Tag: 2023 News

Rose Jones was employed at the University of California, Irvine campus as the Director of Scholarship Opportunities .

On the day of the incident, at the end of her workday, she exited her office suite at UCI’s science library, walked her bike a short distance to the bike path on Outer Ring Road, mounted her bike, and began riding toward her home. After riding for about 10 seconds, Jones reached a trench, cordoned off with orange posts and caution tape. Upon noticing the obstacle, she swerved and attempted to brake but fell off her bike and sustained injuries.

She subsequently sued the University alleging premises liability and negligence, and her husband alleging loss of consortium. The parties and the trial court subsequently treated Jones’s claims as a claim for dangerous condition of public property under Government Code section 835.

The University moved for summary judgment, claiming that Jones’s injuries occurred within the course of her employment and that the workers’ compensation exclusivity rule therefore barred this action. It noted Jones was still on the University’s premises and argued her injuries were subject to the workers’ compensation scheme under the premises line rule. The University alternatively contended Jones could not recover under Government Code section 835 because she did not exercise due care at the time of the accident.

The trial court granted the University’s motion for summary judgment. It concluded the exclusivity rule barred Jones’s claim because her injuries occurred within the course of her employment as a matter of law based on the premises line rule. It further concluded that, as a matter of law, Jones did not use due care at the time of the accident.

The Court of Appeal affirmed the trial court in the unpublished case of Jones v. Regents of the University of California -G061787 (October 2023)

Under the judicially created “going and coming rule” an employee’s injury while commuting to and from work is not compensable under the workers’ compensation system absent “special or extraordinary circumstances.”

In an effort to create a sharp line of demarcation as to when the employee’s commute terminates and the course of employment commences, courts adopted the premises line rule, which provides that the employment relationship generally commences once the employee enters the employer’s premises. The same rule applies when the employee is leaving the work premises, provided he does not unnecessarily loiter thereon.

Highlighting the merits of the premises line rule, our Supreme Court explained in General Ins. Co. v. Workers’ Comp. Appeals Bd. (1976) 16 Cal.3d 595 “The ‘premises line’ has the advantage of enabling courts to ascertain the point at which employment begins-objectively and fairly.”

The Court of Appeal wrote we “conclude the worker’s compensation exclusivity rule barred appellants’ claims because Jones’s injuries occurred in the course and scope of her employment as a matter of law. Her accident occurred on UCI’s campus, undisputedly owned by the University, just after she left her workstation. Under these circumstances, the premises line rule brought Jones’s injuries within the worker’s compensation scheme. (General Ins. Co., supra, 16 Cal.3d at p. 598.)”

Henry Geoffrey Watson, a medical doctor residing in Oakland, California, was convicted by a federal jury of charges that included accepting kickbacks for patient referrals to home health agencies, health care fraud, and false statements relating to a health care matter.

The jury found that 67 year old Watson engaged in three health care kickback schemes from 2013 to 2019, using his position as a licensed medical doctor. The first scheme involved a conspiracy in which Watson agreed to refer patients to home health agency Amity Home Health Carein exchange for illegal kickback payments. The evidence at trial proved that Watson and employees of Amity and its CEO, Amanda Singh, conspired to pay Watson regular and recurring amounts, sometimes in the form of cash payments of $3,000 a month, to ensure that Watson referred Medicare patients to Amity each month.

Title 42, United States Code, Section 1320a-7b, the Anti-Kickback Statute, makes it a crime for any person to knowingly solicit, offer, or pay a kickback, bribe, or rebate for furnishing services under a Federal health care program including Medicare.

In the second scheme proved at trial, Watson accepted kickback payments from an undercover FBI agent posing as a home health agency representative seeking Watson’s agreement to refer his patients to a particular Bay Area home health agency. The evidence at trial included video recordings of Watson accepting envelopes of cash, for a total of more than $10,000, at four meetings in 2017. The jury heard evidence that Watson also suggested other doctors who he believed would be willing to accept illegal payments for referrals from the undercover agent.

The third scheme proved at trial involved a conspiracy between Watson and others to repeatedly and falsely certify individuals for Medicare-funded home health services that the individuals did not seek and did not need. The evidence at trial showed that Watson and co-conspirators arranged for Watson to briefly meet large numbers of unwitting elderly residents of Bay Area retirement homes. After these meetings, held in common areas or recreation rooms, Watson certified that each and every resident he met was homebound, meaning they had a normal inability to leave the home. In fact, according to the evidence and the jury’s verdict, Watson knew that the patients were not homebound and did not need the services he prescribed.

Watson did not conduct any tests or conduct any inquiry about whether they were homebound, according to trial evidence, but he nevertheless made fraudulent referrals to the three home health agencies. During time periods that Watson repeatedly certified that certain individuals were homebound, testimony from these individuals and their regular primary care doctors showed that the individuals were generally healthy and active, engaging in activities such as traveling internationally, shopping, walking stairs, and jogging. The evidence proved Watson falsely billed Medicare for certifying these individuals for home health and for supervising their home health care, despite the fact that the individuals did not need that care. As part of the conspiracy, Watson was paid illegal kickbacks of $100 per patient referral by a co-conspirator working for the three home health agencies.

