Category: Daily News

SpineFrontier, Inc., founded in 2006 by Dr. Kingsley R. Chin, is a Massachusetts-based medical device company. SpineFrontier faced a multi-year investigation by the U.S. Department of Justice (DOJ) starting in 2016, initiated by whistleblower allegations under the False Claims Act. The civil case, settled in November 2023, alleged that SpineFrontier paid kickbacks to spine surgeons consulting with the company.

SpineFrontier products, such as doughnut-shaped plastic cages, titanium screws, and other spinal implants, are used by spine surgeons across the United States, including in surgeries reimbursed by federal health care programs like Medicare and Medicaid, which are active in California.

In addition to the civil cases, in 2021, SpineFrontier, Dr. Chin, and CFO Aditya Humad were indicted on criminal charges including conspiracy to violate the Anti-Kickback Statute and money laundering.

Dr. Chin pleaded guilty in May 2025 to one count of making false statements to the Centers for Medicare & Medicaid Services (CMS) under the Physician Payment Sunshine Act. The false statements involved misreporting a $4,750 payment to a surgeon as “consulting” fees, despite no actual consulting work being performed.

Money laundering charges were dismissed in December 2024, and all criminal charges against Dr. Chin and SpineFrontier were dismissed by May 2025, except for a guilty plea to one count of false statements to CMS.

Dr. Kingsley R. Chin was sentenced on August 7th by U.S. District Court Judge Indira Talwani to one year of supervised release with the first six months to be served in home confinement. He was also ordered to pay a fine of $9,500, in addition to $40,000 he personally agreed to pay as part of a related civil settlement, and $855,000 his wholly-owned company, KICVentures, agreed to pay as part of the same settlement.

KICVentures is a private equity firm led by Dr. Kingsley R. Chin. It focuses on advancing outpatient spine surgery through the Less Exposure Spine Surgery (LESS) philosophy. The firm manages a portfolio of spine technology companies aimed at improving patient outcomes and empowering physician-led innovation.

Pursuant to the Physician Payment Sunshine Act, device manufacturers, like SpineFrontier, are required to report any payments or transfers of value to physicians, including spine surgeons. CMS maintains a database, via the Open Payments website, which makes all such payments or transfers of value publicly accessible.

SpineFrontier offered surgeons the opportunity to engage in purported consulting on product development. Specifically, Chin directed his employees to report the payment of fees paid to a surgeon as consulting fees that were not compensation for actual consulting work.

Chin caused his employees to report a payment of $4,750 on Jan. 19, 2016, to the surgeon as a “consulting” payment, even though Chin knew that the surgeon had not performed actual consulting work for the payment. He also knew that he and SpineFrontier were required to accurately report any payments or transfers of value to the surgeon.

United States Attorney Leah B. Foley; Roberto Coviello, Special Agent in Charge of the U.S. Department of Health & Human Services’ Office of the Inspector General; Ted E. Docks, Special Agent in Charge of the Federal Bureau of Investigation, Boston Division; Christopher Algieri, Special Agent in Charge of the Veterans Affairs Office of Inspector General, Northeast Field Office; and Ketty Larco-Ward, Inspector in Charge of the U.S. Postal Inspection Service’s Boston Division made the announcement today. Assistant U.S. Attorneys Abraham R. George, Christopher R. Looney and Mackenzie A. Queenin prosecuted the case.

Dana Hohenshelt sued his employer, Golden State Foods Corporation, in Los Angeles County Superior Court in November 2020. Hohenshelt alleged discriminatory retaliation, failure to prevent harassment, and Labor Code violations stemming from his reports of workplace sexual harassment and subsequent termination in April 2020.

Hohenshelt had signed a pre-dispute arbitration agreement governed by the Federal Arbitration Act (FAA), requiring binding arbitration for employment claims. Golden State was responsible for paying arbitration fees and costs.

The trial court compelled arbitration in August 2021 via JAMS. Arbitration proceeded for about a year. In July and August 2022, the arbitrator issued invoices totaling over $44,000 to Golden State, due upon receipt. Golden State paid late (after 30 days), citing inadvertence due to the arbitrator’s unavailability notice and counsel’s paternity leave.

Hohenshelt moved to withdraw from arbitration and lift the court stay under California Code of Civil Procedure § 1281.98 (part of the California Arbitration Act, or CAA), claiming Golden State’s late payment constituted a material breach. The trial court denied the motion, interpreting the statute to allow payment within 30 days of a later deadline set by the arbitrator.

The Court of Appeal (Second District, Division Eight) reversed, holding the payment was untimely and § 1281.98 was not preempted by the Federal Arbitration Act. It directed the trial court to lift the stay..

