Category: Daily News

Nimesh Shah, owner of Blue Star Learning, a technical training school in San Diego, was sentenced to 45 months in custody as a result of a multi-year scheme that defrauded the Department of Veterans Affairs out of almost $30 million in education benefits.

Shah was ordered to forfeit about $3 million and pay the VA more than $29 million in restitution. Shah’s wife Nidhi Shah, who was the vice president and director of education at the school, was sentenced to two years of probation as a result of lying to investigators in the course of the investigation into the school.

Shah took extraordinary efforts to deceive regulators from the Department of Veterans Affairs to ensure the school continued to receive VA funds.

Shah provided the VA with false documents, invented fake students and created fake student files. He provided spreadsheets with false employment information and fraudulent contact information for purported graduates of the school and their made up employers.

Eligible schools must be accredited yearly and as part of the process must show that graduates are successfully finding work in their field. To comply, Shah created fictional graduates and hired people overseas to pose as satisfied alumni with fake emails and phone numbers.

He purchased cellular telephones so that he and his employees could field VA regulator calls to purported employers of school graduates, and hired individuals overseas to pretend to be satisfied Blue Star Learning students in response to VA regulator emails.

In reality, the vast majority of actual graduates of the program were working in jobs not related to the training, prosecutors said.

As laid out in court records, Shah’s scheme appears to be one of the largest Post-9/11 G.I. Bill fraud cases that has been prosecuted around the country.

As a result of Shah’s fraud, the VA issued over $11 million in tuition payments to Blue Star Learning, and over $18 million in housing allowances and stipends. In total, as a result of Shah’s fraud, the VA lost $29,350,999.

On September 22, 2020, the U.S. Department of Labor announced a proposed rule addressing how to determine whether a worker is an employee under the Fair Labor Standards Act (FLSA) or an independent contractor.

In this rulemaking, the Department proposes to:

— Adopt an “economic reality” test to determine a worker’s status as an FLSA employee or an independent contractor. The test considers whether a worker is in business for themselves (independent contractor) or is economically dependent on a putative employer for work (employee);
— Identify and explain two “core factors,” specifically: the nature and degree of the worker’s control over the work; and the worker’s opportunity for profit or loss based on initiative and/or investment. These factors help determine if a worker is economically dependent on someone else’s business or is in business for themselves;
— Identify three other factors that may serve as additional guideposts in the analysis including: the amount of skill required for the work; the degree of permanence of the working relationship between the worker and the potential employer; and whether the work is part of an integrated unit of production; an Advise that the actual practice is more relevant than what may be contractually or theoretically possible in determining whether a worker is an employee or an independent contractor.

This proposed rule has triggered a heated battle over the requirements for being an independent contractor.

Weighing in on the battle is the California Attorney General as well as what he says is ” a coalition of 24 attorneys general – as well as local authorities in Chicago, New York City, Philadelphia, and Pittsburgh” who oppose the proposed rule. The coalition joined in writing a comment letter that opposed the DOL position on the rule.

They say that the “proposal upends the test currently used under the federal Fair Labor Standards Act (FLSA) that determines whether workers are entitled to critical employee protections such as paid sick leave, overtime, and unemployment insurance.”

In the comment letter, the coalition urges the Trump Administration to withdraw what they call “the unlawful proposal.”

The Centers for Medicare & Medicaid Services added 11 codes to the list of telehealth services payable under the Medicare Physician Fee Schedule (MPFS). Coverage which are retroactive to March 1, 2020, and is effective for the duration of the public health emergency (PHE) for COVID-19.

Alex Azar has once again renewed the public health emergency (PHE) for the coronavirus pandemic (COVID-19). Set to expire Oct. 23, the PHE is now set to expire Jan. 21, 2021 – one year after declaring a PHE for COVID-19 in the United States.

As a result, the Division of Workers’ Compensation (DWC) has posted an order dated October 20, 2020 adjusting the Physician and Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS) to conform to additional Medicare fee schedule changes pursuant to Labor Code section 5307.1.

DWC has adopted the updated telehealth list which includes 11 new codes which are effective for services rendered on or after October 14, 2020.

The order adopting the updated Physician and Non-Physician Practitioner fee schedule can be found on the DWC fee schedule web page.

