well as other potential solutions that can further enhance recruitment and retention. Sutter closed escrow on more than 6.5 acres of land to develop for workforce housing, that will support the additional primary care, urgent care and rehabilitation services, as well as the physician residency program.

$17.5 million has been approved to date to support planning for these two projects.

Sutter Health is also investing $5.5 million to build a new 6,900-square-foot care center in Lake County’s Hidden Valley Lake—long known as a health care desert with limited options for care. The new site will help address provider shortages and reduce long appointment wait times. When it opens in June 2026, the care center will offer urgent care, primary care, on-site lab and X-ray services, and rotating specialty care in cardiology, OB/Gyn and orthopedics.

As a not-for-profit health system, Sutter Health said it is committed to helping close health care gaps – especially in rural communities. Sutter’s investments in Del Norte and Lake counties are the latest examples of the system’s efforts to provide care that is aligned with local community health needs that can also have a ripple effect on the overall health and well-being of those throughout California.

Munir Uwaydah Entity Loses $2.25M Legal Malpractice Case

Munir Uwaydah was an orthopedic surgeon well known as a treating physician in California workers’ compensation cases. He had been charged as the ringleader in one of California’s biggest health fraud schemes allegedly perpetrated by his company Frontline Medical Associates, which included unnecessary operations by an untrained assistant that scarred patients forever, according to indictments unsealed in Los Angeles County years ago. A total of 102 people testified during two separate Grand Jury proceedings.

A new civil appellate case involving Frontline (as a plaintiff) decided in May 2025 depicts Uwaydah’s absence from the United States as beginning in 2010, allegedly to evade criminal investigations, with subsequent indictments in 2015 and 2019 solidifying his fugitive status in the civil case defendants’ view. Frontline’s conflicting representations – ranging from Uwaydah choosing not to return, to being under a strict travel ban, to potential extradition for perjury in the civil case – were deemed misleading by the court, contributing to the pattern of misconduct that led to the case’s dismissal by the trial court.

This new case, Frontline Medical Associates v. Bird, Marella, Boxer, etc. (CA2/1, B336038) a May 2025 unpublished appellate case involves Frontline Medical Associates, Inc. appealing a trial court’s decision to grant terminating sanctions, resulting in the dismissal of their case against the law firm of  Bird, Marella, Boxer, Wolpert, Nessim, Drooks, Lincenberg & Rhow, P.C., and Benjamin Gluck (collectively, Bird Marella). The dismissal was based on the trial court’s finding of Frontline’s pervasive misconduct during litigation of this case.

Frontline filed this lawsuit in July 2019, with an amended complaint in December 2021, alleging that Bird Marella, their former legal counsel, committed professional misconduct. Specifically, Frontline claimed that Bird Marella made misrepresentations to induce Frontline to pay $2,250,000 for legal services to represent Paul Turley, who operated Frontline before September 2015. Additionally, Frontline alleged that Bird Marella, which had also represented Frontline and Uwaydah, failed to adequately advise Frontline about potential conflicts of interest arising from their simultaneous representation of Turley. The complaint included causes of action for breach of fiduciary duty, fraud by intentional misrepresentation, fraud by fiduciary, conversion, common counts, and declaratory relief, seeking to address the alleged financial and ethical misconduct by Bird Marella.

Paul Turley was a chiropractor and a key figure associated with Frontline Medical Associates. His involvement with Frontline and its owner, Munir Uwaydah, placed him at the center of significant legal and criminal proceedings related to an alleged massive insurance fraud scheme that allegedly generated $150 million in fraudulent workers’ compensation claims. In September 2015, Turley was arrested as part of a Los Angeles County District Attorney’s investigation.

Over 18 months following the 2015 indictments, a judge dismissed most of the 132 counts in the initial indictments due to insufficient evidence, particularly the aggravated mayhem charges, which carried potential life sentences. In March 2017, at the prosecutors’ request, Los Angeles County Superior Court Judge Kathleen Kennedy dismissed the pending charges against 13 defendants, including Turley, except for two fugitives. Prosecutors immediately refiled new charges in three separate criminal complaints, listing 194 counts, including aggravated mayhem, money laundering, insurance fraud, and unlawful patient referrals.

