Menu Close

Tag: 2025 News

No Obligation to Give Notice of 5 Year Statute to Reopen Award

Based upon a stipulated Award of May 27, 2015 it was found that while employed on December 19, 2013 as a tower technician by Pearce Services Inc., Andres Hernandez sustained industrial injury to the left knee causing temporary disability from June 23, 2014 to July 6, 2014, permanent disability of 14%, and the need for further medical treatment.

On August 13, 2015, defendant sent applicant a notice that permanent disability payments were ending because the full amount of the stipulated Award had been paid. The notice sent contained all the information required by Administrative Rule 9812(d). (Cal. Code Regs., tit. 8, § 9812, subd. (d).)

Applicant apparently continued to be provided medical care for his injury on an industrial basis and underwent surgery on October 30, 2018. Defendant reinitiated temporary disability benefits commencing November 3, 2018. On November 14, 2018, defendant sent a notice of resumed temporary disability benefit payments pursuant to Administrative Rule 9812(b) (Cal. Code Regs., tit. 8, § 9812, subd. (b)). Defendant then determined that applicant was entitled to temporary disability benefits at a higher rate pursuant to Labor Code section 4661.5 and sent the appropriate notice on November 28, 2018 pursuant to Administrative Rule 9812(c) (Cal. Code Regs., tit. 8, § 9812, subd. (c).)

On December 17, 2018, defendant sent applicant a notice that temporary disability benefits were ending pursuant to Labor Code section 4656(c)(2) which states that, save exceptions not applicable to the current case, temporary disability indemnity is payable only within five years of the date of injury. Defendant sent applicant a notice that complied with Administrative Rule 9812(d) (Cal. Code Regs., tit. 8, § 9812, subd. (d).)

Additionally, along with the notice that temporary disability was ending, defendant sent a notice pursuant to Administrative Rule 9812(e) (Cal. Code Regs., tit. 8, § 9812, subd. (e)) that applicant’s condition was not yet permanent and stationary and that: “[I]t is too soon to tell if you will have any permanent disability from your injury. I will be checking with your doctor until your condition is permanent and stationary. At that time, your doctor will determine whether you have any permanent disability and if there will be a need for future medical care. I expect to have my information by 3/16/19. I will notify you of the status of permanent disability at that time.”

On February 19, 2019, Hernandez filed a Petition to Reopen alleging that he underwent surgery of his left knee in October of 2018 and that his condition had significantly worsened since the issuance of the stipulated Award. On December 23, 2019 the WCJ found that Hernandez’s Petition to Reopen was barred by the five-year statute of limitations contained in Labor Code section 5410.

After filing a Petition for Reconsideration, the WCAB affirmed the WCJ’s decision in the case of Hernandez v Pearce Services Inc. -ADJ9972218 (May 2025).

Applicant argues that that the statute of limitations should be tolled because he was “misled” by defendant’s claims examiner into not timely filing a petition to reopen. In other contexts, the mere furnishing of benefits without an unequivocal denial in and of itself tolls the statute of limitations.

For instance in McDaniel v. Workers’ Comp. Appeals Bd. (1990) 218 Cal.App.3d 1011 [55 Cal.Comp.Cases 72], the Court of Appeal held that when a defendant provides medical treatment benefits knowing of a potential claim for workers’ compensation benefits, the provision of treatment tolls the one-year limitation period of Labor Code section 5405(c) and triggers the five year period of Labor Code section 5410, running from the date of injury. Only after an explicit unequivocal denial of liability does the statute revert to one year from the denial.

The WCAB noted however that “while McDaniel and similar cases find that the mere furnishing of benefits tolls the one-year statute of limitations found in Labor Code section 5405 for the initial claim of benefits, these claims still remain subject to the five-year statute found in section 5410. While the liberal rules of pleading and construction of the workers’ compensation system militate in favor of tolling of the one-year statute, once five years from the date of injury has elapsed the initial interest favoring an injured worker’s right to present their case on the merits must also be balanced against the interest in finality.”

