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Tag: 2020 News

WCAB Claim Tolls Statute of Limitations for FEHA Action

Jay Brome began his employment at the California Highway Patrol in 1996. During his nearly 20-year career he was openly gay. He claims that other officers subjected him to derogatory, homophobic comments; singled him out for pranks; repeatedly defaced his mailbox; and refused to provide him with backup assistance during enforcement stops in the field.

As a result, Brome feared for his life during enforcement stops, experienced headaches, muscle pain, stomach issues, anxiety and stress, and became suicidal by early 2015. In January 2015, he went on medical leave and filed a workers’ compensation claim based on work-related stress.

Brome’s workers’ compensation claim was resolved in his favor on October 27, 2015. He took industrial disability retirement on February 29, 2016, ending his employment with the Patrol.

On September 15, 2016, Brome filed an administrative complaint with the Department of Fair Employment and Housing. He filed a lawsuit the next day, asserting four claims under the Fair Employment and Housing Act for the conduct he alleged in his workers’ compensation claim.

The CHP sought summary judgment, contending Brome’s claims were untimely because he did not file his administrative complaint within one year of the challenged actions, as required under former section 12960, subdivision (d).

However, because the crux of his case concerns circumstances that occurred before his medical leave began in January 2015, he asserted that exceptions to the one-year deadline were applicable. He argued that the filing of his workers’ compensation claim should stop the clock on his one-year filing deadline during the pendency of his compensation claim. The legal doctrine is known as “equitable tolling.”

The trial court granted summary judgment in favor of the Patrol, holding that Brome’s claims were filed after the statute of limitations expired and a reasonable jury could not have concluded they were timely based on an exception to the deadline.

The Court of Appeal reversed in the published case of Brome v California Highway Patrol.

The equitable tolling doctrine operates to suspend or extend a statute of limitations as necessary to ensure fundamental practicality and fairness. In the case of McDonald v. Antelope Valley Community College Dist. (2008) 45 Cal.4th 88, the California Supreme Court held that the deadline for filing an administrative claim under the Act could be tolled while a plaintiff is voluntarily pursuing alternate remedies.

The time for filing a claim pursuant to the Act may be tolled where the plaintiff can establish three elements: timely notice, and lack of prejudice, to the defendant, and reasonable and good faith conduct on the part of the plaintiff.

It will be the jury’s job to reconcile the evidence at trial, and summary judgment was not justified.

Cal/OSHA Reminds Employers to Post Annual Summary

Cal/OSHA is reminding employers in California to post their 2019 annual summary of work-related injuries and illnesses in a visible and easily accessible area at each worksite. The Form 300A summary must be posted each year through April 30.

Instructions and form templates are available for download from Cal/OSHA’s Record Keeping Overview.

The overview gives instructions on completing both the log (Form 300) and annual summary (Form 300A) of work-related injuries and illnesses.

The annual summary must be placed in a visible and easily accessible area at each worksite. Posting helps ensure workers are aware of work-related injuries and illnesses that occurred the previous year. Current and former employees and their representatives are entitled to a copy of the summary or the log upon request.

The 2019 definitions and requirements for recordable work-related fatalities, injuries and illnesses are outlined in the California Code of Regulations, Title 8, sections 14300 through 14300.48. Employers are required to complete and post the Form 300A even if no workplace injuries occurred.

Many employers in California must also comply with electronic submission of workplace injury and illness records requirements by March 2nd each year. Cal/OSHA has posted details on which employers are required to submit the electronic reports as well as other information online.

The California Division of Occupational Safety and Health, or Cal/OSHA, is the division within the Department of Industrial Relations (DIR) that helps protect California’s workers from health and safety hazards on the job in almost every workplace. Cal/OSHA’s Consultation Services Branch provides free and voluntary assistance to employers to improve their safety and health programs. Employers should call (800) 963-9424 for assistance from Cal/OSHA Consultation Services.

Employees with work-related questions or complaints may contact DIR’s Call Center in English or Spanish at 844-LABOR-DIR (844-522-6734).

Charges Filed in $20M Comp Treatment Kickback Scheme

Bradley Dean Groscost, 59, of Westminster, and Felix Koltsov, 57, of Beverly Hills, self-surrendered last week to the Orange County Central Justice Center after being charged with multiple felony counts of insurance fraud, money laundering, and unlawful referrals for allegedly conspiring to bill insurers in excess of $20 million as part of a kickback referral scheme.

