Menu Close

Tag: 2025 News

SoCal Healthcare Clinic Operator Sentenced for $20M Fraud

A Southern California healthcare clinic operator, Oscar B. Abrons III, has been sentenced for his involvement in a prescription medication diversion scheme that defrauded Medi-Cal, the state’s Medicaid program, of more than $20 million.

Abrons was sentenced by the Orange County Superior Court to four years in jail and stipulated that the loss to the Medi-Cal program exceeded $20 million. A restitution hearing will be held to determine the loss amount owed by Abrons.

Abron’s co-conspirators, Steven Derrick Fleming and Mohamed Waddah El-Nachef, were previously sentenced. Fleming was sentenced to five years in state prison, and El-Nachef was sentenced to a five-year local custody sentence and surrendered his medical license. As part of his sentence, El-Nachef also paid $2.3 million in restitution. At the time of his arrest in 2020 El-Nachef had stipulated to disciplinary charges filed in 2019 with the California Board of Medicine and had been placed on seven years probation. El-Nachef was also suspended from participating in the workers’ compensation system as a physician, practitioner, or provider on February 23, 2023 by an order of the Administrative Director of the DWC.

El-Nachef was charged in March 2020 with a half-dozen felony counts, including executing a scheme to defraud Medi-Cal, making a fraudulent claim for a health benefit, filing a fraudulent insurance benefit claim, conspiring in the unauthorized practice of medicine and grand theft, with sentencing enhancement allegations for aggravated white- collar crime between $100,000 to $500,000 and aggravated white-collar crime exceeding $500,000.

Fleming and Abrons jointly operated God’s Property, an unlicensed clinic where Medi-Cal beneficiaries were paid cash in exchange for obtaining medically unnecessary prescriptions for HIV medications, antipsychotics and controlled substances, which were then sold to buyers on the illicit market.

Fleming and Abrons, alongside Mohamed Waddah El-Nachef, an Orange County medical doctor, carried out the diversion scheme from June 23, 2014, to October 1, 2016. During this time, El-Nachef became the top prescriber of HIV medications in the state. As a result of the scheme, Medi-Cal suffered an estimated loss of over $20 million.

The prosecution of these individuals was carried out by the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse (DMFEA). DMFEA works to protect Californians by investigating and prosecuting those responsible for abuse, neglect, and fraud committed against elderly and dependent adults in the state, and those who perpetrate fraud on the Medi-Cal program.

The Division of Medi-Cal Fraud and Elder Abuse receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $69,244,976 for Federal fiscal year (FY) 2025. The remaining 25 percent is funded by the State of California. FY 2025 is from October 1, 2024, through September 30, 2025.  

CWCI Finds Independent Medical Reviews Are Trending Up

After declining steadily from 2018 through 2022, the number of Independent Medical Review (IMR) decision letters issued in response to California workers’ comp medical disputes is now trending up, increasing in 2023, 2024, and the first quarter of 2025 according to the California Workers’ Compensation Institute (CWCI), though the uphold rate for medical service modifications and denials remains close to 90%.

CWCI’s latest review of IMR activity and outcomes examined 1.57 million IMR decision letters issued from 2015 through March of this year in response to applications submitted to the state after a Utilization Review (UR) physician modified or denied a workers’ comp medical service request. As in prior reviews, CWCI tracked the number of letters issued each quarter; determined the distribution and uphold rates for disputed treatment requests by type of medical service (and the distribution and outcomes of pharmaceutical IMRs by major drug group); measured IMR response times; and calculated the percentage of IMRs associated with high-volume physicians.

IMR, introduced in 2013, was expected to reduce medical disputes by helping to ensure that workers’ comp treatment met evidence-based medicine standards, but it was not until 2019 that the number of IMR disputes began a steady decline, with the number of IMR decision letters falling by 31% from the peak level of 184,385 in 2018 to 127,215 in 2022. That decline coincided with a reduction in the number of job injury claims during the pandemic and a drop in the number of pharmaceutical disputes after the state added Pain Management and Opioid Guidelines to its Medical Treatment Utilization Schedule (MTUS) in late 2017 and adopted the MTUS Drug Formulary in January 2018. More recent data, however, show IMR letter volume rose 2.9% in 2023 and 8.2% in 2024, and initial results for this year show the trend accelerating, with 38,393 IMR decision letters in the first 3 months of 2025, 13% more than in the same period last year.