As the Supreme Court explained in Nickelsberg v. Workers’ Comp. Appeals Bd. (1991) 54 Cal.3d 288, 299 [56 Cal.Comp.Cases 476], section 5410 does ‘not express a mere concern for barring stale claims. The statute[] express[es] legislative concern for certainty and finality in the determination of compensation benefit obligations.’ “

Here, there was no legal obligation to inform applicant of the upcoming five-year statute, and, in any case, there was no evidence that the claims representative intentionally withheld this information. Defendant merely paid the legally required benefits and provided the legally required notices.”

2025 Injury Impact Report Shows Three Trends Intensify

The Travelers Companies, Inc., one of the country’s largest workers compensation insurers, just published its 2025 Injury Impact Report, which compared workers compensation data from the five years leading up to the COVID-19 pandemic with the next five years. The analysis of more than 2.6 million claims submitted during that time found that while the number of workplace injuries overall continues to decline, the costs associated with them are climbing.

Over the past decade, we’ve seen three trends intensify: increasing retirement ages, ongoing employee turnover and longer injury recovery times,” said Rich Ives, Senior Vice President of Business Insurance Claim at Travelers. “Our aim with this report is to provide employers with insights on these dynamics that are contributing to growing claim severity so they can better navigate these workforce challenges, protect their employees and keep their businesses running.”

The report found that the frequency of workplace injuries overall has declined over the past decade. Travelers examined 1.2 million workers compensation claims received during the past five years, down from 1.4 million from 2015 through 2019.

There were many shifts in the workplace over the last 10 years, including continued job churn during and after the pandemic. This created a steady stream of new employees, who are among the most vulnerable to injury.

The report found that employees in their first year on the job accounted for approximately 36% of injuries and 34% of overall claim costs during the last five years. This is an increase from the prior five years, when 34% of injuries and 32% of overall claim costs were attributed to new employees.

The U.S. Bureau of Labor Statistics projects that by 2033, approximately 24% of employees will be age 55 or older – up from 15% in 2003. Travelers has seen the volume of claims involving older employees rise in line with this shift.

During the past five years, employees aged 50 or older made up 41% of the injured employee population, and those 60 and above represented 16%. This is up from 39% and 13%, respectively, when compared with data from 2015 through 2019. This trend is significant because older employees – while typically injured less frequently than their younger counterparts – tend to require longer recovery times and have more costly claims.

From 2020 through 2024, employees missed an average of 80 workdays per injury – an increase of more than seven days when compared with the previous five-year period. Injured employees aged 60 and above were out of work due to workplace injuries for nearly 97 days, almost 17 more days than the overall average and an increase of 14 days from pre-pandemic years.

With proper precautions, many workplace injuries can be prevented. Travelers Workforce Advantage® is the company’s comprehensive approach to helping businesses manage employee safety by focusing on three key areas:

– – Onboarding and training employees to establish safe work practices.
– – Creating a culture of safety by supporting and engaging employees.
– – Managing workplace accidents and injuries through the Travelers Corridor of Care® post-injury management process.

“By examining claim data, which includes information such as injury frequency, severity and causes, we can provide guidance to employers across multiple industries to anticipate future risks and implement preventive strategies,” said Chris Hayes, Assistant Vice President of Workers Compensation and Transportation, Risk Control, at Travelers. “Taking these steps can help employees feel valued and supported, which is key to maintaining a motivated, safe and healthy workforce.”

Additional findings from the 2025 Injury Impact Report can be found at Travelers.com/InjuryImpactReport. For best practices on creating safer workspaces, visit the Workplace Safety Resources page on the company’s website.

Civil Unrest Closes LA WCAB as Political Turf War Begins

The Presiding Judge of the Los Angeles Office of the WCAB issued a notice early this week that he “just received word from our DIR safety and security detail that the WCAB Los Angeles District Office will be closed the remainder of this week due to the civil unrest that has been occurring for the last five days.” The announcement went on to say that in person hearings will proceed using the Court Call platform.

This office of the WCAB is located in the downtown Los Angeles area in close proximity to the federal buildings which are the center of attention of civil unrest related to protests over recent Immigration and Customs Enforcement (ICE) activity in the County and City of Los Angeles. ICE is a federal law enforcement agency under the U.S. Department of Homeland Security. Its primary mission is to enforce immigration laws and customs regulations in the United States.

