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Tag: 2025 News

Employers File More RICO Actions Against Plaintiff Lawyers

Plaintiff Lawyers are now calling the RICO cases filed in several states, including California, by employers against plaintiff lawfirms for filing alleged exaggerated claims a “Very Dangerous Trend.” Ostensibly, this “trend” became of interest recently when Uber Technologies, Inc. filed three racketeering lawsuits recently against lawyers and medical providers for alleged fraudulent insurance claims, with a California lawsuit against Downtown LA Law Group et al.being the third.

The the first was filed in New York in 2025 targeting a group of lawyers and medical providers in New York for allegedly exploiting Uber’s state-mandated $1 million rideshare insurance policy to file fraudulent personal injury claims. The scheme allegedly involved directing claimants to pre-selected medical providers who produced fraudulent medical records and bills to inflate settlement demands.

The second was filed in South Florida (Uber v. Law Group of South Florida et al., Case No. 25-cv-22635-CMA) and Uber accused the defendants of staging car accidents, manufacturing damages, and pursuing unnecessary medical procedures to exploit insurance policies between 2023 and 2024.

Uber Technologies filed another lawsuit in the United States District Court for the Central District of California alleging a fraudulent scheme involving personal injury claims filed against them in California. The complaint alleges that this “scheme begins when Defendants (Igor) Fradkin, Downtown LA Law Group, Emrani, and Law Offices of Jacob Emrani identify individuals with potential personal injury claims against rideshare companies such as Uber.” And goes on to allege “Both firms aggressively pursue clients to sue Uber, as shown in this online advertisement by Emrani” which appears to be screen grab of an advertisement showing Jacob Emrani next to an UBER/Lyft logo above the words “Uber or Lyft Accident?” followed by a banner that reads “Call Jacob.com.”

Uber then alleges that a “key repeat participant in this fraud is Defendant Greg Khounganian, a spinal surgeon who owns and controls GSK Spine, an orthopedics practice. Working with personal injury coordinators at Defendant Radiance Surgery Center, a surgery center which specializes in treating patients with pending personal injury lawsuits and which also does business as Sherman Oaks Surgery Center.

Following these three RICO cases, there were more to come, with Federal Express joining as a plaintiff, when Uber Technologies and Federal Express sued Philadelphia personal injury attorney Marc Simon, his firm Simon & Simon P.C., and several medical professionals — chiropractors Ethel Harvey and Daniel Piccillo of Philadelphia Spine Associates, pain management physician Clifton Burt of Premier Pain & Rehab Center, and medical examiner Lance Yarus — under the federal Racketeer Influenced and Corrupt Organizations Act (RICO). The companies alleged the defendants ran a coordinated fraud scheme spanning dozens of lawsuits filed over the past four years in Philadelphia County courts.

According to the complaint, the scheme worked like a conveyor belt. Simon & Simon would sign up clients involved in motor vehicle accidents with Uber or FedEx drivers — clients who typically suffered minimal or no injuries and often carried limited-tort insurance. The firm then directed those clients to the same small group of medical providers. Drs. Harvey and Piccillo administered extensive chiropractic treatments and ordered MRIs that came back negative or showed only mild degenerative changes unrelated to the accidents. Despite those results, the chiropractors continued treatment at the lawyers’ direction, generating voluminous records that in some cases reflected care that was allegedly never actually delivered or was documented using cut-and-paste boilerplate.

On May 11, 2026 the court denied the defendants’ motion to dismiss in its entirety in the case of Uber Technologies v. Simon & Simon P.C., Case No. 25-5365 (E.D. Pa.) (May 2026)  allowing all of Uber’s RICO claims to proceed to discovery. Every defense raised — Noerr-Pennington immunity, res judicata, the Rooker-Feldman doctrine, and challenges to the sufficiency of the RICO allegations — was rejected at this stage.

Noerr-Pennington immunity is a common defense raised in these cases. The defendants argue their conduct was protected petitioning activity under the First Amendment. The Philadelphia court acknowledged that filing and serving lawsuits is classic petitioning activity, but held the alleged pre-filing conduct — directing doctors to create false medical records and manufacture evidence — was not “incidental” to petitioning.

Even assuming the conduct could qualify as petitioning, the court found Uber plausibly invoked the sham litigation exception. Under the series-of-petitions framework from California Motor Transportation Co. v. Trucking Unlimited, 404 U.S. 508 (1972), the allegations supported an inference the lawyers filed cases without regard to merit and to extract settlement value through the litigation process itself. The abrupt dismissal of claims once discovery threatened to expose the scheme was particularly telling.

Ford Motor Company v. Knight Law Group LLP et al., 2:25-cv-04550, was filed May 21, 2025 in the Central District of California. Plaintiff alleged that attorneys with Knight Law Group, Altman Law Group, and Wirtz Law APC submitted thousands of fictitious time entries in Lemon Law cases over the past decade to extract more than $100 million in inflated legal fees. The legal hook is California’s Song-Beverly Consumer Warranty Act (the state’s Lemon Law), which is fee-shifting — prevailing consumer plaintiffs recover their attorneys’ fees from the manufacturer.

