Category: Daily News

The Insurance Commissioner announced several appointments to the California Department of Insurance related boards and committees.

These appointments include naming Ronald Coleman Baeza as the newest member of the California Life and Health Insurance Guarantee (CLHIGA) Board of Directors, Samantha Tradelius as the newest member of the Curriculum Board,reappointmed members Andrew Chick and Heather Pierce to the California Insurance Guarantee Association (CIGA) Board of Governors, reappointed member Debra Gore-Mann to the California Organized Investment Network (COIN) Advisory Board, reappointed members Linda Akutagawa, Imelda Alejandrino, Annalisa Barrett, and Cecil Plummer to the Insurance Diversity Task Force, and reappointed member Jeremy Smith to the California Workers’ Compensation Insurance Rating Bureau (WCIRB) Governing Committee.

CLHIGA consists of all insurance companies licensed to sell life and health insurance, and annuities in California, and it protects certain policyholders against a company’s financial failure. The Board of Directors is responsible for the overall oversight of CLHIGA, which includes approving contracts and reinsurance treaties, authorizing assessments, borrowing money, taking legal actions, and serving on committees that oversee audit and investment functions. The Board consists of up to thirteen member insurers who are selected by the board members and are subject to the approval of the Commissioner.AB 1104 (Chapter 236, Statutes of 2019) added two additional members to the board who represent the public generally and are appointed directly by the Commissioner.

The Curriculum Board oversees the development of pre-licensing and continuing education curriculum for agents and brokers to uphold professional standards that protect consumers. This includes a list of preapproved courses of study as well as courses of study for professional designations. This Board also develops standards for providers and instructors who offer courses and other training to licensed agents and brokers.

The CIGA Board of Governors oversees the guarantee association’s general operations and management in order to protect policyholders in the event of an insurance company insolvency. Established in 1969 by the Governor and California State Legislature, CIGA comprises all insurance companies admitted to sell homeowners, workers’ compensation, automobile, and other specified property and casualty lines of insurance in California.

The California Organized Investment Network (COIN) was established in 1996 within the Department of Insurance to guide insurers on making financially sound investments that yield environmental benefits throughout California and social benefits within the State’s underserved communities. Commissioner Lara has prioritized COIN investments which drive affordable housing, support small businesses, combat climate change, and encourage investors to utilize diverse investment managers more. The COIN Advisory Board provides guidance to the Commissioner and the COIN program to meet its mission and chief priorities.

The Insurance Diversity Task Force oversees the Department’s Insurance Diversity Initiative, which encourages insurers to advance diversity of insurance company corporate boards and increase procurement contracts with diverse businesses owned by women, veterans and disabled veterans, members of historically disadvantaged communities, and LGBTQ+ people. Additionally, the Task Force makes recommendations to the Commissioner regarding innovative ways to increase diversity within the insurance industry. Last year, Commissioner Lara introduced the first-ever Insurance Diversity Index, a groundbreaking benchmarking tool for a more inclusive insurance industry.

The WCIRB Governing Committee sets policy, oversees WCIRB management, and reviews all issues involving pure premium rates, classifications, rating plans, rating systems, manual rules and policy, and endorsement forms. The WCIRB is a private organization licensed by the Department for the purpose of collecting, analyzing, and compiling rating data, with funding coming from assessments of its insurance company members. All workers’ compensation insurance companies in California are required by law to be members of the WCIRB.  

The next CLHIGA Board of Directors meeting will be held on May 7, 2024, the next Curriculum Board meeting is July 18, 2024, the next CIGA Board of Governors meeting is May 7 and May 8, 2024, the next COIN Advisory Board meeting is March 14, 2024, the next Insurance Diversity Task Force meeting is March 7, 2024, and the next WCIRB Governing Committee meeting is April 17, 2024.

More details are available at: www.insurance.ca.gov/boards. All positions are uncompensated.

Tina Royer was a tenured English professor with the the Los Rios Community College District. For the previous thirteen years, she had worked at the Folsom Lake College campus, and during most of the relevant time period, she was the chair of the English department. Josh Fernandez was an English professor at Folsom Lake College. As department chair, Royer was Fernandez’s supervisor.

Royer is Caucasian, Christian, married to a Christian minister, and active in her church, and her Christian background and conservative views are known to her colleagues at Folsom Lake College. Fernandez is Hispanic and is allegedly affiliated with Antifa.