On November 19, 2024, the Los Angeles City Council unanimously passed a sanctuary city ordinance (13-0 vote, with two council members absent) that prohibits the use of city resources, property, or personnel for federal immigration enforcement. This ordinance codifies protections for immigrants into municipal law, including barring city employees from inquiring about or sharing information on immigration status and prohibiting cooperation with federal immigration agents unless required by state law. It was signed into effect by Mayor Karen Bass and went into effect within 10 days due to an urgency clause. A revised version of the ordinance, approved on December 4, 2024, included exceptions for cases involving individuals convicted of serious felony crimes, allowing limited cooperation with federal authorities in such instances.

The County of Los Angeles has not formally declared itself a “sanctuary county” through a specific ordinance or resolution, unlike the City of Los Angeles. However, it is listed by the Department of Homeland Security (DHS) as a “sanctuary jurisdiction” due to policies that limit cooperation with federal immigration enforcement. These policies align with California’s Senate Bill 54 (SB 54), the California Values Act of 2017, which restricts local and state agencies from cooperating with Immigration and Customs Enforcement (ICE) on immigration enforcement for individuals who have committed misdemeanors.

The current Los Angeles protests, which began on June 6, 2025, have included demands for the release of ICE detainees held in downtown Los Angeles, particularly at the Metropolitan Detention Center and the Edward R. Roybal Federal Building. Hundreds of protesters have rallied outside these federal facilities, condemning the ICE raids that resulted in at least 44 arrests across the city on June 6. Demonstrators, including community organizers and families of detainees, have specifically called for the release of those detained, such as Service Employees International Union (SEIU) California President David Huerta, who was arrested during the raids. Protests have involved blocking entrances to federal buildings and clashing with law enforcement, leading to the deployment of tear gas, flash-bang grenades, and less-lethal munitions by federal agents and the Los Angeles Police Department (LAPD).

Now a political turf war has been launched after President Trump issued a Memorandum on June 7, 2025 “call[ing] into Federal service members and units of the National Guard.” Secretary of Defense Hegseth, in turn, issued a Memorandum (DOD Order) that same day to the Adjutant General of California, ordering 2,000 California National Guard members into federal service. And on June 9, 2025, Secretary Hegseth issued another Memorandum (June 9 DOD Order) ordering an additional 2,000 California National Guard members into federal service.

This federal activity was based upon presidential authority created by federal law 10 U.S.C. §12406 which provides in part that whenever “(2) there is a rebellion or danger of a rebellion against the authority of the Government of the United States; or (3) the President is unable with the regular forces to execute the laws of the United States;” …. “the President may call into Federal service members and units of the National Guard of any State in such numbers as he considers necessary to repel the invasion, suppress the rebacllion, or execute those laws. Orders for these purposes shall be issued through the governors of the States..”

In response, on June 9th Governor Newsome filed case 3:25-cv-04870 in United States District Court for the Northern District of California alleging that 10 U.S.C. §12406 does not authorize President Trump to call the National Guard into Federal service unless the “State requests or consents to federal control.” In this case the lawsuit asserts that Governor Gavin Newsom did not request or consent to the federal control of the State National Guard.

Concurrently he filed an Ex-Parte Motion for a Temporary Restraining Order against Pete Hegseth, in his official capacity as Secretary of the Department of Defense, and the United States Department of Defense from taking any of the actions described in Plaintiffs’ contemporaneously-filed Proposed Order and Order to Show Cause.

According the the Docket, responses to the request for a TRO are due by 6/11/2025, and replies are due by 6/12/2025. The Motion Hearing is set for 6/12/2025 at 1:30 PM in San Francisco, Courtroom 06, 17th Floor, and by videoconference (Zoom Webinar) before Judge Charles R. Breyer. All counsel, members of the public, and media may access the webinar information at https://www.cand.uscourts.gov/crb. Zoom guidance and setup can be found at https://www.cand.uscourts.gov/zoom/.

Long COVID Costs are 73.7% of all COVID Claim Payments

Only one out of every 21 California workers’ compensation COVID-19 claims from accident years (AY) 2020-2022 involved medical treatment beyond 90 days from the injury date, but that small number of “Long COVID” cases consumed 82.1% of the treatment payments on COVID claims and 73.7% of all COVID claim payments according to a new California Workers’ Compensation Institute (CWCI) study.

