A Brea physician, who is being prosecuted in a baby's death and for being part of an alleged $100 million workers compensation fraud scam, recently had his medical license restricted pending the outcome of criminal proceedings filed in Orange County.
The interim suspension order agreed to by Dr. Andrew Robert Jarminski, his attorney Peter R. Osinoff and counsel for the Medical Board of California went into effect on Dec. 22.
Jaminski's legal problems date back to criminal proceedings commenced in 2014 by an Orange County grand jury indictment of Kareem Ahmed of Landmark Medical Management in Ontario and 15 people including Jarminski.
The OCWeekly recent case summary notes that the original indictment specifically cast Ahmed as the ringleader, accusing him of: hiring pharmacists to produce compounded transdermal creams and paying kickbacks to several physicians and chiropractors, including Dr. Jarminski, for prescribing the cream to their workers' compensation patients.
Ahmed's attorneys managed to get most of the counts against their client tossed in March 2016. But the OCDA refiled charges against Ahmed and others that pushed the number of defendants up to 21 people and the alleged fraud ballooned to $100 million. Hearings in the case are set for Feb. 9 and 26 in Orange County Superior Court. Jarminski, had offices in Long Beach and Lawndale when he was first accused of having received $1.9 million in Landmark kickbacks.
As a result of events alleged in the OCDA criminal prosecution, the California Medical Board issued an Accusation against Jarminski in June, 2017 seeking to revoke his license. They claim he commenced treating Priscilla Lujan, an injured worker, in 2011. During the course of her treatment she gave birth to a child who was breastfeeding. The child died after ingesting residue from the compounded transdermal medication he prescribed for her. The ODCA pursued manslaughter charges against Jarminski, and others, for this death.
Attorneys for the defendants have vehemently denied the charges against them. As for Jarminski's medical license, his lawyers argued that staying a suspension is appropriate because he is presumed innocent until proven guilty, and if he is convicted his license will be revoked by the medical board anyway.
Late last month, Administrative Law Judge Susan L. Formaker agreed that the public can be protected through the restrictions of the interim suspension order, which stipulates that Jarminski cannot dispense or prescribe non-FDA approved compounded medications before the matters before the criminal court and medical board are resolved ...
The interim suspension order agreed to by Dr. Andrew Robert Jarminski, his attorney Peter R. Osinoff and counsel for the Medical Board of California went into effect on Dec. 22.
Jaminski's legal problems date back to criminal proceedings commenced in 2014 by an Orange County grand jury indictment of Kareem Ahmed of Landmark Medical Management in Ontario and 15 people including Jarminski.
The OCWeekly recent case summary notes that the original indictment specifically cast Ahmed as the ringleader, accusing him of: hiring pharmacists to produce compounded transdermal creams and paying kickbacks to several physicians and chiropractors, including Dr. Jarminski, for prescribing the cream to their workers' compensation patients.
Ahmed's attorneys managed to get most of the counts against their client tossed in March 2016. But the OCDA refiled charges against Ahmed and others that pushed the number of defendants up to 21 people and the alleged fraud ballooned to $100 million. Hearings in the case are set for Feb. 9 and 26 in Orange County Superior Court. Jarminski, had offices in Long Beach and Lawndale when he was first accused of having received $1.9 million in Landmark kickbacks.
As a result of events alleged in the OCDA criminal prosecution, the California Medical Board issued an Accusation against Jarminski in June, 2017 seeking to revoke his license. They claim he commenced treating Priscilla Lujan, an injured worker, in 2011. During the course of her treatment she gave birth to a child who was breastfeeding. The child died after ingesting residue from the compounded transdermal medication he prescribed for her. The ODCA pursued manslaughter charges against Jarminski, and others, for this death.
Attorneys for the defendants have vehemently denied the charges against them. As for Jarminski's medical license, his lawyers argued that staying a suspension is appropriate because he is presumed innocent until proven guilty, and if he is convicted his license will be revoked by the medical board anyway.
Late last month, Administrative Law Judge Susan L. Formaker agreed that the public can be protected through the restrictions of the interim suspension order, which stipulates that Jarminski cannot dispense or prescribe non-FDA approved compounded medications before the matters before the criminal court and medical board are resolved ...
A former civilian Los Angeles Police Department employee was arrested on suspicion of workers' compensation fraud, authorities said.
Gerald Pulley, 51, was arrested last Thursday on suspicion of the felony-level crime, Los Angeles police said in a press release.
Pulley has since been released on $20,000 bail. No court date was set.
Pulley had worked for the LAPD for 18 years, authorities said. He was last assigned to the Records and Identification Division.
Authorities said Pulley "concealed material documentation and exaggerated the extent of his injuries, while receiving temporary total disability monetary benefits from the LAPD."
Police said Pulley also maintained secondary employment during this time.
The LAPD's Workers' Compensation Fraud Unit conducted an investigation that stemmed from a medical claim Pulley filed in 2016.
LAPD investigators worked with the Los Angeles County District Attorney's Office and the Los Angeles City Attorney's Office in the investigation, police said ...
Gerald Pulley, 51, was arrested last Thursday on suspicion of the felony-level crime, Los Angeles police said in a press release.
Pulley has since been released on $20,000 bail. No court date was set.
Pulley had worked for the LAPD for 18 years, authorities said. He was last assigned to the Records and Identification Division.
Authorities said Pulley "concealed material documentation and exaggerated the extent of his injuries, while receiving temporary total disability monetary benefits from the LAPD."
Police said Pulley also maintained secondary employment during this time.
The LAPD's Workers' Compensation Fraud Unit conducted an investigation that stemmed from a medical claim Pulley filed in 2016.
LAPD investigators worked with the Los Angeles County District Attorney's Office and the Los Angeles City Attorney's Office in the investigation, police said ...
The case of Saul Zuniga involves another challenge to the constitutionality of certain provisions of the IMR process. He asserts that the anonymity of the IMR reviewers violates his right to due process and that the IMR statute violates the guarantee of right to appellate review.
After successfully appealing an IMR determination and obtaining an order remanding the matter back to IMR for review by a different physician reviewer, Zuniga filed a discovery motion seeking the disclosure of the IMR reviewers’ identities. The Workers’ Compensation Judge ruled that he could not release the names of the IMR physicians pursuant to Labor Code section 4610.6(f).
Zuniga filed a petition for reconsideration, which was denied. He then filed a petition in the Court of Appeal arguing that the anonymity of the IMR reviewers violates due process and that the IMR statutes violate the guaranteed right to appellate review. The Court of Appeal rejected his constitutional challenge, and affirmed the WCAB in the unpublished case of Zuniga v WCAB.
Zuniga argued that it is a denial of due process for an IMR to refuse to disclose the identities of the reviewers when the decision of the first reviewer is reversed and the dispute is referred to a different reviewer in the organization. He claimed that without knowing the identities of the reviewers, an applicant is deprived of the opportunity to "dispute the findings of the second reviewer on the ground that they were made by the same reviewer whose opinion was reversed."
The Court of Appeal responded by noting that under Article XIV, Section 4 of the California Constitution, the Legislature "is . . . expressly vested with plenary power unlimited by any provision of this Constitution, to create, and enforce a complete system of worker’s compensation by appropriate legislation."
As the Court of Appeal held in Stevens, the due process clause of the California Constitution (Cal. Const., art. I, § 7, subd. (a)) does not limit the Legislature’s authority to create a workers’ compensation system. (Stevens, supra, 241 Cal.App.4th at pp. 1092-1093.) Section 4 therefore "supersedes the state Constitution’s due process clause with respect to legislation passed under the Legislature’s plenary powers over the workers’ compensation system."
The Court also ruled that Zuniga’s federal due process claim fails as well. The Court of Appeal in Stevens concluded that the IMR process, including the confidentiality requirement of section 4610.6, subdivision (f), does not violate the federal due process clause. (Stevens, supra, 241 Cal.App.4th at pp. 1096-1101; see also Ramirez, supra, 10 Cal.App.5th at pp. 227-229.)
The Court of Appeal in Stevens assumed that an IMR determination is state action and implicates a protected property interest, which are prerequisites to a federal due process claim. (Stevens, supra, 241 Cal.App.4th at pp. 1096-1098.) The court concluded that even so, Stevens’s due process claim failed because the IMR process "afford[s] ample process. ‘The core of due process is the right to notice and a meaningful opportunity to be heard.’"
When due process must be afforded, the amount of process required is determined by balancing the affected private interest, the risk of erroneous deprivation of this interest, the probable value, if any, of additional or substitute safeguards, and the government’s interest in the process ...
After successfully appealing an IMR determination and obtaining an order remanding the matter back to IMR for review by a different physician reviewer, Zuniga filed a discovery motion seeking the disclosure of the IMR reviewers’ identities. The Workers’ Compensation Judge ruled that he could not release the names of the IMR physicians pursuant to Labor Code section 4610.6(f).
Zuniga filed a petition for reconsideration, which was denied. He then filed a petition in the Court of Appeal arguing that the anonymity of the IMR reviewers violates due process and that the IMR statutes violate the guaranteed right to appellate review. The Court of Appeal rejected his constitutional challenge, and affirmed the WCAB in the unpublished case of Zuniga v WCAB.
Zuniga argued that it is a denial of due process for an IMR to refuse to disclose the identities of the reviewers when the decision of the first reviewer is reversed and the dispute is referred to a different reviewer in the organization. He claimed that without knowing the identities of the reviewers, an applicant is deprived of the opportunity to "dispute the findings of the second reviewer on the ground that they were made by the same reviewer whose opinion was reversed."
The Court of Appeal responded by noting that under Article XIV, Section 4 of the California Constitution, the Legislature "is . . . expressly vested with plenary power unlimited by any provision of this Constitution, to create, and enforce a complete system of worker’s compensation by appropriate legislation."
As the Court of Appeal held in Stevens, the due process clause of the California Constitution (Cal. Const., art. I, § 7, subd. (a)) does not limit the Legislature’s authority to create a workers’ compensation system. (Stevens, supra, 241 Cal.App.4th at pp. 1092-1093.) Section 4 therefore "supersedes the state Constitution’s due process clause with respect to legislation passed under the Legislature’s plenary powers over the workers’ compensation system."