The California Supreme Court reversed the Court of Appeal decision in the published case of Hohenshelt v. Superior Court -S284498 (August 2025).

Under California law, employer must pay arbitration fees “within 30 days after the due date” (invoices are due upon receipt unless parties agree otherwise). Late payment constitutes a “material breach,” default, and waiver of the right to compel arbitration. The employee may withdraw or continue arbitration (if the provider agrees). The breaching party must pay the other’s reasonable expenses (mandatory); courts may impose additional sanctions unless justified.

The Legislature enacted section 1281.98 in 2019 (Senate Bill 707) to deter employers/companies from strategically delaying arbitrations by withholding fees, affirming federal cases like Brown v. Dillard’s, Inc. (9th Cir. 2005) and Sink v. Aden Enterprises, Inc. (9th Cir. 2003), which treated willful nonpayment as material breach.

The FAA requires arbitration agreements to be enforced like other contracts (no special rules disfavoring arbitration). Section 1281.98’s default 30-day rule (modifiable by parties) promotes arbitration’s goals of speed and efficiency without deviating from general contract law (e.g., time can be “of the essence” in urgent contexts; willful breaches discharge duties).

The Supreme Court rejected prior appellate interpretations treating section 1281.98 as a “bright-line” rule automatically forfeiting arbitration rights for any late payment (e.g., regardless of inadvertence). For example Gallo v. Wood Ranch USA, Inc. (2022) interpreting section 1281.98 rigidly.

Instead, it harmonized the statute with longstanding contract law principles (Civ. Code §§ 3275, 1511; Code Civ. Proc. § 473(b)), which allow relief from forfeiture for non-willful, non-fraudulent, or non-grossly negligent breaches if the breaching party compensates the other. The Legislature aimed to deter strategic nonpayment (per legislative history and cases like Brown and Sink), not penalize good-faith errors. This avoids preemption concerns by aligning with general contract defenses.

The Supreme Court reversed the Court of Appeal’s directive to lift the stay and remanded for the trial court to assess if Golden State’s delay was excusable (e.g., good faith mistake) and if Hohenshelt suffered compensable harm.

A Los Angeles County Fire Department captain has been charged with fraudulently claiming long-term disability insurance for a work injury that could not have occurred because he was not at work.

45 year old Thomas Merryman was charged in case 25CJCF04929 with one felony count of insurance fraud, one felony count of false personation and two felony counts of forgery.

Merryman is accused of fraudulently claiming long-term disability benefits from Colonial Life & Accident Insurance Company by submitting forged paperwork from a physician and another Los Angeles County Fire Department captain. Merryman allegedly defrauded the insurance company of more than $25,000.

News sources report that Merryman retired on March 1.

The complaint was filed for a warrant on Aug. 8, and his arraignment is scheduled for Sept. 9 at the Clara Shortridge Foltz Criminal Justice Center in downtown Los Angeles. Authorities say Merryman currently resides in Georgetown, Texas. If convicted as charged, Merryman faces a maximum sentence of five years in state prison.

The case is being prosecuted by Deputy District Attorney Arunas Sodonis of the Healthcare Fraud Division and was investigated by the District Attorney’s Bureau of Investigation.

The charges filed in this case are allegations. The defendant is presumed innocent unless and until proven guilty in a court of law.

“Fake disability claims will not be tolerated under my watch, especially by first responders charged with keeping our county safe,” Los Angeles County District Attorney Nathan J. Hochman said. “False healthcare claims raise insurance premiums and make it more difficult for people with legitimate work injuries to claim benefits. My message to public servants who abuse the system is clear: We are watching you. Prosecutors and investigators in my office are working closely with the Los Angeles County Fire Department and other agencies to root out fraud.”

Kaiser Permanente has been experimenting with AI in its patient portal, increasing patient engagement and experience in the process.

“Care is local, but at the same time it’s virtual and it’s become a global commodity,” Khang Nguyen, MD, assistant executive medical director for care transformation at Southern California Permanente Medical Group and chief medical officer of care navigation for the Permanente Federation, told Becker’s. “So patients are really expecting artificial intelligence to support healthcare in a way that is supporting other industries, in the sense that people are able to describe what they want versus being given choices.”

A new study, published in npj Digital Medicine in partnership with Seoul National University Bundang Hospital, focused on the deployment of the Kaiser Permanente Intelligent Integration (KPIN) system by the Southern California Permanente Medical Group (SCPMG), which serves 3.9 million patients. Implemented in October 2024, KPIN is an advanced patient portal system designed to enhance care navigation and patient experience.

KPIN replaced older systems (Microsoft’s LUIS and VSN Query Report) and integrated natural language processing (NLP) to generate clinical alerts for high-acuity cases and recommend appropriate care pathways. It supports multiple channels, including a web-based portal, mobile app, and self-service interactive voice response (IVR) system, ensuring consistent care navigation. The system verifies patient identity and guides them through booking processes, redirecting emergencies to 911 or hospitals.