Ford’s audit allegedly identified 34 days in which a lawyer claimed more than 24 hours of work and 66 entries showing over 20 hours in a single day, including one entry for “an ostensibly heroic but physically impossible 57.5-hour workday in November 2016.” Ford also cited instances where attorneys billed for multiple full-day depositions in different locations on the same day.

On November 24, 2025 the court granted Knight’s motions to dismiss with leave to amend. The dismissal turned on the Noerr-Pennington doctrine — the First Amendment-rooted rule shielding petitioning activity from liability. The court reasoned that Ford was attempting to impose RICO liability “for conduct connected to Defendants’ fee petitions,” and that a successful RICO claim would “quite plainly” burden defendants’ ability to seek fees for their litigation activity, since seeking fees is at least “incidental to the prosecution of the suit”. This is the same doctrinal wall the Gori firm is now invoking against J-M, and the same wall that defeated parts of J-M’s earlier suit against Simmons Hanly Conroy.

Ford did not appeal; it pivoted. In an amended complaint filed January 5, 2026, Ford withdrew its RICO claims against Knight Law Group as an entity, along with Altman Law Group, Wirtz Law APC, and several attorneys and a former paralegal, and instead strengthened its case against three individual attorneys formerly associated with Knight Law — founding partner Steve B. Mikhov, managing partner Roger Kirnos, and partner Amy Morse — alleging perjury and obstruction of justice for submitting false statements to courts about how legal fee records were created.

And another case recently filed case by a California employer adds asbestos claims instead of Uber type automobile type litigation. J-M Manufacturing (the Los Angeles-based pipe maker that does business as JM Eagle) filed its federal RICO complaint against The Gori Law Firm on January 29, 2026 in the U.S. District Court for the Southern District of Illinois, asserting claims under RICO along with common-law fraud, unjust enrichment, and civil conspiracy. It’s based on information from a “whistleblower” attorney who formerly worked at the Gori firm.

J-M accuses the Gori firm of establishing a “bounty” system since at least 2018, in which “depo attorneys” who took clients’ depositions could earn up to 2% of total settlement proceeds if they successfully coached clients to testify they were exposed to J-M’s (and other companies’) products. The complaint alleges depo attorneys were trained to tell plaintiffs that even if they couldn’t recall the products, “the Gori Firm had done lots of research, and based on their research, the plaintiff was exposed to the products of the defendants recommended for inclusion by the attorney” Gori named J-M in more than 400 asbestos lawsuits since 2018, mostly in Madison and St. Clair counties in southern Illinois.

Sutter Health Resolves ERISA Class Action for $4.3M

A class action under ERISA was filed U.S. District Court for the Eastern District of California on behalf of participants and beneficiaries of the Sutter Health 403(b) Savings Plan. The claims alleged breaches of fiduciary duty in the management of the retirement plan.The case was filed in 2020 (case number 1:20-cv-01007). The class was certified by stipulation on January 26, 2024.

Specifically the Plaintiffs allege that Defendants breached their fiduciary duties of prudence and loyalty under ERISA by retaining underperforming funds with excessive fees, instead of offering less expensive, readily available prudent alternative investments. Specifically, Plaintiffs assert Defendants were imprudent in offering the Fidelity Freedom Funds target date series, the Parnassus Core Equity Fund, the Dodge & Cox Stock Fund, and the Lazard Emerging Markers Equity Fund. Plaintiffs also argue that Plan participants paid excessive recordkeeping and administrative fees and the Plan’s total plan cost was too high.

This case falls within a large wave of ERISA excessive-fee lawsuits targeting 403(b) retirement plans at nonprofit hospital systems and universities — cases that accelerated after the Supreme Court’s 2015 decision in Tibble v. Edison International 135 S.Ct. 1823 (2015) 575 U.S. 523, which clarified fiduciaries’ ongoing duty to monitor plan investments. The Uniform Prudent Investor Act confirms that “[m]anaging embraces monitoring” and that a trustee has “continuing responsibility for oversight of the suitability of the investments already made.” § 2, Comment, 7B U.L.A. 21 (1995) (internal quotation marks omitted).”

These are the standard categories of claims in the 403(b) excessive-fee litigation wave, and the Sutter Health case fits squarely within that pattern. Similar cases were filed against Dignity Health, Providence Health, Kaiser Permanente, and many other large nonprofit health systems during the same period.

A settlement was reached through mediation with an experienced neutral mediator, after the parties had sufficient information to evaluate the case’s settlement value.The fairness hearing was held April 10, 2026, and final approval was entered May 11, 2026 by Judge Lee H. Rosenthal.

The Settlement Class includes all participants and beneficiaries of the Plan at any time during the Class Period, including beneficiaries of deceased participants and Alternate Payees under QDROs. Excluded are Sutter Health itself, the Defined Contribution Oversight Committee, the Board of Directors, and their individual members and beneficiaries.

The Settlement Amount was $4,300,000. The court found this amount fair, reasonable, and adequate given the costs, risks, and delay of continued litigation. Distribution requires no claim filing for participants with active accounts; former participants without active accounts need only submit a modest claim form.

