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Category: Daily News

California Insurance Company Placed in Conservatorship

The San Mateo County Superior Court issued an order appointing the California Department of Insurance’s Conservation and Liquidation Office as conservator of California Insurance Company (CIC) and directing the conservator to take immediate possession of the workers’ compensation insurer in response to the company’s willful violation of state law and established pattern of continually flouting California’s regulatory processes.

The Department of Insurance sought the order after company officials unilaterally and illegally attempted to merge its business with a New Mexico-based insurer without first securing the Department’s prior approval.

The order also blocks the attempted merger, which seeks to divest California of its regulatory oversight over this entity. If CIC is permitted to consummate this illegal transfer, CIC employer policyholders, employees with serious work-related injuries and other claimants entitled to vital and necessary insurance benefits, will be left holding policies of a non-admitted insurer not qualified to transact insurance in California.

Effective immediately, the Department of Insurance’s Conservation and Liquidation Office will serve as conservator to protect the company’s existing policyholders and covered workers from an insurer attempting to operate without the approval and authority to continue to transact insurance in California.

The conservator will, to the fullest extent of the law, ensure that California Insurance Company policyholders remain covered under their existing policies and retain the full protections provided to them under California law.

This action follows an established pattern and practice by company officials of illegal actions, misrepresentations, and willful disregard for the authority of the Department of Insurance and other states’ regulators:

— In 2016, the Department of Insurance issued a precedential decision In the Matter of the Appeal of Shasta Linen Supply, Inc. stating that California Insurance Company (CIC) “created a product to circumvent California’s statutory and regulatory requirement; a product that ultimately enriched CIC at the expense of California employers.”
— The Department subsequently served California Insurance Company officials with a Cease and Desist Order for selling unapproved workers’ compensation policies to unsuspecting business owners in what amounted to a “bait and switch” scheme.
— Other states including Vermont, Wisconsin, New York, and New Jersey have also taken regulatory actions against the same company officials’ affiliated companies for engaging in similar unapproved transactions within those states.

While the Department of Insurance was in the process of reviewing the company’s application for sale, on October 9, with less than 48 hours’ notice to California, company officials attempted to transfer the ownership of California-domiciled California Insurance Company to a New Mexico entity called “California Insurance Company II.”

The California Department of Insurance denied an application for approval of the sale of California Insurance Company on October 18, citing, among other reasons, the applicants’ abrupt and unilateral attempt to merge the company with a New Mexico-based entity without seeking or obtaining California’s prior approval.

California law is unequivocal in giving the Department of Insurance the responsibility and power to review transactions of California-based insurers in order to protect policyholders and the public. No company can evade this authority if it wants to sell insurance in this state.

5 Year Sentence in Merced $6M Medical Fraud Case

The embattled ex-CEO of a string of now-shuttered Merced-area health clinics that served thousands of low-income patients signed an agreement to plead guilty to defrauding Medi-Cal of millions of dollars.

Sandra Haar, 59, of Merced, was sentenced to five years in prison and ordered to pay $6,107,846 in restitution for health care fraud and conspiracy to receive kickbacks. Haar was ordered to self-surrender on Jan. 15, 2020, to begin serving her sentence.

Haar was the founder and chief executive officer of Horisons Unlimited, a nonprofit public benefit corporation that provided health and dental services in Merced and surrounding communities. She was a nurse practitioner who had been CEO of the clinic since its opening in 2004

According to its 2014 tax filings, Horisons reported nearly $7.6 million in revenue, with functional expenses of $6.7 million.

According to court documents, between January 1, 2014, and March 2017, Haar orchestrated a scheme to bill Medicare and Medi-Cal for services she knew were not reimbursable, and she profited by over $3.7 million from her fraud.

For example, Haar billed Medi-Cal for health and dental services that were not rendered and for unnecessary health care services. She also billed Medi-Cal for office visits with purportedly licensed doctors when the patients instead were dispensed Suboxone, an opioid medication, in the parking lots of McDonald’s and Rite Aid in baggies.

According to court documents, Haar also received thousands of dollars in kickbacks in cash from an account executive at a laboratory in exchange for using it for patients’ laboratory testing.

This case was the product of an investigation by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG), the California Department of Health Care Services, and the California Bureau of Medi-Cal Fraud & Elder Abuse.

China and US Announce Rare Fentanyl Crackdown

Drug law enforcement officers from China and the United States will jointly brief the media on Thursday on a fentanyl smuggling case, in an unusual disclosure of rare Sino-U.S. cooperation in cracking down on fentanyl crimes.