Even with the increase in IMR volume, the median IMR response time (from receipt of the application to the date of the decision letter) was 32 days in 2024, the same as in 2022. Furthermore, 25% of the letters were issued within 28 days, and 75% were issued within 38 days, all within the time allotted to the state’s Independent Medical Review Organization to confirm the eligibility of the application; request, receive, and process medical records; assign the case to a physician reviewer; and issue a decision.  

Disputes over prescription drug requests represented 30.6% of all IMRs in the first quarter of this year – more than any other type of medical service, but down from 33.4% in 2024 and 50.7% in 2015. Much of that decline was due to the reduction in IMRs involving opioid requests, which dropped from 32% of all pharmaceutical IMRs in 2018 to 18.6% in the first quarter of this year. With prescription drugs representing a declining share of the IMR disputes, the percentage of IMRs involving disputes over other medical services has increased, with physical therapy disputes accounting for 13.6% of IMRs in the first quarter of 2025, injection disputes accounting for 12.9%, and disputes over durable medical equipment, prosthetics, orthotics and supplies accounting for 9.7%.

A small number of physicians continue to drive much of the IMR activity, as the top 1% of requesting physicians (81 doctors) accounted for 42.2% of the disputed service requests that underwent IMR in the 12 months ending on March 30 of this year, and the top 10 individual physicians accounted for 10.9% of the disputed requests. CWCI found that 7 of the providers on the latest top 10 list were also on the top 10 list the prior year.

IMR outcomes remain stable, as IMR physicians upheld 89.1% of UR doctors’ treatment modifications or denials in the first quarter of 2025 compared to 88.0% in 2024. As in the past, uphold rates varied by type of service, ranging from 77.4% for evaluation/management services to 92.9% for acupuncture.

CWCI members and subscribers will find a more detailed summary of IMR experience through March 2025 in Bulletin 25-09 at www.cwci.org. Institute members can also access updated IMR slides under the Research tab.

Class Action Against Employer Can be Decertified at Any Time

Plaintiff Joanne Allison, a former registered nurse (RN), brought the underlying class action against her former employer, Dignity Health, alleging claims for unpaid work, meal period and rest break violations, as well as derivative claims.

Allison filed a motion for class certification on behalf of RNs who worked at three Dignity’s hospitals – St. John’s Regional Medical Center in Oxnard, CA, St. John’s Pleasant Valley Hospital in Camarillo, CA and Mercy General Hospital in Sacramento – since June 1, 2014. She also sought certification of subclasses for certain claims, including meal period violations and rest break violations.

Allison asserted that a “facial review of RN timecards” showed most RNs experienced meal periods that failed to comply with law. Her expert identified all work shifts eligible for one or more meal periods and then “identified each instance where the time records reflected a Sample Class Member’s meal period was either missed, late, or short/interrupted.” After “accounting for premiums paid” based on Dignity’s payroll data, the expert opined that over 70 percent of relevant shifts had a non-compliant meal period with an unpaid premium.

Allison averred that this evidence established a rebuttable presumption of class-wide liability under the Supreme Court case of Donohue v. AMN Services, LLC (2021) 11 Cal.5th 58 (Donohue). Moreover, because Dignity admitted it did not record the reason for any given non-compliant meal period – instead it required class members to self-report and to apply for a premium payment – Allison contended the lawfulness of placing the burden on employees to keep meal break records was a common question.

Allison based her noncompliant rest break claim (and, to some extent, her meal period claim) on purported interruptions from work-issued communication devices – i.e., Vocera devices and Spectralink devices. She asserted “Dignity’s policy required RNs to wear these devices at all times . . . even during breaks,” giving rise to a common question whether this resulted in unlawful off-the-clock interruptions. As common proof to establish Dignity’s class-wide liability under this theory, Allison’s expert opined that a “comparison of Vocera log ins with RN timecards show[ed] nearly 70% of employees in the Vocera sample were using the device while clocked-out in [Dignity’s] timekeeping program.”

In opposing certification, Dignity argued individual inquiries predominated the meal period claim despite Allison’s use of Dignity’s time- clock records as class-wide proof.