Benjamin Gluck, Turley’s attorney, criticized the refiling as an attempt to restart the case after prosecutorial missteps, stating, “They want to basically say, ‘We don’t like the way this game is going so we’re turning the board over.’”

In December 2018, Paul Turley pleaded guilty to multiple charges, including conspiracy to commit insurance fraud, insurance fraud, unlawful referrals, and mayhem. As part of his plea, he confirmed in a factual statement that Frontline paid “cappers” to recruit injured workers to maximize billing, regardless of patient needs, and that services like prescriptions and surgeries were prioritized for profitability.

Returning to the civil case appeal decided this month, Uwaydah’s role was pivotal in the Frontline case against Bird Marella due to his historical control over Frontline and his status as a key witness. The defendants alleged that Frontline was essentially a “fake company” operated by Uwaydah, who had fled to Lebanon in 2010 amid criminal investigations for healthcare fraud.

Frontline claimed Uwaydah transferred his ownership interest in Frontline to Medconsult, S.A.L., a Lebanese company, in early 2022 to satisfy a debt, though this was contested as a misrepresentation. Uwaydah’s inability or unwillingness to travel to Los Angeles for trial or deposition, coupled with contradictory statements about his travel restrictions, was a significant issue. The court ordered a bench trial to determine if Uwaydah was Frontline’s alter ego, and his status as a fugitive and the ownership transfer claims were central to the defendants’ arguments for dismissal.

The trial court ultimately dismissed Frontline’s case with prejudice on October 27, 2023, granting Bird Marella’s third motion for terminating sanctions due to Frontline’s deliberate, egregious misconduct that rendered a fair trial impossible. The court cited both its inherent authority and statutory authority under Code of Civil Procedure section 2023.030 for the dismissal.

The specific conduct included misrepresentations about attorney Browne’s conflict of Interest. Frontline’s attorney, David Browne, declared on May 4, 2023, that he had to withdraw due to an unwaivable conflict of interest stemming from a contempt proceeding related to his representation of Medconsult, S.A.L., the purported owner of Frontline. On June 13, 2023, he reiterated this conflict was mandatory and unwaivable. However, evidence showed Browne continued to act as Frontline’s counsel, preparing key witnesses Paul Turley and Amber Woodley for depositions and trial in July 2023.

The court found Browne’s claims about the conflict’s severity were exaggerated to delay proceedings, constituting a fraud on the court. The court dismissed Frontline’s expert testimony defending Browne’s actions as unpersuasive, noting Browne’s post-withdrawal work contradicted his stated ethical concerns.

The court additionally found that Frontline repeatedly failed to comply with discovery obligations and court orders over several years. Itfailed to timely respond to multiple sets of interrogatories and requests for production of documents served between March 2021 and August 2022. Despite court orders to provide code-compliant responses, Frontline missed deadlines, ignored meet-and-confer efforts, and provided incomplete or evasive responses. The court imposed monetary sanctions ($3,000 and $7,500) for these failures, but Frontline’s noncompliance persisted.

Frontline obstructed depositions of its Person Most Qualified (PMQ) and other witnesses. Frontline failed to appear for PMQ depositions noticed for March and September 2022. When it produced David Livingston as PMQ in November 2022, he was unprepared, answering “I don’t know” over 500 times. A subsequent PMQ, Amber Woodley, arrived late and left early, limiting testimony. The court found these actions willful and noncompliant with court orders.

Depositions of Janek Hunt and Adib Kassir were disrupted by late arrivals, excessive breaks, refusals to answer, and early terminations. Frontline failed to produce Ali Mohsen and Mazen Helou for depositions despite court orders, further evidencing noncompliance.

The court rejected Frontline’s excuses (e.g., documents seized in raids, witnesses overseas) as insufficient, finding a “pattern of willful noncompliance” that violated numerous court orders.