While the number of new COVID claims in California workers’ compensation has gone from a flood shortly after Governor Newsom declared a COVID-19 state of emergency in March 2020 to a trickle over the last year, the new study comes amid growing concern about a potential COVID surge after the CDC adopted new guidelines that may make it more difficult to obtain COVID-19 vaccines just as the summer travel season hits and the new NB.18.1 COVID variant has been detected in multiple locations around the U.S.

The study, based on a review of 126,397 insured and self-insured COVID-19 claims found that most were relatively inexpensive due to little to no medical intervention (only 14.6% involved medical treatment), but 4.7% – or nearly 6,000 of them – were Long COVID claims that involved long-term medical conditions that impeded or prevented the claimants from returning to their jobs and resulted in significant costs. Medical payments for the COVID-19 claims in the study sample totaled $128.4 million, with Long COVID claims accounting for $105.5 million, or 82.1%; while total payments on the COVID-19 claims, including medical treatment, indemnity costs, and expenses, were $350.6 million, with Long COVID claims consuming $258.3 million, or 73.7%.

Overall, average medical payments were 105 times higher on Long COVID cases than on shorter duration COVID claims, and average indemnity payments were 37 times higher. Long COVID claim payments were significantly higher regardless of the body part involved, though the difference was most pronounced for injuries involving the lungs, multiple body parts, and “other” body parts.

The top 10 diagnostic categories for Long COVID claims encompassed a wide range of organ systems, including respiratory (17.8%); circulatory (9.0%); nervous (8.7%); connective, soft tissue and bone disorders (5.2%); endocrine systems (4.9%); as well as mental health (4.4%), and digestive conditions (3.4%). Together the top 10 diagnostic categories associated with the Long COVID claims in the study sample accounted for 80.3% of all the diagnoses on these claims, highlighting the multisystem nature of Long COVID.

The Institute has included more details and graphics from the study in a report, Long COVID-19 Claim Characteristics and Treatment in California Workers’ Compensation. CWCI members and subscribers can log on to www.cwci.org to access the report under the Research tab on the home page, others can purchase a copy from CWCI’s online Store.

Employer’s Unconscionable Arbitration Agreement is Unenforceable

Monroe Operations, LLC, doing business as Newport Healthcare is a nationwide behavioral healthcare company which provides therapy for individuals with mental health issues. It has residential treatment facilities across the country including in California, Utah, Minnesota, Connecticut, and Washington.

Prior to starting her employment at Newport Healthcare, Karla Velarde worked as a customer service agent for Air Tahiti. However, she was laid off in March 2020 due to the COVID-19 pandemic. She was unemployed for nine months until Newport Healthcare agreed to hire her as a care coordinator.

Newport Healthcare required Velarde to attend an orientation scheduled for her first day of work. Upon arriving at Newport Healthcare’s office, Velarde was escorted to a large conference room where she waited until an HR manager arrived. The HR manager presented Velarde with “a stack of [31] documents and told [her she] was required to complete the forms before [she] could start working.” The HR manager told her, ‘“we gotta get through [these to] get you onboard. We’ll try to get through them as fast as possible.”’ Velarde “felt pressured to fill out the forms quickly, since [the HR manager] was waiting for [her] . . . .”

One of the documents was an arbitration agreement, which Velarde refused to sign because she “did not understand what it was.” Velarde told the HR manager that because she did not understand what it was, she did not feel comfortable signing it. The HR manager told her, “‘if there are ever any issues, [the arbitration agreement] will allow us to resolve them for you.”’ Velarde asked if she needed to sign the agreement in order to start working. The HR manager responded, ‘“Yes. This will help us resolve any issues without having to pay lawyers.”’ Velarde executed the agreement because she “knew that [she] had to sign it to begin working . . . .”

Newport Healthcare later terminated Velarde’s employment. Velarde filed a lawsuit alleging, among other things, discrimination, retaliation, and violation of whistleblower protections against Newport Healthcare and its director of residential services, Amanda Seymour.

Defendants filed a motion to compel arbitration which the trial court denied. The trial court ruled Newport Healthcare pressured Velarde to sign the agreement, which she did not want to do, and the agreement unlawfully prohibited Velarde from seeking judicial review of an arbitration award. On appeal, Appellants take issue with the trial court interpreting the agreement in a manner which bars judicial review of an arbitration award.