The trial court granted in part and denied in part Allison’s motion for class certification during a class period of June 1, 2014 to January 13, 2022. The court explained that Dignity’s showing that RNs “sometimes were able to take uninterrupted breaks” was insufficient to defeat the predominance of common issues.

Nineteen months after the initial certification order, Dignity moved to decertify the class on grounds that post-certification discovery refuted the trial court’s prior predominance findings. In opposition to the motion, plaintiffs argued Dignity failed to satisfy its threshold burden to show “new law or new evidence showing changed circumstances” since the certification order. Plaintiffs also countered that the post-certification evidence further demonstrated the propriety of class treatment.

Following a hearing, the trial court granted the decertification motion. As a threshold matter, the trial court ruled the “large number of new declarations” as well as “plaintiffs’ efforts at a statistical analysis” constituted new evidence. And, in light of such new evidence, it determined “there [was] no good reason to ignore other evidence,” and therefore it considered the entire record. The court determined that “ ‘commonality’ ” was not the central issue; rather, “[t]he problem is the ‘predominance’ issue, as individual issues swamp the common issues.” The trial court also expressed concern that plaintiffs’ trial plan betrayed fatal flaws to continued class status.

The Court of Appeal affirmed in the published case of Allison v. Dignity Health CA1/4 – A169225 (June 2025)

Class actions are permitted “when the question is one of a common or general interest, of many persons, . . . and it is impracticable to bring them all before the court . . . .” (Code Civ. Proc., § 382.) Our Supreme Court has articulated that to proceed as a class action there must be “the existence of an ascertainable and sufficiently numerous class, a well-defined community of interest, and substantial benefits from certification that render proceeding as a class superior to the alternatives.” (Brinker Restaurant Corp. v. Superior Court (2012) 53 Cal.4th 1004,1021.) “ ‘In turn, the “community of interest requirement embodies three factors: (1) predominant common questions of law or fact; (2) class representatives with claims or defenses typical of the class; and (3) class representatives who can adequately represent the class.” ’ ” (Ibid.)

A class “can be decertified at any time, even during trial, should it later appear individual issues dominate the case,” (Macmanus v. A. E. Realty Partners (1987) 195 Cal.App.3d 1106, 1117), decertification is appropriate “ ‘only where it is clear there exist changed circumstances making continued class action treatment improper.’ ” (Green v. Obledo (1981) 29 Cal.3d 126, 148.)

Our Supreme Court’s decisions “clearly contemplate the possibility of successive motions concerning certification” based on evidence uncovered in post-certification discovery. (Occidental Land, Inc. v. Superior Court (1976) 18 Cal.3d 355, 360 (Occidental).)

Here, the trial court expressly found there was new evidence, referencing ‘a large number of new declarations,’ plus ‘plaintiffs’ efforts at a statistical analysis.’ Indeed, following certification, Dignity deposed 44 class members from the three hospitals at issue.

WCRI Study Explores Promises and Challenges of AI for WorkComp

A new study from the Workers Compensation Research Institute (WCRI) examines how stakeholders view the promises and challenges of artificial intelligence (AI) in the workers’ compensation system.

In recent years, interest in the role of artificial intelligence in workers’ compensation has grown rapidly,” said Sebastian Negrusa, vice president of research at WCRI. “This study is an important step toward understanding how stakeholders are approaching the opportunities and risks associated with these emerging technologies.”

To develop the study, WCRI researchers conducted semi-structured interviews with 34 leaders across 20 organizations – including employers, insurers, medical providers, worker advocates, and regulators – supplemented by informal discussions. They also reviewed literature and regulations on AI developments and applications.

The key questions asked in the interviews included:

– – How do you define AI and its role in the economy and the workers’ compensation system?
– – Where do you see the value of AI tools for your job, your organization, and the system?
– – What challenges and risks do you foresee with broader AI adoption, and how can these be mitigated?

By outlining current and emerging uses of AI in workers’ compensation and identifying risks and potential guardrails, the study, Artificial Intelligence in Workers’ Compensation: An Overview of Promises and Challenges, aims to provide a common language for stakeholders and inform policy discussions to promote responsible AI use that improves injured workers’ recovery and experience.

The authors of the study are Bogdan Savych and Vennela Thumula.

