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7 Defendants Face $330K SJDB Fraud and Kickback Indictments

A California Department of Insurance investigation has led to the issuance and filing of indictments against seven defendants by the Kern County Grand Jury. The indictments were issued after the defendants allegedly stole over $330,000 in benefits meant to help injured workers re-enter the workforce.

The defendants were employees and owners of a Bakersfield vocational school, Instituto Hispano Americano (IHA), as well as employees of two local law offices.

They allegedly misused Supplemental Job Displacement Benefit Vouchers, which provide injured workers with up to $6,000 for retraining at a post-secondary educational institution. The training helps the injured worker become more competitive in the job market when they are unable to return to their former employer due to being on total or temporary disability.

The Department’s investigation found the defendants conspired to defraud over 20 insurance companies out of more than $330,000. The defendants systematically sent false or misleading documentation to insurance carriers to prove the injured workers were eligible to obtain voucher money, but the students did not actually meet the minimum qualifications for the program. The defendants allegedly lied about dozens of test results for exams that were required for enrollment.

The investigation also found that injured workers were illegally directed to the school by employees of local law offices, who would be paid as much as $600 for each student they referred to the school.

“Like many types of programs that benefit the public at large, workers’ compensation laws can only help the people who need it most if they are protected from fraud and other schemes designed to misappropriate funds,” said Kern County District Attorney Cynthia Zimmer. “When evidence of abuse of the workers’ compensation system is identified, it will be investigated and prosecuted to hold wrongdoers accountable and ensure that benefits remain available for those genuinely qualified to receive them.”

Eighty-five charges have been filed against each defendant including conspiracy to commit insurance fraud, concealing facts affecting entitlement to insurance benefits, and offering or receiving money in exchange for referrals.

All seven defendants have been arraigned and are currently awaiting trial in the Kern County Superior Court. The defendants are Anna Ayala-Reyes, Sylvia Carrillo, Evelyn Cruz, Martin Cruz, Nelfido Rolando Cruz, Cynthia Ozaeta, and Sandra Paredez.

The Kern County District Attorney’s Office is prosecuting this case.

Nurse Practitioners and Physician Assistants Expand in California

Nurse Practitioners growth is expected to be 45%, and Physician Assistants 31% from 2019 to 2029, much faster than the average for all occupations (7%). according to the BLS (2019).

A Nurse Practitioner attends a nursing school, while a Physician Assistant attends a medical school or center of medicine.

Nurses follow a patient-centered model, in which they focus on disease prevention and health education. NPs also handle assessment, diagnosis and treatment. Physician assistants follow a disease-centered model, in which they focus on the biological and pathological components of health while also practicing assessment, diagnosis, and treatment.

NPs can specialize in several areas, including gerontology/geriatrics, mental health, pediatrics, and women’s health. PAs undergo a more generalized education, but can also specialize in areas like emergency medicine, orthopedics, and general surgery.

Both have good job outlooks in California’s future. By a recent count there were nearly 8,000 licensed physician assistants working in California, making an average annual salary of $101,880. Nurse practitioners are earning roughly the same.

The current trend in the healthcare industry is shifting to favor the employment of PAs and NPs as the number of more expensive doctors relatively shrinks. There are currently nine college and university campuses across the state that offer accredited PA degrees with that number expected to rise with the increasing demand for PAs.

The American Academy of PAs (AAPA) recently voted to change the name of their profession from physician assistant to physician associate. It was a decision several years in the making.

“The title physician associate will position PAs to successfully compete in the ever-changing healthcare marketplace by boosting the profession’s relevance and impact among stakeholder groups, especially patients,” AAPA CEO Lisa Gables told MedPage Today via email.

The name change process officially started in 2018. Over 100 possible new titles were considered. The investigation culminated in a final report presented to the AAPA on Nov. 20, 2020.

AAPA said that PAs should refrain from calling themselves “physician associates” until legislative and regulatory changes can be made. The AAPA website said that doing so prematurely could confuse patients, and may be interpreted as stepping beyond the scope of current PA licensure.