The court awarded Class Counsel attorneys’ fees of $1,433,333.33 (approximately one-third of the settlement fund), plus applicable interest and litigation expenses. Class Representatives were awarded $12,500 each as compensatory awards for costs and expenses related to their representation of the class. All amounts are payable from the settlement fund within 35 business days of the Effective Date.

Upon entry of the order, all class members fully and permanently release the Defendant Released Parties from all Released Claims, regardless of whether a class member received notice, filed a claim, objected, or received any monetary benefit.

The court retains exclusive jurisdiction over disputes related to the settlement’s performance, interpretation, or enforcement. If the Settlement Agreement is terminated, the order becomes void and the case reverts to its pre-settlement status. The Settlement Administrator has final authority over allocation decisions, and unresolved distribution questions for active account holders are referred to the Plan’s fiduciaries.

SCIF Prevails in 20 Year Long Employer Premium Audit Litigation

What began as a routine workers’ compensation insurance premium audit mushroomed into a 20-year dispute that wound through nine separate decisionmaking bodies, including two state appellate courts, two federal courts, and a bankruptcy court. At its core, the case asked a deceptively simple question: did nurse-staffing agency ReadyLink Healthcare, Inc. owe State Compensation Insurance Fund (SCIF) an additional $555,327.53 in premiums for the 2005 policy year?

ReadyLink operated by paying its nurses wages far below the California average — in many cases just above minimum wage at $6.75 per hour — while supplementing their pay with large, tax-free daily “per diem” payments. Under workers’ compensation insurance, premiums are calculated based on payroll. If per diem payments counted as payroll, ReadyLink owed more in premiums. For five consecutive policy years (2000–2004), SCIF’s auditors reviewed ReadyLink’s records, which openly disclosed the per diem program, and said nothing. Then, during the 2005 audit, a SCIF auditor — who had never seen an agency pay more than 50 percent of compensation in per diem form — demanded documentation. ReadyLink provided none. SCIF included the per diem payments in payroll and invoiced ReadyLink for $555,327.53 in additional premiums.

ReadyLink refused to pay and challenged the audit through a cascade of proceedings. An administrative law judge (ALJ) ruled against it, finding the per diem payments did not qualify for exclusion from payroll under the California Workers’ Compensation Uniform Statistical Reporting Plan (USRP), because ReadyLink had paid nurses without verifying whether they actually incurred duplicate living expenses — and, notably, 108 of its 257 nurses lived within 20 miles of their job assignments, with 11 living in the same zip code.

The Insurance Commissioner adopted the ALJ’s decision as precedential. The Los Angeles County Superior Court denied writ review. The Second District Court of Appeal affirmed in ReadyLink Healthcare, Inc. v. Jones (2012) 210 Cal.App.4th 1166. A federal class action was dismissed on abstention grounds, and the Ninth Circuit affirmed that dismissal in ReadyLink Healthcare, Inc. v. State Compensation Insurance Fund (9th Cir. 2014) 754 F.3d 754.

Still, ReadyLink did not pay. SCIF filed a breach of contract action in Riverside County Superior Court in 2015. In defending that suit, ReadyLink made a significant discovery: the prior proceedings had all assumed that the USRP governed premium calculation, but ReadyLink claimed that SCIF had filed its own “rate deviation” with the Insurance Commissioner that set a different — and ReadyLink argued more lenient — standard for excluding per diem payments from payroll.

Under the SCIF rate filing, per diem could be excluded if based on “actual or documented expenditures” of a type not normally assumed by an employee, rather than the USRP’s requirement that expenditures be “reasonable” and supported by records showing the employee worked at a location requiring additional expenses. ReadyLink argued its payments qualified because they tracked IRS federal CONUS reimbursement tables. In 2020, the Fourth District reversed an earlier judgment on the pleadings, holding in State Compensation Insurance Fund v. ReadyLink Healthcare, Inc. (2020) 50 Cal.App.5th 422 that the amount actually owed had never been fully litigated and that ReadyLink was entitled to present its defenses at trial.

When the case returned to the Riverside County Superior Court, the court navigated a thicket of pretrial motions. It denied SCIF’s motion for summary judgment, finding a triable issue on ReadyLink’s estoppel defense, but granted summary adjudication dismissing ReadyLink’s fraud and Insurance Code section 381 defenses. It sustained demurrers to ReadyLink’s amended cross-complaint on all claims except breach of contract. It then granted motions in limine and a bifurcation motion that excluded evidence about the SCIF rate filing from the jury trial, sent SCIF’s breach of contract claim and ReadyLink’s waiver defense to the jury, and reserved ReadyLink’s estoppel defense for post-verdict determination.

At trial, SCIF presented two witnesses — a 30-year premium collection specialist and an independent certified public accountant — who each confirmed that the $555,327.53 additional premium had been correctly calculated. ReadyLink did not rebut the testimony and affirmatively stipulated that the mathematical calculations were correct. The jury was instructed that it could not revisit the determination that per diem payments constituted payroll. Both opening and closing arguments by ReadyLink’s counsel framed the sole remaining question as whether SCIF had waived its right to collect the additional premium by accepting ReadyLink’s exclusion of per diem payments in the five prior policy years.