Case Dismissal Affirmed for PI Attorney Misconduct During Trial

This is a personal injury case. Jerry Cradduck sued defendant Hilton Domestic Operating Company, Inc. (Hilton) for negligence arising out of his use of a spa at an Embassy Suites property in Palm Desert in 2019. Liberty Mutual Insurance Company (Liberty) intervened in the case as a defendant because of its potential liability as an insurer. Plaintiff Cradduck was represented in this case. The hotel was independently owned by defendant EHT ESPD, LLC (EHT) under a franchise agreement with a Hilton subsidiary.

His attorney in this case was attorney Todd Samuels. On his website Samuels states that he is “a seasoned litigator practicing in state and federal courts throughout California. He has successfully tried, arbitrated, and mediated hundreds of cases.” And that he “represents individuals in personal injury lawsuits that have been injured by the careless and negligent conduct of others.” The Samuels Law Group has an office in San Diego.

The Cradduck trial began in 2023 with jury selection on May 16 and 17. The matter proceeded with opening statements, during which the attorney representing EHT conceded the duty and breach elements of negligence. The only issues left, counsel stated, were causation and damages.

Plaintiff’s first witness testified in the afternoon, concluding shortly after 3:00 p.m. The court asked for the plaintiff’s next witness, but despite previous discussions between the court and counsel regarding witness availability, Samuels informed the court no other witnesses were available that day. The court asked if Cradduck could begin his testimony, since he was in the courtroom. Samuels was visibly upset. Cradduck testified for approximately 15 minutes before the jurors were excused and asked to return on Monday, May 22.

On Saturday, May 20, Cradduck filed a motion for mistrial based on comments by counsel in EHT’s opening statement. Cradduck argued that although counsel had admitted negligence during its opening statement, two days later, it filed a motion to preclude him from presenting certain evidence, stating it had conceded negligence “‘in its use and maintenance of the subject hotel’” but the jury still had to decide causation and damages. He claimed he had been “severely prejudiced in his ability to receive a fair trial by the misleading and untrue statement to the jury.” The record does not reflect that Samuels made any objections during EHT’s opening statement.

On Monday, May 22, defendants appeared for trial. Neither Cradduck nor Samuels appeared. The court advised defense counsel that it had “received word this morning that Mr. Samuels had a medical emergency so that he could not be here.” On May 23, Samuels filed a declaration. The declaration stated that on Sunday, May 21, around 6:00 p.m., he “suddenly began to feel extremely unwell and was taken to the emergency room” via ambulance. He remained in the emergency room for approximately 24 hours.

A long course of events followed, including a mistrial. The court ultimately decided to dismiss the complaint due to Cradduck’s and Samuels’ failure to appear as ordered. The court’s decision was based primarily on Samuels’ failure to provide evidence of his medical condition justifying his failure to appear. He did not offer such evidence until much later, during post-judgment motions. Additionally, the evidence showed Samuels had continued to work on other cases just days after specially appearing counsel represented that he was disabled to the extent that he could not speak. The court found Samuels’ conduct sufficiently egregious that it ordered a reference to the State Bar of California.

The Court of Appeal affirmed the dismissal of the plaintiff’s case in the published decision of Cradduck v. Hilton Domestic Operating Co. CA4/3 – G064325 (June 2025). It carefully reviewed the record such as the examples below.

At the hearing on May 24, Samuels did not appear, nor did Cradduck. Narine Mkrtchyan specially appeared for Cradduck. Mkrtchyan stated Samuels had been unable to appear at the hearing, and he had “a medical situation that is significant and is disabling to him at this point . . . it’s significant enough that he cannot proceed to trial.” She reiterated Samuels’ request for a mistrial. When asked, Mkrtchyan provided no specific information as to whether Samuels could not return the following Tuesday to resume the trial. Mkrtchyan’s reaction to the court’s statements was strongly negative, accusing the court of a “lack of compassion” that was “astonishing.” She stated she would “file a further declaration with further proof of his disability under ADA which the court is obligated to accommodate.” She did not file a further declaration on these topics at any point. On Friday, May 26, Samuels filed a notice of lodging medical records under seal.

