Tag: 2021 News

A former Orange County chiropractor was found guilty by a jury of federal criminal charges accusing her of defrauding health insurers by submitting $2.2 million in charges for chiropractic services never provided, bogus medical diagnoses, office visits that never occurred, and medical devices falsely prescribed.

56 year old Susan H. Poon, who lives in Dana Point, was found guilty of five counts of health care fraud, three counts of making false statements relating to health care matters, and one count of aggravated identity theft in the first criminal jury trial to occur in the Central District of California since March 2020.

According to the evidence presented at her five-day trial, from January 2015 to April 2018, Poon, whose office was located in Rancho Santa Margarita, schemed to defraud Anthem and Aetna by submitting false reimbursement claims for services that never occurred, false diagnoses and chiropractic services that were never performed.

Poon also submitted fraudulent prescriptions containing fabricated medical diagnoses of individuals that she had never met, including children, causing a medical device manufacturer to submit false claims for reimbursement to Blue Shield of California.

The patient-victims that Poon claimed to have met with and treated were dependents – such as the spouses and children – of Costco Wholesale Corp. and United Parcel Service Inc. employees, dependents whose personal identification information Poon unlawfully took and used in her reimbursement requests and prescriptions. Poon obtained the personal information of employee-dependents by attending health fairs at various UPS warehouses and Costco locations, and soliciting such information from employees.

In total, Poon billed approximately $2.2 million through her scheme.

Poon’s chiropractic license was revoked in July 2019, according to the California Department of Consumer Affairs.

An August 30 sentencing hearing has been scheduled, and Poon will face a statutory maximum sentence of 67 years in federal prison.

The following agencies investigated this matter: Amtrak – Office of the Inspector General, California Department of Insurance, U.S. Department of Labor – Employee Benefits Security Administration, U.S. Department of Labor – Office of the Inspector General, the FBI, and Office of Personnel Management – Office of the Inspector General.

Maureen Ford suffered injuries while employed by Communication Action Board of Santa Cruz.

On April 22, 2014, the parties filed joint Stipulations with Request for Award, for injury to “upper extremity” and “hand” on 8/19/11 (ADJ8177678) and for cumulative injury ending 9/26/11, to “upper extremity,” “hand,” “neck” and “back” (ADJ8177385), while employed as a landscape worker by Community Action Board, insured by State Compensation Insurance Fund.

Applicant reported psychological symptoms to her doctors prior to entering into the 2014 Stipulations with Request for Award. Neither physician expressed an opinion on causation of the psychological symptoms or whether they caused disability.

On 9/10/15, applicant filed a Petition to Reopen in both cases, alleging a change of condition, increase in PD, need for further medical treatment and different vocational factors. On 10/2/17, an Amended Application for Adjudication was filed in ADJ8177385, adding “psyche” as an additional injured body part. The cases went to trial on the issues of injury to the psyche, good cause to reopen per applicant’s 9/13/15 Petition.

A 2018 report concluded, for the first time, that applicant met the requirements of Labor Code Sec. 3208.3, because she had a mental disorder per the DSM that was predominantly caused by the industrial injury in August of 2011.

The WCJ found psychiatric injury and good cause to reopen. The employer’s Petition for Reconsideration was denied in the panel decision of Maureen Ford v Communication Action Board of Santa Cruz, ADJ8177678-ADJ8177385.

The sole issue raised by defendant on reconsideration is that the WCJ erred in finding good cause to reopen the Award in Case No. ADJ8177385 for new and further psychiatric injury and disability where there was evidence of psychiatric injury at the time of the original Findings and Award. Defendant argues that, because the medical record documents that applicant expressed psychiatric symptoms prior to the April 22, 2014 Findings and Award, the psychiatric injury and disability found by the WCJ now is not “new and further.”

In this case, there are only brief mentions of psychiatric symptoms in the medical record. There is no evidence of any psychiatric condition causing either disability or a need for treatment nor is there evidence of a formal diagnosis. Therefore, there is no substantial medical evidence establishing industrial causation for the psychiatric injury pursuant to section 3208.3(a).

The Board concluded that a psychiatric injury does not fall within the ambit of the workers’ compensation system until it causes either disability or a need for medical treatment and it is diagnosed using the terminology and criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.

In this case, the decision was said to be consistent the the outcomes in a number of Appeals Board panel decisions.