The jury answered “No” on waiver — against ReadyLink — but then awarded zero damages. After the verdict, the trial court also found against ReadyLink on its estoppel defense. SCIF moved for judgment notwithstanding the verdict (JNOV) and for a new trial. The court granted both motions and entered an amended judgment awarding SCIF $555,327.53.

The Fourth District Court of Appeal affirmed the amended judgment in favor of SCIF in the unpublished case of State Compensation Insurance Fund v. ReadyLink Healthcare, Inc., Case No. D083359 (May 2026).

1. Exclusion of the SCIF Rate Filing Evidence. ReadyLink argued the trial court committed reversible error by excluding evidence about SCIF’s rate filing and by dismissing its rate-filing-based defenses and cross-claims before trial. The court disagreed. Even accepting ReadyLink’s interpretation of the rate filing’s “documented expenditures” standard as permitting reliance on CONUS tables, the ALJ had already found — in findings affirmed through multiple prior proceedings — that ReadyLink had made no effort to ascertain the distance between nurses’ homes and their job assignments and had kept no documentation of how per diem funds were actually spent. The court concluded that “documented,” however broadly construed, cannot mean blanket, per-employee application of CONUS table amounts without any individualized record-keeping to verify eligibility. Because the factual deficiencies were the same under either standard, the exclusion of rate-filing evidence was not prejudicial.

2. The JNOV Was Proper. The court applied the well-established standard that JNOV is appropriate when no other reasonable conclusion is legally deducible from the evidence — citing In re Lances’ Estate (1932) 216 Cal. 397, 400. The analysis was straightforward: SCIF presented unrebutted expert testimony that the additional premium owed was $555,327.53; ReadyLink stipulated to the accuracy of the calculations; the jury rejected ReadyLink’s only liability defense (waiver); the trial court rejected the remaining defense (estoppel); and no other defenses remained. Under those circumstances, a jury verdict of zero damages was unsupportable. ReadyLink’s argument — that SCIF suffered no “real” harm because it could have chosen not to collect the premium or could have enforced its rights only prospectively — misunderstood contract damages law. Once a breach is established and defenses are defeated, the measure of damages is the benefit of the bargain: the full amount promised under the contract. SCIF was owed $555,327.53, and nothing in the record supported any other figure.

3. New Trial Order Was Moot. Under Code of Civil Procedure section 629, subdivision (d), a new trial order entered alongside a JNOV takes effect only if the JNOV is reversed on appeal. Because the court affirmed the JNOV, the new trial order never took effect, and ReadyLink’s challenge to it was moot.

SCIF is entitled to costs on appeal. A separate appeal concerning $907,998.38 in prejudgment interest awarded by the trial court remains pending as Case No. D086045.

WCAB Arbitrator Held to Same Procedural Standards as WCJ

Antonio Guzman worked as a rebar ironworker for Harris Rebar Northern California for approximately 25 years. The work was physically grueling by any measure — Guzman testified that his daily duties amounted to carrying and bending tons of rebar, with individual rods sometimes weighing over 100 pounds. He filed a workers’ compensation claim for continuing trauma injuries sustained over that career, alleging damage to his low, thoracic, and cervical spine, bilateral knees, shoulders, hips, wrists, a psychiatric injury, and hearing loss.

The case was tried before a workers’ compensation arbitrator (WCA). The employer’s insurer, BITCO Insurance/Old Republic General Insurance (administered by Gallagher Bassett Services), presented a report of a QME, Dr. Charles Xeller, who found injury limited to the left knee, low back, neck, and bilateral shoulders. Guzman was evaluated by his own physicians, Dr. Henri and Dr. Newton (an agreed medical evaluator in neurology), who found a broader range of industrial injuries consistent with his complaints. On the question of vocational rehabilitation and permanent disability, the defense argued that Guzman possessed transferable skills — pointing to his claimed GED, bilingual ability, and smartphone use — and that apportionment to non-industrial factors was appropriate, including a 40% apportionment of his hearing loss to age-related presbycusis.

On January 15, 2026, the arbitrator issued a Findings and Award in Guzman’s favor on virtually every disputed issue. The arbitrator found: (1) all claimed body parts, including the thoracic spine, right knee, bilateral hips, bilateral wrists, and psychiatric injury, were industrially caused; (2) permanent disability was 100%; (3) there was no valid apportionment to non-industrial factors; (4) Guzman was entitled to future medical care; (5) outstanding medical bills were the defendant’s responsibility; and (6) his attorney was entitled to a 15% fee.

The defendants Petitioned for Reconsideration. In his Report on Reconsideration, the arbitrator was plainly skeptical of the defense’s position, describing as absurd the notion that 25 years of heavy ironwork would injure only selected body parts and not others. He also dismissed the defense’s transferable-skills arguments point by point: Guzman’s claimed GED was unsupported by any certificate or documentation; his “bilingual” ability amounted to a limited capacity to understand — not speak — English; his smartphone use consisted of making calls and playing games downloaded by his daughter; and when defense counsel asked whether his job required critical thinking, Guzman answered that when you spend hours carrying rebar on your shoulders, “I don’t think you need too much thinking.” The arbitrator recommended that reconsideration be denied.