From 2014 to 2017, Groscost operated five workers’ compensation clinics in Southern California. Doing business as DSJ MGT, Inc. in Fountain Valley, Groscost controlled treatments, referrals, and medical and financial records at the clinics even though he was not licensed to practice medicine.

The Department of Insurance’s investigation, with the assistance of the National Insurance Crime Bureau, discovered that Groscost allegedly received approximately $2.1 million in kickbacks from Koltsov, owner of LFPS Inc. and Resource Pharmacy Inc., for patient referrals for urine drug screenings and compound cream prescriptions. Koltsov’s companies billed workers’ compensation insurance carriers over $20 million for these claims.

The investigation also revealed that Groscost allegedly failed to report employees to the Employment Development Department (EDD) and paid them as independent contractors. He failed to report over $5.1 million in wages to EDD and as a result, avoided paying over $510,000 in taxes. As of July 5, 2019, Groscost owed EDD over $1.6 million in taxes, penalties, and interest.

“These fraudulent workers’ compensation claims funnel resources away from injured workers and make it more difficult to provide the treatment to those workers who truly need it,” said District Attorney Todd Spitzer. “The Orange County District Attorney’s Office is collaborating with the California Department of Insurance to crack down on workers’ compensation fraud and preserve resources for the truly injured.”

“These co-conspirators allegedly ordered screenings and prescriptions for patients in order to enrich themselves, as part of a kickback referral scheme,” said Insurance Commissioner Ricardo Lara. “By investigating health care fraud, my department is helping keep insurance costs down for all California consumers and businesses.”

This case is being prosecuted by Deputy District Attorney Christine Oh of the Insurance Fraud Unit of the Orange County District Attorney’s Office. Koltsov surrendered to the court on January 22, 2020, and posted bail of $500,000. Groscost surrendered to the court on January 24, 2020, and remains in custody. His bail is set at $500,000.

Non-Opioid “Stem Cell” Pain Treatment Provides Relief

For the first time ever, researchers at the University of Sydney have successfully used human stem cells to produce “pain-killing” neurons. These neurons were then tested on a group of lab mice that were dealing with extreme pain. After just a single treatment, the mice’s pain symptoms were relieved with no side effects.

The research has just been published in the Journal Pain.

Moving forward, scientists will perform additional tests on pigs and other rodents. Then, if all goes well, testing on human patients dealing with chronic pain should begin within the next five years.

These pain-killing neurons could one day serve as a non-addictive, non-opioid pain management option for people all over the world.

“We are already moving towards testing in humans,” says Associate Professor Greg Neely, a leader in pain research at the Charles Perkins Centre and the School of Life and Environmental Sciences, in a release.

“Nerve injury can lead to devastating neuropathic pain and for the majority of patients there are no effective therapies. This breakthrough means for some of these patients, we could make pain-killing transplants from their own cells, and the cells can then reverse the underlying cause of pain.”

Researchers used human induced pluripotent stem cells (iPSC), derived from bone marrow, to create the neurons in a lab setting. Then, the neurons were placed inside the spinal cords of mice dealing with constant neuropathic pain.

“Remarkably, the stem-cell neurons promoted lasting pain relief without side effects,” comments co-senior author Dr Leslie Caron. “It means transplant therapy could be an effective and long-lasting treatment for neuropathic pain. It is very exciting.”

John Manion, the study’s lead author, adds: “Because we can pick where we put our pain-killing neurons, we can target only the parts of the body that are in pain. This means our approach can have fewer side effects.”

WCAB Panel Specifies Requirements for 4903.8(d) Lien Declaration

Luisa Rodriguez was employed by Kelly Services, and injured her low back, and claimed to have injured her neck, left leg, left hip, psyche, head, bilateral shoulders, and suffered a sleep disorder. Some of her treatment was provided on a lien basis.

Mr. Patrick Christoff executed a section 4903.S(d) declaration on behalf of lien claimants Comprehensive Outpatient Surgery Center (COSC) and Technical Surgery Support (TSS). In both declarations, Mr. Christoff declared under penalty of perjury that “the services or products described in the bill for services or products were actually provided to the injured employee”; and that “the billing statement . . . truly and accurately describes the services and products that were provided to the injured employee.”