Frontline initially represented that Uwaydah was its primary principal (until December 8, 2022). After the court ordered an alter ego trial, Frontline claimed in January 2023 that Uwaydah had transferred his ownership to Medconsult in early 2022 to satisfy a debt. Contradictory evidence, including a January 11, 2022 contract showing Medconsult paid $1 million for Frontline (despite its assets being worth millions and Medconsult already holding a 2005 security interest), and the lack of documentation for a $10 million arbitration award, led the court to find these representations “highly misleading, if not wholly false.” The court concluded Frontline misrepresented ownership to manipulate the use of Uwaydah’s testimony.

Frontline provided conflicting statements about Uwaydah’s ability to travel to Los Angeles. Initially, it claimed Uwaydah chose not to return due to criminal charges (July 2022), with Browne guaranteeing in January 2023 that Uwaydah could travel if he agreed to extradition. Later, Frontline asserted Uwaydah was under a travel ban in Lebanon, unable to leave legally. A Lebanese decree and Uwaydah’s extradition waiver suggesting Frontline misrepresented his status to avoid in-person testimony while seeking to use his deposition, potentially evading perjury accountability.

The court found that Frontline’s cumulative misconduct – misrepresentations, discovery abuses, and disregard for court orders – demonstrated a “mockery of the judicial process.” Previous monetary and evidentiary sanctions had failed to deter Frontline’s behavior, and the court concluded that lesser sanctions would not ensure future compliance. The pervasive, deliberate, and egregious nature of the misconduct, which prejudiced the defendants and undermined trial fairness, justified terminating sanctions.

The appellate court affirmed the trial court’s dismissal of the case, finding substantial evidence supported the trial court’s findings and no abuse of discretion in the dismissal.

Reserve LAPD Officer & Brother Face Insurance Fraud Charges

Eric Benjamin “Ben” Halem, 37, of Porter Ranch, a former full-time Los Angeles Police Department officer and current LAPD reserve officer, and his brother, Jacob Halem, 32, of Tarzana, were arraigned on felony insurance fraud charges following an investigation by the California Department of Insurance. The investigation found the brothers allegedly filed a fraudulent auto insurance claim in an attempt to obtain benefits they were not entitled to receive.

The Department of Insurance began its investigation after receiving a fraud referral alleging Eric Halem falsely reported a crash involving his 2020 Bentley Continental GT, stating his brother Jacob Halem had borrowed the vehicle and was involved in a solo-collision on January 5, 2023. However, the investigation revealed that the luxury vehicle had actually been rented out through Eric Halem’s exotic car rental company, Drive LA, and crashed by the renter three days earlier.

Los Angeles Sheriff’s Department (LASD) deputies responded to the accident scene, documenting the vehicle’s damage with body-worn camera footage before it was impounded. Shortly after, Eric Halem contacted his insurance company twice to obtain proof of insurance, which he then used to release the Bentley from impound. Meanwhile, the renter filed a claim with their insurance company, but it was denied due to lack of first-party collision coverage.

Upon learning that the rental driver’s claim had been denied, Eric Halem allegedly filed a fraudulent claim with his insurance company on his personal policy, misrepresenting the accident details. He claimed that his brother, Jacob Halem, had been driving the vehicle at the time of the crash. To support their false claim, Eric and Jacob Halem submitted staged photographs of the damaged Bentley on a tow truck near the alleged accident location. These photos were intended to mislead adjusters, but the investigation discovered that the damage in the photos was identical to the damage captured in LASD’s body-worn camera footage from January 2, 2023, showing the damage was created before when the brothers claimed.

Further investigation revealed that Jacob Halem also provided a false statement to the insurance company investigator in an effort to corroborate his brother’s fraudulent claim. The total potential loss from the fraudulent claim was $229,283.

Insurance fraud impacts all Californians by driving up costs for consumers and businesses. If you suspect insurance fraud, report it to the California Department of Insurance at 800-927-4357 or visit www.insurance.ca.gov.

The National Insurance Crime Bureau assisted with the investigation and the Los Angeles County District Attorney’s Office is prosecuting this case.

WCRI Studies Variations in Hospital Outpatient Payments Growth

As policymakers nationwide focus on the rising costs of health care, a new study from the Workers Compensation Research Institute (WCRI) reveals that hospital outpatient payments for workers’ compensation grew faster in states with fee schedules based on a percentage of hospital charges and in states without fee schedules.