The Workers’ Compensation Appeals Board granted the defendant’s Petition for Reconsideration in the panel decision of Guzman v. Harris Rebar Northern California; BITCO Insurance/Old Republic General Insurance, -ADJ12909831; -ADJ12910091 (May 2025). However the WCAB panel expressly stated that this was not a final decision on the merits. The Board deferred issuance of a final decision pending further review of the record and applicable law.

The Board’s decision to grant reconsideration rested on procedural and record-completeness grounds, not on any disagreement with the arbitrator’s substantive findings.

The central reason for granting reconsideration was that the arbitration record forwarded to the Board was materially incomplete. Citing WCAB Rule 10914 (Cal. Code Regs., tit. 8, § 10914(c)), the Board identified five categories of required documents that were missing: minutes of the arbitration proceedings; pleadings, briefs, and responses filed by the parties; a clear identification of exhibits offered and any objections thereto; the parties’ stipulations and the issues submitted for decision; and the arbitrator’s summary of evidence with evidentiary rulings. Only the transcript of the November 18, 2025 hearing had been received.

The Board emphasized that meaningful review of an arbitrator’s decision requires an “ascertainable and adequate record,” including an orderly identification of what evidence was submitted, admitted, or excluded — relying on Lewis v. Arlie Rogers & Sons (2003) 69 Cal.Comp.Cases 490, 494, and Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc). Without such a record, the Board stated it could not evaluate whether the arbitrator’s findings were supported by substantial evidence, the governing standard under Braewood Convalescent Hospital v. Workers’ Compensation Appeals Board (Bolton) (1983) 34 Cal.3d 159, 164 [48 Cal.Comp.Cases 566], and Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Board en banc).

The Board underscored that administrative efficiency cannot come at the cost of due process, citing Fremont Indemnity Co. v. Workers’ Compensation Appeals Board (1984) 153 Cal.App.3d 965, 971 [49 Cal.Comp.Cases 288], and Ogden Entertainment Services v. Workers’ Compensation Appeals Board (Von Ritzhoff) (2014) 233 Cal.App.4th 970, 985 [80 Cal.Comp.Cases 1]. Every party seeking reconsideration is entitled to a meaningful, de novo consideration of the merits based on the evidentiary record and applicable law.

Finally, the Board noted that granting reconsideration has the effect of reopening the entire record — not just the issues raised in the petition — citing Great Western Power Co. v. Industrial Accident Commission (Savercool) (1923) 191 Cal. 724, 729 [10 I.A.C. 322]. The Board retains full authority under Labor Code section 5803 to rescind, alter, or amend any order or award for good cause at any time.

Huntington Park Doctor Resolves False Claim Act Case for $6.7M

A Huntington Park-based medical practice and its physician have agreed to pay more than $6.73 million to resolve allegations that they violated the False Claims Act by submitting false claims for medically unnecessary vascular interventional procedures on 20 Medicare beneficiaries.

The United States alleged that, from 2016 to 2024, Dr. Feliciano Serrano of Serrano Kidney & Vascular Access Center performed medically unnecessary dialysis access interventions, including angioplasty and stent procedures, on 18 patients, purportedly to treat stenosis in patients’ dialysis segments.

Dr. Serrano scheduled interventions on a routine basis, without waiting for complications to present, and he frequently repeated procedures on patients every few days or weeks despite that the procedures were not effective and did not result in any clinical benefit. One Medicare patient received approximately 42 stents in the dialysis segment between 2016 and 2023, including during a period when Dr. Serrano informed the patient he did not need dialysis.

The United States also alleged that from 2019 to 2024, Dr. Serrano performed medically unnecessary peripheral artery disease interventions, including stent and atherectomy procedures, on 17 patients, purportedly to treat stenosis in patients’ legs. Dr. Serrano performed interventions on patients who had only mild or no stenosis and who had only minor symptoms.

Although patients complained of pain only in one leg, he performed procedures on both legs and then repeated procedures on both legs every few months. Dr. Serrano told patients that if they did not receive the procedure, their legs would need to be amputated, when, in fact, there was little risk of amputation for mildly symptomatic peripheral artery disease. One Medicare patient received approximately 16 atherectomies in his legs between 2019 and 2023.

The United States alleged that across both categories of procedures, Dr. Serrano performed interventional procedures on vessels that did not qualify for treatment under accepted standards of medical practice; overstated the degree of stenosis to make the procedures appear to meet generally recognized medical standards when, in fact, they did not; falsely documented patient symptoms and conservative therapy measures in medical records to justify the procedures; and performed procedures in excess of accepted standards of medical practice.

As a result of the settlements, Dr. Serrano will pay nearly $6.51 million to the United States and nearly $229,000 to the State of California.

The civil settlement includes the resolution of claims brought by Lincoln Analytics, Inc. under the qui tam or whistleblower provisions of the False Claims Act. Under the act, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States and State of California ex rel. Lincoln Analytics, Inc. v. Dr. Feliciano Serrano, et al., Civil Action No. 23-cv-04178 (C.D. Cal.).  Lincoln Analytics, Inc. will receive approximately $976,000 as its share of the federal recovery.