The Court of Appeal noted that “During the proceedings, attorney Narine Mkrtchyan specially appeared twice on Samuels’s behalf. During these appearances, she made numerous uncivil and disrespectful attacks on the court, including accusing the court of misrepresenting and ignoring evidence, and demonstrating bias. She ordered the court, at one point, to ‘stop making any rulings right now,’ and also interrupted the court and demanded the court ‘let me finish.’ Such conduct is reprehensible and untenable, and accordingly, we are referring Mkrtchyan to the State Bar of California for potential disciplinary action.

On May 30, defendants appeared at trial, as did the jury. Cradduck did not appear, nor did Samuels. The court noted it had received and reviewed the lodged medical records, but to protect Samuels’ privacy, it did not discuss the contents in any detail. The court stated that having reviewed the records, it took the proper action the previous week by excusing the jury until the following Tuesday. The court did not “find any good cause for an additional continuance.”

Defendants ultimately made an oral motion to dismiss. As the defendants and the court were discussing various matters, Mkrtchyan appeared remotely (rather than in person, as the court had ordered) and several minutes late. The court informed her of its tentative. She asserted that Samuels “is in the hospital under specialized care and requires significant medical treatment.” She again requested a continuance for another “week or until Mr. Samuels recovers from hospital” or a mistrial. The court again noted that “Mkrtchyan’s representations were in conflict with Samuels’ prior declaration and the documents filed under seal.” The court continued the matter to 10:00 a.m. the next morning as an “OSC as to why the matter should not be dismissed.”

On May 31, both Samuels and Mkrtchyan appeared remotely. Defense counsel appeared in person. The focus of the Defense argument was CCP section 581, subdivision (l), which allows a court to dismiss a case when a party fails to appear at trial. the court stayed further action and continued the hearing to June 7. Defendants attached documents undercutting representations on Samuels’ behalf that he was disabled, unable to speak, and in a life-threatening emergency during the relevant time period. Those documents discussed several other litigation matters in which Samuels had been active during this time period. One set of documents demonstrated that on June 1, Samuels exchanged e-mails with opposing counsel in another Riverside County matter, stating that he was “still engaged in trial.” They discussed a trial continuance based on the trial in which he was purportedly engaged as well as one opposing counsel had coming up.

After review of the record, the Court of Appeal said “In this appeal, Cradduck argues multiple errors. He contends the trial court abused its discretion in denying no less than six motions and by ultimately granting the defense’s motion to dismiss. In doing so, he fails to adequately develop most of his legal arguments.”

‘Based on the information the court had before it at the hearing where it dismissed the case, we find no abuse of discretion. Samuels had weeks prior to the dismissal hearing to submit evidence of his medical condition and his unavailability. He failed to do so, forcing the court to rely on a scant evidentiary record that often conflicted with counsel’s oral representations. While he finally submitted evidence with postjudgment motions, those motions failed to adequately meet the legal standard required to justify relief. Accordingly, we find no abuse of discretion and affirm the judgment.”

AG Claims Skilled Nursing Facility Chain Puts Patients at Risk

The California Attorney General filed a lawsuit against Sweetwater Care, a San Diego-based operator of skilled nursing facilities (SNFs). The lawsuit, which pertains to Sweetwater’s 19 California skilled nursing facilities, alleges that Sweetwater violated California law, specifically the Unfair Competition Law, due to their failure to meet statutory minimum staffing levels and to protect California residents under its care. The Attorney General said that this failure led to delayed care and critical oversights, resulting in severe harm to patients who depended on timely medical attention. The lawsuit also highlights that while Sweetwater received significant payments from Medi-Cal, the chain engaged in a pattern of violations of California law and regulations related to minimum skilled nursing facility staffing.  

The California Department of Justice (DOJ)’s Division of Medi-Cal Fraud and Elder Abuse (DMFEA)’s investigation found that Sweetwater was engaging in a pattern of unlawful conduct leading to associated patient harm, preventable neglect, abuse, and injuries.

From 2020 through 2024, Sweetwater SNFs were staffed below California minimum staffing levels in over 14,126 instances. This unlawful level of understaffing led to patients at Sweetwater’s SNFs being exposed to preventable neglect, abuse, and injuries including fractured bones that went days without assessment or medical care, patients with head trauma leaving the facility unbeknownst to staff, unwitnessed falls, pressure injuries so severe that a patient’s hip bone was visible, medical emergencies that were not timely assessed or responded to, and patients being left for hours and overnight in soiled diapers because staff were too few or unwilling to provide care.