The Court of Appeal affirmed the trial court denial of the motion to compel arbitration in the published case of Velarde v. Monroe Operations, CA4/3 – G063626 – (June 2025).

Procedural unconscionability ‘addresses the circumstances of contract negotiation and formation, focusing on oppression or surprise due to unequal bargaining power.’” (Ramirez v. Charter Communications, Inc. (2024) 16 Cal.5th 478, 492.) “This element is generally established by showing the agreement is a contract of adhesion, i.e., a ‘standardized contract which, imposed and drafted by the party of superior bargaining strength, relegates to the subscribing party only the opportunity to adhere to the contract or reject it.’” (Ibid.)

Substantive unconscionability looks beyond the circumstances of contract formation and considers ‘the fairness of an agreement’s actual terms’ [citation], focusing on whether the contract will create unfair or one-sided results [citation].” (Ramirez, supra, 16 Cal.5th at p. 493.) Substantively “[u]nconscionable terms “‘impair the integrity of the bargaining process or otherwise contravene the public interest or public policy”’ or attempt to impermissibly alter fundamental legal duties. [Citation.] They may include fine-print terms, unreasonably or unexpectedly harsh terms regarding price or other central aspects of the transaction, and terms that undermine the nondrafting party’s reasonable expectations.” (OTO, L.L.C. v. Kho (2019) 8 Cal.5th 111, 130 (OTO).)

After a review of the record, the Court of Appeal noted that there “was extensive evidence of procedural unconscionability, with an adhesive contract, buried in a stack of 31 documents to be signed as quickly as possible while a human resources (HR) manager waited, before Velarde could start work that same day.

“Most problematically, in response to Velarde’s statements that she was uncomfortable signing the arbitration agreement as she did not understand it, false representations were made by Newport Healthcare’s HR manager to Velarde about the nature and terms of the agreement.”

“These representations, which specifically and directly contradicted the written terms of the agreement, rendered aspects of the agreement substantively unconscionable. These procedural and substantively unconscionable aspects, taken together, render the agreement unenforceable.”

Hospice CEO Faces $2.5M Six Count Fraud Indictment

A federal grand jury returned a six-count indictment charging Jessa Zayas, 34, of Santa Clarita, with health care fraud and aggravated identity theft for submitting millions of dollars in of fraudulent claims for hospice care to Medicare.

Hospice is a type of care and support for terminally ill patients. Medicare is a federal health insurance program that covers certain hospice expenses. Generally, a patient must be certified as being terminally ill to qualify for hospice care payments under Medicare.

According to court records, Zayas was the CEO and owner of Healing Hands Hospice and Humane Love Hospice, which are based in Van Nuys, while also working another full-time job. Zayas caused Healing Hands and Humane Love to fraudulently bill Medicare for hospice care supposedly provided to over 100 people who were not in fact terminally ill. Zayas knew these individuals were not terminally ill as was represented to Medicare, and that they therefore were ineligible for the Medicare hospice payments. The total amount of fraudulent Medicare billings caused by Zayas from June 2023 through May 2025 was at least $2,500,000.

Zayas and others obtained personal Medicare information for the supposed hospice patients by going to retirement homes in Fresno and Kern Counties. To avoid detection, they made these visits after hours when most of the retirement residences’ managers were gone for the day. Zayas and others knocked on the patients’ doors and asked them for their information so that they could enroll them in hospice. Zayas then caused the Medicare claims to be submitted with false representations about terminal illness and submitted forged doctor’s certifications when Medicare asked for supporting documentation. The Medicare payments were deposited into banks accounts that Zayas controlled.

The FBI and HHS OIG arrested Zayas and executed a search warrant at her home last week.  Among other evidence, the FBI seized $77,000 in cash that Zayas had hidden in boxes underneath her bed.

This case is the product of an investigation by the FBI and HHS OIG.  Assistant United States Attorneys Joseph Barton and Brittany Gunter are prosecuting the case.

If convicted, Zayas faces a maximum term of 10 years in prison and a $250,000 fine for the health care fraud charge.  She also faces an additional mandatory two years in prison for the aggravated identity theft charge, consecutive to any other sentence.  Any sentence, however, would be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables.  The charges are only allegations.  Zayas is presumed innocent until and unless proven guilty beyond a reasonable doubt.