The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the United States Attorney’s Office for the Central District of California, and the California Department of Justice, with assistance from the Department of Health and Human Services, Office of Inspector General.

Assistant United States Attorney Karen Y. Paik of the Civil Frauds Section and Justice Department Trial Attorney Tiffany L. Ho of the Civil Division’s Commercial Litigation Branch, Fraud Section handled this case.

The claims resolved by the settlement are allegations only and there has been no determination of liability.

Jury Convicts Bay Area Man of Insurance Fraud After 7 Day Trial

A federal jury convicted Colin Jackson of conspiracy to commit wire fraud, wire fraud, and money laundering. The jury’s verdict followed a seven-day trial before U.S. District Judge Trina L. Thompson.

The jury found that Jackson conspired with others, including a previously convicted defendant, Kirill Afanasyev, to defraud an automobile insurance company concerning the submission of a fraudulent insurance claim on an already-wrecked car in 2018.

According to court documents and the evidence presented at trial, Jackson, 39, of San Francisco, obtained an insurance policy on an undrivable car in June 2018. He made a number of misstatements in his application for that policy, including regarding his estimated annual mileage on the car.

Five months later, in November 2018, Jackson and Afanasyev worked together to submit a fraudulent claim concerning a fake accident to the insurer. Unaware it had insured a wrecked car, the defrauded automobile-insurance company approved the claim and paid Jackson about $27,000—the insurer’s estimate of the replacement value of the car, which had been titled in Jackson’s name.

The 2018 fraud followed a similar scheme in 2017, when Jackson and Afanasyev obtained a payout from the insurer of approximately $30,000 on another already-wrecked car titled in Jackson’s name.

United States Attorney Craig Missakian, FBI Acting Special Agent in Charge Matthew Cobo, and IRS Criminal Investigation (IRS-CI) Oakland Field Office Special Agent in Charge Linda Nguyen made the announcement.

Jackson is next scheduled to appear before Judge Thompson for sentencing on September 25, 2026.

With the jury’s verdict against Jackson, more than a dozen defendants have either pleaded guilty or been convicted at trial as part of an ongoing federal investigation into automobile insurance frauds and an unrelated arson conspiracy involving an overlapping defendant, Jose Badillo, who previously pleaded guilty to participating in both parts of the scheme.

Operation Hammer Down was a federal investigation into automobile-insurance frauds orchestrated by Afanasyev and Badillo, the former owner of Jose’s Towing, Auto Towing, and Specialty Towing. In total, Afanasyev, Badillo, and others submitted and conspired to submit more than 50 fraudulent insurance claims that caused in excess of $1.5 million dollars in losses to automobile insurance companies.

Operation Hammer Down also concerned arsons orchestrated by Badillo, who sought to impede his competitors’ business prospects to exact revenge against them for perceived wrongs. For his role in the arson campaign, Badillo was sentenced in February 2026 to 60 months in custody by U.S. District Judge Rita F. Lin.

Clinic Pays $750K to Resolve Illegal Use of Misbranded Implants

Salud Para La Gente, is a nonprofit network of primary care clinics serving low-income individuals and families in Santa Cruz County and Monterey County. Salud was founded in 1978 as a single free clinic offering healthcare primarily to farmworkers living and working on California’s Central Coast. Since that time, Salud has become a federally qualified health center (FQHC), and grown to five clinics and four school-based health centers providing healthcare to nearly 27,000 patients.

Among the services it provides, Salud offers contraceptive care, including etonogestrel marketed under the brand name Nexplanon, to Medicaid beneficiaries. Nexplanon is a thin rod that is inserted under the skin of a patient’s upper arm that, once implanted, works to prevent pregnancy. It is a prescription birth control for the prevention of pregnancy for up to 5 years.

Salud has agreed to pay a total of $750,000 to resolve allegations that it submitted false claims for payment to the Medicaid program in connection with its purchase and administration of misbranded contraceptive implants.

United States Attorneys Office for the Northern District of California alleged that between May 17, 2017, and Sept. 11, 2020, Salud purchased misbranded Nexplanon from an unlicensed wholesaler and administered the misbranded Nexplanon to Medicaid patients. According to the United States, Salud knowingly submitted false claims for payment to Medicaid by using incorrect National Drug Code numbers, unique drug identifiers used by the FDA for reporting and patient safety purposes, for the misbranded Nexplanon and for its administration.

“Patient safety must be at the forefront of medical decision-making,” said United States Attorney Craig H. Missakian. Using misbranded drugs jeopardizes public health and constitutes a serious False Claims Act violation. We will continue to hold violators accountable.”

It’s clearly dangerous and unethical for health care providers to administer misbranded drugs obtained from unlicensed sources to their patients,” said Special Agent in Charge Robb R. Breeden of the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG). “Working with our law enforcement partners, HHS-OIG will continue to aggressively protect the health and well-being of patients and the integrity of federal health care programs.”