The California Department of Consumer Affairs, Physician Assistant Board posted an Alert on its website that warns “While the Physician Assistant Board is aware of the title change, it is inappropriate for PAs to hold themselves out as “physician associates” unless and until legislative and regulatory changes are made to incorporate the new title.

7 Businesses Cited for $1.4M Wage Theft From 107 Workers

The Labor Commissioner’s Office has cited La Mina De Oro, Inc., and six other businesses $1,393,909 for wage theft violations affecting 107 workers. The Norco-based businesses operated a designer fragrance distribution warehouse and numerous retail stores in Riverside and San Bernardino Counties, with locations in the Los Angeles area and Orange County.

The following businesses and individuals are named in the wage theft citations:

– – La Mina De Oro, Inc., a California Corporation
– – KD Nutley Properties, LLC, a California Limited Liability Company
– – CGC Trading Inc., a California Corporation
– – KD Distributors, Inc., a California Corporation
– – Desire Fragrances Inc., a California Corporation
– – Designer Fragrance Warehouse, a California Corporation
– – Desiree Canlas Nutley, an Individual.

The Labor Commissioner’s Office opened an investigation into the retailer’s operation in June 2018 based on a referral from the Warehouse Worker Resource Center (WWRC), a nonprofit worker-rights community based organization in Ontario. The investigation showed that workers at the retailer’s stores were working off the clock before and after their shifts to receive merchandise from the retailer’s distribution warehouse. They were also forced to work through their meal and rest break periods, particularly during peak holiday seasons.

The citations issued included $126,274 in minimum wages, $102,622 in overtime wages, $188,596 in meal period premiums, $116,113 in rest period premiums, $185,831 in waiting time penalties, $24,563 in contract wages, $160,442 in liquidated damages, and $204,350 in damages to workers. The citations also include $162,750 in penalties payable to the state, $88,200 in civil penalties and $34,168 in interest.

When workers are paid less than minimum wage, they are entitled to liquidated damages that equal the amount of underpaid minimum wages plus interest. Waiting time penalties are imposed when the employer intentionally fails to pay all wages due to the employee at the time of separation. This penalty is calculated by taking the employee’s daily rate of pay and multiplying it by the number of days the employee was not paid, up to a maximum of 30 days.

Enforcement investigations typically include a payroll audit of the previous three years to determine minimum wage, overtime and other labor law violations, and to calculate payments owed and penalties due. Civil penalties collected are transferred to the State’s General Fund as required by law.

According to it’s website, Warehouse Worker Resource Center is a nonprofit, 501(c)(3), organization founded in 2011, dedicated to improving working conditions in the warehouse industry in Southern California. It focuses on education, advocacy and action to change poor working conditions in the largest hub of warehousing in the country.

It assists workers dealing with issues of health and safety, wage theft and workers’ compensation when injured. It also serves as a community center for workers, family members and supporters interested in knowing their rights, joining with other workers to share experiences and learn from each other, and building a movement for workers’ rights in the Inland Empire and throughout Southern California.

“Workers in the warehouse industry who experience wage theft should report it to the Labor Commissioner’s Office,” added García-Brower. “My office will work to hold the employer accountable, ensure workers get their owed wages, and prevent law-abiding employers from being undercut.”

Owner of Construction Co. Faces $25M Premium Fraud Charge

49 year old Nissim Vaknin, who lives in Encino, was arraigned for felony insurance fraud after an investigation by the California Department of Insurance revealed he allegedly underreported employee payroll by over $70 million, in order to fraudulently reduce his business’s premium for workers’ compensation insurance by over $25 million.

The State Compensation Insurance Fund (SCIF) filed a suspected fraudulent claim in 2018 with the Department of Insurance after a routine payroll audit for Van Nuys-based NV Construction, owned by Vaknin, identified large discrepancies.

