Category: Daily News

Melony Light began working as a seasonal Park Aide at the California Department of Parks and Recreations’s Ocotillo Wells District in San Diego County in 2010. In 2011 she was promoted to a permanent position as an Office Assistant.

Kathy Dolinar was the Superintendent of the Ocotillo Wells District and Leda Seals’s supervisor. Seals and Dolinar were close friends.

In fall 2011, Seals recommended Light for an “out-of-class” assignment as an Office Technician. An “out-of-class” assignment is a temporary assignment to a position in a higher classification with an accompanying increase in pay. Before the end of that assignment, in approximately February 2012, Seals recommended Light for a second out-of-class assignment as a Management Services Technician.

Melony Light was friends with a coworker, Delane Hurley. Seals believed Hurley to be a lesbian. Seals repeatedly made comments to Light intended to make her uncomfortable about her friendship with Hurley, to enlist Light in Seals’s harassment of Hurley based on her sexual orientation, and to encourage Light to cease all contact with Hurley. Seals’s actions allegedly caused Light to suffer emotional distress.

Hurley eventually took medical leave for stress. While she was absent, Seals asked Light to go through Hurley’s workspace and remove any personal items. Light objected because she did not feel comfortable going through Hurley’s things, but Seals insisted. Seals also told Light to move into Hurley’s office because Hurley would not be coming back to the District. Light again objected, but Seals told her the move was nonnegotiable. This situation escalated ultimately involving Kathy Dolinar as Superintendent and a convoluted series of related events.

Ultimately Light filed civil litigation against the Department for retaliation, disability discrimination, and failure to prevent retaliation and discrimination, all in violation of the Fair Employment and Housing Act. The trial court ruled in favor of the Recreation Department, and her former supervisors, defendants Leda Seals and Kathy Dolinar, following orders granting defendants’ motions for summary judgment. The Court of Appeal reversed in the partially published case of Light v Calif. Dept. of Parks and Recreation.

As to Seals and Dolinar, the court concluded contrary to the trial court that workers’ compensation exclusivity does not bar Light’s claim for intentional infliction of emotional distress under the circumstances here. As to the Department, the court concluded that triable issues of material fact preclude summary adjudication of Light’s retaliation claim, but not her disability discrimination claim.

“[T]he exclusive remedy provisions are not applicable under various circumstances, sometimes various identified as ‘conduct where the employer or insurer stepped out of their proper roles’ [citations], or ‘conduct of an employer having a “questionable” relationship to the employment’ [citations], but which may be essentially defined as not stemming from a risk reasonably encompassed within the compensation bargain.”

“Because our discussion of the interplay between workers’ compensation exclusivity and intentional infliction of emotional distress addresses an important legal issue, and our interpretation differs from a recent opinion by our colleagues in Division Three of this court (Yau v. Santa Margarita Ford, Inc. (2014) 229 Cal.App.4th 144) , we will publish that discussion, as well as our discussion of the FEHA retaliation claim on which it relies.”

Yau interpreted the California Supreme Court’s 2008 opinion in Miklosy v. Regents of the University of Cal. (2008) 44 Cal.4th 876, 902 to allow only a single exception to the workers’ compensation exclusivity rule and concluded,that the “exception does not, however, allow a ‘distinct cause of action, not dependent upon the violation of an express statute or violation of a fundamental public policy.’ ” (Ibid., quoting Miklosy, supra 44 Cal.4th at p. 902.).

“We believe Yau reads Miklosy too narrowly……..In sum, absent further guidance from our Supreme Court, we are unwilling to abandon the longstanding view that unlawful discrimination and retaliation in violation of FEHA falls outside the compensation bargain and therefore claims of intentional infliction of emotional distress based on such discrimination and retaliation are not subject to workers’ compensation exclusivity.”

Sovereign Health is a mental health and addiction provider with a footprint throughout Southern California, several states and India. Tonmoy Sharma is its chief executive.

Sharma started Sovereign the year after he lost his license in the UK. He was a psychiatrist in the UK, until his license was revoked for conduct deemed dishonest, unprofessional and misleading, according to documents from the General Medical Council of the UK, which licenses physicians there. There is no record that he holds a license as a physician in California.