On June 3rd, the Occupational Safety and Health Standards Board readopted Cal/OSHA’s revised COVID-19 prevention emergency temporary standards.

Last year, the Board adopted health and safety standards to protect workers from COVID-19. The standards did not consider vaccinations and required testing, quarantining, masking and more to protect workers from COVID-19.

The changes adopted by the Board phase out physical distancing and make other adjustments to better align with the state’s June 15 goal to retire the Blueprint. Without these changes, the original standards, would be in place until at least October 2. These restrictions are no longer required given today’s record low case rates and the fact that we’ve administered 37 million vaccines. The revised emergency standards are expected to go into effect no later than June 15 if approved by the Office of Administrative Law in the next 10 calendar days. Some provisions go into effect starting on July 31, 2021.

The revised standards are the first update to Cal/OSHA’s temporary COVID-19 prevention requirements adopted in November 2020.

The Board may further refine the regulations in the coming weeks to take into account changes in circumstances, especially as related to the availability of vaccines and low case rates across the state.

The standards apply to most workers in California not covered by Cal/OSHA’s Aerosol Transmissible Diseases standard. Notable revisions include:

– – Face Coverings: Fully vaccinated workers without COVID-19 symptoms do not need to wear face coverings in a room where everyone else is fully vaccinated and not showing symptoms. Fully vaccinated and unvaccinated workers without symptoms do not need to wear face coverings outdoors except when working at “outdoor mega events” with over 10,000 attendees, which may include events or theme parks. Indoors, all workers – regardless of vaccination status – will continue to be required to wear a face covering.
– – Physical Distancing: When the revised standards take effect, employers can eliminate physical distancing and partitions/barriers for employees working indoors and at outdoor mega events if they provide respirators, such as N95s, to unvaccinated employees for voluntary use. After July 31, physical distancing and barriers are no longer required (except during outbreaks), but employers must provide all unvaccinated employees with N95s for voluntary use. – – Prevention Program: Employers are still required to maintain a written COVID-19 Prevention Program but there are some key changes to requirements:
– – – – Employers must review the California Department of Public Health’s Interim guidance for Ventilation, Filtration, and Air Quality in Indoor Environments.
– – – – COVID-19 prevention training must now include information on how the vaccine is effective at preventing COVID-19 and protecting against both transmission and serious illness or death.
– – Exclusion from the Workplace: Fully vaccinated workers who do not have COVID-19 symptoms no longer need to be excluded from the workplace after a close contact. – – Special Protections for Housing and Transportation: Special COVID-19 prevention measures that apply to employer-provided housing and transportation no longer apply if all occupants are fully vaccinated.

The Standards Board will file the readoption rulemaking package with the Office of Administrative Law, which has 10 calendar days to review and approve the temporary workplace safety standards enforced by Cal/OSHA. Once approved and published, the full text of the revised emergency standards will appear in the Title 8 sections 3205 (COVID-19 Prevention), 3205.1 (Multiple COVID-19 Infections and COVID-19 Outbreaks), 3205.2 (Major COVID-19 Outbreaks) 3205.3 (COVID-19 Prevention in Employer-Provided Housing) and 3205.4 (COVID-19 Prevention in Employer-Provided Transportation) of the California Code of Regulations. Pursuant to the state’s emergency rulemaking process, this is the first of two opportunities to readopt the temporary standards after the initial effective period.

The Standards Board also convened a representative subcommittee to work with Cal/OSHA on a proposal for further updates to the standard, as part of the emergency rulemaking process. It is anticipated this newest proposal, once developed, will be heard at an upcoming Board meeting. The subcommittee will provide regular updates at the Standards Board monthly meetings.

A California Department of Insurance investigation has led to the issuance and filing of indictments against seven defendants by the Kern County Grand Jury. The indictments were issued after the defendants allegedly stole over $330,000 in benefits meant to help injured workers re-enter the workforce.

The defendants were employees and owners of a Bakersfield vocational school, Instituto Hispano Americano (IHA), as well as employees of two local law offices.

They allegedly misused Supplemental Job Displacement Benefit Vouchers, which provide injured workers with up to $6,000 for retraining at a post-secondary educational institution. The training helps the injured worker become more competitive in the job market when they are unable to return to their former employer due to being on total or temporary disability.