At trial the employer objected to the liens and claimed that Mr. Christoff did not have personal knowledge of the facts set forth in the declarations to sign them on behalf of lien claimants.

Christoff testified that he has worked for COSC since 2003 as an attorney, and he collects liens for COSC and TSS. His job duties included understanding billing procedures and codes, reviewing and negotiating bills, and reviewing surgical and medical reports, which includes over 10,000 operative reports. He reviewed these reports to have an understanding of what was billed for what service for each case. He also spoke to pain management doctors to get an understanding of the medical services that had been provided and billed to negotiate billing.

Christoff stated that he reviewed the operative reports to ensure that the description of the services in the operative reports matched the services that were billed in the invoice. Mr. Christoff testified that he relied on the information in the operative reports to determine the accuracy and specificity of the actual billing to ensure that they were the same and matched each other. Mr. Christoff explained that he received education on decompression procedures as well as training on bill review practices; he has reviewed over 10,000 bills. Mr. Christoff testified that he reviewed medical and surgical reports prior to signing his section 4903 .8( d) declarations on September 1, 2017.

On cross-examination, Mr. Christoff testified that he did not have any formal training or classroom instruction on CPT coding; did not attend any seminars in bill review; and did not recall being in the operating room for any of the procedures that were billed. Mr. Christoff testified that he based his declaration on the doctor’s chart notes, and the doctor declared under penalty of perjury that the services were provided on that date.

The WCJ found that Christoff was competent to sign Labor Code section 4903.8(d) declarations on behalf of lien claimants Comprehensive Outpatient Surgery Center (COSC) and Technical Surgery Support (TSS). The decision was affirmed in the panel decision of Rodriguez v Kelly Services.

Here, Mr. Christoff s section 4903.S(d) declarations comply with section 4903.8(d) in that he declared under penalty of perjury the facts found in subsections (d)(l) and (d)(2). Therefore, the burden shifted to defendant to prove that Mr. Christoff’s section 4903.S(d) declarations were invalid.

Defendant argues that lien claimants’ 4903.S(d) declarations are invalid because Mr. Christoff is not competent to testify to the facts in his declarations; in particular, Mr. Christoff does not have “personal knowledge that the billing statement accurately describes the products/services provided to the injured employee and that those products/services were actually performed.”

Although section 4903.8(d) does not define exactly what is meant by the phrase, “competent to testify,” there guidance in Evidence Code section 702, which provides: “A witness’ personal knowledge of a matter may be shown by any otherwise admissible evidence, including his own testimony.”

Here, Mr. Christoff s knowledge of lien claimants’ medical services was based, in part, on Dr. Williams’ medical reports, which Dr. Williams declared and signed under penalty of perjury.

Based on the facts of this case, the WCAB concluded that Mr. Christoff is competent to testify to the facts stated in his section 4903. 8( d) declarations.

Arch Health Partners Resolves Kickback Allegations for $3M

Arch Health Partners, Inc. has agreed to pay the United States $2,910,370 to resolve allegations that it violated the False Claims Act by submitting false claims to Medicare. Arch Health is a San Diego-based medical organization that contracts with physician groups to provide care through the Palomar Health system.

Palomar operates three hospitals in the San Diego area, Palomar Medical Center Escondido, Palomar Medical Center Downtown Escondido and Palomar Medical Center Poway, in addition to a physician network and other health care services on an outpatient basis.

The United States alleged that Arch Health violated the False Claims Act by submitting claims for federal reimbursement for medical evaluation and management services absent sufficient documentation regarding the nature and complexity of the services provided.

Those particular allegations were originally brought in a lawsuit filed by a former employee of Arch Health, Catherine Jones, under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens with knowledge of fraud against the government to bring suit on behalf of the government and to share in any recovery. Ms. Jones will receive $183,830 of the settlement proceeds.

The United States also alleged, based on certain self-disclosures by Arch Health, that it paid compensation to referring physicians and physician groups that was above fair market value in violation of the Anti-Kickback Act, the Stark Statute, and, by extension, the False Claims Act.