One center with six beds grew to 17 centers with 743 beds. A giant map hanging on the conference room wall details another 851 beds in development across the nation, which would bring the total to 1,594 beds.

Last year, his company sued Health Net , one of the nation’s largest insurers, for failing to pay $55 million for medical services rendered by Sovereign-related companies. Sovereign Health’s claims were routinely denied, according to the Los Angeles Superior Court complaint. In 2015, only 36 percent of Sovereign Health’s claims were paid. In 2016 only 3 percent of its claims were paid.

In a counter-suit Health Net argued that Sharma and his companies are engaged in massive fraud that harms all consumers. Sovereign-related companies – and many other addiction-treatment providers – “have abused the Affordable Care Act in a manner that threatens the ongoing viability of health insurers,” Health Net’s suit said. “This scheme, which involves fraudulently obtaining insurance policies and the submission of thousands of false and fraudulent claims, also raises the costs of healthcare coverage to consumers, who ultimately will have to pay higher insurance premiums.”

Sovereign and its affiliates comprise one of the largest groups of fraudulent providers, Health Net charged. Within the span of a single year, Sovereign’s companies went from billing Health Net less than $50,000 a month to more than $13 million a month, Health Net’s counter-suit said. How can that happen? Many clinics – including Sovereign’s – “have been engaged in a sophisticated fraud involving paying kick-backs to ‘buy’ hundreds of patients from teams of brokers, or ‘cappers,’ who find the patients in 12-step programs, AA meetings, homeless shelters and jails, often from outside California, and then ‘sell’ them for cash to the highest-bidding clinic,” its suit said.

What Health Net describes echoes a recent investigation of the industry by the Southern California News Group. Though many legitimate centers remain, critics and long-time insiders say a darker version of the industry is emerging, built around an illicit world of patient recruiters, fraud-driven clinics and drug-testing mills. Southern California, where the implementation of Obamacare makes it easy for recent arrivals to sign on for insurance, is on the front line of the conflict.

This summer federal and state agents raided several locations of Sovereign Health as part of an ongoing probe. No arrests were made when officials executed search warrants at sites in Culver City, Palm Desert, San Clemente and San Juan Capistrano. The search warrants were filed under seal, and officials were barred from discussing the extent of the investigation.

Litigation and FBI probes are not the least of Sharma’s worries. The article in the Orange County Register also reports that “body brokers” from other providers are in his parking lots trying to steal away his patients – and their insurance coverage ‘ every day.

The Department of Industrial Relations’ Division of Workers’ Compensation has issued a notice of public hearing which will take place on September 6, 2017 for proposed evidence-based updates to the Medical Treatment Utilization Schedule (MTUS) regulations by Administrative Director order.

There have been many new scientific and medical developments since the MTUS was initially adopted in 2007. Because most of the treatment guidelines have not been updated since 2007, these new scientific and medical developments have not been incorporated into the MTUS. The MTUS must be able to keep up with the evolving nature of scientific evidence to ensure that its recommendations accurately represent current standards of care. Thus, the primary policy objective of this action is to update the MTUS’ medical treatment guidelines so that its recommendations accurately represent current evidence-based standards of care.

These proposed evidence-based updates to the MTUS incorporate by reference the American College of Occupational and Environmental Medicine’s (ACOEM’s) most recent treatment guidelines to the General Approaches, Clinical Topics, and Special Topics sections of the MTUS.Below is a list of the most recent ACOEM guidelines that will be incorporated by reference into the MTUS:

– Initial Approaches to Treatment Guideline (ACOEM June 30, 2017)
– Cervical and Thoracic Spine Disorders Guideline (ACOEM May 27, 2016)
– Shoulder Disorders Guideline (ACOEM August 1, 2016)
– Elbow Disorders Guideline (ACOEM 2013)
– Hand, Wrist, and Forearm Disorders Guideline (ACOEM June 30, 2016)
– Low Back Disorders Guideline (ACOEM February 24, 2016)
– Knee Disorders Guideline (ACOEM October 28, 2015)
– Ankle and Foot Disorders Guideline (ACOEM September 2015)
– Eye Disorders Guideline (ACOEM April 1, 2017)
– Hip and Groin Guideline (ACOEM May 1, 2011)
– Occupational/Work-Related Asthma Medical Treatment Guideline (ACOEM January 4, 2016)
– Occupational Interstitial Lung Disease Guideline (ACOEM January 4, 2016)
– Chronic Pain Guideline (ACOEM May 15, 2017)
– Opioids Guideline (ACOEM April 20, 2017)

The public hearing is scheduled for September 6, 2017 at 10:00 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland, California. Members of the public may review and comment on the proposed evidence-based updates to the MTUS until 5 p.m. on September 6, 2017.