Assistant U.S. Attorney Michelle Lo handled this matter. The resolution resulted from a coordinated effort between the U.S. Attorney’s Office for the Northern District of California, HHS-OIG, and FDA’s Office of Criminal Investigations.

The claims resolved by the settlement are allegations only, and there has been no determination of liability.

WCRI Reports Comp Claim Costs Grew 6 Percent Annually 2022-2025

New research from the Workers Compensation Research Institute (WCRI), based on data from 18 study states, found that total workers’ compensation claim costs grew by an average of 6 percent per year from 2022 to 2025 in the median study state.

“The increase reflects sustained growth in the last few years across all major components of a claim, including medical payments, indemnity benefits, and benefit delivery expenses,” said Sebastian Negrusa, vice president of research at WCRI. “Workers’ compensation costs were fairly flat through 2022, but in the last few years, costs began to rise again, driven by increasing wages, higher medical prices, longer disability duration, and rising costs to administer claims.”

Key findings from the studies include:

– – Medical payments per claim increased, primarily by price growth for medical services rather than changes in utilization, with high‑cost claims a key driver of growth in some states.
– – Indemnity benefits per claim continued to rise, as longer durations of temporary disability placed upward pressure on benefits; wages for injured workers continued to grow but at a slower pace in more recent years.
– – Benefit delivery expenses per claim grew steadily, reflecting increases in medical cost containment expenses and litigation expenses.
– – Cost growth was widespread across states, with most study states experiencing rising total costs per claim and increases in most cost components.

The findings are drawn from CompScope™ Benchmarks, 2026 Edition, a series of studies covering 18 states that monitor the changes in workers’ compensation claim costs and their components. The studies examine claims with more than seven days of lost time, evaluated at 12 months of experience through 2025. The study states are Arkansas, California, Delaware, Florida, Illinois, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, North Carolina, Pennsylvania, Texas, Virginia, and Wisconsin.

California specific research questions include:

– – How have California’s system performance metrics changed recently?
– – How does California’s workers’ compensation system compare with 17 other states?
– – What has been the impact of changes in the economic environment during the recovery from the pandemic on California’s workers’ compensation system?

All state studies included in this edition are available free to WCRI members and for a fee to nonmembers.

Staffing Company Arbitration Agmt. Not Applicable to Employer

Robert Toothman was hired by Apex Life Sciences, LLC, a temporary staffing agency, which placed him on assignment at Redwood Toxicology Laboratory, Inc. As a condition of that placement, Toothman signed both an Employment Agreement and a companion Arbitration Agreement with Apex. The Arbitration Agreement bound “Employee” (Toothman) and “Company” — defined as Apex and “its affiliates, subsidiaries and parent companies” — to arbitrate any dispute “arising out of or related to” Toothman’s employment with, or termination from, Company. It also waived class and representative claims.

Toothman’s Apex assignment ended in April 2018. Two days later, Redwood hired him directly — without any new arbitration agreement and without any reference to the Apex documents. Toothman worked for Redwood until June 2022. In September 2022, he filed a class action against Redwood alleging Labor Code violations covering the period of his direct employment, starting no earlier than September 26, 2018 — well after his Apex tenure had ended.

After Redwood subpoenaed Apex and obtained a copy of the Arbitration Agreement, Toothman filed an amended complaint that redefined the proposed class to exclude workers staffed by third parties while on assignment, but retained individuals like Toothman himself who had transitioned from staffed to direct employment.

Redwood moved to compel arbitration of Toothman’s individual claims and to dismiss his class claims, arguing three alternative theories: (1) it was a party to the Arbitration Agreement as an “affiliate” of Apex; (2) it could enforce the agreement as a third-party beneficiary; and (3) Toothman was equitably estopped from resisting arbitration. The Sonoma County Superior Court denied the motion in its entirety.

The First Appellate District affirmed the trial court’s denial of the motion to compel arbitration in the published case of Toothman v. Redwood Toxicology Laboratory, Inc. Case No. A171567 (May 2026). The court reviewed the matter de novo, as the material facts were undisputed.

The court first addressed who bore the burden of proof. Because Redwood was not a signatory to the Arbitration Agreement, it could not simply produce the agreement and shift the burden to Toothman to defeat it. Relying on Jones v. Jacobson (2011) 195 Cal.App.4th 1, the court held that a nonsignatory moving party must affirmatively establish its entitlement to enforce the agreement as part of its own initial burden — whether proceeding as a party, a third-party beneficiary, or under equitable estoppel.

Redwood argued it qualified as an “affiliate” of Apex and was therefore a “Company” party to the agreement. The court rejected this, applying standard California contract interpretation principles. The term “affiliates,” appearing alongside “subsidiaries and parent companies,” plainly connoted relationships of common ownership or corporate control — not arms-length commercial arrangements. The companion Employment Agreement used the separate term “Clients” to describe businesses like Redwood, and the parties never incorporated that term into the Arbitration Agreement’s definition of “Company.” Accepted dictionary definitions — including Black’s Law Dictionary (10th ed. 2014) at page 69 — confirmed that “affiliate” in a corporate context means entities related “by shareholdings or other means of control.” The court also noted the practical absurdity of Redwood’s theory: it would mean that Apex unilaterally prescribed dispute resolution procedures for its clients’ own direct-hire employees without those clients’ knowledge or consent.