The investigation was conducted by the United States Attorney’s Office for the Southern District of California, the U.S. Department of Health and Human Services’ Office of Inspector General, and the Federal Bureau of Investigation. U.S. Attorney Brewer commended the excellent work by AUSA Glen Dorgan of the office’s Civil Division, whose diligence was a major factor in resolving this matter.

This case is captioned United States ex rel. Jones v. Arch Health Partners, Inc., et al., Case No. 3:17-cv-0090-MMA-BLM, and the matter was handled by Assistant U.S. Attorney Glen F. Dorgan of the Affirmative Civil Enforcement Unit of the U.S. Attorney’s Office.

Looking Back at the Validity of NFL Concussion Claims

A Nigerian American pathologist portrayed by Will Smith in the 2015 film, “Concussion,” Bennet Omalu M.D. is partly responsible for the most important sports story of the 21st century. He triggered thousands of claims against the NFL that have settled for around $1 billion, and hundreds of workers’ compensation claims filed, and now for the most part settled, in California.

Since 2005, when Omalu first reported finding widespread brain damage in a former NFL player, concerns about CTE have inspired a global revolution in concussion safety and fueled an ongoing existential crisis for America’s most popular sport. Omalu’s discovery – initially ignored and then attacked by NFL-allied doctors – inspired an avalanche of scientific research that forced the league to acknowledge a link between football and brain disease.

Nearly 15 years later, Omalu has withdrawn from the CTE research community and remade himself as an evangelist, traveling the world selling his frightening version of what scientists know about CTE and contact sports. In paid speaking engagements, expert witness testimony and in several books he has authored, Omalu portrays CTE as an epidemic and himself as a crusader, fighting against not just the NFL but also the medical science community, which he claims is too corrupted to acknowledge clear-cut evidence that contact sports destroy lives.

And since his discovery, Omalu told Sports Illustrated, researchers have uncovered evidence that shows adolescents who participate in football, hockey, wrestling and mixed martial arts are more likely to drop out of school, become addicted to drugs, struggle with mental illness, commit violent crimes and kill themselves.

But a new report from the Washington Post – “From scientist to Salesman How Bennet Omalu, Doctor of ‘Concussion’ Fame, Built a Career on Distorted Science” tells the other side of his story.

After more than a decade of intensive research by scientists from around the globe, the state of scientific knowledge of CTE remains one of uncertainty. Among CTE experts, many important aspects of the disease – from what symptoms it causes, to how prevalent or rare it is – remain the subject of research and debate.

But across the brain science community, there is wide consensus on one thing: Omalu, the man considered by many the public face of CTE research, routinely exaggerates his accomplishments and dramatically overstates the known risks of CTE and contact sports, fueling misconceptions about the disease, according to interviews with more than 50 experts in neurodegenerative disease and brain injuries, and a review of more than 100 papers from peer-reviewed medical journals.

Omalu did not discover CTE, nor did he name the disease. The alarming statistics he recites about contact sports are distorted, according to the author of the studies that produced those figures. And while Omalu cultivates a reputation as the global authority on CTE, it’s unclear whether he is diagnosing it correctly, according to several experts on the disease.

Omalu’s definition for CTE, as described in his published papers, is incredibly broad and all-encompassing, describing characteristics that can be found in normal, healthy brains, as well as in other diseases, according to experts including Ann McKee, lead neuropathologist for Boston University’s CTE Center. “His criteria don’t make sense to me,” McKee said. “I don’t know what he’s doing.”

McKee’s assessment was supported by three neuropathologists who worked with her to develop guidelines for diagnosing CTE used by researchers around the world.

McKee and other experts confirmed, in interviews, something that long has been an open secret in the CTE research community: Omalu’s paper on Mike Webster – the former Pittsburgh Steelers great who was the first NFL player discovered to have CTE – does not depict or describe the disease as the medical science community defines it. McKee and other experts believe Webster had CTE, based on his history of head trauma and his mental disorders. But the paper Omalu published shows images that are not CTE and could have come from the brain of a healthy 50-year-old man, they said.

“This is the problem,” McKee said. “People lump me with him, and they lump my work with him, and my work is nothing like this.” “My God, if people were actually following these [Omalu’s] criteria, the prevalence of this disease would be enormous, and there’s absolutely no evidence to support that.”