In the fall of 2018, Fernandez was up for tenure, and Royer was one of three members of his tenure review committee. During the tenure review process, all three committee members expressed concerns about Fernandez’s conduct on campus. All three members of the tenure review committee initially determined Fernandez did not meet the guidelines for granting tenure.

Fernandez, however, had threatened to sue the District for attempting to curtail his activities on campus, and purportedly in response to his threat, Dean Snowden ultimately changed his mind about granting tenure. Royer claimed Dean Snowden and Folsom Lake College President Whitney Yamamura successfully pressured her to vote in favor of granting Fernandez tenure.

Although Royer voted in favor of granting tenure, her evaluation included some “less than satisfactory” marks, and Fernandez received a copy of the evaluation. Shortly thereafter, a colleague told Royer that Fernandez was telling other department members he “hated” her “because he received a ‘less than satisfactory’ evaluation” from her.

Around March 2019, Royer complained to the District about Fernandez’s conduct and the effect it was having on her physical and mental health, and she asked that his classroom be moved so it was not next to hers. The District declined to move Fernandez’s classroom, and offered to move her classroom instead, but she did not think she should have to move when she had done nothing wrong. She asked to work remotely in order to avoid interactions with Fernandez on campus. The District agreed

Controversies escalated, and ultimately Royer sued her employer for six separate violations of the Fair Employment and Housing Act (Gov. Code, § 12900 et seq.) (FEHA) and for invasion of privacy.

She claims a coworker subjected her to harassment because of her race and religion, and the District discriminated against her because of her race and religion, retaliated against her for complaining about harassment, failed to prevent harassment, and failed to reasonably accommodate her disability. She also claims that, after she filed a claim pursuant to the Government Claims Act (Gov. Code, § 810 et seq.), the District invaded her privacy by publishing the claim on its Web site without redacting her home address and confidential information about her disability.

The District responded to the lawsuit by filing a special motion to strike pursuant to Code of Civil Procedure section 425.16 (the anti-SLAPP statute). The District’s motion was directed at the entirety of the causes of action for harassment and invasion of privacy, and portions of the causes of action for discrimination, retaliation, and failure to prevent harassment.

The trial court granted the motion as to the discrimination cause of action and denied it as to the other causes of action. The District appealed, and the Court of Appeal reversed in part and affirmed in part, and remanded the case in the unpublished case of Royer v. Los Rios Community College District -C096484 (March 2024).

The District challenges the trial court’s finding that the invasion of privacy claim does not arise out of protected activity under the anti-SLAPP statutes.However when the board met to consider and act on Royer’s claim submitted pursuant to the Government Claims Act, that meeting was an official proceeding authorized by law within the meaning of the anti-SLAPP statute.

Royer argues she “is not suing [the District] for publishing her tort claim,” but instead is suing “because [it] published her tort claim in full without redacting her confidential information.” The trial court appears to have agreed, because it found, “the gravamen of [Royer’s] claim is not the publication of the Tort Claim itself, but the inclusion of her private medical and identifying information unnecessarily.” However the trial court thus should have proceeded to the second step and determined whether Royer met her burden of establishing a probability of prevailing.

The order denying the anti-SLAPP motion was reversed as to Royer’s first cause of action for harassment because she did not establish a probability of prevailing on that cause of action. The order denying the anti-SLAPP motion as to Royer’s seventh cause of action for invasion of privacy is also reversed because the trial court erred in finding it did not arise out of protected activity, and we remand this case to the trial court to determine whether Royer established a probability of prevailing on the invasion of privacy cause of action.

A former Antelope Valley physician was sentenced to 37 months in federal prison for illegally dispensing prescriptions for often-abused controlled substances – including opioid-based medications – during telemedicine sessions with “patients” from across the United States.

Raphael Tomas Malikian, 39, who resides in Llano and Palmdale, was sentenced also ordered to pay a fine of $20,000.

Malikian pleaded guilty in October 2023 to one count of aiding and abetting the acquisition of a controlled substance by fraud and one count of distribution of oxycodone.

The Medical Board of California suspended Malikian’s medical license in November 2021. His license expired in November 2022.

From at least December 2019 to August 2021, Malikian was a licensed physician in California and, in this role, was authorized by the Drug Enforcement Administration (DEA) to prescribe medication. Malikian also owned and operated Happy Family Medicine, a medical clinic that was advertised as being in a co-working space in the Hollywood, but primarily offered telehealth services via telephone or text message communications.