October 1, 2024, to March 1, 2025, KPIN facilitated 2,960,945 digital visits, with 1,046,504 unique patients interacting with the system. Demographic data showed 36.6% of users were aged 30–49, 47.8% were female, and 38.9% were of Hispanic origin.

The study evaluated KPIN’s Clinical Alert System (CAS) and Virtual Safety Net (VSN) models for detecting high-acuity symptoms (e.g., chest pain, dyspnea) and guiding care navigation. Metrics included accuracy, precision, recall, F1-score, and area under the curve (AUC).

KPIN processed an average of 193,134 encounters daily, with a peak of 19,364. The adjusted successful booking rate was 53.8%, reflecting effective appointment scheduling. The abandonment rate was low at 0.94% (IQR: 2.7–3.1%), indicating high user engagement, attributed to a streamlined interface limiting interactions to nine per page.

Patient surveys showed an 8.6 percentage point increase in positive sentiment, suggesting improved user satisfaction. The system struggles with vague “Reason for Visit” entries, which can affect care pathway accuracy.

The authors of the study concluded that “KPIN’s integration into the patient portal significantly improved care navigation, clinical alert accuracy, and patient satisfaction within an integrated value-based care model, demonstrating the effectiveness of advanced digital tools in healthcare delivery.”

Dr. Nguyen called that the “biggest surprise” from the findings. “We all know with websites, if you want to bury anything on a website, just make it two clicks away, and then no one can ever find it,” he said. And when patients abandon the app because they can’t locate what they need, they typically contact the call center.

A Glendale woman was sentenced to 108 months in federal prison for participating in a scheme in which hundreds of thousands of dollars in illegal kickbacks were paid and received for patient referrals that resulted in the submission of approximately $10.6 million in fraudulent claims to Medicare for purported hospice care.

Nita Almuete Paddit Palma, 75, of Glendale, was sentenced by United States District Judge Dolly M. Gee, who also ordered her to pay $8,270,032 in restitution.

At a separate hearing, Judge Gee sentenced Percy Dean Abrams, 75, of Lakewood, to three years of probation, which will include two years of home confinement.

At the conclusion of a six-day trial, a federal jury in December 2024 found Palma guilty of 12 counts of health care fraud and 16 counts of paying illegal kickbacks for health care referrals. The jury also found Abrams guilty of six counts of receiving illegal kickbacks for health care referrals.

Palma was excluded from Medicare, a federal health insurance program for people aged 65 and older, because of prior federal convictions for receiving illegal kickbacks. While she was excluded from Medicare, Palma purchased Magnolia Gardens Hospice through her daughter and bought C@A Hospice through her husband in 2015 and concealed her ownership interest in both hospices from Medicare.

Palma then paid “marketers”, including Abrams, hundreds of thousands of dollars in illegal kickbacks for patient referrals that Palma could bill to Medicare for purported hospice care.

Hospice is only for those who are terminally ill and have a life expectancy of six months or less. Hospice provides comfort care to a patient instead of trying to cure the patient’s illness, and a patient forfeits certain benefits under Medicare when electing hospice.

Consistent with instructions provided by Palma, Abrams falsely represented to prospective patients that they did not need to be dying to be on hospice. After collecting personal identifying information from prospective patients that were not dying, Abrams sent the information to Nita Palma so she could bill Medicare for purported hospice care.

Through Magnolia Gardens Hospice and C@A Hospice, Palma caused the submission of approximately $10.6 million in fraudulent claims to Medicare beginning in 2015 for purported hospice care for patients that were not dying. Palma received approximately $6,000 each month a patient was billed to Medicare for hospice. In turn, Palma paid Abrams and other marketers up to $1,000 per month in illegal kickbacks for each patient referred to her that was billed to Medicare for hospice. Many of the patients that were billed to Medicare through Magnolia Gardens Hospice did not know they were signed up for hospice, and some patients only found out after they were denied medical coverage for services they needed.

During the health care fraud scheme, Medicare requested additional documentation from Magnolia Gardens Hospice to support the purported hospice claims. In response, Palma and her husband directed employees to create fake patient charts and had those fake patient charts submitted to Medicare. Court documents allege that while awaiting trial in this matter, Palma took control of three other hospices and caused the submission of approximately $4.8 million in claims for purported hospice care.

The United States Department of Health and Human Services Office of Inspector General and the FBI investigated this matter.

Assistant United States Attorney Roger A. Hsieh of the Major Frauds Section and Matt Coe-Odess of the Domestic Security and Immigration Crimes Section prosecuted this case.