China’s National Narcotics Control Commission and enforcement officers from both countries will give “detailed information” at a press conference in Xingtai city in northern Hebel province about a fentanyl smuggling case that was jointly uncovered by both sides, according to a notice circulated by the State Council Information Office.

Reporters will also be able to view a live broadcast of the trial at the Xingtai court, before the press conference.

Fentanyl is a cheap, relatively easy-to-synthesize opioid painkiller 50 times more potent than heroin that has played a major role in a devastating U.S. opioid addiction crisis.

U.S. officials say China is the main source of illicit fentanyl and fentanyl-related substances that are trafficked into the United States, much of it through international mail. China denies that most of the illicit fentanyl entering the United States originates in China.

U.S. President Donald Trump accused Chinese President Xi Jinping in August of failing to meet his promises to crack down on the deluge of fentanyl and fentanyl analogues flowing into the United States. China labeled that “blatant slander”.

The dispute over fentanyl comes with the United States in the middle of a major trade dispute with China.

China’s National Narcotics Control Commission said in September that Sino-U.S. cooperation on investigating and prosecuting fentanyl-related substances was “extremely limited”, even though counter-narcotics law enforcement departments from both sides had long maintained a good cooperative relationship.

The sudden show of cooperation announced on Tuesday coincides with intense bilateral negotiations over a phase-one trade agreement which Trump said he hoped to sign with Xi.

DEA Warns: “Mass Quantities” Counterfeit Pills

The Drug Enforcement Administration is alerting the public of dangerous counterfeit pills killing Americans.

Mexican drug cartels are manufacturing mass quantities of counterfeit prescription pills containing fentanyl, a dangerous synthetic opioid that is lethal in minute doses, for distribution throughout North America.

Based on a sampling of tablets seized nationwide between January and March 2019, DEA found that 27 percent contained potentially lethal doses of fentanyl.

“Capitalizing on the opioid epidemic and prescription drug abuse in the United States, drug trafficking organizations are now sending counterfeit pills made with fentanyl in bulk to the United States for distribution,” said DEA Acting Administrator Uttam Dhillon. “Counterfeit pills that contain fentanyl and fentanyl-laced heroin are responsible for thousands of opioid-related deaths in the United States each year.”

Fentanyl and other highly potent synthetic opioids remain the primary driver behind the ongoing opioid crisis, with fentanyl involved in more deaths than any other illicit drug.

Much of U.S. fentanyl originates in China, but is pressed into pills in Mexico and smuggled into the U.S.

A lethal dose of fentanyl is estimated to be about two milligrams, but can vary based on an individual’s body size, tolerance, amount of previous usage and other factors.

The full Fentanyl Signature Profiling Program Report on the recent drug sampling and testing is available on the DEA.gov website.

Response to AB-5: California Freelancers “Need Not Apply”

Now that the dust has settled on AB-5, the new law that classifies more independent contractors as employees, industries that are expected to be affected include: golf caddies, exotic dancers, some freelance journalists, cable installers, bartenders, and most delivery drivers. The Recording Industry Association of America, and the American Association of Independent Music. AB5 could make workers, including producers, engineers, musicians, publicists and background vocalists, full-time employees.

According to the Freelancing in America survey, there is a reported 57 million American freelancers contributing an excess of $1 trillion dollars to the economy each year. And California based freelance writers are now cast as industry pariah by some employers.

The Hollywood Reporter stated many publications are going to avoid working with California freelancers to avoid potential lawsuits. They’ve admitted to already seeing SEO, transcription and writing job notices explicitly state California freelancers won’t be considered.

The exemption for freelance journalists contains what some say is a potentially career-ending requirement for a writer to remain a freelancer: If a freelance journalist writes for a magazine, newspaper or other entity whose central mission is to disseminate the news, the law says, that journalist is capped at writing 35 “submissions” per year per “putative employer.” At a time when paid freelance stories can be written for a low end of $25 and high end of $1 per word, some meet that cap in a month just to make end’s meet.

Amy Lamare, who writes for money site Celebritynetworth.com and YourTango.com, adds, “Everyone’s freaking out, like my anxiety is going through the damn roof.”

Many publications that employ California freelancers aren’t based in the state and it’s not clear how AB 5 will affect them. Still, some are choosing to opt out entirely. Indeed, several freelance writers who spoke to THR say that various out-of-state employers – some with offices in California – have already told them they’re cutting ties with California freelancers.

