- New L.C. Whistleblower Attorney Fee Law Applies to Pending Caseson December 18, 2024 at 2:05 PM
Harold Winston is "an African-American male" with "over 30 years of service" with the County of Los Angeles. Winston worked in the Department of Treasurer and Tax Collector as the supervising deputy public conservator administrator in the public administration branch.
Winston sued his employer L.A. County alleging race-based discrimination, retaliation, and failure to maintain a discrimination free environment under the California Fair Employment and Housing Act (FEHA) (Gov. Code, § 12900 et seq.) and whistleblower retaliation in violation of Labor Code section 1102.5.
While Winston’s case was pending, Labor Code section 1102.5 was amended, effective January 1, 2021, to add a provision - subdivision (j) - authorizing courts to award reasonable attorney fees to whistleblower plaintiffs who prevail against their employer under section 1102.5.
Trial began on November 17, 2021. On November 24, 2021, the jury returned a verdict on the three causes of action submitted to them. It found in favor of L.A. County and against Winston on the causes of action for retaliation under FEHA and failure to prevent discrimination/ harassment under FEHA. The jury found in Winston’s favor on his cause of action for whistleblower retaliation under section 1102.5. It awarded him damages totaling $257,000.
After the jury found in Winston’s favor on his retaliation claim under section 1102.5, Winston filed a motion for attorney fees and requested $1,854,465 as the prevailing party based on section 1102.5’s recently enacted subdivision (j).
The trial court denied the motion, ruling that the fee provision does not apply to Winston’s case because it was not in effect in 2019 when the complaint was filed and because it found no legislative intent supporting retroactive application.
The Court of Appeal reversed in the published case of Winston v. County of Los Angeles - B323392 (December 2024).
On appeal, Winston argued section 1102.5, subdivision (j) applies to his case "because [his] case was still in action at the time the provision became effective." He contends the trial court erroneously denied his motion based on "no legislative intent demonstrating retroactive application of [the statute]." The Court of Appeal agreed with Winston and reversed.
The law invoked here, section 1102.5, is "California’s general whistleblower statute." When Winston filed this case, section 1102.5 did not include a one-way fee-shifting provision "authoriz[ing] an award of attorney fees to a worker who prevails on a claim of retaliation for blowing the whistle on workplace legal violations." The California Legislature amended the law by passing Assembly Bill No. 1947, which allows discretionary recovery of reasonable attorney fees to a prevailing whistleblower plaintiff.
Effective January 1, 2021, section 1102.5, subdivision (j) provides: "The court is authorized to award reasonable attorney’s fees to a plaintiff who brings a successful action for a violation of these provisions." (§ 1102.5, subd. (j).)
Under California law, the general rule is that absent a clear, contrary indication of legislative intent, courts interpret statutes to apply prospectively. However, "the California Supreme Court and many, many Courts of Appeal have treated legislation affecting the recovery of costs, including attorney fees, as addressing a ‘procedural’ matter that is ‘prospective’ in character and thus not at odds with the general presumption against retroactivity." (USS-Posco Industries v. Case (2016) 244 Cal.App.4th 197, 217-218)
"Neither party points to a California decision directly addressing the issue of whether section 1102.5, subdivision (j) applies to cases pending at the amendment’s effective date and we have found none."
"We conclude the statute authorizes an award of attorney fees to Winston because his action was pending when section 1102.5, subdivision (j), became effective. For that reason, we reverse."
- Cal/OSHA Cites City of Los Angeles Animal Services Center $563Kon December 18, 2024 at 2:05 PM
The California Division of Occupational Safety and Health (Cal/OSHA) has issued $563,250 in penalties to Harbor Animal Services Center (A department of the City of Los Angeles that provides animal services and volunteer opportunities for people who live in the city of Los Angeles) based in San Pedro, California, for failing to evaluate and correct overcrowding at their animal shelter, which resulted in animal attacks and bites on employees.