Malikian issued prescriptions for controlled substances to customers without first obtaining the person’s full medical history, conducting a physical examination, requiring medical testing, or utilizing diagnostic tools. Malikian did not verify his customers’ identities before prescribing controlled substances, and he allowed customers to obtain prescriptions in the names of others.

He also worked with two co-conspirators, who provided Malikian with false names, addresses, dates of birth, and Malikian issued controlled substance prescriptions accordingly, which the co-conspirators then filled and re-sold on the black market.

Many of Malikian’s fraudulent controlled substance prescriptions contained notes on the prescriptions or accompanying documentation that falsely urged pharmacies not to verify such prescriptions because medications were urgently needed and the failure to dispense could be life threatening because of the COVID-19 pandemic.

Malikian issued hundreds of false prescriptions for liquid promethazine with codeine during this period – including to people he knew were fictitious patients and which totaled more than 82 liters – and directed them to be sent to various pharmacies across the nation for co-conspirators to obtain.

From April to July of 2020, Malikian prescribed to a buyer 702 pills of 10 milligrams oxycodone and 240 milliliters of promethazine with codeine. The customer, in fact, was an undercover law enforcement officer. Malikian issued each prescription to this buyer without conducting proper medical evaluations or verifying the buyer’s identity and was performed outside the scope of professional practice and without a legitimate medical purpose.

In addition, from May to July of 2020, Malikian prescribed to a customer – who also was an undercover law enforcement officer – 234 pills of the painkiller Norco, which contained a total of 2,340 milligrams of the opioid hydrocodone, and 180 pills of alprazolam, an anxiety medication sold under the brand name Xanax. Once again, Malikian issued each prescription to this buyer without conducting proper medical evaluations or verifying the buyer’s identity and was performed outside the scope of professional practice and without a legitimate medical purpose.

The DEA investigated this matter. The California Department of Justice, Bureau of Medi-Cal Fraud and Elder Abuse provided substantial assistance.. Assistant United States Attorney Brittney M. Harris of the International Narcotics, Money Laundering, and Racketeering Section prosecuted this case.

In February 2021, a strategically coordinated, six-week nationwide federal law enforcement action announced it has resulted in criminal charges against 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States for their alleged participation in various health care fraud schemes that resulted in approximately $1.4 billion in alleged losses.

Two of these 138 defendants were prosecuted in the U.S. District Court for the Southern District of California. Charles Ronald Green Jr. and his wife, Melinda Elizabeth Green, were sentenced to 27 months each for fraudulently billing government healthcare programs more than $125 million for medically unnecessary treatments.

According to court filings, the Greens engaged in a scheme to defraud two major federal health care programs: TRICARE, the medical benefits program for military servicemembers and their families, and Medicare, the program that provides benefits to elderly or disabled Americans.

Chief U.S. District Judge Dana M. Sabraw also ordered $4.5 million in restitution to TRICARE and $69,915,909.69 to Medicare.

Between May 12, 2014, and June 29, 2015, the Greens conspired to submit false and fraudulent claims to TRICARE for expensive and medically unnecessary pain creams, scar creams and multi-vitamins, which were billed through various pharmacies. During this period, the Greens owned or were officers of several companies they used in furtherance of their scheme. The pharmacies paid these companies millions of dollars in illegal kickbacks and other remuneration in exchange for the referral of the false and fraudulent prescriptions for compounded medications to TRICARE beneficiaries.

In turn, the Greens and others paid a portion of their profits as kickbacks to so-called “marketing” organizations in exchange for more prescriptions for compounded medications. TRICARE and other payers often reimbursed compounding pharmacies thousands of dollars for a 30-day supply of a compounded pain or scar cream for one beneficiary. In just one example, on May 8, 2015, a false and fraudulent claim was submitted to TRICARE in the amount of $14,178 for Baclofen Powder.

In furtherance of the compounding fraud scheme, the Greens and others developed compounded medication formulations for the primary purpose of inflating the amount of money TRICARE would reimburse, and to correspondingly increase the amount of kickbacks and remuneration that affiliated marketers would receive.

The Greens’ knowing participation in the compounding fraud scheme resulted in the submission of false and fraudulent claims by one pharmacy in the approximate amount of $8,107,816, of which TRICARE paid at least $6,776,222.