I have heard from clients that they’re just going to avoid working with California freelancers,” freelance entertainment writer Fred Topel says (Topel chose not to name those clients in case they change their minds). THR has additionally reviewed several job notices in transcription, blogging and SEO writing that have explicitly stated that California freelancers will not be considered.

Large California-based news media brands are still figuring out the logistics of how to comply with the law. Asked how he plans to handle the implementation of AB 5 next year, San Diego Union-Tribune publisher and editor-in-chief Jeff Light says, “We’re in the process of sorting through the implications right now. Unfortunately, I suspect a number of freelancers will end up with less work from us as a result of the 35-piece limit. I don’t have anything more detailed than that at this point.”

Of the freelancer exemption, San Francisco Chronicle publisher Bill Nagel says, “This was a poorly considered part of the law, likely based on a fundamental misunderstanding of why companies use freelancers. There are situations in which we cannot make a freelancer an employee, which inhibits our First Amendment rights as a publication. It also seems odd and problematic that broadcast freelancers are treated differently than their colleagues in print media. Unfortunately, AB 5 will limit opportunities for some freelancers and silence a number of voices in the market. We will, of course, comply with the law.”

Meanwhile, national outlets are remaining mostly silent publicly. The Los Angeles Times – which just negotiated its first newsroom union contract – The New York Times, The Washington Post, The Wall Street Journal and Southern California News Group (which owns the O.C. Register and Los Angeles Daily News) declined to comment. USA Today owner Gannett, which has freelancers at papers in California, and movie website Rotten Tomatoes, which is based in Los Angeles, did not respond to requests for comment.

4 in 10 Deal With Weekly Burnout Caused Health Issues

The World Health Organization recently recognized occupational burnout as a legitimate health syndrome. While that may sound a bit excessive at first glance, consider the results of a recent survey involving 2,000 working Americans: A shocking 36% of respondents reported dealing with feelings of on-the-job burnout every single week. Another 56% say they get burnt out on on the job at least once per month.

On the other hand, if stress and exhaustion isn’t gripping you mentally and physically at your desk, sadly you’re in a small minority. Only 12% of surveyed employees say they have never felt burnt out while working in their current position.

Conducted by telecommunications company TollFreeForwarding.com, the survey also revealed that roughly four in 10 employees deal with weekly health issues brought on by job-induced burnout. More specifically, 40% suffer from anxiety regularly, 44% report feeling exhausted on a weekly basis, and 56% say that intense feelings of stress have become part of their weekly routine.

All of that burnout is creeping into other areas of people’s lives as well, with 54% of respondents saying their sleep patterns have suffered due to burnout, 44% say their work / life balance has been impacted, 37% have become less ambitious in their career motivations, and 36% have seen their overall productivity drop.

It isn’t just the employees who are paying for all this burnout, either. Sick days and loss of personnel is also costing many U.S. businesses. In all, 34% of respondents say they take a day off at least every six months due to burnout, and nearly half (48%) say they their job satisfaction has taken a blow due to burnout. In fact, over half of respondents (55%) have already considered leaving their job due to a perceived lack of support regarding burnout, stress, etc.

It seems many employees feel like their employers aren’t doing enough; 50% of respondents say the companies they work for need to do more to curb employee burnout. Another two-thirds (67%) are worried what all of that stress, anxiety, and exhaustion is going to do their bodies in the long-term.

“Burnout is now officially recognized as an illness, so we thought now was a good time to help uncover more about how employees are feeling in their workplace, and how much support they feel they’re getting,” comments COO of TollFreeForwarding.com James O’Brien in a statement. “Awareness of overworking, and the health problems this can cause, is increasing. Here however, we’ve discovered there is much work to be done. What businesses must recognize is that not addressing burnout is not only bad for health reasons, it’s also bad for business.”

Among the survey’s other findings was that healthcare workers are experiencing burnout symptoms at greater rates than any other profession. Furthermore, it’s clear from the survey’s findings that modern businesses and organizations need to address employee burnout in a proactive, not reactive, manner. For example, a “high-pressure working environment” was the most often-cited reason given by respondents for burnout (44%), followed by “lack of support or communication from management” (38%).

Insurance Fraud Leads to Murder Conviction

A Hawthorne man was found guilty by a jury of 14 federal felonies for intentionally driving his family off a wharf and into the water at the Port of Los Angeles in a scheme to collect money on insurance policies he had taken out on their lives.

Ali F. Elmezayen, 45, was found guilty of four counts of mail fraud, four counts of wire fraud, one count of aggravated identity theft, and five counts of money laundering.