The Department’s investigation found the defendants conspired to defraud over 20 insurance companies out of more than $330,000. The defendants systematically sent false or misleading documentation to insurance carriers to prove the injured workers were eligible to obtain voucher money, but the students did not actually meet the minimum qualifications for the program. The defendants allegedly lied about dozens of test results for exams that were required for enrollment.

The investigation also found that injured workers were illegally directed to the school by employees of local law offices, who would be paid as much as $600 for each student they referred to the school.

“Like many types of programs that benefit the public at large, workers’ compensation laws can only help the people who need it most if they are protected from fraud and other schemes designed to misappropriate funds,” said Kern County District Attorney Cynthia Zimmer. “When evidence of abuse of the workers’ compensation system is identified, it will be investigated and prosecuted to hold wrongdoers accountable and ensure that benefits remain available for those genuinely qualified to receive them.”

Eighty-five charges have been filed against each defendant including conspiracy to commit insurance fraud, concealing facts affecting entitlement to insurance benefits, and offering or receiving money in exchange for referrals.

All seven defendants have been arraigned and are currently awaiting trial in the Kern County Superior Court. The defendants are Anna Ayala-Reyes, Sylvia Carrillo, Evelyn Cruz, Martin Cruz, Nelfido Rolando Cruz, Cynthia Ozaeta, and Sandra Paredez.

The Kern County District Attorney’s Office is prosecuting this case.

The Labor Commissioner’s Office has cited La Mina De Oro, Inc., and six other businesses $1,393,909 for wage theft violations affecting 107 workers. The Norco-based businesses operated a designer fragrance distribution warehouse and numerous retail stores in Riverside and San Bernardino Counties, with locations in the Los Angeles area and Orange County.

The following businesses and individuals are named in the wage theft citations:

– – La Mina De Oro, Inc., a California Corporation
– – KD Nutley Properties, LLC, a California Limited Liability Company
– – CGC Trading Inc., a California Corporation
– – KD Distributors, Inc., a California Corporation
– – Desire Fragrances Inc., a California Corporation
– – Designer Fragrance Warehouse, a California Corporation
– – Desiree Canlas Nutley, an Individual.

The Labor Commissioner’s Office opened an investigation into the retailer’s operation in June 2018 based on a referral from the Warehouse Worker Resource Center (WWRC), a nonprofit worker-rights community based organization in Ontario. The investigation showed that workers at the retailer’s stores were working off the clock before and after their shifts to receive merchandise from the retailer’s distribution warehouse. They were also forced to work through their meal and rest break periods, particularly during peak holiday seasons.

The citations issued included $126,274 in minimum wages, $102,622 in overtime wages, $188,596 in meal period premiums, $116,113 in rest period premiums, $185,831 in waiting time penalties, $24,563 in contract wages, $160,442 in liquidated damages, and $204,350 in damages to workers. The citations also include $162,750 in penalties payable to the state, $88,200 in civil penalties and $34,168 in interest.

When workers are paid less than minimum wage, they are entitled to liquidated damages that equal the amount of underpaid minimum wages plus interest. Waiting time penalties are imposed when the employer intentionally fails to pay all wages due to the employee at the time of separation. This penalty is calculated by taking the employee’s daily rate of pay and multiplying it by the number of days the employee was not paid, up to a maximum of 30 days.

Enforcement investigations typically include a payroll audit of the previous three years to determine minimum wage, overtime and other labor law violations, and to calculate payments owed and penalties due. Civil penalties collected are transferred to the State’s General Fund as required by law.

According to it’s website, Warehouse Worker Resource Center is a nonprofit, 501(c)(3), organization founded in 2011, dedicated to improving working conditions in the warehouse industry in Southern California. It focuses on education, advocacy and action to change poor working conditions in the largest hub of warehousing in the country.

It assists workers dealing with issues of health and safety, wage theft and workers’ compensation when injured. It also serves as a community center for workers, family members and supporters interested in knowing their rights, joining with other workers to share experiences and learn from each other, and building a movement for workers’ rights in the Inland Empire and throughout Southern California.

“Workers in the warehouse industry who experience wage theft should report it to the Labor Commissioner’s Office,” added García-Brower. “My office will work to hold the employer accountable, ensure workers get their owed wages, and prevent law-abiding employers from being undercut.”