An employee was mauled on May 31, 2024, and according to Cal/OSHA it was due to the employer’s (the City of Los Angeles) willful violations of safety regulations. Kennel supervisor Leslie Corea was attacked by a pitbull mix that day after opening the dog's cage for a rescue group. According to a report by Fox 11, he dog isn't new to the the Harbor shelter and neither is Corea. She's spent 24 years at the city shelter.
Her right leg was severely damaged and she needed extensive physical therapy and unfortunately, the dog was euthanized. Workers said the attack spotlights the growing crisis of overcrowding at local shelters because of illegal breeding, COVID returns, housing restrictions and situations like this.
L.A. Animal Services acknowledged the severity of the attack and issued the following statement, "LA Animal Services has already launched an investigation into this incident. Due to the open investigation status of this incident and to protect the privacy of the staff involved, no further details are available at this time."
Cal/OSHA, found that the employer had significant safety and training lapses, which put employees of Harbor Animal Services Center in harm’s way and resulted in a serious injury to the worker, whose leg was badly mauled, requiring hospitalization.
What Cal/OSHA Chief Debra Lee said: "This incident underscores the severe consequences that arise when employers fail to take proper measures to protect their staff from preventable risks. While we cannot undo the harm caused, we can hold employers accountable. Every employee deserves a workplace that prioritizes their health and safety."
Cal/OSHA has cited Los Angeles City Animal Services operating as Harbor Animal Services Center for six violations, including one general, two willful serious, and three willful serious accident-related in nature. Cal/OSHA’s key findings of the employer’s failure to protect its employees included:
- - Overcrowding of Animals: The employer failed to evaluate and mitigate risks caused by overcrowding, which led to employee injuries from animal attacks.
- - Inadequate Training: Employees and supervisors received insufficient training in handling animals or using personal protective devices.
- - Personal Protective Equipment: Proper assessment and provision of personal protective equipment were not conducted.
- - Emergency Communication: The lack of an effective communication system delayed critical emergency response and treatment for injuries.
Representatives for the Los Angeles Animal Services Department, Mayor Karen Bass and City Councilman Tim McOsker, who represents the area where the shelter is located, did not immediately respond to a request by Fox 11 for comment.
- First Pharmaceutical "Consultant" Based Opioid Criminal Case Settles for $650Mon December 17, 2024 at 3:57 PM
McKinsey & Company Inc., a global management consulting firm based in New York, has agreed to pay $650 million to resolve a criminal and civil investigation into the firm’s consulting work with opioids manufacturer Purdue Pharma L.P. The resolution pertains to McKinsey’s advice to Purdue concerning the sales and marketing of Purdue’s extended-release opioid drug, OxyContin, including a 2013 engagement in which McKinsey advised on steps to "turbocharge" sales of OxyContin.
This resolution marks the first time a management consulting firm has been held criminally responsible for advice resulting in the commission of a crime by a client and reflects the Justice Department’s ongoing efforts to hold actors accountable for their roles in the opioid crisis. The resolution is also the largest civil recovery for such conduct.
Additionally, a former McKinsey senior partner who worked on Purdue matters has been charged with obstruction of justice in federal court in Abingdon, Virginia. Martin E. Elling, 60, a U.S. citizen currently residing in Bangkok, Thailand, has been charged with one count of knowingly destroying records, documents and tangible objects with the intent to impede, obstruct and influence the investigation and proper administration of a matter within the jurisdiction of the Justice Department. Elling has agreed to plead guilty and is expected to appear in federal court in Abingdon to enter his plea and for sentencing at later dates.
As part of the government’s resolution with McKinsey, the company has entered into a five-year deferred prosecution agreement (DPA) in connection with a criminal Information filed in U.S. District Court for the Western District of Virginia against McKinsey’s U.S. subsidiary (McKinsey & Company Inc. United States. The information charges McKinsey U.S. with one felony count of knowingly destroying records, documents and tangible objects with the intent to impede, obstruct, and influence the investigation and proper administration of a matter within the jurisdiction of the Justice Department; and one misdemeanor count of knowingly and intentionally conspiring with Purdue and others to aid and abet the misbranding of prescription drugs, held for sale after shipment in interstate commerce, without valid prescriptions.