Omalu declined several requests for an interview and refused to answer any questions for this story. In an email, he dismissed questions raised by experts as coming from “a minority of doctors who are seeking very cheap and bogus popularity . . . who work directly or indirectly with these sports organizations.” “Your paper engaging in such bogus controversies will bolster some people’s allegations of ‘Fake News,’ ” Omalu wrote.

This is typically how Omalu responds to criticism: by claiming it comes from scientists corrupted by relationships with sports leagues. But his depiction of the science of CTE and his prominence in the CTE research community have yielded his own financial benefits.

Billing himself as the man who discovered CTE, Omalu has built a lucrative business as an expert witness for hire in lawsuits – including in the growing CTE-related litigation field – charging a minimum of $10,000 per case, according to his testimony. He also maintains a busy schedule of paid speaking engagements, charging $27,500 per appearance, records show, as he delivers his sermon against contact sports.

Convicted Surgeon Extradited from Israel to Serve 20 Years

A cosmetic surgeon who oversaw a long-running health care fraud scheme that conned insurance companies into paying tens of millions of dollars for unnecessary cosmetic procedures has been extradited from Israel to serve a 20-year federal prison sentence issued while he was a fugitive.

Dr. David M. Morrow, 75, a former Rancho Mirage resident, arrived late Thursday night at Los Angeles International Airport. During a court hearing, United States District Judge Josephine L. Staton ordered that Morrow immediately begin serving his prison sentence.

In September 2017, Judge Staton sentenced Morrow in absentia to 240 months in federal prison for running a scheme that duped health insurance companies into paying tens of millions of dollars for cosmetic procedures with false claims that procedures being performed were medically necessary. When the sentence was issued, Morrow had been on the run for four months after pleading guilty to conspiracy to commit mail fraud and filing a false tax return.

Morrow fled the United States along with his wife, Linda Morrow, 67, who was deported by Israel last July. Linda Morrow is facing a 31-count grand jury indictment that charges her with participating in the $50 million scheme run through The Morrow Institute (TMI) in Rancho Mirage. In a separate case, she faces contempt of court charges for fleeing the United States while free on bond in the health care fraud case. Her trial date in the contempt of court case is June 16.

Linda Morrow was the executive director of TMI, while David Morrow, a dermatologist-turned-cosmetic-surgeon, was the owner. The Morrows oversaw a scheme in which TMI submitted millions of dollars in claims for procedures that were certified as “medically necessary” – but in fact were cosmetic procedures such as “tummy tucks,” “nose jobs” and breast augmentations.

Authorities believe the Morrows fled in May 2017. Prior to becoming fugitives, they failed to report to court officials, among other things, the sale of their $9.45 million home in Beverly Hills.

Court records show that, prior to the Morrows fleeing to Israel, they transferred more than $4 million dollars to Israeli bank accounts using the names of third parties. Recently filed court documents detail how both Morrows used fraudulent Mexican passports – with their photos, but other persons’ names – to enter Israel, and after they entered Israel they applied for Israeli citizenship using those fraudulent identities.

When the Morrows were arrested in Israel last year, they were no longer using the fraudulent Mexican identities, but were living under different fake identities and were using fraudulent Guatemalan passports. When Israeli law enforcement arrested Linda Morrow, she falsely claimed that her name was “Hannah.” Court documents also show that FBI agents have determined that the Morrows used an Israeli attorney and others in Israel in an attempt to launder more than $2 million.

Arrests Made for $3.2M Sober Living Fraud

A joint effort by the Orange County District Attorney’s Office and the California Department of Insurance has shut down an alleged $3.2 million health care fraud ring which preyed on vulnerable substance abuse patients in order to bilk an insurance company out of millions.

Steven Lomonaco, 61, of Laguna Beach, Mahyar “Christian” Mohases, 37, of Santa Ana, Robert Williams, 41, of Murrieta, Nicholas Reeves, 42, of Aliso Viejo, and James Frageau, 29, of Temecula have been charged with multiple felony counts including insurance fraud and money laundering in connection with the scheme.

Mohases, Williams, Reeves, and Frageau have each been charged with two counts of committing medical insurance fraud, one count of fraudulent written claim to an insurance company, two counts of money laundering in excess of $150,000, four counts of money laundering, and one enhancement for aggravated white collar crime over $200,000. They each face a maximum sentence of 14 years if convicted on all charges.