The Court also ruled that Zuniga’s federal due process claim fails as well. The Court of Appeal in Stevens concluded that the IMR process, including the confidentiality requirement of section 4610.6, subdivision (f), does not violate the federal due process clause. (Stevens, supra, 241 Cal.App.4th at pp. 1096-1101; see also Ramirez, supra, 10 Cal.App.5th at pp. 227-229.)
The Court of Appeal in Stevens assumed that an IMR determination is state action and implicates a protected property interest, which are prerequisites to a federal due process claim. (Stevens, supra, 241 Cal.App.4th at pp. 1096-1098.) The court concluded that even so, Stevens’s due process claim failed because the IMR process "afford[s] ample process. ‘The core of due process is the right to notice and a meaningful opportunity to be heard.’"
When due process must be afforded, the amount of process required is determined by balancing the affected private interest, the risk of erroneous deprivation of this interest, the probable value, if any, of additional or substitute safeguards, and the government’s interest in the process ...
Last Friday, a federal judge sentenced the former owner of Pacific Hospital in Long Beach to 63 months in prison for overseeing a 15-year-long health care fraud scheme that involved more than $40 million in illegal kickbacks paid to doctors and other medical professionals in exchange for referring thousands of patients who received spinal surgeries.
The scheme operated by Michael D. Drobot led to more than $500 million in fraudulent bills being submitted during last five years of the scheme - much of which was paid by the California worker’s compensation system.
Drobot, 73, of Corona Del Mar, was sentencing by United States District Judge Josephine L. Staton, who noted that Drobot "introduced greed into the doctor-patient relationship."
Drobot pleaded guilty in 2014 to charges of conspiracy and paying illegal kickbacks, admitting that he orchestrated a wide-ranging fraud scheme in which "[t]housands of patients received surgeries at Pacific Hospital not knowing that [Drobot] bribed their physician to perform their surgery at Pacific Hospital," prosecutors wrote in a sentencing memorandum filed with the court. Drobot "was motivated by greed and ultimately profited millions of dollars through the scheme."
From at least 1997 thorugh 2013, Drobot, who owned and/or operated Pacific Hospital during this time, ran a scheme in which he billed workers’ compensation insurers hundreds of millions of dollars for spinal surgeries performed on patients who had been referred by dozens of doctors, chiropractors and others who were paid illegal kickbacks.
"The patients believed that they were receiving conflict-free medical advice when, in fact, [Drobot] illegally incentivized their physician to perform the surgery at Pacific Hospital," prosecutors said in court documents.
The kickbacks were financed largely by money generated from Drobot’s sale of medical devices implanted into state workers’ comp patients during spinal surgeries. Drobot set up a scheme that exploited a now-repealed California law known as the spinal "pass-through" legislation, which permitted hospitals to pass on to workers’ comp insurers the full cost of medical devices implanted in spinal surgery patients.
Drobot generated the kickback money through his own medical hardware company - the Newport Beach-based International Implants (I2) to sell hardware used in spinal surgeries performed at Pacific Hospital. I2 submitted bills to Drobot’s Hospital and tacked on an additional $250 per device knowing that the "pass-through" law required to state to pay the full amount of the invoices.
"Through the operation of I2, [Drobot] generated substantial profits that he used to pay at least $40 million dollars in kickbacks," prosecutors wrote in court papers. "According to the former CFO of Pacific Hospital, his income, bonuses, and other compensation at the hospital was in excess of $20,000,000."
As part of the health care fraud scheme, Drobot paid bribes to California State Senator Ronald Calderon in exchange for Calderon performing official acts to keep the spinal pass-through law on the books. Calderon is currently serving a 3½-year sentence in federal prison after admitting that he took bribes from Drobot and undercover FBI agents.
Drobot typically paid a kickback of $15,000 per lumbar fusion surgery and $10,000 per cervical fusion surgery. Some of the patients lived as much as hundreds of miles away from Pacific Hospital, and closer to other qualified medical facilities.
Drobot and his co-conspirators concealed the kickback payments by entering into bogus contracts with the doctors, chiropractors, and others who received kickbacks. In reality, the contracts merely provided a cover story for the kickback payments.
In addition to the prison term, which Drobot will begin serving on June 4, Judge Staton imposed a $500,000 criminal fine and issued an order directing Drobot to forfeit $10 million to the government. As part of the forfeiture judgment, which Judge Staton signed on Wednesday, Drobot was ordered to liquidate assets that include real estate and a 1965 Aston Martin, a 1958 Porsche, and a 1971 Mercedes Benz.
Judge Staton has scheduled a restitution hearing for May 11.
In addition to Drobot, prosecutors have charged seven other defendants in relation to the kickback scheme ...
The scheme operated by Michael D. Drobot led to more than $500 million in fraudulent bills being submitted during last five years of the scheme - much of which was paid by the California worker’s compensation system.
Drobot, 73, of Corona Del Mar, was sentencing by United States District Judge Josephine L. Staton, who noted that Drobot "introduced greed into the doctor-patient relationship."
Drobot pleaded guilty in 2014 to charges of conspiracy and paying illegal kickbacks, admitting that he orchestrated a wide-ranging fraud scheme in which "[t]housands of patients received surgeries at Pacific Hospital not knowing that [Drobot] bribed their physician to perform their surgery at Pacific Hospital," prosecutors wrote in a sentencing memorandum filed with the court. Drobot "was motivated by greed and ultimately profited millions of dollars through the scheme."
From at least 1997 thorugh 2013, Drobot, who owned and/or operated Pacific Hospital during this time, ran a scheme in which he billed workers’ compensation insurers hundreds of millions of dollars for spinal surgeries performed on patients who had been referred by dozens of doctors, chiropractors and others who were paid illegal kickbacks.
"The patients believed that they were receiving conflict-free medical advice when, in fact, [Drobot] illegally incentivized their physician to perform the surgery at Pacific Hospital," prosecutors said in court documents.
The kickbacks were financed largely by money generated from Drobot’s sale of medical devices implanted into state workers’ comp patients during spinal surgeries. Drobot set up a scheme that exploited a now-repealed California law known as the spinal "pass-through" legislation, which permitted hospitals to pass on to workers’ comp insurers the full cost of medical devices implanted in spinal surgery patients.
Drobot generated the kickback money through his own medical hardware company - the Newport Beach-based International Implants (I2) to sell hardware used in spinal surgeries performed at Pacific Hospital. I2 submitted bills to Drobot’s Hospital and tacked on an additional $250 per device knowing that the "pass-through" law required to state to pay the full amount of the invoices.
"Through the operation of I2, [Drobot] generated substantial profits that he used to pay at least $40 million dollars in kickbacks," prosecutors wrote in court papers. "According to the former CFO of Pacific Hospital, his income, bonuses, and other compensation at the hospital was in excess of $20,000,000."
As part of the health care fraud scheme, Drobot paid bribes to California State Senator Ronald Calderon in exchange for Calderon performing official acts to keep the spinal pass-through law on the books. Calderon is currently serving a 3½-year sentence in federal prison after admitting that he took bribes from Drobot and undercover FBI agents.
Drobot typically paid a kickback of $15,000 per lumbar fusion surgery and $10,000 per cervical fusion surgery. Some of the patients lived as much as hundreds of miles away from Pacific Hospital, and closer to other qualified medical facilities.
Drobot and his co-conspirators concealed the kickback payments by entering into bogus contracts with the doctors, chiropractors, and others who received kickbacks. In reality, the contracts merely provided a cover story for the kickback payments.
In addition to the prison term, which Drobot will begin serving on June 4, Judge Staton imposed a $500,000 criminal fine and issued an order directing Drobot to forfeit $10 million to the government. As part of the forfeiture judgment, which Judge Staton signed on Wednesday, Drobot was ordered to liquidate assets that include real estate and a 1965 Aston Martin, a 1958 Porsche, and a 1971 Mercedes Benz.
Judge Staton has scheduled a restitution hearing for May 11.
In addition to Drobot, prosecutors have charged seven other defendants in relation to the kickback scheme ...
On February 20, 2014, the owner of the Pacific Hospital of Long Beach, Michael D. Drobot, entered into a plea agreement in the case captioned United States v. Michael D. Drobot, pursuant to which he agreed to plead guilty to conspiracy and payment of kickbacks in connection with a federal health care program.
Pursuant to his plea agreement, Drobot agreed to forfeit all "right title, and interest" in assets "derived from or acquired as a result of, or used to facilitate the commission of, defendant’s illegal activities." Drobot further agreed "[t]o the Court’s entry of an order of forfeiture at or before sentencing with respect to these assets and to the forfeiture of the assets."
After a number of "sealed" documents were filed by the parties, and reviewed by the court on the topic of this forfeiture, Federal Judge Josephine L. Staton signed an Order on January 10, 2018 directing a personal money judgment of forfeiture in the amount of $10,000,000.00 in favor of the United States of America against defendant Michael D. Drobot.
The terms of the forfeiture require the payment of $300,000 in cash. In addition liens were imposed on in the favor of the United States Attorney's Office (USAO) on all properties in Oregon owner by Drobot. He was then ordered to sell the Oregon properties and pay all net proceeds (gross proceeds less taxes, costs, and other normal and customary costs associated with the sale) to the USAO.
He was also ordered to sell his 1965 Aston Martin, 1958 Porsche, and 1971 Mercedes Benz, and pay the proceeds to the USAO.
This personal money judgment of forfeiture is part of the sentence imposed on defendant in this case. The Court retained jurisdiction to enforce this judgment.
But that is not all for Mr. Drobot.
A hearing to determine victim losses pursuant to 18 U.S.C. § 3664(d)(5) and to determine the final amount of restitution is scheduled for May 11, 2018 at 10:30 a.m. And the Court will determine his criminal sentence this week.
However, Drobot plead guilty early in the case, and agreed to "cooperate" with authorities. Conceptually, as a result of his cooperation, many successful prosecutions of well known physicians were successful. No doubt this will be taken into consideration.
Drobot has also filed letters from various supporters asking for leniency.
Attorney Donald G. Norris authored a support letter dated January 11. He handleled many of Mr. Drobot's civil matters, both before and after the government investigation and prosecution in the case now before the Court, including the civil RICO case that was brought by State Compensation Insurance Fund before Judge Andrew Guilford. He argues that Drobot "already suffered considerable punishment" as a result of the many criminal and civil cases. He asks that "this Court not impose a sentence of imprisonment, and if one is imposed, a short term." ...