“This study provides meaningful state comparisons at a time when many are considering or revising hospital fee regulations,” said Sebastian Negrusa, vice president of research at WCRI. “It offers a clear, evidence-based perspective on how different regulatory approaches influence cost growth and payment levels.”

The report, Hospital Outpatient Payment Index: Interstate Variations and Policy Analysis, 14th Edition, analyzes payments for common outpatient surgeries across 36 states, representing 88 percent of the nation’s workers’ compensation benefits. Covering data from 2005 to 2023, the study also compares workers’ compensation hospital payments to Medicare rates.

The following are among the major findings:

– – Faster growth in states with charge-based fee regulations and in non-fee schedule states: From 2011 to 2023, growth in outpatient payments for common surgeries reached 61–81 percent among states with charge-based fee schedules, and 55–88 percent in non-fee schedule states, substantially higher than 24 percent in the median fixed-amount fee schedule state.
– – Higher payments in states without fee schedules: Outpatient payments were 63 to 154 percent higher than the median of states with fixed-amount fee schedules. In these states, workers’ compensation paid $7,550 to $22,002 more per surgical episode than Medicare.
– – Percent-of-charge states cost more: States like Alabama and Louisiana, using percent-of-charge-based fee schedules, paid 83 to 233 percent more than states with fixed-amount fee schedules.
– – Wide variation vs. Medicare: Average workers’ compensation payments for a common group of outpatient surgeries ranged from 40 percent below Medicare in Nevada to 480 percent above in Alabama.

The report also tracks the impact of recent policy reforms. In May 2023, Florida expanded its fixed-amount fee schedule by eliminating charge-based reimbursement for unlisted procedures. This policy change led to a 6 percent decrease in hospital outpatient payments per surgical episode within the same year.

Prominent SoCal “Rehab Riviera” Founder and Ex-CEO Arrested

The founder and former CEO of the now-defunct Sovereign Health Group addiction treatment provider was arrested on an eight-count federal grand jury indictment alleging he submitted more than $149 million in fraudulent claims to health insurers – including for fraudulent urinalysis claims – and, in addition, paid more than $21 million in illegal kickbacks for patient referrals.

Tonmoy Sharma, 61, of Tustin, was arrested at Los Angeles International Airport and is expected to make his initial appearance and be arraigned in United States District Court in downtown Los Angeles.

Sharma is charged with four counts of wire fraud, one count of conspiracy, and three counts of illegal remunerations for referrals to clinical treatment facilities.

Also arrested was co-defendant Paul Jin Sen Khor, 45, of Irvine, who worked as Sovereign’s cash management and accounts payable supervisor. Khor is charged with one count of conspiracy and one count of illegal remunerations for referrals to clinical treatment facilities. Khor was arraigned in United States District Court in Santa Ana. He pleaded not guilty and a July 29 trial date was scheduled. A federal magistrate judge ordered him released on $20,000 bond.

According to the indictment, the San Clemente-based Sovereign once was a prominent addiction treatment provider throughout Southern California and several other states. From 2014 to 2020, Sovereign billed private insurance companies for drug addicted and mentally ill patients often at high, out-of-network rates.

At Sharma’s direction, Sovereign employees aggressively pursued patients through various forms of marketing, directing the patients to contact the company at its toll-free phone number. Once patients called in to Sovereign’s call center, employees used various tactics to enroll patients into the company’s treatment facilities, including misrepresentations. One such misrepresentation was that a patient’s treatment would be paid for by a foundation funded by donations from former Sovereign patients.

In fact, the foundation was a sham organization and a ruse for Sovereign employees – at Sharma’s direction – to obtain patients’ names, dates of birth, and Social Security numbers for use in surreptitiously obtaining health insurance coverage on their behalf. In order to obtain these private health insurance plans, Sovereign employees, at Sharma’s direction, made false representations on insurance applications, claiming qualifying life events that had not happened in order to obtain new insurance outside the enrollment period and inflating or underreporting their income so the patients would qualify for Affordable Care Act government-subsidized private insurance instead of Medicaid, whose reimbursement rates were significantly lower than private insurers.