The investigation also revealed that Sweetwater extracted over $31 million as “profit” or “management fees” instead of using those dollars to provide the legally required staffing to meet minimum nursing staff levels.

The California Department of Justice is alleging Sweetwater violated California’s Unfair Competition Law in its lawsuit. The DOJ is also seeking remedies including civil monetary penalties, injunctive relief to prevent violations of California laws and regulations, the installation of a receiver or compliance monitor, and costs of suit.  

Pursuant to California’s Unfair Competition Law, Defendants are potentially liable for a civil penalty of up to $2,500 for each violation. That penalty may be doubled for each violation perpetrated against a senior citizen or disabled person.

DMFEA works to protect Californians by investigating and prosecuting those responsible for abuse, neglect, and fraud committed against elderly and dependent adults in the state, and those who perpetrate fraud on the Medi-Cal program. The Division of Medi-Cal Fraud and Elder Abuse receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $69,244,976 for Federal fiscal year (FY) 2025. The remaining 25 percent is funded by the State of California. FY 2025 is from October 1, 2024, through September 30, 2025.

Public Officials Face Arson and Insurance Fraud Charges

As part of an ongoing investigation of a 2024 Butte County arson, arrest and search warrants were issued and served in Butte, Sutter, and Sacramento Counties alleging multiple counts of arson and insurance fraud. Of those who were arrested, two men were public figures in their communities. Aaron Pamma who is the Live Oak Vice Mayor was arrested with Simren Pamma, who is a Live Oak Unified School District board member.

In total three men were arrested on individual $1,000,000 warrants issued out of Butte County Superior Court. They were identified as:

– – Aaron Pamma, 30, of Live Oak, was arrested on a warrant alleging Arson, Supporting a False Insurance – – -Claim, Perjury, Fraud, and Conspiracy to Destroy Insured Property for Fraud.
– – Simren Pamma, 28, of Sacramento, was arrested on a warrant alleging Arson and Conspiracy to Destroy Insured Property for Fraud.
– – Gurtej Singh, 28, of Yuba City, was arrested on a warrant alleging Arson, Destroying Insured Property for Fraud, Presenting a False Insurance Claim, Perjury, Fraud, and Wire Fraud.

Butte County District Attorney Mike Ramsey said the arrest and search warrants were the result of a lengthy joint investigation involving the CalFire Law Enforcement Division, the Butte County District Attorney, and the Federal Bureau of Investigation.

The investigation arose out of a February 17, 2024 arson fire that severely damaged a farmhouse on Ord Ferry Road in Butte County. During the investigation, CalFire investigators determined the house and surrounding orchards had been purchased in April of 2023 by Singh using a U.S. Department of Agriculture mortgage program. Approximately one month after purchasing the property Singh transferred fifty percent ownership of the property to Aaron Pamma and Simren Pamma.

CalFire investigators determined Singh had purchased an insurance policy on the house approximately three months before the fire. Working with the insurance company, investigators determined Singh had made numerous false and/or misleading representations in the application for the insurance policy and that Singh and Aaron Pamma had made numerous false and/or misleading representations to the insurance company after the fire.

Investigators alleged that shortly after the fire, Singh, Aaron Pamma, and Simren Pamma sold the Ord Ferry property and then collected payment from the insurance company resulting in an estimated gross profit of over $200,000.

As part of the alleged conspiracy, investigators also determined that after buying the property in 2023, Singh, Aaron Pamma, and Simren Pamma hired Big Dog Handyman of Corning to renovate and improve the farmhouse. As part of the renovations and improvements, Big Dog Handyman purchased thousands of dollars’ worth of goods and materials from multiple Chico area businesses, using checks on a non-existent bank account.

The owner of Big Dog Handyman, Javier Molina-Bravo, 37, of Corning, was charged in Butte County Superior Court with multiple felony counts of check fraud last March. Molina-Bravo failed to appear for a scheduled hearing in Butte County Superior Court and is currently a wanted fugitive from justice.

Ontrak CEO Sentenced to Over 3 Years in Prison

The former CEO and chairman of the board of directors of Ontrak Inc., a Miami, Florida-based publicly traded health care company, was sentenced to 42 months in federal prison for engaging in an insider trading scheme – using Rule 10b5-1 stock trading plans – to avoid losses of more than $12.5 million.