Pursuant to his plea agreement, Drobot agreed to forfeit all "right title, and interest" in assets "derived from or acquired as a result of, or used to facilitate the commission of, defendant’s illegal activities." Drobot further agreed "[t]o the Court’s entry of an order of forfeiture at or before sentencing with respect to these assets and to the forfeiture of the assets."
After a number of "sealed" documents were filed by the parties, and reviewed by the court on the topic of this forfeiture, Federal Judge Josephine L. Staton signed an Order on January 10, 2018 directing a personal money judgment of forfeiture in the amount of $10,000,000.00 in favor of the United States of America against defendant Michael D. Drobot.
The terms of the forfeiture require the payment of $300,000 in cash. In addition liens were imposed on in the favor of the United States Attorney's Office (USAO) on all properties in Oregon owner by Drobot. He was then ordered to sell the Oregon properties and pay all net proceeds (gross proceeds less taxes, costs, and other normal and customary costs associated with the sale) to the USAO.
He was also ordered to sell his 1965 Aston Martin, 1958 Porsche, and 1971 Mercedes Benz, and pay the proceeds to the USAO.
This personal money judgment of forfeiture is part of the sentence imposed on defendant in this case. The Court retained jurisdiction to enforce this judgment.
But that is not all for Mr. Drobot.
A hearing to determine victim losses pursuant to 18 U.S.C. § 3664(d)(5) and to determine the final amount of restitution is scheduled for May 11, 2018 at 10:30 a.m. And the Court will determine his criminal sentence this week.
However, Drobot plead guilty early in the case, and agreed to "cooperate" with authorities. Conceptually, as a result of his cooperation, many successful prosecutions of well known physicians were successful. No doubt this will be taken into consideration.
Drobot has also filed letters from various supporters asking for leniency.
Attorney Donald G. Norris authored a support letter dated January 11. He handleled many of Mr. Drobot's civil matters, both before and after the government investigation and prosecution in the case now before the Court, including the civil RICO case that was brought by State Compensation Insurance Fund before Judge Andrew Guilford. He argues that Drobot "already suffered considerable punishment" as a result of the many criminal and civil cases. He asks that "this Court not impose a sentence of imprisonment, and if one is imposed, a short term." ...
The Division of Workers’ Compensation last week suspended seven more medical providers from participating in California’s workers’ compensation system, bringing the total number of providers suspended to 166.
The providers were suspended for fraud or other criminal actions, or the loss of their license.
The most notable new suspension announced was "David Wayne Fish, Los Angeles businessperson, was convicted in Los Angeles County Superior Court in 2010 for receiving compensation or inducement for the referral of clients. Fish organized dozens of lawyers and doctors to steer more than 4,000 cases to preferred medical providers in order to run up high bills. Fish was ordered to pay $10,000 in restitution and approximately $390,000 in unpaid taxes."
One might say "it's about time!"
Fish at the time was the president of Premier Medical Management Systems. He and former attorney Birger Greg Bacino of Rancho Santa Fe, were each charged in 2010 with one felony count of compensation or inducement for referring clients. Premier was also charged in the complaint for submitting a false and fraudulent workers' compensation claim and for filing a false tax return.
Albert MacKenzie, deputy-in-charge of the Fraud Interdiction Program, said the investigation revealed that Fish and Bacino engaged in the illegal acquisition of patients through an elaborate scheme through which they purchased several thousand workers' compensation client referrals from an attorney television advertising service.
When a referral was received for a prospective workers' compensation case, the client was sent to doctors and other healthcare providers within the defendants' business network. Premier Medical Management Systems handled the billing and collection work in return for a 50-percent or greater fee. After meeting with a healthcare provider, the client was sent to a workers' compensation attorney with whom the defendants also had a business relationship.
Fish and Bacino paid $750,000 and $150,000 respectively to the State of California Department of Insurance Fraud Division for costs associated with carrying out the investigation. Under the terms of the plea agreement, Bacino was ordered to additionally pay $210,000 -- and Fish $390,000 -- to the California Franchise Tax Board in unpaid taxes.
As part of the negotiated settlement, the duo waived all rights to any benefits or proceeds from the more than $60 million in liens and bills pending in the workers' compensation system.
But that was not the end of the story. Later, in 2013, the Court of Appeal agreed to arguments presented by Universal Psychiatric Medical Center Inc. that Fish did not have authority to waive its liens, and WCAB dismissals of those liens were reversed ...
The providers were suspended for fraud or other criminal actions, or the loss of their license.
The most notable new suspension announced was "David Wayne Fish, Los Angeles businessperson, was convicted in Los Angeles County Superior Court in 2010 for receiving compensation or inducement for the referral of clients. Fish organized dozens of lawyers and doctors to steer more than 4,000 cases to preferred medical providers in order to run up high bills. Fish was ordered to pay $10,000 in restitution and approximately $390,000 in unpaid taxes."
One might say "it's about time!"
Fish at the time was the president of Premier Medical Management Systems. He and former attorney Birger Greg Bacino of Rancho Santa Fe, were each charged in 2010 with one felony count of compensation or inducement for referring clients. Premier was also charged in the complaint for submitting a false and fraudulent workers' compensation claim and for filing a false tax return.
Albert MacKenzie, deputy-in-charge of the Fraud Interdiction Program, said the investigation revealed that Fish and Bacino engaged in the illegal acquisition of patients through an elaborate scheme through which they purchased several thousand workers' compensation client referrals from an attorney television advertising service.
When a referral was received for a prospective workers' compensation case, the client was sent to doctors and other healthcare providers within the defendants' business network. Premier Medical Management Systems handled the billing and collection work in return for a 50-percent or greater fee. After meeting with a healthcare provider, the client was sent to a workers' compensation attorney with whom the defendants also had a business relationship.
Fish and Bacino paid $750,000 and $150,000 respectively to the State of California Department of Insurance Fraud Division for costs associated with carrying out the investigation. Under the terms of the plea agreement, Bacino was ordered to additionally pay $210,000 -- and Fish $390,000 -- to the California Franchise Tax Board in unpaid taxes.
As part of the negotiated settlement, the duo waived all rights to any benefits or proceeds from the more than $60 million in liens and bills pending in the workers' compensation system.
But that was not the end of the story. Later, in 2013, the Court of Appeal agreed to arguments presented by Universal Psychiatric Medical Center Inc. that Fish did not have authority to waive its liens, and WCAB dismissals of those liens were reversed ...
A massive federal lawsuit aims to hold pharmaceutical companies responsible for contributing to the opioid crisis, and a federal judge is seeking a quick resolution.
More than 200 individual cases have been consolidated in a multi-district process being overseen by U.S. District Judge Dan A. Polster in Cleveland.,
The governments are suing over what they claim are false marketing practices by pharmaceutical companies that manufacture prescription painkillers, as well as claims that drug wholesalers brought more pills than needed into areas with high levels of addiction, knowing that the pills would be diverted for illegal use.
At an initial hearing on Tuesday, Judge Polster pushed for the pharmaceutical manufacturers and governments to settle the dispute quickly. Attorneys from across the country filled every corner of Polster's courtroom at the federal courthouse in downtown Cleveland, with others either in an overflow room watching a video feed or listening on the phone.
According to the transcript of the hearing and news reports, he told more than 100 attorneys that the United States is at risk this year of seeing life expectancy go down for the third straight year, a statistic unmatched since the 1918 influenza pandemic, which killed at least 50 million people worldwide, including 550,000 in the United States.
But unlike that particularly deadly strain of flu virus, "this is 100 percent manmade," Polster said. "I’m pretty ashamed that this has occurred while I've been around."
"I don't think anyone in the country is interested in a whole lot of finger pointing at this point, and I'm not either. People aren't interested in depositions, and discovery,and trials. People aren't interested in figuring out the answer to interesting legal questions like preemption and learned intermediary,or unraveling complicated conspiracy theories."
Among other things, he said that "what I'm interested in doing is not just moving money around, because this is an ongoing crisis. What we've got to do is dramatically reduce the number of the pills that are out there and make sure that the pills that are out there are being used properly. ... So that's what I want to accomplish. And then we'll deal with the money. We can deal with the money also and the treatment. I mean, that's what -- you know, we need a whole lot -- some new systems in place, and we need some treatment."
He acknowledged to those in the courtroom that his statements were likely not what they expected to hear in the first hearing but that he had given it a lot of thought prior to hearing. He wants to find a way to stop the flow of pills onto the street, while still ensuring that those who really need them can still acquire them.
Despite Polster’s call for a quick settlement, Young predicted that the litigation would involve months of discovery, test cases and monthly meetings before the judge. "We don't need a lot of briefs and we don't need trials." ...
More than 200 individual cases have been consolidated in a multi-district process being overseen by U.S. District Judge Dan A. Polster in Cleveland.,
The governments are suing over what they claim are false marketing practices by pharmaceutical companies that manufacture prescription painkillers, as well as claims that drug wholesalers brought more pills than needed into areas with high levels of addiction, knowing that the pills would be diverted for illegal use.
At an initial hearing on Tuesday, Judge Polster pushed for the pharmaceutical manufacturers and governments to settle the dispute quickly. Attorneys from across the country filled every corner of Polster's courtroom at the federal courthouse in downtown Cleveland, with others either in an overflow room watching a video feed or listening on the phone.
According to the transcript of the hearing and news reports, he told more than 100 attorneys that the United States is at risk this year of seeing life expectancy go down for the third straight year, a statistic unmatched since the 1918 influenza pandemic, which killed at least 50 million people worldwide, including 550,000 in the United States.
But unlike that particularly deadly strain of flu virus, "this is 100 percent manmade," Polster said. "I’m pretty ashamed that this has occurred while I've been around."
"I don't think anyone in the country is interested in a whole lot of finger pointing at this point, and I'm not either. People aren't interested in depositions, and discovery,and trials. People aren't interested in figuring out the answer to interesting legal questions like preemption and learned intermediary,or unraveling complicated conspiracy theories."
Among other things, he said that "what I'm interested in doing is not just moving money around, because this is an ongoing crisis. What we've got to do is dramatically reduce the number of the pills that are out there and make sure that the pills that are out there are being used properly. ... So that's what I want to accomplish. And then we'll deal with the money. We can deal with the money also and the treatment. I mean, that's what -- you know, we need a whole lot -- some new systems in place, and we need some treatment."