Between June 1, 2018, and April 2019, the Greens also conspired to defraud Medicare by submitting false and fraudulent claims for expensive durable medical equipment, or “DME,” similarly induced through a system of illegal kickbacks.  The Greens and others executed the DME fraud scheme by purchasing “completed doctors’ orders” from various “marketers” for Medicare beneficiaries, which included a prescription signed by a doctor certifying the beneficiary received an exam that met Medicare’s requirements and that the DME was medically necessary.

In an attempt to disguise the DME fraud scheme from detection, the Greens and their co-conspirators entered into sham “marketing” and other contracts that concealed the pay-per-order arrangement. For example, on March 14, 2019, Charles Ronald Green prepared and submitted an invoice from the Greens’ company, NHS Pharma, concealing that NHS Pharma was being paid a per-brace kickback for selling completed doctors’ orders, but claimed instead to be charging for a $35,000 “TV Campaign,” a quantity of 716 website “Landing Pages,” and $6,928.71 for processing hours.

In addition to purchasing doctors’ orders in furtherance of making false and fraudulent claims on behalf of DME companies they owned or controlled, in some instances the Greens brokered the doctors’ orders by re-selling them at a markup to other DME companies.

The Court set a hearing for May 24, 2024, to resolve additional claims for restitution.

The EEO-1 Component 1 report is a mandatory annual data collection that requires all private sector employers with 100 or more employees, and federal contractors with 50 or more employees meeting certain criteria, to submit demographic workforce data to the EEOC.

As announced this week,the 2023 EEO-1 Component 1 data collection will open on Tuesday, April 30, 2024. The deadline to file the 2023 EEO-1 Component 1 report is Tuesday, June 4, 2024.

The EEOC’s EEO-1 Component 1 online Filer Support Message Center (i.e., filer help desk) will also be available on Tuesday, April 30, 2024, to assist filers with any questions they may have regarding the 2023 collection.

All updates about the 2023 EEO-1 Component 1 data collection, including the 2023 EEO-1 Component 1 Instruction Booklet and the 2023 EEO-1 Component 1 Data File Upload Specifications, will be posted to www.eeocdata.org/eeo1 as they become available.

The EEOC anticipates posting the 2023 EEO-1 Component 1 Instruction Booklet and the 2023 Data File Upload Specifications by Tuesday, March 19, 2024.

Traditionally, EEO-1 reports require employers to pick a payroll end date between October 1, 2023, and December 31, 2023, as your “workforce snapshot period.” This which will become the basis of reporting all employees as of that date. New for this reporting cycle, the EEOC has said that you will need to file an EEO-1 report if you reached 100 or more employees during any point of the fourth quarter of 2023.

The EEO job categories are:

(1.1) Executive/Senior-level officials and managers
(1.2) First/Mid-level officials and managers
(2) Professionals
(3) Technicians
(4) Sales workers
(5) Administrative support workers
(6) Craft workers
(7) Operatives
(8) Laborers and helpers
(9) Service workers

Employees must be given an opportunity to self-identify their sex and race/ethnicity, and be provided a statement about the voluntary nature of the inquiry.

The race/ethnicity categories are unchanged:

– – Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
– – White (Not Hispanic or Latino):A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
– – Black or African American (Not Hispanic or Latino):A person having origins in any of the black racial groups of Africa.
– – Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino):A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
– – Asian (Not Hispanic or Latino):A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
– – American Indian or Alaska Native (Not Hispanic or Latino):A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
– – Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.

The EEO-1 reporting system has slowed down significantly as the deadline approached, which makes filing more challenging. Employers might want to allow yourself sufficient time before the deadline so you aren’t scrambling at the last minute with technical challenges. Typically, the EEOC does not provide for extensions. It would be beneficial to file well before the June 4, 2024 deadline.

The EEOC has recently made significant updates to the EEO-1 Report. The changes include revised nomenclature for report types, guidelines for remote employees, and the inclusion of non-binary employees. The report now also requires the use of Unique Entity IDs (UEI) for federal contractors instead of DUNS numbers. Employers need to stay updated with these changes and ensure their reporting is in line with the latest guidelines.

Employers are encouraged to actively stay informed about EEO-1 reporting updates and reach out to legal counsel for guidance and support in ensuring your compliance with the 2024 requirements.