The following are the new telehealth codes added by this order:

— 93797 Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session)
— 93798 with continuous ECG monitoring (per session)
— 93750 Interrogation of ventricular assist device (VAD), in person, with physician or other qualified health care professional analysis of device parameters (eg, drivelines, alarms, power surges), review of device function (eg, flow and volume status, septum status, recovery), with programming, if performed, and report
— 95970 Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming
— 95971 with simple spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional
— 95972 with complex spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional
— 95983 with brain neurostimulator pulse generator/transmitter programming, first 15 minutes face-to-face time with physician or other qualified health care professional
— 95984 with brain neurostimulator pulse generator/transmitter programming, each additional 15 minutes face-to-face time with physician or other qualified health care professional (List separately in addition to code for primary procedure)
— G0422 Intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise, per session
— G0423 with or without continuous ECG monitoring; without exercise, per session
— G0424 Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day

CartiHeal, developer of Agili-C, a proprietary implant for the treatment of cartilage lesions in arthritic and non-arthritic joints, announced that FDA has granted Breakthrough Device Designation for the Agili-C implant.

FDA’s Breakthrough Device Program is reserved for certain medical devices that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions. This program is intended to help patients receive more timely access to these medical devices by expediting their development, assessment and review by FDA.

Cartilage, the flexible soft tissue that cushions joints – especially in the knee – cannot self-heal once damaged, because it lacks blood vessels.

The Agili-C surgical implant is a biological scaffold onto which the body’s own stem cells grow and regenerate the damaged bone and cartilage naturally. Gradually, over six to 12 months, the scaffold is replaced with a top layer of hyaline cartilage and a bottom layer of bone identical to the body’s own tissues in a normal joint.

The CartiHeal Agili-C implant is placed where the natural cartilage has degenerated and is immediately infiltrated with blood, starting a biological chain reaction. The result is regenerated bone and cartilage though migration and adhesion of stem cells. The tissue created by this little implant becomes genetically identical to the body’s own tissue. The clinical evidence of the Agili-C slowly becoming a part of the human anatomy is astounding!

“We are extremely pleased that FDA granted the Agili-C implant Breakthrough Device Designation,” said Nir Altschuler, CartiHeal’s Founder & CEO. “We look forward to working closely with FDA to expedite Agili-C’s review process, once the final IDE study results will be available, in order to provide a promising treatment for millions of patients who suffer from cartilage defects and currently lack good treatment options.”

CartiHeal, a privately-held medical device company headquartered in Israel and New Jersey, develops proprietary implants for the treatment of cartilage and osteochondral defects in traumatic and osteoarthritic joints.

Angelica Reynoso was employed as a service officer by the Gardena Police Department and worked at the city jail. On February 20, 2016, an inmate who had scabies was transferred to another jail. Service Officer BrianLee packaged the inmate’s property but Reynoso may have touched the inmate’s shoes.

That same day, Reynoso or her former husband purchased 1,049 square feet of flooring from Lumber Liquidators.Over the next few months, Reynoso purchased additional flooring from Lumber Liquidators.

On February 23, 2016, Reynoso reported to her employer that she had a rash and believed it to be scabies due to the inmate exposure. Reynoso received treatment that day from a medical clinic.

On March 9, 2016, Reynoso informed her employer that she believed that scabies had infected her children and her residence. The employer sent a professional cleaning crew to Reynoso’s residence. The cleaners found an infestation of bedbugs, but not scabies. The crew steam-cleaned the carpet, but did not advise Reynoso to replace the carpet with new flooring.

Later Reynoso stated that her physician advised her to replace her flooring, and sent flooring invoices to her employer dated from February to May 2016, amounting to $8,640.22. When asked to provide the physician’s note, Reynoso replied that the replacement recommendation came from the cleaning crew who cleaned her residence.

A jury convicted Reynoso of workers’ compensation insurance fraud and insurance fraud. The court of appeal sustained the conviction in the unpublished case of People v Reynoso.

The issue on appeal was the admissibility of her recorded interview taken by Investigator Michael Downs at the police department. Downs died before the criminal trial, and the recording was admitted into evidence without his authentication.

Recordings are writings as defined by the Evidence Code. To be admissible, a writing must be relevant and authenticated. The Code defines authentication as “the introduction of evidence sufficient to sustain a finding that it is the writing that the proponent of the evidence claims it is.”

The fact conflicting inferences can be drawn regarding authenticity goes to the document’s weight as evidence, not its admissibility.

The trial court acted within its discretion by deciding that the prosecutor established a prima facie showing of authenticity for the Downs recording.

The parties stipulated that the voices on the regarding were Downs and Reynoso. The parties also agreed that their respective transcripts of the recording had no material differences. At the beginning and end of the recording, Downs announced the time.From this information, the court could measure the duration of the interview and decide that it was complete.