He acknowledged to those in the courtroom that his statements were likely not what they expected to hear in the first hearing but that he had given it a lot of thought prior to hearing. He wants to find a way to stop the flow of pills onto the street, while still ensuring that those who really need them can still acquire them.
Despite Polster’s call for a quick settlement, Young predicted that the litigation would involve months of discovery, test cases and monthly meetings before the judge. "We don't need a lot of briefs and we don't need trials." ...
Finding alternatives for pain management, expanding autonomous claims processes and controlling the opioid prescription drug crisis are among the workers compensation issues and trends that employers should watch for in 2018, according to a report from Sedgwick Claims Management Services Inc.
Pain management will remain at the forefront of workers compensation industry discussions, and experts say they anticipate that there will be more collaboration between employers, physicians, pharmacists, claims specialists and patients as they move away from long-term drug therapy and test alternatives.
These may include physical therapy, pharmacy management, physician-patient opioid contracts, pain coaching partnerships, behavioral health networks or alternative therapies, Sedgwick said in its Navigating 2018 report, released Tuesday.
Sedgwick also says that the movement toward a whole health approach increases trust and engagement, and places less influence on individual providers in favor of a more holistic, consensus view of treatments and interventions. Under the new norm, centralized support links cross-disciplinary teams, all focused on quality care. More and more employers will be embracing principles of advocacy, empathy and responsiveness within a whole health environment.
The claims process will continue to become more autonomous, meaning on-demand claims adjusting services and smart interfaces that push low-touch claims through the process more efficiently and effectively, according to the report.
Smart interfaces that push low-touch claims through the process more efficiently and effectively are on the horizon. In addition, on-demand claims adjusting services will allow more flexibility and self-sufficiency when facing property claims. The goal: Speeding up the turnaround for high frequency/low severity claims and easing the process for consumers.
Chatbots and avatars will become more prevalent as support and service options for all lines of business; the industry is even seeing potential for these tools as virtual health coaches for workers’ compensation, disability and wellness programs. What are the possible advantages, limitations and liability risks of these cutting-edge virtual assistants?
To avoid getting caught in the compliance web of ERISA, MSA, FMLA, ADA and state requirements, collaboration becomes more necessary between disability, leave of absence and workers’ compensation. We expect regulatory complexity to continue to increase, and fines and litigation to be a looming threat for non-compliance.
Additionally, diversity and inclusion with claims management will be a key issue. With different populations and generations, the industry will need to adapt to address the needs of everyone, according to the report ...
Pain management will remain at the forefront of workers compensation industry discussions, and experts say they anticipate that there will be more collaboration between employers, physicians, pharmacists, claims specialists and patients as they move away from long-term drug therapy and test alternatives.
These may include physical therapy, pharmacy management, physician-patient opioid contracts, pain coaching partnerships, behavioral health networks or alternative therapies, Sedgwick said in its Navigating 2018 report, released Tuesday.
Sedgwick also says that the movement toward a whole health approach increases trust and engagement, and places less influence on individual providers in favor of a more holistic, consensus view of treatments and interventions. Under the new norm, centralized support links cross-disciplinary teams, all focused on quality care. More and more employers will be embracing principles of advocacy, empathy and responsiveness within a whole health environment.
The claims process will continue to become more autonomous, meaning on-demand claims adjusting services and smart interfaces that push low-touch claims through the process more efficiently and effectively, according to the report.
Smart interfaces that push low-touch claims through the process more efficiently and effectively are on the horizon. In addition, on-demand claims adjusting services will allow more flexibility and self-sufficiency when facing property claims. The goal: Speeding up the turnaround for high frequency/low severity claims and easing the process for consumers.
Chatbots and avatars will become more prevalent as support and service options for all lines of business; the industry is even seeing potential for these tools as virtual health coaches for workers’ compensation, disability and wellness programs. What are the possible advantages, limitations and liability risks of these cutting-edge virtual assistants?
To avoid getting caught in the compliance web of ERISA, MSA, FMLA, ADA and state requirements, collaboration becomes more necessary between disability, leave of absence and workers’ compensation. We expect regulatory complexity to continue to increase, and fines and litigation to be a looming threat for non-compliance.
Additionally, diversity and inclusion with claims management will be a key issue. With different populations and generations, the industry will need to adapt to address the needs of everyone, according to the report ...
The California Labor Commissioner issued citations totaling $7,137,036 to the operator of six adult care facilities in Los Angeles for wage theft and other labor law violations.
Adat Shalom Board & Care, Inc. was ordered to pay underpaid wages and penalties to 149 former and current employees who provided care to elderly residents 24 hours a day, six days a week. For years, officials say the caregivers were paid less than $3 an hour for their work.
The Labor Commissioner’s Office opened its investigation last June after receiving a report of labor law violations. The investigation uncovered that from July 2014 to July 2017, the caregivers at the six facilities in West Hills were:
- Paid less than the minimum wage for each hour they worked.
- Not paid overtime for working 24-hour shifts, six days a week.
- Not relieved from their duties to take meal or rest breaks.
- Provided pay stubs that withheld key information such as hourly rate of pay and total number of hours worked.
The live-in caregivers were responsible for monitoring and caring for elderly residents and hospice patients, many of them suffering from Alzheimer’s or dementia. The caregivers were paid fixed amounts ranging from $1,500 to $1,800 per month, or $2.40 to $2.88 per hour.
The citations issued against Adat Shalom Board & Care include $2,272,343 for under payment of minimum wages, $1,871,990 in overtime wages, $128,196 for meal period violations, and $2,689,907 in liquidated damages.
When workers are paid less than minimum wage, they are entitled to liquidated damages that equal the amount of underpaid minimum wages plus interest.
In addition to the money for the workers, $174,600 in civil penalties were levied for nonpayment of overtime and minimum wages, meal period violations as well as for failing to provide workers accurate itemized wage statements with their paychecks. The civil penalties collected will be transferred to the State’s General Fund, as required by law ...
Adat Shalom Board & Care, Inc. was ordered to pay underpaid wages and penalties to 149 former and current employees who provided care to elderly residents 24 hours a day, six days a week. For years, officials say the caregivers were paid less than $3 an hour for their work.
The Labor Commissioner’s Office opened its investigation last June after receiving a report of labor law violations. The investigation uncovered that from July 2014 to July 2017, the caregivers at the six facilities in West Hills were:
- Paid less than the minimum wage for each hour they worked.
- Not paid overtime for working 24-hour shifts, six days a week.
- Not relieved from their duties to take meal or rest breaks.
- Provided pay stubs that withheld key information such as hourly rate of pay and total number of hours worked.
The live-in caregivers were responsible for monitoring and caring for elderly residents and hospice patients, many of them suffering from Alzheimer’s or dementia. The caregivers were paid fixed amounts ranging from $1,500 to $1,800 per month, or $2.40 to $2.88 per hour.
The citations issued against Adat Shalom Board & Care include $2,272,343 for under payment of minimum wages, $1,871,990 in overtime wages, $128,196 for meal period violations, and $2,689,907 in liquidated damages.
When workers are paid less than minimum wage, they are entitled to liquidated damages that equal the amount of underpaid minimum wages plus interest.
In addition to the money for the workers, $174,600 in civil penalties were levied for nonpayment of overtime and minimum wages, meal period violations as well as for failing to provide workers accurate itemized wage statements with their paychecks. The civil penalties collected will be transferred to the State’s General Fund, as required by law ...
Authorities arrested former Visalia Public Cemetery manager Dona Shores last month on charges of embezzling and laundering as much as $1.3 million over a five-year period between July 1, 2011, and June 30, 2016.
Shores was arrested on Dec. 22 on suspicion of embezzlement and money laundering charges after a year-long investigation by Visalia Police.
Attorney Kris Pederson, who represents the Visalia Cemetery, said she now believes the embezzlement dates back to 2005 when a new accounting system was adopted - and that more than $1.3 million was stolen.
Pederson said Shores was getting ready to retire at the end of 2016. Ahead of her retirement, Shores handed in the cemetery's accounting books and a forensic audit revealed the allegedly missing funds, she said,
Shores, who managed the Visalia Cemetery for nearly 20 years, was fired in late 2016 before she could officially retire.
Citing the forensic audit's findings, Pederson said cash funds had been recorded as received by the district for services, but the money was never deposited into the cemetery's bank account.
Earlier this week, Shores appeared before Tulare County Superior Court Judge Brett Alldredge. During the quick hearing, Shores spoke only once, saying she agreed to a delay on the court procedures.
Attorney Charles Magill, who's representing Shores, denied all charges. "I believe there's a government conspiracy against Ms. Shores," he said. "I believe it's politically motivated." Magill, whose office is in Fresno, said the conspiracy against Shores includes the Visalia police officers investigating the case.
Magill said Shores' arrest was retaliation for a workers' compensation case the former manager has filed. Shores was injured on the job when she was struck by a vehicle, Magill said.
Magill also lamented Shores' arrest timing. "There's no reason to arrest her on the Friday before Christmas," Magill said. "She spent Christmas in jail. That was punitive."
There's also no evidence that proves the embezzlement, Magill said. "At no time was her accounting ever out of balance," he said. "They have no evidence of money she received. Where's the money?"
Magill plans to have a new forensic accounting investigation into the cemetery's finances to help clear his client. "I will try this case and then sue the board, the cemetery and the county for malicious prosecution," he said ...
Shores was arrested on Dec. 22 on suspicion of embezzlement and money laundering charges after a year-long investigation by Visalia Police.
Attorney Kris Pederson, who represents the Visalia Cemetery, said she now believes the embezzlement dates back to 2005 when a new accounting system was adopted - and that more than $1.3 million was stolen.
Pederson said Shores was getting ready to retire at the end of 2016. Ahead of her retirement, Shores handed in the cemetery's accounting books and a forensic audit revealed the allegedly missing funds, she said,
Shores, who managed the Visalia Cemetery for nearly 20 years, was fired in late 2016 before she could officially retire.
Citing the forensic audit's findings, Pederson said cash funds had been recorded as received by the district for services, but the money was never deposited into the cemetery's bank account.