These proposed evidence-based updates to the MTUS regulations are exempt from Labor Code sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act. However, DWC is required to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period, and publish the order online.

Senate Bill (SB) 1160 and Assembly Bill (AB) 1244 introduced new changes to the workers’ compensation system for adjudicating liens.

Following a criminal conviction that provides a disposition order that the liens will be dismissed, those liens in which the convicted medical provider has an ownership interest will be automatically dismissed in the Workers’ Compensation system by operation of law.

Where the criminal case disposition is silent regarding the outstanding liens, the DWC Administrative Director will identify all liens owned, in whole or in part, by the convicted medical provider and will schedule a consolidated proceeding at a venue designated by the Chief Judge.

According to Labor Code Section 139.21(g), it will be presumed that the liens of the convicted medical provider were based on services connected to the fraud which resulted in the criminal conviction. The statute specifically requires that the medical provider affirmatively prove by a preponderance of the evidence that the services were not connected to the fraud.

Even assuming that the medical provider is able to overcome this hurdle, the employer will retain its ability to defeat the lien on all existing grounds, such as that the services were not reasonably designed to effectuate cure or relief of an industrial injury, that the services were not reasonably calculated to offer proof in connection with a contested issue or that the charges exceeded the Official Medical Fee Schedule or the Medical-Legal Fee Schedule.

The industry will now be given an opportunity to see how this new law works. Pending lien consolidation hearings for suspended physicians, practitioners or providers are posted on the DWC Website. The DWC has scheduled lien consolidation status conferences in August for suspended providers Philip A. Sobol, Michael R. Drobot and Michael D. Drobot on August 16, 17 and 23 respectively. All three will be heard in Van Nuys before WCJ William Gunn.

Combined, the three have roughly 13,000 liens, which have been consolidated pursuant to the chief judge’s order, in the workers’ compensation system pending further determination, according to the DWC.  The list of lien claims for Philip A. Sobol, is 322 pages, Michael R. Drobot is 183 pages, and Michael D. Drobot is 74 pages long.  The documents reflect the case number, injured worker, employer and claims administrator.  

Although LC 139.21(h) provides that “The special lien proceedings shall be governed by the same laws, regulations, and procedures that govern all other matters before the appeals board,” it is not yet clear if any of the employers will have due process rights to call witnesses and present evidence at the consolidated lien hearings, rights to discovery, or more importantly, if employers do not participate if they will be limited in presenting defenses at hearings on each individual case.

Michael D. Drobot, former CEO and owner of Pacific Hospital of Long Beach, pled guilty for his role in a scheme to illegally refer patients for spinal surgeries. DWC suspended him from participating in the California workers’ compensation system on April 28.

Michael R. Drobot operated California Pharmacy Management and Industrial Pharmacy Management, companies that also participated in the kickback scheme. The son of Michael D. Drobot, he pled guilty in U.S. District Court last year to conspiracy and illegal kickback charges and was suspended May 15.

Philip Sobol, an orthopedic surgeon in Los Angeles, was suspended in May based on a criminal conviction involving fraud and abuse of the workers’ compensation system. Sobol pled guilty for participating in the kickback scheme at Pacific Hospital of Long Beach, illegally referring thousands of his patients for spinal surgeries.

The operators of seven sham Southern California “pop-up” medical clinics were among 12 defendants taken into custody this week on federal drug trafficking charges that allege they diverted at least 2 million prescription pills – including oxycodone and other addictive and dangerous narcotics – to the black market.

Two indictments returned by a federal grand jury alleges that members of the conspiracy profited from illicit prescriptions that were issued without any legitimate medical purpose through a series of clinics that periodically opened and closed in a “nomadic” style.