McKinsey has agreed to pay a penalty of over $231 million, a forfeiture amount of over $93 million (reflecting all money it was paid by Purdue from 2004 to 2019) and a payment of $2 million to the Virginia Medicaid Fraud Control Unit to resolve the criminal allegations. McKinsey also has entered into a civil settlement agreement in which it will pay over $323 million to resolve its liability under the False Claims Act for allegedly providing advice to Purdue Pharma L.P. that caused the submission of false and fraudulent claims to federal healthcare programs for medically unnecessary prescriptions of OxyContin, as well as allegedly failing to disclose to the U.S. Food and Drug Administration (FDA) conflicts of interest arising from McKinsey US’s concurrent work for Purdue and the FDA. This brings the total payments under the global resolution to $650 million.
Today’s filing includes a 71-page Agreed Statement of Facts, which provides a detailed account of McKinsey’s work with Purdue relating to OxyContin. As part of the resolution, McKinsey has agreed to implement a significant compliance program, including a system of policies and procedures designed to identify and assess high-risk client engagements. As part of this compliance program, McKinsey will implement new document retention procedures and training for all partners, officers and employees who provide or implement advice to clients. This compliance program is in addition to the provisions negotiated between McKinsey and the Department in a concurrent resolution with McKinsey & Company Africa that was announced on Thursday, Dec. 5.
McKinsey has also agreed that it will not do any work related to the marketing, sale, promotion or distribution of controlled substances during the five-year term of the DPA. The resolution requires McKinsey’s Managing Partner to certify, on an annual basis, the firm’s compliance with its obligations under the DPA and federal law.
"For the first time in history, the Justice Department is holding a management consulting firm and one of its senior executives criminally responsible for the sales and marketing advice it gave resulting in the commission of crime by a client," said U.S. Attorney Christopher R. Kavanaugh for the Western District of Virginia. "This ground-breaking resolution demonstrates the Justice Department’s ongoing commitment to hold accountable those companies and individuals who profited from our Nation’s opioid crisis."
- Ventura County Physician to Serve 2 Years for $3M Healthcare Fraudon December 17, 2024 at 3:56 PM
A Ventura County physician who worked for two Pasadena hospices was sentenced to 24 months in federal prison for defrauding Medicare out of more than $3 million through claims for medically unnecessary hospice services.
Dr. Victor Contreras, 69, of Santa Paula, was sentenced by United States District Judge André Birotte Jr., who also ordered him to pay $3,289,889 in restitution.
Contreras pleaded guilty on July 24 to one count of health care fraud.
From July 2016 to February 2019, Contreras and co-defendant Juanita Antenor, 62, formerly of Pasadena, schemed to defraud Medicare by submitting nearly $4 million in false and fraudulent claims for hospice services submitted by two hospice companies: Arcadia Hospice Provider Inc., and Saint Mariam Hospice Inc. Antenor controlled both companies.
Medicare only covers hospice services for patients who are terminally ill, meaning that they have a life expectancy of six months or less if their illness ran its normal course.
Contreras falsely stated on claims forms that patients had terminal illnesses to make them eligible for hospice services covered by Medicare, typically adopting diagnoses provided to him by hospice employees whether or not they were true. Contreras did so even though he was not the patients’ primary care physician and had not spoken to those primary care physicians about the patients’ conditions. Medicare paid on the claims supported by Contreras’ false evaluations and certifications and recertifications of patients.
In total, approximately $3,917,946 in fraudulently claims were submitted to Medicare, of which a total of approximately $3,289,889 was paid.
According to Medical Board of California records, Contreras is a licensed physician in California, but has been on a 10 year probation with the Board since 2015 and is subject to limitations on his practice. On August 6, 2024 the Medical Board filed a Petition to Revoke his Probation. The expiration of his ten year probation is extended until there is a resolution of this Petition.