Earlier this week, Shores appeared before Tulare County Superior Court Judge Brett Alldredge. During the quick hearing, Shores spoke only once, saying she agreed to a delay on the court procedures.
Attorney Charles Magill, who's representing Shores, denied all charges. "I believe there's a government conspiracy against Ms. Shores," he said. "I believe it's politically motivated." Magill, whose office is in Fresno, said the conspiracy against Shores includes the Visalia police officers investigating the case.
Magill said Shores' arrest was retaliation for a workers' compensation case the former manager has filed. Shores was injured on the job when she was struck by a vehicle, Magill said.
Magill also lamented Shores' arrest timing. "There's no reason to arrest her on the Friday before Christmas," Magill said. "She spent Christmas in jail. That was punitive."
There's also no evidence that proves the embezzlement, Magill said. "At no time was her accounting ever out of balance," he said. "They have no evidence of money she received. Where's the money?"
Magill plans to have a new forensic accounting investigation into the cemetery's finances to help clear his client. "I will try this case and then sue the board, the cemetery and the county for malicious prosecution," he said ...
Day laborers in California hired on a one-time basis would be covered by the state’s workers compensation laws under amendments to a year-old bill intended to extend coverage to more workers.
A.B. 206, introduced by Assemblywoman Lorena Gonzalez Fletcher, D-Chula Vista, in January 2017, was amended Thursday to include workers comp coverage mandates for a "person, including a day laborer, employed by the owner or occupant of a residential dwelling whose duties are incidental to the ownership, maintenance, or use of the dwelling, including the care and supervision of children, or whose duties are personal and not in the course of the trade, business, profession, or occupation of the owner or occupant," according to the latest draft of the bill.
The draft defines a day laborer as "a person who is directly hired by the home owner or occupant on a one-time basis, to perform general maintenance, repairs, upgrades, gardening, or landscaping, and who does not have a valid business license or contractor’s license, or is not required to have those licenses for the work performed."
This requirement would apply without regard to immigration status, according to the draft.
According to the Legislative Analysis, the proposed bill expands the definition of "employee" for workers’ compensation purposes thereby expanding the scope of standard homeowners’ insurance policies. Specifically, this bill deletes from the definition of "employee" the exclusion of workers who work for a homeowner for less than 52 hours in a 90 day period.
According to the author, "the 52 hour requirement is detrimental to day laborers because they are usually hired to work for short-term jobs. This outdated provision in the workers’ compensation system prevents legitimate day laborers who are injured on the job from obtaining workers’ compensation benefits because these workers are specifically defined as not 'employees.' AB 206 is designed to remedy this anachronism in the law. "
There are a range of people who perform work in various contexts who are not eligible for workers’ compensation benefits because they are defined as "not employees." One such group is excluded because the work they perform is covered by the "52-hour" rule in the Labor Code.In essence, this exclusion provides that certain workers are simply, as a matter of definitional law, "not employees" for workers’ compensation purposes..
By merely deleting the 52-hour rule, a fairly large actual list of workers, would now be "employees" eligible for workers’ compensation benefits. The Legislative Analysis points out that this would include the teenager you hire to mow your lawn; the high school girl who babysits twice a month for you and the man who congregates in the Home Depot parking lot who is hired on a 1 or 2 day basis by a roofing contractor; and the tax preparer who works in tax season out of her home, and who is hired from a Craigslist ad ...
A.B. 206, introduced by Assemblywoman Lorena Gonzalez Fletcher, D-Chula Vista, in January 2017, was amended Thursday to include workers comp coverage mandates for a "person, including a day laborer, employed by the owner or occupant of a residential dwelling whose duties are incidental to the ownership, maintenance, or use of the dwelling, including the care and supervision of children, or whose duties are personal and not in the course of the trade, business, profession, or occupation of the owner or occupant," according to the latest draft of the bill.
The draft defines a day laborer as "a person who is directly hired by the home owner or occupant on a one-time basis, to perform general maintenance, repairs, upgrades, gardening, or landscaping, and who does not have a valid business license or contractor’s license, or is not required to have those licenses for the work performed."
This requirement would apply without regard to immigration status, according to the draft.
According to the Legislative Analysis, the proposed bill expands the definition of "employee" for workers’ compensation purposes thereby expanding the scope of standard homeowners’ insurance policies. Specifically, this bill deletes from the definition of "employee" the exclusion of workers who work for a homeowner for less than 52 hours in a 90 day period.
According to the author, "the 52 hour requirement is detrimental to day laborers because they are usually hired to work for short-term jobs. This outdated provision in the workers’ compensation system prevents legitimate day laborers who are injured on the job from obtaining workers’ compensation benefits because these workers are specifically defined as not 'employees.' AB 206 is designed to remedy this anachronism in the law. "
There are a range of people who perform work in various contexts who are not eligible for workers’ compensation benefits because they are defined as "not employees." One such group is excluded because the work they perform is covered by the "52-hour" rule in the Labor Code.In essence, this exclusion provides that certain workers are simply, as a matter of definitional law, "not employees" for workers’ compensation purposes..
By merely deleting the 52-hour rule, a fairly large actual list of workers, would now be "employees" eligible for workers’ compensation benefits. The Legislative Analysis points out that this would include the teenager you hire to mow your lawn; the high school girl who babysits twice a month for you and the man who congregates in the Home Depot parking lot who is hired on a 1 or 2 day basis by a roofing contractor; and the tax preparer who works in tax season out of her home, and who is hired from a Craigslist ad ...
The City of Los Angeles sued three port trucking companies Monday, alleging the firms exploit their drivers by misclassifying them as independent contractors.
The City alleged that CMI Transportation, K&R Transportation California and Cal Cartage Transportation Express have engaged in schemes to avoid paying minimum wage and employee benefits by classifying hundreds of workers as independent contractors even though the companies "exert near complete control" over the drivers’ schedule.
According to the report in the Los Angeles Times, all three companies are owned by NFI Industries, a New Jersey-based logistics firm. NFI purchased the businesses from Long Beach-based California Cartage in October.
The suits are the latest in a long-running dispute at the twin ports of Los Angeles and Long Beach, where many port truck drivers say they are improperly classified as independent contractors and must lease their rigs under unfair terms.
The terms, they say, are so onerous that for some pay periods they make nothing and actually end up owing the trucking company money.
A large part of the problem, the lawsuits say, are lease programs the companies established to comply with 2008 city rules mandating low-emission trucks be used to deliver goods to and from the ports of Los Angeles and Long Beach.
The city attorney alleged the leases place strict requirements on how many loads must be undertaken for the company, essentially chaining a so-called independent contractor to one firm.
At the end of the leases, the lawsuits allege drivers do not own their truck but are given an opportunity to purchase it for a "significant lump sum." That leads many drivers to refinance the lease, once again binding the worker to one company.
Last decade, the Port of Los Angeles tried to mandate truckers be employees of companies, fearful that workers couldn’t afford the newer, cleaner rigs. But that mandate was struck down by federal courts, a decision that driver advocates blame for exacerbating an existing problem of abusive leases.
Though ongoing for years, the issue received renewed attention following a series of stories last year in USA Today.
In December, the Los Angeles City Council approved a plan to investigate claims of wage theft by port truck companies and look into whether the city could deny port access to companies in violation of labor laws.
Asked why the suit was filed against the three NFI companies when drivers allege misclassification among many operators, the City Attorney said his office is investigating "additional companies as well."
Since 2011, the California labor commissioner's office has awarded port truck drivers more than $46 million in cases where they contended they were misclassified as contractors.
Drivers and the Teamsters union have also organized numerous strikes to put pressure on trucking companies, as well as politicians ...
The City alleged that CMI Transportation, K&R Transportation California and Cal Cartage Transportation Express have engaged in schemes to avoid paying minimum wage and employee benefits by classifying hundreds of workers as independent contractors even though the companies "exert near complete control" over the drivers’ schedule.
According to the report in the Los Angeles Times, all three companies are owned by NFI Industries, a New Jersey-based logistics firm. NFI purchased the businesses from Long Beach-based California Cartage in October.
The suits are the latest in a long-running dispute at the twin ports of Los Angeles and Long Beach, where many port truck drivers say they are improperly classified as independent contractors and must lease their rigs under unfair terms.
The terms, they say, are so onerous that for some pay periods they make nothing and actually end up owing the trucking company money.
A large part of the problem, the lawsuits say, are lease programs the companies established to comply with 2008 city rules mandating low-emission trucks be used to deliver goods to and from the ports of Los Angeles and Long Beach.
The city attorney alleged the leases place strict requirements on how many loads must be undertaken for the company, essentially chaining a so-called independent contractor to one firm.
At the end of the leases, the lawsuits allege drivers do not own their truck but are given an opportunity to purchase it for a "significant lump sum." That leads many drivers to refinance the lease, once again binding the worker to one company.
Last decade, the Port of Los Angeles tried to mandate truckers be employees of companies, fearful that workers couldn’t afford the newer, cleaner rigs. But that mandate was struck down by federal courts, a decision that driver advocates blame for exacerbating an existing problem of abusive leases.
Though ongoing for years, the issue received renewed attention following a series of stories last year in USA Today.
In December, the Los Angeles City Council approved a plan to investigate claims of wage theft by port truck companies and look into whether the city could deny port access to companies in violation of labor laws.
Asked why the suit was filed against the three NFI companies when drivers allege misclassification among many operators, the City Attorney said his office is investigating "additional companies as well."
Since 2011, the California labor commissioner's office has awarded port truck drivers more than $46 million in cases where they contended they were misclassified as contractors.
Drivers and the Teamsters union have also organized numerous strikes to put pressure on trucking companies, as well as politicians ...
Allianz has agreed to a $59.2 million investment and strategic partnership with leading telehealth platform American Well to develop digital solutions that will widen access, lower cost and improve quality of healthcare for millions of patients worldwide.
Allianz X, the digital investment unit of Allianz, led the investment and will join American Well’s Board of Directors.
Allianz and American Well will develop digital health solutions that build on American Well’s platform and leverage Allianz’s international expertise by combining wearable sensors, remote monitoring, and virtual visits. Working with local healthcare stakeholders, the partnership will deliver healthcare to both developed and emerging markets, addressing local regulations, clinical preferences and financing choices.