Even assuming Redwood could qualify as a third-party beneficiary, the court held that Toothman’s claims still fell outside the Arbitration Agreement’s substantive scope. The agreement covered only disputes “arising out of or related to” employment with “Company” — i.e., Apex. Toothman’s claims arose entirely from his direct employment with Redwood, which began after his Apex employment ended. The court cited Vazquez v. SaniSure, Inc. (2024) 101 Cal.App.5th 139 for the principle that an arbitration agreement from one period of employment does not automatically govern disputes arising in a separate, subsequent period.

Finally, the court rejected Redwood’s argument that Toothman was equitably estopped from contesting arbitration. Equitable estoppel applies when a plaintiff’s claims are “dependent upon, or founded in and inextricably intertwined with” the underlying agreement containing the arbitration clause — as articulated in Goldman v. KPMG, LLP (2009) 173 Cal.App.4th 209. Here, Toothman’s Labor Code claims depended entirely on his employment agreement with Redwood, not on the Apex Arbitration Agreement. The court also rejected Redwood’s contention that Toothman’s amendment of the class definition was an implicit admission that his claims were intertwined with the Arbitration Agreement, finding no authority to support that proposition and noting that a plaintiff’s decision to narrow or limit claims does not constitute the kind of “artful pleading” that triggers estoppel.

Last Holdout Regeneron Signs On to Most Favored Nation Pricing

When the White House announced a Most Favored Nation (MFN) drug pricing agreement with Regeneron Pharmaceuticals on April 23rd, it wasn’t just another deal. It was the final piece of a puzzle the Trump administration had been assembling for over a year. Regeneron was the 17th — and last — of the major pharmaceutical companies targeted by the administration to sign on, completing a full sweep that few in Washington had expected to happen this quickly.

What Is “Most Favored Nation” Pricing? The concept is straightforward, even if the politics are anything but. For decades, Americans have paid dramatically more for prescription drugs than patients in other wealthy nations. The same medication sold in Germany, Japan, or Canada often carries a fraction of the U.S. price tag. The administration’s MFN policy aims to fix that by tying what American patients pay to the lowest price offered in comparable developed nations — ensuring the U.S. gets the same deal as everyone else.

President Trump signed an executive order outlining the initiative in May 2025 and launched TrumpRx.gov on February 5, 2026, a government portal where patients can access drugs at MFN-aligned prices. Since then, administration officials have been negotiating voluntary pricing agreements one company at a time.

Under the deal, Regeneron committed to several significant concessions:

– – Medicaid access at MFN prices — Every state Medicaid program will now have access to Regeneron products at MFN pricing, with the White House projecting hundreds of millions in savings for the program that serves the country’s most vulnerable patients.
– – Future drugs at MFN rates — Regeneron agreed to align pricing for all new innovative medicines it brings to market with prices set in the comparable group of developed nations — a notably forward-looking commitment.
– – Praluent on TrumpRx.gov — The company’s cholesterol-lowering drug will be available at a discounted price through the government portal.
– – A free gene therapy — Coinciding with the announcement, Regeneron received FDA approval for Otarmeni, the first gene therapy for genetic hearing loss. As part of the deal, the company agreed to make it available at no cost to eligible U.S. patients.
– – $27 billion U.S. investment — Regeneron separately announced a commitment to invest $27 billion in American research, development, and manufacturing by 2029, more than doubling its domestic biologic production capacity.

Regeneron co-founder and CEO Dr. Leonard Schleifer didn’t sound like a reluctant partner in his statement. “For too long, American patients and taxpayers have shouldered a disproportionate share of the cost of biotechnology innovation,” he said, adding that other high-income nations have not been “paying their fair share” for the breakthroughs they rely on. Schleifer has reportedly made this argument privately for over a decade — the MFN framework, in his framing, gave him a mechanism to finally act on it.

The Regeneron deal brings the total number of MFN agreements to 17, encompassing pharma giants including Pfizer, AstraZeneca, Eli Lilly, Novo Nordisk, Amgen, Bristol Myers Squibb, Gilead Sciences, Merck, Novartis, Sanofi, Johnson & Johnson, and AbbVie, among others. The White House estimates that combined U.S. pharmaceutical investment commitments under President Trump now total $448 billion over just 15 months.

The administration has also signaled it intends to expand the framework beyond the original 17, with expectations of reaching similar agreements with most manufacturers of sole-source brand-name drugs and biologics. Efforts are also underway to codify the voluntary agreements into law through Congress, which would lock in the pricing protections for the long term.

Whether the MFN model delivers lasting relief for American patients will depend on several factors still unresolved: how aggressively the agreements are enforced, whether Congress acts to make them permanent, and how drug companies manage pricing globally as they balance domestic commitments against foreign markets. Critics have also raised questions about potential impacts on pharmaceutical innovation incentives over the long run.

For now, though, one chapter has clearly closed. Every company on the administration’s list has signed on — and the last holdout brought a gene therapy giveaway and a $27 billion investment pledge along with it.