SCOTUS Rejects “Reverse” Employment Discrimination Standard

Marlean Ames, a heterosexual woman employed by the Ohio Department of Youth Services, applied for a management position in 2019 but was denied in favor of a lesbian candidate. She was subsequently demoted from her program administrator role to a lower-paying secretarial position, which was then filled by a gay man.

Ames filed a lawsuit under Title VII, alleging discrimination based on her sexual orientation. The District Court granted summary judgment to the agency, citing Sixth Circuit precedent requiring majority-group plaintiffs (like heterosexuals) to show “background circumstances” indicating discrimination against the majority. The Sixth Circuit affirmed, reinforcing a circuit split on whether majority-group plaintiffs face a higher evidentiary burden under the McDonnell Douglas framework.

In the unanimous decision in Ames v Ohio Department of Youth Services – 23-1039 – (June 2025), the United State Supreme Court vacated the Sixth Circuit’s judgment and remanded the case, holding that Title VII does not impose a heightened evidentiary standard on majority-group plaintiffs. The “background circumstances” rule, which required majority-group plaintiffs to provide additional evidence suggesting that the employer discriminates against the majority, was deemed inconsistent with Title VII’s text and Supreme Court precedents.

Ohio conceded that Title VII imposes the same standard for all plaintiffs but argued the “background circumstances” rule was not a heightened burden. The Court rejected this, noting the Sixth Circuit explicitly applied a higher standard to Ames because of her heterosexual status.

The Court emphasized that Title VII prohibits discrimination against “any individual” based on protected characteristics (race, color, religion, sex, or national origin), without distinguishing between majority and minority groups. The statute’s focus is on individual protection, not group status (citing Bostock v. Clayton County 140 S.Ct. 1731 (2020) 590 U.S. 644).

Prior cases, such as Griggs v. Duke Power Co. 401 U.S. 424 (1971) and McDonald v. Santa Fe Trail Transportation Co., 427 U.S. 273 (1976) confirm that Title VII applies equally to all individuals, regardless of majority or minority status. The “background circumstances” rule violated this principle by imposing a higher burden on majority-group plaintiffs.

The Court reiterated that the McDonnell Douglas framework is a flexible, burden-shifting tool to evaluate disparate-treatment claims based on circumstantial evidence. The prima facie burden is not onerous, and the Sixth Circuit’s additional requirement for majority-group plaintiffs was an inflexible and improper deviation.

Justice Thomas agreed with the majority but wrote separately to criticize judge-made doctrines like the “background circumstances” rule and the McDonnell Douglas framework itself.

He argued that the “background circumstances” rule lacks textual basis in Title VII, distorts the statute by imposing unequal burdens, and is unworkable due to the difficulty of defining “majority” status (e.g., by race, sex, or religion) in varying contexts.

Thomas expressed skepticism about the McDonnell Douglas framework’s applicability at the summary judgment stage, noting its lack of textual grounding, incompatibility with Federal Rule of Civil Procedure 56, failure to capture all ways to prove discrimination (e.g., mixed-motive cases), and tendency to cause judicial confusion. He suggested the Court reconsider its use in a future case.

The decision eliminates a circuit split, clarifying that Title VII’s protections apply uniformly to all plaintiffs, regardless of majority or minority status, and reinforces the statute’s focus on individual discrimination. It also signals potential future scrutiny of the McDonnell Douglas framework itself.

NorCal Doctor to Pay $125K For DEA Record Keeping Violations

Philip Yen, M.D. has agreed to pay the United States $125,000 to resolve allegations that he failed to comply with federal statutory requirements related to his role as the Drug Enforcement Administration registrant at Sutter Imaging Capitol Pavilion, Acting U.S. Attorney Michele Beckwith announced today.

Dr. Yen is a radiologist employed by Sutter Medical Group. From 2018 to 2024, he was the DEA registrant at Capitol Pavilion, which is located at 2725 Capitol Avenue, next to Sutter Medical Center, in Sacramento. As the registrant, Dr. Yen was required by the Controlled Substances Act to keep detailed records related to Capitol Pavilion’s receipt and dispensing of controlled substances, to ensure that controlled substances including opioids and other addictive and dangerous drugs were maintained, recorded, and documented properly in order to prevent their diversion.

