Almirante Perez, 43, of Highland, was arraigned on multiple felony counts of insurance fraud and tax evasion after allegedly underreporting employees and wages in an attempt to reduce his businesses’ insurance premiums and payroll taxes by over $2.5 million.

Perez was the owner of Capital Janitorial Services, Cal Best Service Group Inc., Southern Pacific Janitorial Group and United Pacific Contractors Inc., from March 2013 to November 2018.

An investigation by the Department of Insurance revealed Perez failed to report employees and wages to his workers’ compensation insurance carrier and to the Employment Development Department (EDD). The investigation discovered $1,982,597 in underreported premium fraud and $609,430 in payroll taxes owed to the EDD.

It is further alleged, as to some of the counts, that the offenses alleged are related felonies, a material element of which is fraud and embezzlement, which involved a pattern of related felony conduct, and the pattern of related felony conduct involved the taking of, and resulted in the loss by Republic Underwriters Insurance Company, NorGuard Insurance Company, dba Atlas General Insurance Company, and Ohio Security Insurance Company of more than five hundred thousand dollars ($500,000).

These allegations subject Almirante Perez to the additional punishment provided for in Penal Code sections 186.11(a)(2), which is the aggravated white collar crime enhancement. White collar crime generally refers to non-violent crime, often involving professionals, for financial gain. White collar crime may involve small amounts of money or millions of dollars. The penalties for white collar crimes in California depend, in part, on the extent of the alleged crime.

The Insurance Commissioner said that “Legitimate businesses and California consumers pay the price when business owners cheat the system by illegally underreporting employees and wages.”

Perez was arraigned on October 22, 2020, at San Bernardino County Superior Court and pleaded not guilty to all charges. The San Bernardino County District Attorney’s Office is prosecuting this case.

The Division of Workers’ Compensation has issued a notice of public hearing for the amendment of the Medical-Legal Fee Schedule, which can be found at California Code of Regulations, title 8, sections 9793-9795.

The public hearing will be held via Zoom on Monday, December 14, 2020 at 10 a.m. Options for participation are at the bottom of this notice.

The proposed amendments to the medical-legal fee schedule include, but are not limited to, the following:

— A 25% increase in the multiplier used for setting fees for evaluations.
— Standardization of the fee that can be charged for a missed appointment.
— Flat fees for comprehensive, follow-up, and supplemental medical-legal evaluations.
— A single rate for review of medical records based upon the amount of pages reviewed.
— A meet and confer requirement for records sent to the physician.
— Elimination of complexity factors from the Medical-Legal Fee Schedule.
— An increased modifier for reports dealing with psychiatric issues.
— An increase in the hourly fee for medical-legal testimony.

The implementation of a predominantly fixed fee for all procedure billing codes is anticipated to reduce frictional costs. Moving to a flat-fee-based schedule and removing complexity factors is contemplated to reduce the incidence of disputes over billing.

The fee schedule was formulated after multiple stakeholder meetings where carriers, employers, physicians, and medical management companies were able to provide input. In addition, the proposed regulations were revised after review of the results of a 15-day comment period from a prior forum posting of the proposed regulations. The notice and text of regulations can be found at the proposed regulations page.

The proposed amendment to revise the Medical-Legal Fee Schedule is exempt from the rulemaking provisions of the Administrative Procedure Act. However, DWC is required under Labor Code sections 5307.3 and 5307.4 to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period and publish the order adopting the new regulations online.

Members of the public may attend the public meeting as follows:

— Computer: Join from PC, Mac, Linux, iOS or Android: https://dir-ca-gov.zoom.us/j/92474087436
— Or Telephone Dial options: +1 253 215 8782 +1 301 715 8592 +1 312 626 6799 +1 346 248 7799 +1 669 900 6833 +1 929 205 6099 USA 1 (866) 434-5269 (US Toll Free) – Conference code: 956474
— Find local AT&T Numbers: https://www.teleconference.att.com/servlet/glbAccess?process=1&accessNumber=2532158782&accessCode=956474

Members of the public may review and comment on the proposed regulations no later than December 15, 2020.

The Los Angeles County District Attorney’s Office announced that a chiropractor and a claims adjuster have been charged with conspiring to process false insurance claims for payment amounting to more than $1.6 million.

65 year old Agop Sarafian, the claims adjuster of La Crescenta, and 65 year old Shahe Kevork Topjian, the chiropractor of Granada Hills, each face one felony count of insurance fraud in case BA491001. Their arraignment will be scheduled at Department 30 of the Foltz Criminal Justice Center.

HIs office was located at 22030 Clarendon Street, Suite 111, in Woodland Hills. His NPI number is 1477817898 and was assigned on June 2012. The practitioner’s primary taxonomy code is 111N00000X with California license number 21857.