Terren Scott Peizer, 65, a resident of Puerto Rico and Santa Monica, was sentenced by United States District Judge Dale S. Fischer, who also ordered him to pay a $5.2 million fine and $12.7 million in restitution.

At the conclusion of a 10-day trial in June 2024, a jury found Peizer guilty of one count of securities fraud and two counts of insider trading.

The case is part of a data-driven initiative led by the Justice Department’s Criminal Division’s Fraud Section to identify executive abuses of 10b5-1 trading plans. Rule 10b5-1 trading plans can offer an executive a defense to insider trading charges. However, the defense is unavailable if the executive is in possession of material, non-public information at the time he or she enters into the 10b5-1 trading plan. Additionally, a plan does not protect an executive if the trading plan was not entered into in good faith or was entered into as part of an effort or scheme to evade the prohibitions of Rule 10b5-1.

Peizer avoided losses of approximately $12.5 million by entering into two Rule 10b5-1 trading plans while in possession of material, non-public information concerning the serious risk that Ontrak’s then-largest customer would terminate its contract.

In May 2021, Peizer entered into his first 10b5-1 trading plan shortly after learning that the relationship between Ontrak and the customer was deteriorating, and that the customer had expressed serious reservations about continuing its contract with Ontrak. Peizer later learned that the customer informed Ontrak of its intent to terminate the contract. Then, in August 2021, Peizer entered into his second 10b5-1 trading plan approximately one hour after Ontrak’s chief negotiator for the contract confirmed to Peizer that the contract likely would be terminated.

In establishing his 10b5-1 plans, Peizer refused to engage in any “cooling-off” period – the time between when he entered into the plan and when he sold stock – despite warnings from two brokers, a senior Ontrak executive, and attorneys. Instead, Peizer began selling shares of Ontrak on the next trading day after establishing each plan. On August 19, 2021, just six days after Peizer adopted his August 10b5-1 plan, Ontrak announced that the customer had terminated its contract and Ontrak’s stock price declined by more than 44%.

The FBI investigated the case, with substantial assistance from the Financial Industry Regulatory Authority’s (FINRA) Criminal Prosecution Assistance Group.

The U.S. Attorneys Office and Matthew Reilly of the Justice Department’s Criminal Division’s Fraud Section prosecuted this case. Assistant United States Attorney Jonathan S. Galatzan of the Asset Forfeiture and Recovery Section handled the forfeiture proceedings.

Plaintiff Must Hold or Desire Job at Time of ADA Discrimination

Karyn Stanley worked as a firefighter for the City of Sanford, Florida, starting in 1999. At first, she planned to serve for 25 years. Part of the reason for that had to do with health insurance. When Ms. Stanley was hired, the City offered health insurance until age 65 for two categories of retirees: those with 25 years of service and those who retired earlier due to disability.

In 2003, the City changed its policy to provide health insurance up to age 65 only for retirees with 25 years of service, while those who retired earlier due to disability would receive just 24 months of coverage.

Ms. Stanley later developed Parkinson’s disease, a disability that forced her to retire in 2018, entitling her to only 24 months of health insurance under the revised policy.

Ms. Stanley sued, claiming the City violated the Americans with Disabilities Act by providing different health-insurance benefits to those who retire with 25 years of service and those who retire due to disability.

The City responded by filing a motion to dismiss Ms. Stanley’s complaint for failure to state a claim. The district court denied that motion in part, allowing some of Ms. Stanley’s claims to proceed. But with respect to her ADA claim, The district court dismissed her ADA claim, reasoning that the alleged discrimination occurred after she retired, when she was not a “qualified individual” under Title I of the ADA, 42 U. S. C. §12112(a), because she no longer held or sought a job with the defendant. The Eleventh Circuit Court of Appeals affirmed the trial court.

The Supreme Court of the United States affirmed the the Eleventh Circuit in the case of Stanley v City of Sanford, Florida -No. 23–997 (June 2025).

Title I of the Americans with Disabilities Act bars employers from “discriminat[ing] against a qualified individual on the basis of disability in regard to . . . compensation” and other matters. 42 U. S. C. §12112(a). The statute defines a “qualified individual” as “an individual who, with or without reasonable accommodation, can perform the essential functions of the employment position that such individual holds or desires.” §12111(8).