Department detectives conducted a search warrant of NV Construction’s bank records, which showed that for the policy period of October 2014 through March 2018, Vaknin reported a total of $4,083,483 in payroll to SCIF; however, the Department’s investigation found the actual payroll was $74,741,381.

Vaknin underreported payroll by over $70 million, resulting in a premium loss to SCIF of $25,129,032.

“By allegedly underreporting payroll, this business owner not only hurt other businesses who pay for this fraud through higher premiums, he also put their own employees at risk,” said Insurance Commissioner Ricardo Lara. “My Department is committed to investigating fraud in order to protect workers and honest businesses, especially now as our state is struggling through this pandemic.”

Vaknin was arraigned at the Los Angeles Superior Court on May 28, 2021. This case is being prosecuted by the Los Angeles County District Attorney’s Office.

WCAB Panel Allows New QME to Review Retired QME Reports

In 2018, Diana Barrett claimed injury to her psyche, hypertension and gastrointestinal system while employed as an animal services manager by the City of Yuba City. The employer denied her claim in its entirety.

Helayna Taylor, Ph.D. was the original psychological QME and issued a medical-legal evaluative report regarding applicant dated February 25, 2019. Dr. Taylor retired and the parties have stipulated that she is no longer a QME.

The parties disputed which documents may be sent to the replacement QME, Dr. Poston, and the contents of defendant’s proposed letter to the QME. Defendant objected to sending Dr. Taylor’s report to Dr. Poston.

The matter proceeded to trial regarding the issue of what documents should go to a new QME Dr. Poston.

The WCJ ordered that certain exhibits were not to be forwarded to Dr. Poston, including Dr. Taylor’s report. This aspect of the order was reversed in the panel decision of Barrett v City of Yuba City.

An adequate history and examination by the current QME should include review of the previous QME’s report in the absence of a basis for excluding the report from the record. The record reflects that Dr. Taylor’s report was obtained in accordance with the Labor Code. She was replaced as the QME because she retired. The record does not indicate a basis to preclude review of her report by the current QME.

Furthermore, Labor Code section 4062.3(a)(2) permits any party to provide medical records relevant to determination of the medical issues to a QME. (See also Cal. Code Regs., tit. 8, § 35(a)(2) [the employer shall provide to the medical-legal evaluator “[o]ther medical records, including any previous treatment records or information, which are relevant to determination of the medical issue(s) in dispute.”)

The panel noted that this “language is fairly expansive in what medical records may be provided to the QME.”

“Dr. Taylor conducted a psychological evaluation of applicant and addressed her psychiatric claim of injury. Causation for applicant’s psychiatric claim remains in dispute since defendant has not accepted it as compensable. Dr. Taylor’s report is consequently relevant to determination of the medical issues in dispute and may be provided to the current QME for his review.

Lyft Employee Classification Suit Favors State Over Federal Law

Million Seifu worked as a driver for Lyft, Inc.

Seifu filed a complaint against Lyft in July 2018, alleging a single Private Attorneys General Act of 2004 (PAGA) (Lab. Code, § 2698 et seq.) claim on behalf of the state of California and other similarly situated individuals who worked as drivers for Lyft in California.

He alleged that Lyft misclassified him and other drivers as independent contractors rather than employees, thereby violating multiple provisions of the Labor Code.

Lyft petitioned to compel arbitration of Seifu’s individual PAGA claim and stay proceedings in the trial court pending arbitration. Lyft asserted that the PAGA waiver in Seifu’s arbitration agreement was enforceable under the 2018 United States Supreme Court opinion in Epic Systems Corp. v. Lewis.

The trial court denied the motion, rejecting Lyft’s argument that the clause in the arbitration provision waiving Seifu’s right to bring a representative PAGA claim was enforceable.

The court of appeal affirmed the trial court, and held the Lyft arbitration agreement was unenforceable in the unpublished case of Seifu v Lyft.

Epic Systems Corp. v. Lewis was one of three cases consolidated by the United States Supreme Court in 2017 that raised the issue of the Federal Arbitration Act’s preemptive effect over private employment arbitration agreements prohibiting class and collective actions.