Antenor remains at large. Co-defendant Callie Black, 66, of Lancaster, who allegedly recruited patients for the hospice companies in exchange for illegal kickbacks, has pleaded not guilty and is scheduled to go to trial on March 4, 2025.
The United States Department of Health and Human Services Office of Inspector General, the FBI, and the California Department of Justice investigated this matter.
Assistant United States Attorneys Kristen A. Williams of the Major Frauds Section and Aylin Kuzucan of the General Crimes Section are prosecuting this case.
- Physician Admits $3M SIBTF Fraud Naming O.C. Judge as Co-Conspiratoron December 16, 2024 at 3:30 PM
According to the California Medical Board records, Kevin Tien Do M.D.was born in Saigon, Vietnam and came to the United States in 1982, when he was 16 years old. He graduated from USC Medical School in 1991 and completed his residency in Physical Medicine and Rehabilitation at UCLA on June 30, 1995.
After about eight years following completion of his UCLA Residency, Dr. Do was convicted, on on August 15, 2003, following his plea of guilty, of violating Title 18, United States Code, sections 2 and 1347 (aiding and abetting health care fraud) in the United States District Court for the Eastern District of California, Case Number 2:02CR00338-01, entitled The United States of America v. Kevin Tien Do,
He was sentenced to 12 months in federal prison, commencing October 15, 2003, and ordered to pay an assessment of $100 and restitution of $366,031.24
From April of 1997 through December 31, 1998, he aided and abetted a billing company named "Medi-Syn" in a scheme to defraud Medi-Cal. He permitted Medi-Syn to use hisr Medi-Cal provider number to submit claims requesting payment for services purportedly rendered by him which he did not provide and which were never provided by anyone else. Do Medi-Syn opened a joint account under the name "Premier Health Providers Network" into which the Medi-Cal checks were deposited. Do provided 80 percent of these funds to Medi-Syn and kept 20 percent for himself. As a result of the scheme, Medi-Cal was defrauded out of $366,031.24.
In order to obtain leniency in the 2003 case against him, Do agreed to act as an undercover operative and to cooperate with the FBI in its investigation of Edgemont Hospital a psychiatric hospital in Los Angeles, and in a third investigation regarding podiatrist Gary Feldman and the West Pico Medical Clinic where Do worked. He participated in 43 undercover operations from December of 1998 through May of 1999. He also provided additional assistance in 2000. Respondent's cooperation led to the conviction of Dr. Feldman.
Do began serving his federal prison sentence in the 2003 case on October 15, 2003, and was officially released from custody on October 13, 2004. He remained on federal probation until October of 2007.By 2004, Do had paid in full the $366,03 1.24 restitution ordered by the criminal court.
The Physician's and Surgeon' s Certificate No. G 76640 issued to Kevin Tien Do was revoked in late 2005 after an Accusation was filed against him by the California Medical Board. However, the revocation was stayed and he was placed on probation for ten years under several terms and conditions.
On October 26, 2016 the Medical Board concluded that Dr. Do had "completed probation in Case No. 06-2002-136106, is entitled to full restoration of the Physician's and Surgeon's Certificate." It was therefore ordered that his medical license "be fully restored to renewed/current status and free of probation requirements, effective September 22, 2016."
Now, more than two decades after his 2003 conviction,,Kevin Tien Do, M.D., who is now 59 years old and lives in Pasadena, worked for an Inland Empire medical company, and has now agreed to plead guilty - in new case - to conspiring to defraud California’s workers’ compensation fund of millions of dollars by continuing to work on workers’ compensation matters after being suspended due to a prior health care fraud conviction. He agreed to plead guilty to one count of conspiracy to commit mail fraud and one count of subscribing to a false tax return. .
Beginning in 2016, Do began to work for Liberty Medical Group Inc., a Rancho Cucamonga-based medical company, for which he would draft SIBTF-related medical reports that Liberty would then bill to the California SIBTF program. In October 2018, California suspended Do from participating in California’s workers’ compensation program, which included the SIBTF, because he had previously been convicted of federal health care fraud in 2003. Despite his suspension, Do continued to work for Liberty on SIBTF-related workers’ compensation matters.