The question before the United States Supreme Court in this case concerns whether a retired employee who does not hold or seek a job is a “qualified individual.”

The Eleventh Circuit concluded that §12112(a) does not reach allegations of discrimination against a retiree “who does not hold or desire to hold an employment position” that she is capable of performing with reasonable accommodation. 83 F. 4th 1333, 1337 (2023).

But, the court acknowledged, not every court of appeals would agree. Like the Eleventh Circuit, the Sixth, Seventh, and Ninth Circuits (Weyer v. Twentieth Century Fox Film Corp., 198 F.3d 1104, 1112 (9th Cir. 2000) ) have said that Title I’s anti-discrimination provision “does not protect people who neither held nor desired a job with the defendant at the time of discrimination.” Id., at 1341.

But the Second and Third Circuits take a different view. As those courts see it, the ADA’s definition of “qualified individual” is “ambiguous,” and they have resolved that ambiguity “in favor of ” extending the statute to reach retirees like Ms. Stanley. Ibid.

SCOTUS resolved the circuit court conflict, and agreed with the Eleventh Circuit in this case, (and with California and the 9th Circuit which previously came to the same conclusion.) To prevail under the ADA §12112(a), a plaintiff must plead and prove that she held or desired a job, and could perform its essential functions with or without reasonable accommodation, at the time of an employer’s alleged act of disability-based discrimination.

NSC Grant Recipients Tackle Most Common Workplace Injuries

The National Safety Council (NSC) is America’s leading nonprofit safety advocate – and has been for over 110 years. As a mission-based organization, we work to eliminate the leading causes of preventable death and injury, focusing our efforts on the workplace and roadways. We create a culture of safety to not only keep people safer at work, but also beyond the workplace so they can live their fullest lives.

The NSC just released findings from 2023-2024 MSD Solutions Lab Research to Solutions (R2S) and MSD Solutions Pilot Grant programs. Results showed practical applications and measurable progress toward reducing musculoskeletal disorders (MSDs), the most common workplace injury.

Launched by the MSD Solutions Lab, a groundbreaking NSC initiative established in 2021 with funding from Amazon (NASDAQ: AMZN), the grant programs empower researchers and employers to explore and pilot new solutions that can help prevent MSDs. Now in its third grant cycle, nearly $850,000 has been awarded by NSC, including $275,000 to nine pioneering organizations during the inaugural 2023-2024 cycle.

“The 2023-2024 grantees have made remarkable progress in turning innovative concepts into actionable solutions,” said Katherine Mendoza, senior director of workplace safety programs at NSC. “By investing in both academic research and employer-led pilot projects, we’re advancing scalable strategies that can help protect workers across any industry.”

Highlights from the 2023-2024 R2S program include:

– – Rutgers University developed an AI-based image captioning tool that helps employers identify ergonomic risks in real time
– – Iowa State University created a predictive model to evaluate shoulder MSD hazards in high-risk jobs
– – Virginia Tech implemented low-cost, camera-based sensors with machine learning to assess workplace MSD exposures
– – University of Waterloo produced guidance for integrating computer vision into workplace ergonomics programs

The 2023-2024 MSD Solutions Pilot Grant program supported Amerisure Insurance, Burlington Hydro, General Electric Aerospace and Guarantee Electrical Company in applying emerging technologies to manual materials handling – a major driver of MSDs. Trials were conducted with HeroWear, an exosuit developer, and TuMeke Ergonomics, which uses computer vision to detect risky postures and movements. Notable takeaways from participants included positive employee feedback regarding use of the technologies and improvements in risk identification and injury prevention strategies.

“When we partnered with NSC to launch the MSD Solutions Lab in 2021, we recognized that addressing MSDs effectively requires strategic investment, innovative thinking, and collaboration across industries,” said Sarah Rhoads, vice president of Global Workplace Health and Safety at Amazon. “We’re pleased to see the Lab explore a wide range of technologies and programs that may lead to the next great advancement in workplace safety practices, benefitting workers across industries.”

From reducing ergonomic risks to providing data-backed insights on emerging safety technology, the R2S and MSD Solutions Pilot grants are among several initiatives led by the MSD Solutions Lab to prevent MSDs. To learn more about these efforts, visit nsc.org/msd.