An inspection conducted in 2022 of controlled substance records at Capitol Pavilion identified multiple recordkeeping violations at the facility. Other evidence developed that Dr. Yen was not adequately trained regarding the role and responsibilities of a DEA registrant, and that Sutter staff was aware of the risk of diversion of controlled substances from Capitol Pavilion.

In addition to paying civil monetary penalties, Dr. Yen has agreed to complete comprehensive training on his obligations under the CSA as a registrant, including recordkeeping requirements and effective controls against theft and diversion.

“Healthcare facilities and their employees are entrusted to handle dangerous drugs with care,” said Acting US Attorney Beckwith. “Compliance with the CSA and its recordkeeping requirements is critical to preventing diversion and protecting the public.”

Controlled substance recordkeeping requirements are an essential line of defense against prescription drug diversion. Every dose must be accounted for to prevent misuse and save lives,” said DEA Special Agent in Charge Bob P. Beris. “The DEA will continue to pursue healthcare providers who are not in compliance with mandatory regulations.”

The investigation was conducted by the DEA Tactical Diversion Squad. Assistant U.S. Attorney Emilia P. E. Morris handled the case for the United States.

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

W.C. Exclusivity Ends Janitor’s Intentional Injury at School Case

Hector Gutierrez began working as a school janitor and maintenance worker in August 2011 at Inglewood Middle School Academy. The school operated under the control of Inner City Education Foundation (ICEF).

On February 14, 2012, at the end of the school day, Gutierrez walked to the school’s front office, where school employees had gathered and were laughing. The principal angrily approached plaintiff and, “out of nowhere,” violently kicked him in the groin, causing plaintiff to bend over in “agony.” Several employees saw the incident and laughed. Plaintiff suffered severe pain and emotional distress and has been unable to work since the injury. His last day of work due to the injury was June 29, 2012.

Later, Gutierrez filed three separate worker’s compensation claims with the Workers’ Compensation Appeals Board. Two of those claims – one with an injury date of February 14, 2022, and another filed January 12, 2023 – related to injuries he allegedly sustained from the kick to the groin. As to the January 2023 claim, Gutierrez alleged, “In retrospect beginning 3 weeks or so later after the kick applicant believes depression and other factors caused by the assault unbeknownst to him has caused him to become morbidly obese.”

On January 10, 2023, Gutierrez (in pro. per.) sued ICEF for general negligence, intentional tort, and sexual assault and battery based on injuries he allegedly sustained from the principal’s kick to his groin almost 11 years earlier. ICEF demurred on the following grounds: (1) the Worker’s Compensation Appeals Board had exclusive jurisdiction over plaintiff’s injury claims; (2) worker’s compensation was plaintiff’s exclusive remedy; and (3) plaintiff’s claims were time barred. Plaintiff did not file an opposition. On April 18, 2023, the court sustained ICEF’s demurrer with leave to amend.

Plaintiff filed his FAC on May 9, 2023. He again pleaded the same causes of action, except for “intentional tort,” and added causes of action – without the court’s permission – for negligent and intentional infliction of emotional distress, as well “malice.” ICEF demurred on the same grounds as before and argued the new causes of action were time-barred, insufficiently pleaded, or weren’t causes of action at all.

The court sustained ICEF’s demurrer without leave to amend. The court found plaintiff’s claims were barred by the statute of limitations and the FAC’s allegations were insufficient to state a cause of action. The court also noted plaintiff failed to allege sufficient facts to support an exception to worker’s compensation exclusivity.

After judgment had been entered, on September 27, 2023, plaintiff moved for reconsideration. Plaintiff accused ICEF’s attorneys of fraud and of having “bamboozled” the court into believing counsel had agreed to give plaintiff more time to respond to discovery, not to a continuance of the demurrer hearing. Plaintiff argued “[d]efendants” violated his due process rights.

The court denied plaintiff’s motion for reconsideration. Plaintiff appealed the judgment of dismissal on the grounds he was denied his federal constitutional rights to due process and of access to the courts under the Fourteenth and First Amendments, respectively.