Criminal charges against Watson were unsealed on September 5, 2019, when the United States Attorney’s Office announced charges by criminal complaint against 30 defendants in a wide-ranging, patients-for-kickback scheme. Those charges included criminal kickback charges against Amity Home Health Care, which was then the largest home health care provider in the San Francisco Bay Area, and Advent Care, a provider of hospice care. In relation to the investigation that led to the charges and conviction of Watson, other individuals and doctors were also convicted of illegal kickbacks:

– – Amity’s CEO, Ridhima Amanda Singh pled guilty to charges of conspiracy to pay kickbacks for the referrals of Medicare beneficiaries on August 5, 2022, in Court Case No. 22-CR-267 CRB.
– – Dr. Bhupinder Bhandari pled guilty to violations of the Anti-Kickback Statute on June 6, 2022, in Court Case No. 20-CR-374 JD.
– – Dr. Zheng Zhang pled guilty to violations of the Anti-Kickback Statute on April 25, 2022, in Court Case No. 22-CR-090 VC.
– – Dr. Gerald Myint pled guilty to violations of the Anti-Kickback Statute on November 18, 2020, in Court Case No. 20-CR-408 CRB.
– – Dr. Juan Posada pled guilty to violations of the Anti-Kickback Statute on January 27, 2021, in Court Case No. 20-CR-420 RS.

All those defendants have been sentenced by the judges assigned to those cases.

Watson remains released on bond pending sentencing. Watson’s sentencing hearing is scheduled for February 28, 2024, before Judge Breyer in San Francisco. Any sentence will be imposed by the court after consideration of the U.S. Sentencing Guidelines and the federal statute governing the imposition of a sentence, 18 U.S.C. § 3553.

A Bakersfield attorney pleaded no contest Monday and was sentenced to two years in jail for his part in a $12.5 million scheme to overbill insurance companies for urine tests at sober living homes in Orange County.

Between January 2008 and December 2016, defendants Pamela and Philip Ganong owned sober living homes in Orange County, Bakersfield, Los Angeles, and San Diego, through their business William Mae Company, which operated as Compass Rose Recovery. In December 2011, the Ganongs formed a medical testing lab called Ghostline Labs.

Philip William Ganong, 70, accepted a plea agreement approved by Orange County Superior Court Judge Joy Markman. He pleaded no contest to 10 felony counts of fraudulent claims for a health benefit.

Multiple charges were filed in 2017 in connection with the scheme allegedly led by Ganong and his wife and co-defendant Pamela Mae Ganong, 67, who owned sober living homes in Orange County, Bakersfield, Los Angeles and San Diego, according to the Orange County District Attorney’s Office.

Pamela Mae Ganong is awaiting trial, but her case has been assigned to a court that handles defendants who are facing questions about whether they are mentally healthy enough to assist in their defense.

Pamela Ganong’s sister, 70 year old Susan Stinson of Carlsbad, was charged with conspiracy to commit medical insurance fraud. Stinson pleaded guilty to two felony counts of fraudulent claim for a health benefit on Wednesday and sentenced to time served behind bars, which was 34 days, according to court records.

Judge Markman ordered Stinson and Ganong to pay the $12.5 million restitution.

Charges against the Ganongs’ son, William Ganong, were dismissed in 2019 after he died, according to court records. Carlos X. Montano, M.D Newport Beach pleaded guilty in 2018 to insurance fraud and was sentenced to one year in county jail. His California medical license was revoked in June 2021.

  The Ganongs formed a medical testing lab in December 2011, and prosecutors said sober living home residents were recruited to join the scheme to overbill insurance companies for urine tests, which involved listing them as employees and signing them up fraudulently for health insurance.

California State Bar records show that Philip Ganong continues to be licensed as an attorney, but does show a cautionary note that he has been charged with a felony.

Neutral time-rounding is a commonplace and efficient timekeeping method used by countless employers throughout California and across the country. For decades, employers have used rounding to efficiently manage their payroll systems and to ensure that their employees are appropriately compensated for all work performed.

When applied neutrally – i.e., when time is rounded both up and down – time rounding reduces employers’ overhead costs while providing employees with flexibility when clocking in and out. Over the long run, the compensation for each employee will average out, leaving employees with the same total compensation that they would receive under a system that rigidly recorded their time down to the minute or second.

Camp v. Home Depot is a case pending in the California Supreme Court that will decide whether employers in California are permitted to use neutral time-rounding practices to calculate employees’ work time for payroll purposes.