This global telehealth system will allow providers to treat patients more successfully in the transforming world of connected care.
Boston-headquartered American Well has developed a telehealth platform that connects patients live with doctors, specialists and other healthcare providers over secure video. It handles clinical, administration, and security requirements consistent with US healthcare regulations and best practices.
American Well serves millions of patients, working with national health plans, hospitals, employers and pharmacies in the United States.
Allianz X, led the investment and was supported by the Health Innovation Center of Allianz Partners, the B2B2C unit of the Allianz Group dedicated to developing protection and care solutions.
Allianz has local knowledge of healthcare financing, regulation and delivery, and a qualified network of more than 800,000 medical providers across the world.
The joint effort of Allianz X and Allianz Partners should enable Allianz to deliver the greatest value from Allianz to American Well and strengthens the Group’s ability to provide best-in-class healthcare in a mobile, digital world.
"Allianz X’s investment with American Well will result in better access, lower cost and more connected care for our customers through a leading-edge health platform. This collaboration emphasizes Allianz’s commitment to digitalization, our goal of investing in digital frontrunners and encourages advancements within the whole healthcare ecosystem," said Solmaz Altin, the Chief Digital Officer of Allianz Group ...
Allianz X, the digital investment unit of Allianz, led the investment and will join American Well’s Board of Directors.
Allianz and American Well will develop digital health solutions that build on American Well’s platform and leverage Allianz’s international expertise by combining wearable sensors, remote monitoring, and virtual visits. Working with local healthcare stakeholders, the partnership will deliver healthcare to both developed and emerging markets, addressing local regulations, clinical preferences and financing choices.
This global telehealth system will allow providers to treat patients more successfully in the transforming world of connected care.
Boston-headquartered American Well has developed a telehealth platform that connects patients live with doctors, specialists and other healthcare providers over secure video. It handles clinical, administration, and security requirements consistent with US healthcare regulations and best practices.
American Well serves millions of patients, working with national health plans, hospitals, employers and pharmacies in the United States.
Allianz X, led the investment and was supported by the Health Innovation Center of Allianz Partners, the B2B2C unit of the Allianz Group dedicated to developing protection and care solutions.
Allianz has local knowledge of healthcare financing, regulation and delivery, and a qualified network of more than 800,000 medical providers across the world.
The joint effort of Allianz X and Allianz Partners should enable Allianz to deliver the greatest value from Allianz to American Well and strengthens the Group’s ability to provide best-in-class healthcare in a mobile, digital world.
"Allianz X’s investment with American Well will result in better access, lower cost and more connected care for our customers through a leading-edge health platform. This collaboration emphasizes Allianz’s commitment to digitalization, our goal of investing in digital frontrunners and encourages advancements within the whole healthcare ecosystem," said Solmaz Altin, the Chief Digital Officer of Allianz Group ...
Former licensed insurance agent Frederick Donald Rollins, 42, of Moreno Valley, was sentenced after pleading guilty to one felony count of grand theft, two counts of securities fraud and an aggravated white-collar crime enhancement for stealing more than $100,000 in insurance premiums and investment funds from 10 victims. Rollins has been sentenced to one year in custody and to pay $100,363 in restitution to his victims.
The California Department of Insurance launched an investigation after receiving multiple complaints, including one from an insurance carrier after a company attempted to file a claim for its injured employee under what turned out to be a non-existent policy number and the other from a business owner who discovered they had no legitimate workers' compensation or liability coverage.
The investigation revealed that Rollins, while working as a licensed agent at an insurance agency, collected premium payments from several clients for workers' compensation and commercial general liability coverage, but failed to place coverage with any insurance carrier.
After leaving that insurance agency, Rollins continued to sell fraudulent policies under a corporation he registered with the Nevada Secretary of State, but never licensed by the California Department of Insurance. The investigation revealed over $20,000 in premium payments Rollins collected from his victims, either made payable directly to him or to FDR Presidential Services, were spent on personal expenses and not forwarded to insurance carriers to obtain insurance coverage.
To conceal the scheme, Rollins issued false Certificates of Insurance, which listed the names of valid insurance carriers as the insurance providers of the fraudulent policies.
In addition to collecting premium payments for policies that were never placed, Rollins also allegedly presented himself as a registered stockbroker and accepted funds for investments from several victims. Rollins collected nearly $80,000 from various individuals, including insurance clients, under the guise that he was investing their money in stocks.
The Financial Industry Regulatory Authority, a non-governmental organization that regulates stockbrokers and brokerage firms, verified that Rollins has never been licensed in any capacity to act as a stockbroker.
Rollins is no longer licensed as he failed to renew his license after it expired in March 2014. The Department of Insurance is taking appropriate administrative action against Rollins' license. The case was prosecuted by the Riverside County District Attorney's Office.
...
The California Department of Insurance launched an investigation after receiving multiple complaints, including one from an insurance carrier after a company attempted to file a claim for its injured employee under what turned out to be a non-existent policy number and the other from a business owner who discovered they had no legitimate workers' compensation or liability coverage.
The investigation revealed that Rollins, while working as a licensed agent at an insurance agency, collected premium payments from several clients for workers' compensation and commercial general liability coverage, but failed to place coverage with any insurance carrier.
After leaving that insurance agency, Rollins continued to sell fraudulent policies under a corporation he registered with the Nevada Secretary of State, but never licensed by the California Department of Insurance. The investigation revealed over $20,000 in premium payments Rollins collected from his victims, either made payable directly to him or to FDR Presidential Services, were spent on personal expenses and not forwarded to insurance carriers to obtain insurance coverage.
To conceal the scheme, Rollins issued false Certificates of Insurance, which listed the names of valid insurance carriers as the insurance providers of the fraudulent policies.
In addition to collecting premium payments for policies that were never placed, Rollins also allegedly presented himself as a registered stockbroker and accepted funds for investments from several victims. Rollins collected nearly $80,000 from various individuals, including insurance clients, under the guise that he was investing their money in stocks.
The Financial Industry Regulatory Authority, a non-governmental organization that regulates stockbrokers and brokerage firms, verified that Rollins has never been licensed in any capacity to act as a stockbroker.
Rollins is no longer licensed as he failed to renew his license after it expired in March 2014. The Department of Insurance is taking appropriate administrative action against Rollins' license. The case was prosecuted by the Riverside County District Attorney's Office.
...
The operator of two now-defunct medical supply companies in Hawthorne and Ventura, as well as two former employees, have been arrested on federal healthcare fraud charges for allegedly billing Medicare well over $24 million for medically unnecessary power wheelchairs (PWC) and the repair of medical equipment.
The scheme is outlined in a 29-count indictment that was returned by a federal grand jury on December 14. According to the indictment, Tamara Yvonne Motley operated Action Medical Equipment and Supplies, which was based in Hawthorne until 2014, and Kaja Medical Equipment & Supply, which was based in Ventura until late 2016. Motley allegedly orchestrated a scheme in which corrupt physicians prescribed medically unnecessary durable medical equipment (DME), such as PWCs, and Motley oversaw the submission of fraudulent bills to Medicare.
In January 2011, when Medicare changed the reimbursement rules for PWCs, Action largely stopped Medicare billing for PWCs and, instead, started billing Medicare for PWC repairs. Action and Kaja allegedly submitted bills for PWC repair or replacement services that were not medically necessary, were not needed to make the PWCs serviceable, and often simply were not performed. The majority of bills submitted in this case allegedly involve fraudulent repair work.
According to the indictment, over a nearly eight-year period, Action billed Medicare more than $18.2 million for DME - most for PWCs, but also for PWC accessories, knee braces and back braces - and the repair or replacement of PWCs. Medicare paid Action nearly $10.3 million.
Between July 2013 and November 2016, Kaja billed Medicare $6.3 million for PWCs, PWC-related accessories, and the repair or replacement of PWCs. Medicare paid Kaja approximately $2.8 million for those claims, the indictment alleges.
The indictment charges all three defendants with 20 counts of healthcare fraud and one count of conspiring to launder money.
Motley and Marquez are further charged with two counts of aggravated identity theft in relation to the use of other persons’ names to operate the medical supply companies. Motley is additionally charged with six counts of structuring cash transactions to avoid federal reporting requirements for transactions of more than $10,000.
If convicted, each of the three defendants would potentially face decades in federal prison. Each count of healthcare fraud carries a statutory maximum sentence of 10 years in federal prison.
All three defendants entered not guilty pleas to the charges in the indictment and a trial was scheduled for February 13. A United States Magistrate Judge set bond for Motley and Murillo, and Marquez was ordered detained.
...
The scheme is outlined in a 29-count indictment that was returned by a federal grand jury on December 14. According to the indictment, Tamara Yvonne Motley operated Action Medical Equipment and Supplies, which was based in Hawthorne until 2014, and Kaja Medical Equipment & Supply, which was based in Ventura until late 2016. Motley allegedly orchestrated a scheme in which corrupt physicians prescribed medically unnecessary durable medical equipment (DME), such as PWCs, and Motley oversaw the submission of fraudulent bills to Medicare.
In January 2011, when Medicare changed the reimbursement rules for PWCs, Action largely stopped Medicare billing for PWCs and, instead, started billing Medicare for PWC repairs. Action and Kaja allegedly submitted bills for PWC repair or replacement services that were not medically necessary, were not needed to make the PWCs serviceable, and often simply were not performed. The majority of bills submitted in this case allegedly involve fraudulent repair work.
According to the indictment, over a nearly eight-year period, Action billed Medicare more than $18.2 million for DME - most for PWCs, but also for PWC accessories, knee braces and back braces - and the repair or replacement of PWCs. Medicare paid Action nearly $10.3 million.
Between July 2013 and November 2016, Kaja billed Medicare $6.3 million for PWCs, PWC-related accessories, and the repair or replacement of PWCs. Medicare paid Kaja approximately $2.8 million for those claims, the indictment alleges.
The indictment charges all three defendants with 20 counts of healthcare fraud and one count of conspiring to launder money.
Motley and Marquez are further charged with two counts of aggravated identity theft in relation to the use of other persons’ names to operate the medical supply companies. Motley is additionally charged with six counts of structuring cash transactions to avoid federal reporting requirements for transactions of more than $10,000.
If convicted, each of the three defendants would potentially face decades in federal prison. Each count of healthcare fraud carries a statutory maximum sentence of 10 years in federal prison.