The Court of Appeal affirmed the trial court in the unpublished case of Gutierrez v Inner City Education Foundation CA2/3 – B333337 – (June 2025)

The Court of Appeal noted it reviewed the record and found no error.

“The record shows plaintiff received adequate, effective, and meaningful access to the court. After ICEF demurred to plaintiff’s initial complaint, he had an opportunity to file his FAC. At plaintiff’s request, the court continued the hearing on ICEF’s demurrer to the FAC from July to August 2023 due to plaintiff’s medical emergency. Before ruling on ICEF’s demurrer, the court considered the written response plaintiff filed, even though he filed the response late and did not appear at the hearing. (Code Civ. Proc., § 1005, subd. (b) [opposition papers must be filed nine court days before the hearing].)8 Indeed, the court explained in detail plaintiff’s position in its ruling.”

“Nor did plaintiff demonstrate he did not receive due process under the Fourteenth Amendment.”  … “Accordingly, plaintiff has failed to meet his burden on appeal to demonstrate the court erred in sustaining ICEF’s demurrer to his FAC or that it abused its discretion in denying plaintiff leave to amend the FAC.”

SoCal Hospice Operators Arrested for $3.8M Fraud

The owner and operator of two West Covina hospices was arrested on a 14-count federal grand jury indictment alleging she filed more than $4.8 million in false and fraudulent claims to Medicare – which paid more than $3.8 million on those claims – for medically unnecessary services for people not terminally ill and for paying kickbacks to marketers to procure patients.

Normita Sierra, 71, a.k.a. “Normie,” of West Covina, is charged with nine counts of health care fraud, one count of conspiracy, and four counts of illegal remuneration for health care referrals. Also arrested was Rowena Elegado, 55, a.k.a. “Weng,” also of West Covina, who is charged with one count of conspiracy, and four counts of illegal remuneration for health care referrals.

Both defendants are expected to make their initial appearances and be arraigned in United States District Court in downtown Los Angeles.

According to the indictment, Sierra owned and operated Golden Meadows Hospice Inc., and D’Alexandria Hospice Inc., which billed Medicare for hospice services for patients who were not terminally ill during a scheme that lasted from September 2018 to October 2022.

Sierra and Elegado allegedly worked together to pay marketers to recruit patients to the hospices, knowing that most of those patients had not been referred by their primary care physicians for such services. Those kickbacks, often referred to internally using the code words “girl scout cookies,” amounted to as much as $1,300 per patient, per month that the patient stayed on hospice service.

Others involved in the scheme included Carl Bernardo, 53, of Chino, who pleaded guilty in September 2024 to one count of receiving kickbacks in connection with a federal health care program and is scheduled to be sentenced on October 23. Relyndo Salcedo, 60, of Fontana, a nurse practitioner involved in the scheme, pleaded guilty on May 22 to one count of health care fraud and is scheduled for sentencing on November 20.

Salcedo, a nurse practitioner, conducted initial assessments for the hospice and found many of the patients ineligible for hospice. But, under pressure from Sierra, who made the ultimate enrollment decisions even though she wasn’t a medical professional, and marketers such as Bernardo, Salcedo exaggerated and falsified the patients’ conditions to make them seem terminally ill. Hospice physicians then relied on Salcedo’s records to certify the patients as hospice appropriate.

Once enrolled, those patients – who were not in fact terminally ill – rarely died, and instead were often discharged at around six months at Sierra’s direction, sometimes to her home health company or the other hospice company.

During the scheme, Golden Meadows submitted at least approximately $3,870,642 in fraudulent claims, on which Medicare paid approximately $2,912,187. D’Alexandria submitted approximately $945,647 in fraudulent claims, on which Medicare paid approximately $894,199.

An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed innocent until and unless proved guilty beyond a reasonable doubt.

If convicted of the charges, Sierra would face a statutory maximum sentence of 10 years in federal prison for each health care fraud count. Sierra and Elegado would face up to five years in federal prison for the conspiracy count and up to 10 years in federal prison for each illegal kickback count.

The United States Department of Health and Human Services Office of the Inspector General and the FBI investigated this matter.

Assistant United States Attorney Kristen A. Williams of the Major Frauds Section is prosecuting this case.