To conceal that Do was unlawfully continuing to participate in the workers’ compensation SIBTF program after his suspension, Liberty’s owner came up with a plan. That plan was that Do would continue to author the SIBTF-related reports, which Liberty would then continue to mail to the California SIBTF for payment. rather than listing Do’s name on the billing forms and the attached medical reports mailed to the California SIBTF, like they had had done before Do’s suspension, Liberty instead fraudulently listed other doctors’ names on the billing forms and attached medical reports, even though Do had drafted and compiled the reports.
Do admitted that Liberty was paid more than $3 million by California SIBTF for such reports that Liberty mailed to the California SIBTF for payment after Do’s October 2018 suspension.
Do’s plea agreement also details that Liberty’s owner edited Do’s medical reports, even though that co-conspirator was not a doctor or other licensed medical professional.
Under California law, shareholders/owners of a medical corporation must be licensed in the practice of medicine or other related medical fields, such as a psychologist, registered nurse, or licensed physician assistant. In his plea agreement, Do admitted that real owner of Liberty and Do’s co-conspirator was another person who was not a doctor or other medical professional, but rather, was a California attorney then employed as a prosecutor for the Orange County District Attorney’s Office, and who later became an Orange County Superior Court judge during the conspiracy.
According to the Orange County Register, the Orange County Superior Court Judge named in the plea agreement is Israel Claustro, Claustro has served as a Senior Deputy District Attorney and an Assistant Head of Court at the Orange County District Attorney’s Office since 2020, where he has served in several roles since 2002. He served as a Law Clerk at the Orange County District Attorney’s Office from 2001 to 2002. Claustro earned a Juris Doctor degree from the Western State College of Law.
And MSN reports that the plea agreement with Do refers to the judge only as "co-conspirator #1," but an investigation by the Southern California News Group has identified the jurist as Israel Claustro, who was appointed to the bench in 2022..
A reporter’s request for comment from Claustro was relayed to him through Orange County Superior Court officials. In response, court spokesperson Kostas Kalaitzidis said, "The court cannot discuss any case pending before any court, as ethical rules prohibit any such discussion."
Officials with the U.S. Attorney’s Office declined to comment. Additionally, the state Commission on Judicial Performance would not disclose whether it is investigating Claustro,
That true owner who was Do’s co-conspirator not only was a signatory on Liberty’s bank account, but also issued and signed Liberty’s checks to Do and others. The plea agreement specifies that much of the more than $3 million that the SIBTF paid Liberty during the years following Do’s suspension then flowed to another company controlled by Liberty’s owner and his wife, which totaled to more than $1.5 million.
Do also admitted that he failed to accurately report to the IRS all the money he had been paid by Liberty. Do admitted that on his 2021 tax return, he failed to report approximately $66,227 of the income that Liberty paid him.
Once Do enters his guilty plea, he will face a statutory maximum sentence of 20 years in federal prison for the mail fraud count and up to three years in federal prison for the tax fraud count.
The FBI, IRS Criminal Investigation, and the California Department of Insurance are investigating this matter. Assistant United States Attorneys Charles E. Pell of the Orange County Office and Ryan J. Waters of the Asset Forfeiture and Recovery Section are prosecuting the case.
- Cal/OSHA Issues $276,425 Citation for First Serious Willful Heat Violationson December 16, 2024 at 3:30 PM
The California Division of Occupational Safety and Health (Cal/OSHA) has issued $276,425 in penalties to Parkwood Landscape Maintenance, based in Van Nuys, California, for willfully violating state heat illness prevention regulations. Cal/OSHA, a division of the Department of Industrial Relations (DIR), determined that the employer deliberately and knowingly failed to follow heat protection requirements, marking its first willful heat violation citation.