All three defendants entered not guilty pleas to the charges in the indictment and a trial was scheduled for February 13. A United States Magistrate Judge set bond for Motley and Murillo, and Marquez was ordered detained.
...
Cal/OSHA has issued citations to Hadley Date Gardens Inc. of Thermal for serious workplace safety and health violations following a bee swarm that stung and killed a tree worker.
On July 3, 2017, a tree worker, Gerardo Balbuena, 49, was spraying water on date palm fruit from the elevated bucket of a spraying rig when a beehive was disturbed. The bees repeatedly stung the worker, who suffered anaphylactic shock and died at the site.
After he was attacked, Balbuena went into cardiac arrest, said Tawny Cabral, a spokeswoman for the Riverside County Fire Department. He was pronounced dead at the scene.
Balbuena, a native of Morelos, Mexico, worked at Hadley Date Gardens for 27 years, said Albert P. Keck, the company’s president. He said Balbuena was a talented and hardworking employee with a loving family. "He is an immigrant that we should be very proud of as Americans," Keck said.
Keck said he has been working alongside Balbuena since his family acquired the gardens. He recently told Balbuena they were "going to grow old together."
"Recognized workplace hazards for tree workers include bee and other harmful insect exposure," said Cal/OSHA Chief Juliann Sum. "Employers must identify and evaluate workplace hazards, and provide appropriate personal protective equipment and effective training to their workers."
Cal/OSHA issued four citations totaling $41,310 in proposed penalties for workplace safety and health violations, two of which were classified as serious accident-related.
Hadley Date Gardens, Inc. failed to evaluate the worksite for hazardous bee and insect exposure, and failed to establish appropriate safety protocols, which include providing appropriate personal protective equipment and training that could have prevented this incident.
Cal/OSHA's Tree Work Safety guidelines specifically cite bee stings as a potentially fatal hazard of which employers must be aware ...
On July 3, 2017, a tree worker, Gerardo Balbuena, 49, was spraying water on date palm fruit from the elevated bucket of a spraying rig when a beehive was disturbed. The bees repeatedly stung the worker, who suffered anaphylactic shock and died at the site.
After he was attacked, Balbuena went into cardiac arrest, said Tawny Cabral, a spokeswoman for the Riverside County Fire Department. He was pronounced dead at the scene.
Balbuena, a native of Morelos, Mexico, worked at Hadley Date Gardens for 27 years, said Albert P. Keck, the company’s president. He said Balbuena was a talented and hardworking employee with a loving family. "He is an immigrant that we should be very proud of as Americans," Keck said.
Keck said he has been working alongside Balbuena since his family acquired the gardens. He recently told Balbuena they were "going to grow old together."
"Recognized workplace hazards for tree workers include bee and other harmful insect exposure," said Cal/OSHA Chief Juliann Sum. "Employers must identify and evaluate workplace hazards, and provide appropriate personal protective equipment and effective training to their workers."
Cal/OSHA issued four citations totaling $41,310 in proposed penalties for workplace safety and health violations, two of which were classified as serious accident-related.
Hadley Date Gardens, Inc. failed to evaluate the worksite for hazardous bee and insect exposure, and failed to establish appropriate safety protocols, which include providing appropriate personal protective equipment and training that could have prevented this incident.
Cal/OSHA's Tree Work Safety guidelines specifically cite bee stings as a potentially fatal hazard of which employers must be aware ...
The U.S. Justice Department on Thursday will rescind a marijuana policy begun under Democratic former President Barack Obama that eased enforcement of federal laws as a growing number of states and localities legalized the drug, a source familiar with the matter said.
The Obama-era policy, outlined in 2013 by then-Deputy Attorney General James Cole, recognized marijuana as a "dangerous drug," but said the department expected states and localities that authorized various uses of the drug to effectively regulate and police it.
Going forward, federal prosecutors around the country will have deference to enforce U.S. laws on marijuana as they see fit in their own districts, added the source, speaking on condition of anonymity.
The upcoming policy change comes just days after California formally launched the world’s largest regulated commercial market for recreational marijuana.
Besides California, other states that permit the regulated sale of marijuana for recreational use include Colorado, Washington, Oregon, Alaska and Nevada. Massachusetts and Maine are on track to follow suit later this year.
The policy being reversed had sought to provide more clarity on how prosecutors would enforce federal laws that ban marijuana in states that have legalized it for medicinal or recreational use. Its rescission could sow confusion and potentially hamper efforts to cultivate local marijuana businesses.
U.S. Attorney General Jeff Sessions has made no secret about his disdain for marijuana. He has said the drug is harmful and should not be legalized. He also described marijuana as a gateway drug for opioid addicts.
A task force created under a February 2017 executive order by Trump and comprised of prosecutors and other law enforcement officials was supposed to study marijuana enforcement, along with many other policy areas, and issue recommendations.
Its recommendations were due in July 2017, but the Justice Department has not made public what the task force determined was appropriate for marijuana.
Sessions and some law enforcement officials in states such as Colorado blame legalization for a number of problems, including drug traffickers who have taken advantage of lax marijuana laws to illegally grow and ship the drug across state lines, where it can sell for much more. The decision was a win for marijuana opponents who had been urging Sessions to take action.
"There is no more safe haven with regard to the federal government and marijuana, but it’s also the beginning of the story and not the end," said Kevin Sabet, president and CEO of Smart Approaches to Marijuana, who was among several anti-marijuana advocates who met with Sessions last month. "This is a victory. It’s going to dry up a lot of the institutional investment that has gone toward marijuana in the last five years."
...
The Obama-era policy, outlined in 2013 by then-Deputy Attorney General James Cole, recognized marijuana as a "dangerous drug," but said the department expected states and localities that authorized various uses of the drug to effectively regulate and police it.
Going forward, federal prosecutors around the country will have deference to enforce U.S. laws on marijuana as they see fit in their own districts, added the source, speaking on condition of anonymity.
The upcoming policy change comes just days after California formally launched the world’s largest regulated commercial market for recreational marijuana.
Besides California, other states that permit the regulated sale of marijuana for recreational use include Colorado, Washington, Oregon, Alaska and Nevada. Massachusetts and Maine are on track to follow suit later this year.
The policy being reversed had sought to provide more clarity on how prosecutors would enforce federal laws that ban marijuana in states that have legalized it for medicinal or recreational use. Its rescission could sow confusion and potentially hamper efforts to cultivate local marijuana businesses.
U.S. Attorney General Jeff Sessions has made no secret about his disdain for marijuana. He has said the drug is harmful and should not be legalized. He also described marijuana as a gateway drug for opioid addicts.
A task force created under a February 2017 executive order by Trump and comprised of prosecutors and other law enforcement officials was supposed to study marijuana enforcement, along with many other policy areas, and issue recommendations.
Its recommendations were due in July 2017, but the Justice Department has not made public what the task force determined was appropriate for marijuana.
Sessions and some law enforcement officials in states such as Colorado blame legalization for a number of problems, including drug traffickers who have taken advantage of lax marijuana laws to illegally grow and ship the drug across state lines, where it can sell for much more. The decision was a win for marijuana opponents who had been urging Sessions to take action.
"There is no more safe haven with regard to the federal government and marijuana, but it’s also the beginning of the story and not the end," said Kevin Sabet, president and CEO of Smart Approaches to Marijuana, who was among several anti-marijuana advocates who met with Sessions last month. "This is a victory. It’s going to dry up a lot of the institutional investment that has gone toward marijuana in the last five years."
...
James Garbe, an experienced pharmacist, began working at Kmart pharmacy in Ohio in 2007. One day, Garbe picked up a personal prescription at a competitor pharmacy. When he reviewed his receipt, Garbe got a surprise: the competitor pharmacy had charged his Medicare Part D insurer far less than Kmart ordinarily charged it for the same prescription.
Curious to see whether his discovery was a one-off, he started inspecting Kmart’s pharmacy reimburse-ment claims. His amateur detective work revealed that Kmart routinely charged customers with insurance - whether public or private - higher prices than customers who paid out of pocket.
Not all cash customers were charged the same price: people in Kmart’s "discount programs" paid much less. But the ensuing investigation revealed that nearly all cash customers received the lower "discount program" prices. Meanwhile, those "discount program sales were ignored when Kmart calculated its "usual and customary" prices for its generic drugs for purposes of Medicare reimbursement.
Garbe shared his discovery with the government and filed a qui tam suit against Kmart Corporation on July 12, 2008 in the federal district in Los Angeles and later transferred to the Southern District of Illinois. He claimed that Kmart knowingly failed to disclose those discount prices when reporting to federal health programs its usual and customary prices, which are typically used by those programs to establish reimbursement rates.
Now Kmart Corporation has agreed to pay $32.3 million to the United States to settle allegations that in-store pharmacies in Kmart stores failed to report discounted prescription drug prices to Medicare Part D, Medicaid, and TRICARE, the health program for uniformed service members and their families, the Justice Department announced today.
The agreement resolves allegations arising from a lawsuit brought under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery.
The settlement agreement with the United States is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. Garbe, who litigated the case after the government declined to intervene in the action, will receive $9.3 million.
The case was handled by the Justice Department’s Civil Division and the U.S. Attorney’s Offices for the Southern District of Illinois and Central District of California. Auditing assistance for the government’s investigation was provided by the U.S. Attorney’s Office for the Central District of California and the National Association of Medicaid Fraud Control Units. Investigative assistance was provided by the U.S. Department of Health and Human Services, Office of Inspector General.
The lawsuit is captioned U.S. ex rel. Garbe v. Kmart Corp., Case No. 12-CV-881-NJR-PMF (S.D. Ill.). The claims settled by this agreement are allegations only, and there has been no determination of liability.m ...
Curious to see whether his discovery was a one-off, he started inspecting Kmart’s pharmacy reimburse-ment claims. His amateur detective work revealed that Kmart routinely charged customers with insurance - whether public or private - higher prices than customers who paid out of pocket.
Not all cash customers were charged the same price: people in Kmart’s "discount programs" paid much less. But the ensuing investigation revealed that nearly all cash customers received the lower "discount program" prices. Meanwhile, those "discount program sales were ignored when Kmart calculated its "usual and customary" prices for its generic drugs for purposes of Medicare reimbursement.