Patients generally did not know that Sovereign would enroll them into these policies or authorize Sovereign to do so. Sovereign employees at times even pretended to be the patients when calling into those insurance companies. Those insurance companies would not have covered any services under plans obtained by these fraudulent means.

Sovereign also fraudulently billed insurers more than $29 million for urinalysis tests not authorized by the purported ordering health providers. At Sharma’s direction, Sovereign submitted fraudulent claims for comprehensive urinalysis screening, including through its laboratory, Vedanta Laboratories Inc. Sovereign patients were frequently drug tested through both cup testing and comprehensive panel testing. The cup testing returned results within minutes, while the panel testing was much more comprehensive, with results taking several days to return. The comprehensive panel testing screened for dozens of different substances and, accordingly, was billed at a significantly higher rate than cup testing.

Sharma directed Sovereign employees to frequently administer cup testing and comprehensive panel testing on patients, including comprehensive panel testing up to three times a week. Sovereign submitted thousands of claims to insurance companies, including for comprehensive panel tests that purportedly were authorized by physicians when, in reality, the physicians did not authorize the tests. Sovereign also submitted numerous claims to the insurance companies, including urinalysis tests, after physicians were no longer working at Sovereign.

Finally, in addition to the patients obtained through the call center above, Sharma and Khor also procured patients for Sovereign by paying illegal kickbacks to patient brokers. To conceal the nature of these transactions, Sharma and Khor caused Sovereign to enter sham contracts that referred to the brokers’ services as “marketing hours,” a term the brokers used when sending invoices to Sovereign for payment. Sovereign paid more than $21 million in illegal kickbacks for patient referrals.

A 2017 investigative series, “Rehab Riviera,” by the Southern California News Group highlighted widespread fraud and lack of oversight in the industry, with Sovereign Health as a key example. Families and advocates have also criticized Sharma’s facilities for negligence, linking poorly run centers to patient deaths, including overdoses.

In 2022, a Los Angeles jury ordered Sharma and Sovereign Health to pay nearly $45 million to Health Net for fraudulent claims, finding that they acted with “malice, oppression, or fraud” and violated the Racketeering Influence and Corrupt Organizations Act (RICO).

Additionally, in 2008, the British General Medical Council revoked Sharma’s medical license in the UK for lying about his academic qualifications and conducting unethical drug studies. Despite this, he became CEO of Sovereign Health in 2009.

San Diego Dermatologist Faces 22 Charges for $1.3M Fraud

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.

Woman Arrested for Staged Carjacking and Insurance Fraud

The Madera County Sheriff’s Office arrested 57-year-old Martha Gutierrez DeRomero. She is facing a felony insurance fraud charge after claiming two men stole her van with thousands of dollars’ worth of items inside – but, according to Sheriff Tyson Pogue, that was a lie.

On May 23, 2025, DeRomero reported a carjacking at knifepoint near Avenue 21 and Road 26. She claimed an unknown assailant stole her white Chevrolet panel van, which contained $60,000 worth of merchandise.

The Madera County Sheriff’s Office, led by Sheriff Tyson Pogue, investigated the incident and discovered it was a staged event orchestrated by DeRomero and her boyfriend, Alfredo Delezma, to commit insurance fraud.

The investigation revealed that the van, reported stolen, was later found by the Merced County Sheriff’s Office in a storage facility in Merced, along with the supposedly stolen merchandise. This discovery unraveled the scheme, confirming that no carjacking had occurred.

On May 28, 2025, DeRomero was arrested and booked into Madera County Jail on charges of felony insurance fraud, conspiracy, and filing a false police report. Authorities indicated that Alfredo Delezma may also face charges for his role in the conspiracy, although no further details on his status were provided in the reports.

The case was reported by multiple news outlets, including ABC30 Fresno, ABC7 Los Angeles, ABC7 Chicago, and KMPH, all citing the Madera County Sheriff’s Office.

Sheriff Pogue commended the deputies for their thorough investigation, which prevented an fraudulent insurance claim. For further information, contact the Madera County Sheriff’s Office at (559) 675-7770 or visit www.maderacounty.com/sheriff.