The case began when Delmer Camp and Adriana Correa filed a putative class action lawsuit against Home Depot, alleging that the company’s quarter-hour rounding policy violated California law. Under Home Depot’s policy, employees’ work time was rounded up or down to the nearest quarter-hour, which resulted in some employees being paid for less time than they actually worked.

The trial court granted Home Depot summary judgment, finding that its rounding policy was lawful under California law. However, the California Court of Appeal reversed, holding that the rounding policy violated California law because it resulted in employees being underpaid.

Home Depot appealed the Court of Appeal’s decision to the Supreme Court, which granted a review in February 2023 (Docket Number S277518). The case is expected to be heard in the fall of 2023.

The U.S. Chamber of Commerce coalition just filed an anamicus brief this October, urging the California Supreme Court to hold that employers are permitted to use neutral time-rounding policies to calculate time worked.

The Chamber argues that the practice of neutral time-rounding is expressly authorized by federal law and endorsed by California’s Division of Labor Standards Enforcement (“DLSE”), had been uniformly affirmed by California courts since the seminal decision in See’s Candy Shops, Inc. v. Superior Court (2012) 210 Cal.App.4th 889.

In See’s Candy, the court recognized that the Labor Code is silent as to the lawfulness of time rounding and thus looked to federal law for guidance, as have courts and administrative agencies in other states when interpreting similar provisions in those states’ labor codes.

Nonetheless the Court of Appeal in the Camp opinion clearly said it’s opinion applies “in the limited circumstance here, where the employer can capture and has captured all the minutes an employee has worked and then applies a quarter-hour rounding policy. In this regard, we also respectfully invite the California Supreme Court to review the issue of neutral time rounding by employers and to provide guidance on the propriety of time rounding by employers, especially in view of the “technological advances” that now exist which “help employers to track time more precisely.”

The case has generated significant interest from the business community, as it could have far-reaching implications for employers across the country. If the Supreme Court holds that employers in California are not permitted to use neutral time-rounding practices, it could lead to similar challenges to time-rounding policies in other states.

The Documents obtained under the Public Records Act and Prop 103 reveal what Consumer Watchdog claims are details of the secret proposal, drafted in private discussions with insurance lobbyists. to bail out the insurance industry that Commissioner Lara and insurers unsuccessfully tried to jam through the Legislature during the final days of session. The language previews the plan that Lara announced a week later, under which he will issue new anti-consumer regulations that track the failed legislative proposal.

The documents reveal what Consumer Watchdog claims are two massive loopholes that make the deal Lara cut to deregulate the price of fire insurance in California, in return for a “commitment” from insurers to expand home insurance coverage in wildfire areas to 85% of their market share outside risky areas, a fraud.

– – Insurers would be allowed to meet their commitment by offering bare bones policies – the type of policy homeowners already have access to under the FAIR Plan.
– – The commissioner could waive the “85% commitment” to sell more home insurance in wildfire areas for any insurer that claims it cannot meet its commitment.

The records obtained are emails and bill language circulated by the commissioner’s chief deputy to the insurance industry’s top lobbyists and legislative staff in late August.

“These documents prove Commissioner Lara’s deal with the insurance industry is an outrageous fraud on the public that will make Californians pay vastly more for insurance but not get more people insured. Lara tried to jam the deal through the legislature, and when that failed repackaged it as a regulatory plan. He must explain to the public how he can support an agreement that eviscerates insurance oversight in California without getting a single new homeowner insurance,” said Harvey Rosenfield, author of insurance reform Proposition 103 and founder of Consumer Watchdog.

The documents also confirm that the proposal circulating in Sacramento in late-August and early-September would have forced homeowners and business owners to bail out insurers for billions in FAIR Plan liabilities.

The organization said that the only purported consumer benefit of Lara’s legislative and regulatory plans is a “commitment” by insurers to expand home insurance coverage in wildfire areas to 85% of their market share in the rest of the market. The actual language of the August bill proves that promise is false and will not expand insurance to homeowners struggling to find coverage.

Consumer Watchdog also claims the deal also illegally guts the consumer protections of Prop 103 that have saved Californians hundreds of billions of dollars, including the right of the public to independently scrutinize and challenge rate increases that are unjustified, another target of Lara’s September announcement.

They say the documents also confirmed that the legislation would have bailed out insurers for their FAIR Plan obligations, a proposal that was not part of Commissioner Lara’s September announcement presumably because the change must be done by legislation, not regulation.

A story published by MSN reports that the commissioner’s office in turn accused Consumer Watchdog of seeking to protect a regulatory system its founder crafted from which it has been paid nearly $9 million as an “intervenor” reviewing insurance rates that remain below market and have left many homeowners unable to obtain coverage.

“Consumer Watchdog’s latest cynical claims hide the truth that the group has earned millions of dollars signing off on rate increases – while denying the reality that insurance has become impossible for some Californians to find at any price,” Deputy Insurance Commissioner Michael Soller said in a statement.