According to the evidence presented at his nine-day trial, Elmezayen bought from eight different insurance companies more than $7 million worth of life and accidental death insurance policies on himself and his family. Elmezayen paid premiums in excess of $6,000 per year for these policies – even though he reported income of less than $30,000 per year on his tax returns. Elmezayen began purchasing the insurance policies the same year he exited a Chapter 11 bankruptcy proceeding.

After purchasing the policies, Elmezayen repeatedly called the insurance companies – sometimes pretending to be his wife in whose name he had obtained some of the policies – to verify that the policies were active and that they would pay benefits if his wife died in an accident. Elmezayen also called at least two of the insurance companies to confirm they would not investigate claims made two years after the policies were purchased. These telephone calls were recorded and were played for the jury.

On April 9, 2015, 12 days after the 2-year contestability period on the last of his insurance policies expired, Elmezayen drove a car with his wife and two youngest children off a wharf at the Port of Los Angeles. The site of the crash was a loading dock and worksite for commercial fishermen.

Elmezayen swam out the open driver’s side window of the car. Elmezayen’s wife, who did not know how to swim, escaped the vehicle and survived when a nearby fisherman threw her a flotation device. Two of the couple’s three sons, who were 8 and 13 and who were both severely autistic, were strapped into the car and drowned. The third son was away at camp at the time and was not in the car at the time his father drove it into the water.

Elmezayen repeatedly lied – to law enforcement officers, insurance companies, and in subsequent civil litigation he filed concerning the crash – about the extent of the insurance he had purchased on his family, and specifically about whether he had insured his disabled children’s lives. The evidence at trial also showed that he attempted to persuade witnesses to falsely tell law enforcement that he had given the insurance proceeds to charity.

Elmezayen then collected more than $260,000 in insurance proceeds from Mutual of Omaha Life Insurance and American General Life Insurance on the accidental death insurance policies he had taken out on the children’s lives. He used part of the insurance proceeds to purchase real estate in Egypt as well as a boat.

Prosecutors argued that Elmezayen was an abusive husband and parent who “hatched a plan” to make all of his financial problems disappear.

Elmezayen will face a statutory maximum sentence of 212 years in federal prison.

San Diego Military Doctor Signs off on Fake Insurance Claims

A federal grand jury in San Diego returned a superseding indictment that charges U. S. Navy servicemembers Dr. Michael Villarroel, Paul Craig, and Christopher Toups with fraud, false claims and conspiracy to defraud the United States.

The charges arise from a scheme where the defendants filed fraudulent claims to obtain unearned benefits from the Traumatic Servicemembers Group Life Insurance Program (“TSGLI”).

The TSGLI program is an insurance program that compensates servicemembers who suffer serious and debilitating injuries while on active duty. The program is funded by fees paid directly by individual service members and the Department of Defense.

Dr. Michael Villarroel, a Commander in the U.S. Navy, was the medical doctor for the Explosive Ordinance Disposal Expeditionary Support Unit One (“EOD ESU One”) from March 2010 through May 2013. In that capacity, Dr. Villarroel knowingly signed off on false and fraudulent TSGLI applications on behalf of multiple servicemembers that were part of or connected to EOD ESU One.

Both Christopher Toups, a former Chief Petty Officer Construction Mechanic, and Paul Craig, a former Lt. Commander in the U.S. Navy, filed fraudulent TSLGI applications. To support their applications, each defendant submitted fabricated applications that included forged signatures and altered hospital records. According to the superseding indictment, Craig fraudulently collected $150,000 and Toups collected at least $100,000.

In addition to Christopher Toups, four other individuals were previously indicted in connection with this scheme. Three of those individuals – Richard Cote, Earnest Thompson, and Kelene Meyer – have pleaded guilty to conspiracy to commit wire fraud, and as part of their plea, admitted that the conspirators defrauded the TSGLI program of nearly $2 million.

According to the plea agreement, Meyer, a former nurse in the U.S. Navy, stated that Toups, Villarroel, and she received kickbacks for creating and filing the fraudulent TSGLI applications for other U.S. Navy servicemembers.

No WCAB Exclusive Jurisdiction Over AOE-COE in CIGA Case

School bus driver Colleen Knowles sought workers’ compensation from her employer, Mountain Empire Unified School District.

The District is a self-insured employer under the workers’ compensation scheme, and its workers’ compensation claims are administered through the San Diego County Schools Risk Management Joint Powers Authority. The JPA purchased excess workers’ compensation insurance to cover claims exceeding a set retention. The District is an additional insured under those policies.