This investigation began on June 6, 2024, when the Cal/OSHA Van Nuys District Office received a complaint about employees working outdoors without access to water or heat illness training provided by their employer.
The company failed to provide employees with required protections, such as access to water, shaded areas, and proper training on preventing heat-related illnesses. Additionally, they lacked written procedures for addressing work conditions in high temperatures, which often exceeded 95 degrees Fahrenheit. Employees also had to purchase their own drinking water, a breach of California's heat illness prevention standard.
This citation follows a previous violation in 2022, in which the company was cited under Title 8 Section 3395(i) for failing to meet heat safety requirements. Despite being provided with model heat illness prevention procedures, Parkwood Landscape Maintenance did not implement the necessary preventive measures to ensure worker safety.
Cal/OSHA investigates heat-related incidents and complaints of hazards at both indoor and outdoor worksites in industries such as agriculture, landscaping, and construction among others. These investigations ensure compliance with the heat illness prevention standard, the injury and illness prevention standard, and indoor heat illness protections.
Cal/OSHA’s Heat Illness Prevention special emphasis program includes enforcement of the heat regulation as well as multilingual outreach and training programs for California’s employers and workers. Details on heat illness prevention requirements and training materials are posted on Cal/OSHA’s Heat Illness Prevention web page and the 99calor.org informational website. A Heat Illness Prevention online tool is also available on Cal/OSHA’s website.
Cal/OSHA helps protect workers from safety and health hazards on the job in almost every workplace in California. Employers who have questions or need assistance with workplace health and safety programs can call Cal/OSHA’s Consultation Services Branch at 800-963-9424.
Employers with Questions on Requirements May Contact: InfoCons@dir.ca.gov, or call your local Cal/OSHA Consultation Office.
- CEO of Large Vocational Center Faces 23 Counts of SJDB Insurance Fraudon December 12, 2024 at 3:49 PM
CEO of one of California’s largest vocational return to work counseling centers, Hazel Ortega, 53, of La Habra, appeared in court after being charged with 23 felony counts including insurance fraud, theft, and forgery.
A Department of Insurance investigation found Ortega allegedly defrauded at least four insurance companies by forging documents on behalf of unknowing injured workers.
The Department’s investigation began after receiving multiple referrals from insurance companies alleging Ortega, owner of Ortega Counseling Center, a motivational speaker, and author of "From Bounced Checks to Private Jets," was referring injured workers to schools which were not approved and not eligible to receive the voucher funds through the Supplemental Job Displacement Benefit (SJDB) program, which provides an allowance of $6,000 to $10,000 for educational retraining or skill enhancement for qualifying injured workers to provide them a marketable skill to re-enter the workforce after a workplace injury. This benefit is provided as a voucher that can be used at state-approved or accredited schools.
The Department of Insurance is urging any injured workers who believe they may have been victimized by Ortega or the Ortega Counseling Center to contact Detective Kuhlman or Sergeant Jimenez at the Department of Insurance by phone at (909) 919-2200.
Through the course of the investigation, detectives located and interviewed injured workers who had SJDB and Vocational Return to Work counseling invoices submitted to insurance companies by Ortega and discovered Ortega was pressuring and coercing injured workers to attend these unapproved schools and not providing them with any other additional choices.
Ortega also submitted forms to insurance companies on the injured workers' behalf which they had not seen or reviewed. Multiple injured workers were shown documents submitted on their behalf which they had never seen and stated their signature had been forged. In one instance, detectives interviewed an injured worker for whom Ortega submitted an invoice to an insurance company alleging she provided nearly five hours of counseling services. When the injured worker was contacted, they confirmed they had never heard of Ortega nor met with her for counseling services.
Ortega was arraigned and charged previously in Los Angeles County for her participation in another nearly $1 million-dollar insurance fraud scheme. It is alleged Ortega and other vocational counselors received nearly $500,000 in illegal kick back payments for referring students to a fraudulent school in the Los Angeles area.
This case is being prosecuted by the Los Angeles County District Attorney’s Office.