In Iskanian Iskanian v. CLS Transportation Los Angeles, LLC (2014) 59 Cal.4th 348, the California Supreme Court held “that an employee’s right to bring a PAGA action is unwaivable,” and that “where . . . an employment agreement compels the waiver of representative claims under the PAGA, it is contrary to public policy and unenforceable as a matter of state law.”

Numerous California Courts of Appeal have rejected the contention that Iskanian is no longer good law in the wake of Epic. On federal questions, intermediate appellate courts in California must follow the decisions of the California Supreme Court, unless the United States Supreme Court has decided the same question differently.

In this case the Court of Appeal agreed with the reasoning of the line of state cases, and conclude that Lyft’s argument regarding the PAGA waiver’s enforceability is without merit.

Jacoby & Meyers Referral Attorney Faces 26 Counts of Insurance Fraud

Bloomberg Law reports that a California attorney is facing charges for felony offenses stemming from an alleged marketing scheme involving the well known Jacoby & Meyers firm.

The 26 count criminal complaint filed by Orange County prosecutors alleges that 45 year old Steven Omid Mehr, used an illegal referral system to send potential clients to Jacoby & Meyers and load them up with fees in the process. His website claims his firm was awarded “Best Attorneys of America” by Rues Rating Service.

Mehr also allegedly used the system to direct business to copying and printing services providers he controlled, bilking unsuspecting clients and worker compensation insurance companies.

The indictment accuses Mehr of purchasing usage rights from Jacoby & Meyers in a referral-for-compensation criminal conspiracy for his attorney marketing firm, Web Shark 360. The URL for webshard360.com redirects to the Mehr website.

Mehr, has been a licensed attorney in California since 2005. Bloomberg Law reports that he described himself as “chairman of the Law Office of Jacoby & Meyers California operations” in a 2015 interview with an online legal industry publication. He purchased the L.A. Weekly in 2017 with other investors.

The indictment outlines a five-year conspiracy from 2011 to 2016 that allegedly involved Mehr and George Pershing Hobson, who is not an attorney.

Prosecutors say Mehr and Hobson’s arrangement violated California Labor Code Section 3215, which prohibits paid referrals in the worker’s compensation and insurance industries, as did their co-ownership of an interpretation company, National Translations Services.The indictment charges Mehr with two felony conspiracy counts for referral of clients for compensation, as well as 22 counts of insurance fraud.

He’s being prosecuted by Orange County Deputy District Attorney Noorul Hasan, who also is prosecuting Mehr. Hassan declined comment when reached by Bloomberg Law.

The case is California v. Mehr, Cal. Super. Ct., No. 21ZF0015. Mehr is set to be arraigned July 12 on the indictment, which a grand jury returned last April. Both defendants have posted $100,000 bond while they await trial.

The criminal indictment in California may have a similar pattern, and follows a proposed New Jersey class action against Jacoby & Meyers, in which the plaintiffs say a third-party service company extracted thousands of dollars in additional fees that should have already been paid by their lawyers.

The suit, filed in federal court in Newark, New Jersey, pertains to Nancy and Jeffrey Harding and their former lawyers, Finkelstein & Partners, LLP, and a similar dispute between Barbara J. Smalls and her former lawyers, Jacoby & Myers, LLP.for work sent to Total Trial Solutions, MedTrial Solutions and CineTrial Solutions.

According to the suit, the litigation support companies are owned by Andrew Finkelstein, a partner of both Jacoby and Finkelstein, and Kenneth Oliver, a former partner of both firms. Plaintiffs also allege that the Law Firm Defendants improperly marked-up the cost of Total Trial’s work in order to make a profit.

In a January 2020 ruling, U.S. District Judge John Michael Vazquez granted Jacoby & Meyers’ motion to dismiss a claim for unjust enrichment, but declined to dismiss the case based on a lack of standing for plaintiff Barbara Smalls. He also declined to throw out allegations that defendants Andrew Finkelstein, his firm Finkelstein & Partners, and a company called Total Trial Solutions are alter egos.