Lomonaco has been charged with two counts of committing medical insurance fraud, one count of fraudulent written claim to an insurance company, one count of medical insurance fraud, and one enhancement for aggravated white collar crime over $200,000. He faces a maximum sentence of 8 years 4 months if convicted on all charges.

Mohases, Frageau, Williams and Reeves are accused of finding patients across the country who were seeking help for substance use recovery and flying them to California to enter treatment at Casa Bella International Inc., which was owned and operated by Lomonaco. In order to obtain payment from the insurance company for these patients, Mohases, Frageau, Williams and Reeves directed employees to fill out policies for the patients using false information.

They are accused of lying on the insurance applications, stating that patients lived in California, when in actuality the addresses were for employees or businesses related to the co-conspirators. Lomonaco paid the other co-conspirators upwards of $10,000 per patient who stayed enrolled in treatment for more than 30 days.

In order to pay the insurance premiums, the defendants are accused of developing a massive money laundering scheme in which they filtered money through non-profit, StopB4UStart, by providing “donations” from Mohases, Frageau, Williams and Reeves under their corporation, Nationwide Recovery. These “donations” would be cashed out, and the owner of StopB4UStart would receive cashier’s checks in specified amounts based on the information he received from one of the other co-conspirators. More than 800 checks in total were used to pay the insurance premiums on the fraudulent policies.

Mohases was arrested on January 13, 2020 and arraigned on January 14, 2020, he has pleaded not guilty. He is out on $250,000 bail and is scheduled for a pre-trial on February 5, 2020 in Department C-57.

Reeves was arrested on January 14, 2020 and arraigned on January 15, 2020, he has pleaded not guilty. He is out on $100,000 bail and is scheduled for a pre-trial on January 22, 2020 in Department C-55. A preliminary hearing for this suspect is scheduled for February 13, 2020 in Department C-55.

Frageau appeared in Court on warrant on January 15, 2020, he was arraigned on January 15, 2020. He is out on $250,000 bail and is scheduled for a continued arraignment on February 7, 2020.

Williams turned himself into Huntington Beach Police Department on January 15, 2020. No arraignment date has been scheduled for him yet.

Lomonaco was arrested on January 16, 2020. He is scheduled to be arraigned January 17, 2020.

7th San Diego “Pill Mill” Doctor Pleads Guilty

Egisto Salerno, a medical doctor practicing in San Diego, pleaded guilty to illegal opioid distribution, admitting that he signed bogus prescriptions for multiple deceased or incarcerated patients.

According to his plea agreement, Salerno illegally distributed 78,544 hydrocodone pills. Hydrocodone is an opioid pain medication commonly known as Norco or Vicodin. Salerno admitted that his prescriptions for the 10 mg tablets were outside the usual course of his medical practice and were without a legitimate medical purpose.

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

In a separate instance, on a date when the undercover agent did not visit the clinic and the doctor did not see him, Salerno acknowleged that a prescription was written in the name used by the undercover agent and that Salerno completed and signed a progress note in the “patient” chart for the purported visit that did not occur.

Salerno used his medical practice on El Cajon Boulevard in San Diego to carry out this criminal activity between November 2014 and February 2018, the plea agreement said.

During this period, Salerno also acknowledged that he pre-signed prescriptions and often allowed his non-physician employees to complete those prescriptions; and that, with regard to one of the multiple dead “patients,” his signature appeared on at least five prescriptions made out in the “patient’s” name that were issued and filled more than a year after the “patient” died.

Salerno is the seventh defendant to enter a guilty plea in connection with the pending case that flowed from the investigation of this “pill mill.” Each of the defendants is awaiting sentencing.

The plea agreements of the six other defendants show that paid patient “recruiters” were bringing “patients,” many of whom were homeless, to Salerno’s office to secure hydrocodone prescriptions; that, after the prescriptions were written, the “patients” were brought to pharmacies to fill the prescriptions; “patients” turned over their hydrocodone tablets to the recruiters in exchange for payment and, in some instances, recruiters picked up the tablets from the pharmacies themselves; and, in turn, those hydrocodone pills were being sold by the lead recruiter in San Diego and that such pills were also smuggled into Mexico and sold to a pharmacy there.

Salerno will be sentenced on May 11, 2020.