Head Deputy Marc Beaart of the Healthcare Fraud Division said that the alleged insurance fraud occurred between June 8, 2007 and November 25, 2019. In November 2019, State Compensation Insurance Fund where Sarafian worked began an internal investigation before the California Department of Insurance and the Los Angeles County District Attorney’s Office became involved.

The pair is accused of defrauding State Fund by setting up fake workers’ compensation lien settlements to receive undeserved insurance payouts.

If convicted as charged, the defendants each face a maximum sentence of five years in county jail.

The case remains under investigation by the California Department of Insurance, Fraud Division.

The Workers’ Compensation Appeals Board issued two En Banc decisions reinstating a few of the Rules of Practice and Procedure that had been suspended earlier this year as a result of limitations caused by the COVID-19 pandemic.

The first case was Workers’ Compensation Appeals Board State of California In Re: Covid-19 State Of Emergency En Banc – No. 5 – Case No. Misc. No. 264.

The relevant section of the Opinion provided that “The Appeals Board hereby rescinds its suspension of WCAB Rules 10755, 10756 and 10888 effective as of the date of this decision. Suspension of the other Rules as outlined in the March 18, 2020 In Re: COVID-19 State of Emergency En Banc (Misc. No. 260) remains in effect until further notice.”

These three rules pertain to sanctions available to the WCJ for failure to appear and scheduled hearings. The rules that are now renstated can be reviewed using the links below.

— § 10755. Failure to Appear at Mandatory Settlement Conference in Case in Chief.
— § 10756. Failure to Appear at Trial in Case in Chief.
— § 10888. Dismissal of Lien Claims.

The second case was Workers’ Compensation Appeals Board State of California In Re: Covid-19 State Of Emergency En Banc – No. 6 – Case No. Misc. No. 265.

The relevant section of the Opinion provided that “The Appeals Board hereby rescinds its suspension of WCAB Rules 10620 and 10670(b)(3) as of December 1, 2020. These Rules will become effective again with respect to all workers’ compensation matters on December 1, 2020. Therefore, WCAB Rules 10620 and 10670(b)(3) apply to all trials on or after December 1, 2020.”

These two rules pertain to requirements for filing and service is proposed exhibits for trial. The rules that will be reinstated on December 1 can be reviewed using the links below.

— § 10620. Filing Proposed Exhibits.
— § 10670. Documentary Evidence.

Other than these five rules, all other Emergency Orders of prior En Banc decisions remain in effect.

75 year old Egisto Salerno, M.D., an internal medicine physician practicing in San Diego, was sentenced to 18 months in custody for causing the illegal distribution of an opioid pain medication commonly known as Norco or Vicodin.

He is a 1976 graduate of the National University of La Plata Faculty of Medicine in Argentina, and licensed in California on January 4, 1982. He surrendered his California medical license on May 25, 2018 and is no longer licensed to practice medicine in California. He stipulated to surrender his license to resolve disciplinary actions then pending against him for gross negligence.

Salerno, whose medical practice was located at 5532 El Cajon Boulevard, pleaded guilty in January, admitting that he signed prescriptions for 78,544 pills that lacked a legitimate medical purpose and were outside the usual course of professional medical practice.

Salerno also admitted that an undercover federal agent who visited Salerno’s office on six occasions received six hydrocodone prescriptions.

In a separate instance, on a date when the undercover agent did not visit Salerno’s office and the doctor did not see him, Salerno acknowleged that a prescription was improperly issued by him in the name used by the undercover agent. After the prescription was issued, Salerno ginned up and signed a progress note in the “patient” chart for the purported visit that did not occur.

The prescription was then picked up by another as part of a larger scheme to divert these pills. That scheme involved two medical assistants in Salerno’s practice who falsified medical records and sold prescriptions that Salerno had pre-signed to a co-defendant though the “patients” identified on those prescriptions did not even see Salerno.

In fact, as Salerno acknowledged, many of those in whose names these prescriptions were written were deceased or jailed at the time the prescriptions were written.

The pills were, in turn, diverted to the “capper” or patient recruiter, who also arranged to bring homeless and other individuals to Salerno’s office and paid them to secure these prescriptions from Salerno. Others assisted the patient recruiter by transporting the purported patients to Salerno’s office and then to pharmacies to pick up the pills. In turn, pills were sold in San Diego and delivered to a pharmacy in Mexico for cash.

As the plea documents show, the criminal activity occurred between November 2014 and February 2018. Seven other defendants have been convicted in this case including Salerno’s two medical assistants – April J. Cervantes and David D. Apple; the lead patient “recruiter” – Stephen Toney; and Toney’s associates – Shalina D. Latson, Lonnell Ligon, LaJuan D. Smith and Amber N. Grabau.

Defendant David D. Apple, one of Salerno’s medical assistants, will be sentenced on December 2, 2020.