According to the lengthy federal court docket, motions are pending in the case which is not yet scheduled for trial.

What remains to be seen, is the evidence in the Orange County criminal case that may or may not connect the dots showing a similar practice in California as what is alleged in the New Jersey civil case, specifically with respect to workers’ compensation claims, and the liens generated for services in those cases. The focus in California will start with National Translations Services, and what is alleged by prosecutors.  And then to the copying and printing service providers.

No End in Sight to EDD Fraud Prosecutions.

A federal grand jury brought a six-count indictment against 34 Cecilia Aquino, of Fresno, charging her with mail fraud, wire fraud, and aggravated identity theft for submitting unemployment insurance claims and applications for Small Business Administration (SBA) Economic Injury and Disaster Loans using stolen identities.

According to court documents, from June through November 2020, Aquino submitted unemployment benefit claims in at least seven states and at least four loan applications that contained misrepresentations. She claimed that the named individuals last worked as self-employed dancers and owned interior design businesses, and that because of the COVID-19 pandemic, they lost their jobs and business revenue, respectively.

The state workforce agencies that administer the unemployment insurance system, the SBA, and the United States suffered an actual loss of at least $220,000 and were subject to a potential loss of more than $350,000 because of Aquino’s fraud. Aquino used the money for gambling, rent, shopping, and other personal expenditures.

If convicted, Aquino faces a maximum statutory penalty of 20 years in prison and a fine of up to $250,000 for each of the mail and wire fraud counts, and a mandatory two-year sentence consecutive to other counts and a fine of up to $250,000 for each of the aggravated identity theft counts.

And in an unrelated case, 44 year old Deborah Shannell Hollimon, of West Memphis, Arkansas, pleaded guilty to committing mail fraud in connection with California state unemployment insurance benefits.

This case was well before the current pandemic, and demonstrates that EDD fraud has existed for many years.

According to court documents, from September 2012 through September 2015, Hollimon and others filed over 100 fraudulent unemployment insurance claims with the California EDD seeking approximately $882,991 using fictitious businesses.

Hollimon created fictitious employers with EDD and then submitted information to EDD reporting fake employees for the businesses. Almost all, of the individuals reported as employees of the companies were actually victims of identity theft. Hollimon subsequently filed unemployment claims in her own name and in the names of the fake employees in order to collect the benefits. Approximately $569,168 in fraudulent benefits was paid out by EDD.

Hollimon is scheduled to be sentenced on Aug. 19. Hollimon faces a maximum statutory penalty of 20 years in prison and a $250,000 fine.

DOJ COVID – Health Care Fraud Coordinated Law Enforcement Actions

The Department of Justice announced criminal charges against 14 defendants in seven federal districts across the United States for their alleged participation in various health care fraud schemes, that exploited the COVID-19 pandemic and resulted in over $143 million in false billings.

Multiple defendants offered COVID-19 tests to Medicare beneficiaries at senior living facilities, drive-through COVID-19 testing sites, and medical offices to induce the beneficiaries to provide their personal identifying information and a saliva or blood sample.

The defendants are alleged to have then misused the information and samples to submit claims to Medicare for unrelated, medically unnecessary, and far more expensive laboratory tests, including cancer genetic testing, allergy testing, and respiratory pathogen panel tests.

In some cases, and as alleged, the COVID-19 test results were not provided to the beneficiaries in a timely fashion or were not reliable, risking the further spread of the disease, and the genetic, allergy, and respiratory pathogen testing was medically unnecessary, and, in many cases, the results were not provided to the patients or their actual primary care doctors.

The proceeds of the fraudulent schemes were allegedly laundered through shell corporations and used to purchase exotic automobiles and luxury real estate.

The Fraud Section is prosecuting the cases in the following districts: Western District of Arkansas, Northern District of California, Middle District of Louisiana, Central District of California, Southern District of Florida, District of New Jersey, and the Eastern District of New York.