Garbe shared his discovery with the government and filed a qui tam suit against Kmart Corporation on July 12, 2008 in the federal district in Los Angeles and later transferred to the Southern District of Illinois. He claimed that Kmart knowingly failed to disclose those discount prices when reporting to federal health programs its usual and customary prices, which are typically used by those programs to establish reimbursement rates.
Now Kmart Corporation has agreed to pay $32.3 million to the United States to settle allegations that in-store pharmacies in Kmart stores failed to report discounted prescription drug prices to Medicare Part D, Medicaid, and TRICARE, the health program for uniformed service members and their families, the Justice Department announced today.
The agreement resolves allegations arising from a lawsuit brought under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery.
The settlement agreement with the United States is a part of a global $59 million settlement that includes a resolution of state Medicaid and insurance claims against Kmart. Garbe, who litigated the case after the government declined to intervene in the action, will receive $9.3 million.
The case was handled by the Justice Department’s Civil Division and the U.S. Attorney’s Offices for the Southern District of Illinois and Central District of California. Auditing assistance for the government’s investigation was provided by the U.S. Attorney’s Office for the Central District of California and the National Association of Medicaid Fraud Control Units. Investigative assistance was provided by the U.S. Department of Health and Human Services, Office of Inspector General.
The lawsuit is captioned U.S. ex rel. Garbe v. Kmart Corp., Case No. 12-CV-881-NJR-PMF (S.D. Ill.). The claims settled by this agreement are allegations only, and there has been no determination of liability.m ...
The Division of Workers’ Compensation last month suspended 28 more medical providers from participating in California’s workers’ compensation system, bringing the total number of providers suspended to 159. The providers were suspended for fraud or other criminal actions, or the loss of their license.
Most notable among them was Khristine Eroshevich M.D., a Beverly Hills physician, was convicted in federal court in 2010 of unlawfully prescribing controlled substances following the death of of patient, actress Anna Nicole Smith, by fraud, deceit, misrepresentation, or concealment of a material fact.
Eroshevich wrote numerous unnecessary prescriptions for controlled substances using false names and information for individuals who were not her patients. Eroshevich was also suspended by the California Department of Health Care Services from participating in the Medi-Cal program for an indefinite period of time.
On October 6, 2017 Eroshevich filed a federal lawsuit against officials of the DIR. She alleges that the remaining misdemeanor count "was ordered set aside, a plea of not guilty was entered, and it was also dismissed by the Superior Court." Thus it could not be used as grounds for her suspension.
Her federal action was dismissed on December 21 based upon the "Younger" abstention doctrine. In Younger v. Harris, [401 U.S. 37 (1971)], the U.S. Supreme Court reaffirmed the longstanding principle that federal courts sitting in equity cannot, absent exceptional circumstances, enjoin pending state criminal proceedings and civil enforcement actions "akin to" criminal proceedings.
Also suspended was Gary Ordog M.D., a Newhall physician and operator of a mobile medical clinic, who was convicted in 2016 of health care fraud for submitting claims to Medicare totaling approximately $6.5 million. Ordog submitted false and fraudulent claims to Medicare for office visits or other outpatient visits that never occurred.
And Owusu Ananeh Firempong M.D., another Beverly Hills physician, who was convicted in 2012 in federal court of health care fraud for submitting false and fraudulent claims to Medicare. Firempong was also convicted in 2011 in federal court of conspiracy to distribute cocaine and conspiracy to launder money. Firempong was sentenced to 57 months in federal prison and ordered to pay nearly $800,000 in restitution. Firempong’s medical license was revoked in 2016.
The list of all of the 28 vendors who have been recently suspended is contained in the latest DWC notice, and on the DWC webpage that lists all suspended providers to date ...
Most notable among them was Khristine Eroshevich M.D., a Beverly Hills physician, was convicted in federal court in 2010 of unlawfully prescribing controlled substances following the death of of patient, actress Anna Nicole Smith, by fraud, deceit, misrepresentation, or concealment of a material fact.
Eroshevich wrote numerous unnecessary prescriptions for controlled substances using false names and information for individuals who were not her patients. Eroshevich was also suspended by the California Department of Health Care Services from participating in the Medi-Cal program for an indefinite period of time.
On October 6, 2017 Eroshevich filed a federal lawsuit against officials of the DIR. She alleges that the remaining misdemeanor count "was ordered set aside, a plea of not guilty was entered, and it was also dismissed by the Superior Court." Thus it could not be used as grounds for her suspension.
Her federal action was dismissed on December 21 based upon the "Younger" abstention doctrine. In Younger v. Harris, [401 U.S. 37 (1971)], the U.S. Supreme Court reaffirmed the longstanding principle that federal courts sitting in equity cannot, absent exceptional circumstances, enjoin pending state criminal proceedings and civil enforcement actions "akin to" criminal proceedings.
Also suspended was Gary Ordog M.D., a Newhall physician and operator of a mobile medical clinic, who was convicted in 2016 of health care fraud for submitting claims to Medicare totaling approximately $6.5 million. Ordog submitted false and fraudulent claims to Medicare for office visits or other outpatient visits that never occurred.
And Owusu Ananeh Firempong M.D., another Beverly Hills physician, who was convicted in 2012 in federal court of health care fraud for submitting false and fraudulent claims to Medicare. Firempong was also convicted in 2011 in federal court of conspiracy to distribute cocaine and conspiracy to launder money. Firempong was sentenced to 57 months in federal prison and ordered to pay nearly $800,000 in restitution. Firempong’s medical license was revoked in 2016.
The list of all of the 28 vendors who have been recently suspended is contained in the latest DWC notice, and on the DWC webpage that lists all suspended providers to date ...
Reuters Health reported that drugmakers opened the new year by raising U.S. prices on dozens of medicines, but early data showed the increases generally remained within a 10 percent self-imposed limit in response to a backlash from consumers and politicians.
Soaring U.S. prices for both branded and generic drugs have sparked public outrage and government investigations over the past few years.
"Drug price increases are somewhat more constrained in 2017 and 2018 than they have been previously," Cowen and Co analyst Eric Schmidt said.
Allergan Inc raised prices on 18 different drugs, including dry eye treatment Restasis and irritable bowel syndrome drug Linzess, by 9.5 percent, according to a research note released by Jefferies on Tuesday.
Jefferies cited data collected by Medi-Span Price Rx and refers to list price increases, before potentially significant discounts and rebates that drugmakers provide to win preferred coverage by insurers. Medi-Span did not respond to requests to confirm the data.
Allergan’s chief executive, Brent Saunders, in late 2016 pledged to keep price increases below 10 percent as part of what he called the company’s "Social Contract with Patients."
Allergan spokesman Mark Marmur said the increases will be the only ones taken on those brands in 2018, adding that discounts to various payers should bring the actual increases to consumers down to the low single digits.
Other drugmakers raising prices include Amgen Inc (AMGN.O), Teva Pharmaceutical Industries Inc (TEVA.TA) (TEVA.N) and Horizon Pharma (HZNP.O), according to Jefferies and Cowen. Amgen raised the price on its blockbuster rheumatoid arthritis and psoriasis drug Enbrel by 9.7 percent and Teva increased prices on its ProAir HFA and ProAir RespiClick asthma inhalers by 6 and 3 percent, respectively.
Drug price increases are coming under more scrutiny from states. California Governor Jerry Brown in October signed legislation requiring drug manufacturers to give 60-day notice if prices are raised more than 16 percent over a two-year period.
However, the trade group representing U.S. drugmakers filed a lawsuit to stop California from implementing a law aimed at reining in prescription drug prices.The Pharmaceutical Research and Manufacturers of America (PhRMA) initiated litigation in the United States District Court for the Eastern District of California challenging SB 17, which it alleges is an unprecedented and unconstitutional California law.
In its federal complaint, PhRMA argues that SB 17 attempts to dictate national health care policy related to drug prices in violation of the United States Constitution, singles out drug manufacturers as the sole determinant of drug costs despite the significant role many other entities play in the costs patients pay, and will cause market distortions such as drug stockpiling and reduced competition.
...
Soaring U.S. prices for both branded and generic drugs have sparked public outrage and government investigations over the past few years.
"Drug price increases are somewhat more constrained in 2017 and 2018 than they have been previously," Cowen and Co analyst Eric Schmidt said.
Allergan Inc raised prices on 18 different drugs, including dry eye treatment Restasis and irritable bowel syndrome drug Linzess, by 9.5 percent, according to a research note released by Jefferies on Tuesday.
Jefferies cited data collected by Medi-Span Price Rx and refers to list price increases, before potentially significant discounts and rebates that drugmakers provide to win preferred coverage by insurers. Medi-Span did not respond to requests to confirm the data.
Allergan’s chief executive, Brent Saunders, in late 2016 pledged to keep price increases below 10 percent as part of what he called the company’s "Social Contract with Patients."
Allergan spokesman Mark Marmur said the increases will be the only ones taken on those brands in 2018, adding that discounts to various payers should bring the actual increases to consumers down to the low single digits.
Other drugmakers raising prices include Amgen Inc (AMGN.O), Teva Pharmaceutical Industries Inc (TEVA.TA) (TEVA.N) and Horizon Pharma (HZNP.O), according to Jefferies and Cowen. Amgen raised the price on its blockbuster rheumatoid arthritis and psoriasis drug Enbrel by 9.7 percent and Teva increased prices on its ProAir HFA and ProAir RespiClick asthma inhalers by 6 and 3 percent, respectively.
Drug price increases are coming under more scrutiny from states. California Governor Jerry Brown in October signed legislation requiring drug manufacturers to give 60-day notice if prices are raised more than 16 percent over a two-year period.
However, the trade group representing U.S. drugmakers filed a lawsuit to stop California from implementing a law aimed at reining in prescription drug prices.The Pharmaceutical Research and Manufacturers of America (PhRMA) initiated litigation in the United States District Court for the Eastern District of California challenging SB 17, which it alleges is an unprecedented and unconstitutional California law.
In its federal complaint, PhRMA argues that SB 17 attempts to dictate national health care policy related to drug prices in violation of the United States Constitution, singles out drug manufacturers as the sole determinant of drug costs despite the significant role many other entities play in the costs patients pay, and will cause market distortions such as drug stockpiling and reduced competition.
...