When a dispute over compensation arose, Knowles and the District sought adjudication before the Workers’ Compensation Appeals Board. An administrative law judge ultimately approved their stipulation that Knowles suffered a “specific” injury on May 6, 2003.

The distinction between a “cumulative” and a “specific” injury matters for determining which of JPA’s excess insurance policies was triggered. As JPA’s excess insurer during the stipulated injury date, Kemper Insurance Company indemnified the JPA until it went insolvent. The JPA then approached California Insurance Guarantee Association, a statutorily created insolvency insurer of last resort, to make up what Kemper had failed to pay.

But CIGA is only obligated to pay “covered claims,” defined to exclude claims for which other insurance is available. On this basis CIGA denied coverage, asserting Knowles suffered a cumulative injury, which meant that JPA might recover from a different excess insurer (other than Kemper).

CIGA then sued the JPA and the District for declaratory relief, asserting that because Knowles suffered a cumulative injury, JPA’s claim was not a “covered claim.” In their cross-complaint, defendants sought reimbursement from CIGA of benefit payments made to Knowles after Kemper went insolvent.

The trial court granted both of Defendants motions for summary judgment on the complaint and cross-complaint. and entered judgment in their favor, requiring CIGA to reimburse $129,836.91 plus costs. CIGA appealed that decision.

Central to the court’s ruling, and to CIGA’s appeal, is a jurisdictional question: Does the superior court have jurisdiction to find that Knowles suffered a cumulative injury even if this conflicts with the stipulation before the WCAB, or is injury characterization an issue within the WCAB’s exclusive jurisdiction? The court granted defendants’ motions because it believed the WCAB had exclusive jurisdiction to decide the nature of Knowles’s injury. The Court of Appeal agreed that it did, in the published case of CIGA v the San Diego County Schools Risk Management Joint Powers Authority.

Although this issue appears to be one of first impression in California, federal courts have rejected WCAB exclusivity in similar cases involving excess workers’ compensation insurance. (San Francisco BART Dist. v. General Reinsurance Corp. (N.D.Cal. 2015) 111 F.Supp.3d 1055, 1074 (BART I), affirmed (9th Cir. 2017) 726 F.App’x. 562 (BART II); San Diego Cty. Schs. Risk Mgmt. Joint Powers Auth. v. Liberty Ins. Corp., et al. (2018) 339 F.Supp.3d 1019, 1030 (Liberty).)

The Court of Appeal we agreed with these authorities and concluded, based on the purpose of excess insurance, that the superior court has jurisdiction to characterize Knowles’s injury in this action differently than was reflected in the WCAB stipulation.

Accordingly, it reversed the judgment and direct the trial court to enter a new order denying defendants’ motions for summary judgment.

Enough Fentanyl Seized to “Wipe Out” Entire State of Ohio

Investigators seized over 44 pounds of fentanyl in an Ohio drug bust, a quantity large enough to wipe out the state’s entire population “many times over,” officials revealed Wednesday.

The raid unfolded in Dayton last week. In addition to the fentanyl, investigators seized some 1,500 grams of suspected methamphetamine, 500 grams of suspected heroin, three firearms and $30,000, the Montgomery County Sheriff’s Office announced.

“Twenty kilograms of fentanyl is enough to kill the entire population of Ohio, many times over,” Vance Callender, the Homeland Security Investigations special agent in charge for Michigan and Ohio, said in a statement.

Officers arrested three suspects — Shamar Davis, 31, Anthony Franklin, 30, and Grady Jackson, 37. All faced charges including possession with intent to distribute 400 or more grams of fentanyl, the Montgomery County Sheriff’s Office said in a statement.

The quantity of fentanyl in this case amounts to chemical warfare and a weapon of mass destruction,” Ohio Attorney General Dave Yost said. “I applaud the work of our task force and our law enforcement partners – this is an enormous amount of deadly drugs that will no longer be on our streets.”

This multi-million dollar fentanyl seizure clearly shows the enormity of the opioid problem in this area,” Acting Special Agent in Charge Joseph M. Deters of the FBI’s Cincinnati Division added. “Law enforcement will continue to work aggressively to address the illegal drug supply, but there is also a continuing need to address demand as well.”

Ohio was one of four states in the U.S. — along with Pennsylvania, Massachusetts and New Hampshire — that saw an increase of more than 500 fentanyl-related incidents from 2014 to 2015, according to the latest data available from the U.S. Centers for Disease Control and Prevention.

Most recently, the state grappled with a surge of overdoses linked to fentanyl, resulting in six deaths over the span of 24 hours this past September. Prior to that, in July, nine people died from overdoses in a two-day period.