Northern District of California

Mark Schena, 58, of Los Altos, California, the president of Arrayit Corporation, is charged along with two others, the Arrayit Vice President of Marketing and the President of an Arizona marketing organization, in connection with the submission of over $70 million in false and fraudulent claims for allergy and COVID-19 testing. The superseding indictment against Schena includes new counts of health care fraud, a conspiracy to pay kickbacks, and payment of kickbacks in connection with false and fraudulent statements about the existence, regulatory status, and accuracy of an Arrayit COVID-19 test. The conspiracy allegedly sought to induce the ordering of the Arrayit COVID-19 test and to bundle, i.e., require combination with, the COVID-19 test and Arrayit’s medically unnecessary allergy test. The COVID-19 test results were not provided in a timely fashion and were not reliable in detecting COVID-19.

Central District of California

Petros Hannesyan, 36, of Burbank, California, was charged with the theft of government property and wire fraud in connection with $229,454 that he obtained from COVID-19 relief programs. Hannesyan, the owner of Hollywood Home Health Services, Inc., a home health agency located in Los Angeles, allegedly misappropriated funds from the CARES Act Provider Relief Fund and submitted false loan applications and a false loan agreement to the Economic Injury Disaster Loan Program, rather than use the funds for COVID-19 patient care and to support small businesses experiencing disruption due to the COVID-19 pandemic.

Federal Judge Rejects $2B California Roundup Cancer Case Settlement

Many California agricultural workers have been exposed to a pesticide known as Roundup, and some of them may develop cancers. These cancer cases can then become continuous trauma claims under workers’ compensation law.

Thousands of Roundup tort cases are pending in civil courts in several states. A favorable outcome will likely support subrogation in the decades ahead for these claims.

Monsanto Company manufactures Roundup, a pesticide with the active ingredient glyphosate. Bayer AG acquired the agrochemical company in a multibillion-dollar merger in 2018.

Bayer to date has lost several U.S. jury trials in the Roundup litigation, with juries in California awarding multi-million dollar awards. In a recent California case, the jury returned a verdict in favor of plaintiff Edwin Hardeman, awarding him $5,267,634.10 in compensatory damages and $75 million in punitive damages. The district court reduced the jury’s punitive damages award to $20 million. This May, the Ninth Circuit Court of Appeals affirmed the a district court result in the published case of Edwin Hardeman v Monsanto Company.

These bellwether cases led up to attorneys for certain individual plaintiffs in the Multi District Litigation pending in Northern California, negotiating a class action settlement with Monsanto that would cover potential future lawsuits. Last February, Bayer announced it had reached a $2 billion settlement resolving outstanding and future legal issues). The proposed compensation would only have been considered for those who develop non-Hodgkins lymphoma within four years of settlement.

Attorneys representing cancer victims objected to the proposed settlement earlier this month and, ultimately, Judge Vince Chhabria agreed with them. In his newly issued opinion, Chhabria said Bayer’s proposed settlement was “clearly unreasonable” with “glaring flaws” that “vastly overstated” the potential benefits to future cancer victims from Roundup, particularly those who have not yet been diagnosed.

Judge Chhabria added “This is not a situation where the defendant is at risk of going bankrupt, such that only the first set of plaintiffs will be able to recover. Bayer (which recently acquired Monsanto) is a massive, wealthy company, and it continues to make money specifically from Roundup sales.”

“Nor is there any indication that the company will cease its efforts to settle cases. As recently as last week, Bayer stated publicly that it remains committed to settling Monsanto’s Roundup litigation. This is not surprising because the alternative to settling – continuing to lose trials left and right – is not attractive.”

In 2019, Chhabria oversaw the first federal trial on Edwin Hardeman’s claims that Monsanto sold Roundup without a warning label, after which a jury awarded Hardeman $75 million in punitive damages after finding years of Roundup use likely caused his non-Hodgkin lymphoma.