Those arrested include Minas Matosyan, an Encino man also known as “Maserati Mike,” who is charged with leading the scheme. He owned six of the seven sham clinics, which were, at times, located in the Westlake District, North Hollywood and the city of Orange.

The indictments and search warrants describe how Matosyan would “rent out recruited doctors to sham clinics.” Matosyan allegedly supplied corrupt doctors in exchange for kickbacks derived from proceeds generated when the other sham clinics created fraudulent prescriptions or submitted fraudulent bills to health care programs.

In one example described in the court documents, Matosyan provided a corrupt doctor to a clinic owner in exchange for $120,000. When the clinic failed to pay the money and suggested instead that Matosyan “take back” the corrupt doctor, Matosyan demanded his money and said, “Doctors are like underwear to me. I don’t take back used things.”

The conspirators also allegedly stole the identities of doctors who refused to participate in the scheme. In an intercepted telephone conversation described in court documents, Matosyan offered a doctor a deal to “sit home making $20,000 a month doing nothing.” When the doctor refused the offer, the conspirators nevertheless created prescription pads in the doctor’s name and allegedly began selling fraudulent prescriptions for oxycodone without the doctor’s knowledge or consent.

The indictment also charges Matosyan and others – including Glendale-based criminal defense attorney Fred Minassian – with obstruction of justice for allegedly creating fraudulent medical records in an effort to deter the investigation. After a load of Vicodin was seized from one of the conspiracy’s major customers, Matosyan allegedly oversaw the creation of fake medical paperwork in an effort to make it appear the drugs had been legitimately prescribed. The indictment describes intercepted conversations in which Minassian strategized on how to deceive law enforcement, which included a plan to bribe a doctor to lie to authorities.

The 12 defendants arrested are:

– Minas Matosyan, 36, of Encino, who is accused of leading the scheme by recruiting corrupt doctors, overseeing the theft of other doctors’ identities, and negotiating the sale of fraudulent prescriptions and narcotic pills;
– Armen Simonyan, 52, of Burbank, who allegedly managed the operations at some of the fraudulent clinics;
– Grisha Sayadyan, 66, of Burbank, who allegedly managed the operations at various clinics and sold oxycodone and Vicodin pills directly to black market customers;
– Sabrina Guberman, 45, of Encino, who, while working at the sham clinics, allegedly lied to pharmacies seeking to verify the fraudulent narcotic prescriptions, which included creating and sending fake medical paperwork;
– Frederick Manning Jr., 47, of Santa Ana, allegedly one of the major drug customers of the clinics, who is charged with agreeing to purchase as many as 1,000 pills per week of narcotics from Matosyan;
– Fred Minassian, 50, of Glendale, the criminal defense attorney who allegedly spearheaded the scheme to lie to law enforcement by making it falsely appear that Vicodin seized from Freddie Manning Jr. had been legitimately prescribed by a doctor;
– Ralph Manning, 49, of North Hills (no relation to Frederick Manning Jr.), who is charged with being one of the principal couriers Matosyan used to deliver fraudulent prescriptions and “bulk quantities” of narcotic pills;
– Hayk Matosyan, 30, of Granada Hills, Matosyan’s brother, who allegedly filled fraudulent narcotic prescriptions at pharmacies and sold the resulting narcotics pills to black-market customers.
– Marisa Montenegro, 54, of West Hills, who allegedly filled fraudulent prescriptions;
– Elizabeth Gurumdzhyan, 25, of Hollywood, who allegedly filled fraudulent prescriptions;
– Anait Guyumzhyan, 27, of Hollywood, who allegedly filled prescriptions for oxycodone and returned the drugs to Matosyan-operated clinics in exchange for cash payment; and
– James Wilson, 54, of Venice, who alone is charged in the second indictment with illegally selling oxycodone prescriptions out of a Long Beach clinic that he controlled.

Authorities are continuing to seek two defendants named in the main indictment. Those fugitives are: Gary Henderson, 62, of Lancaster, who allegedly purchased fraudulent oxycodone prescriptions from Matosyan; and an unidentified conspirator known only by the name “Cindy.”