- Oroville Hospital Resolves Kickbacks and False Billing Claim for $10.25Mon December 12, 2024 at 3:49 PM
Oroville Hospital was founded in 1962 and is a 153-bed acute care facility that offers a variety of services, including inpatient and outpatient care, a radiology department, and multiple physician practices. It's a Level 3 Trauma Center, which means its Emergency Service Department treats all but the most severe neurological, pediatric, and burn patients. It is owned by OroHealth Corporation, a private, non-profit organization. OroHealth Corporation has two subsidiaries: Oroville Hospital, an acute care inpatient and outpatient facility, and OroLake Corporation, a regional sales and service organization. .
Oroville Hospital has agreed to pay $10.25 million to the United States and the State of California to resolve allegations that it violated the False Claims Act and the Anti-Kickback Statute, U.S. Attorney Phillip A. Talbert announced today.
The settlement resolves allegations that Oroville Hospital engaged in an illegal kickback and physician self-referral scheme by paying kickbacks to physicians for patients they admitted to the hospital, and that it knowingly submitted false claims to Medicare and Medi-Cal for medically unnecessary hospital admissions and claims that included false diagnosis codes. Oroville Hospital will pay $9,518,954 to the federal government and $731,046 to the State of California.
The settlement resolves allegations that, to increase hospital admissions, Oroville Hospital illegally paid kickbacks to its physicians who were responsible for deciding whether individuals should be admitted as inpatients. These physicians allegedly received a bonus based on how many patients they admitted, according to the settlement agreement.
The settlement also resolves allegations that Oroville Hospital admitted patients as inpatients when it knew inpatient care was not medically necessary. Oroville Hospital then submitted claims to Medicare and Medicaid for inpatient care, which is more expensive. Oroville Hospital further allegedly submitted claims to Medicare and Medicaid that included false diagnosis codes for systemic inflammatory response syndrome (SIRS), resulting in excessive reimbursement to the Hospital.
In connection with the settlement, Oroville Hospital entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) that requires, among other requirements, the implementation of a risk assessment and internal review process designed to identify and address evolving compliance risks. The Corporate Integrity Agreement also requires an independent review organization to, among other requirements, annually assess both the medical necessity and appropriateness of select claims billed to Medicare and policies and systems to track arrangements with some referral sources.
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Cecilia Guardiola. Under those provisions, 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 ex rel. Cecilia Guardiola v. Oroville Hosp., Case No. 2:20-CV-1558 (E.D. Cal.). As part of the settlement announced today, Ms. Guardiola will receive approximately $1.8 million.
"Physicians should make decisions based the best interests of their patients, not their own personal financial interests," said U.S. Attorney Talbert. "Hospitals engaging in kickback schemes betray the trust placed in them by their communities and distort care decisions that should be untainted by illegal kickbacks. This settlement demonstrates my office’s commitment to preserving the integrity of public healthcare programs and ensuring that the well-being of patients remains paramount."
"Improperly billing federal health care programs depletes valuable government resources used to provide medical care to millions of Americans," said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. "We will continue to advocate for the appropriate use of Medicare and Medicaid funds, and we will pursue health care providers who defraud taxpayers by knowingly submitting false claims."
Assistant U.S. Attorney Steve Tennyson handled the case for the U.S. Attorney’s Office. The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Eastern District of California, the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the Department of Health and Human Services, Office of the Inspector General, and the California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
- Kaiser Permanente Quadrupled Hospital at Home Care in 2024on December 11, 2024 at 4:52 PM
Kaiser Permanente's hospital-at-home program (HaH) has grown significantly in the past year, nearly quadrupling its capacity. The program's average daily census has increased from 22.5 to 80.6 across all regions. Some of the areas where Kaiser Permanente offers Care at Home services include: Northern California, Southern California, Georgia, Mid-Atlantic states, Northwest, and Washington state.
Kaiser Permanente has been developing infrastructure to support the program's growth, and building confidence in the program among patients and staff. The program is also encouraging more admissions from the emergency department and inpatients.
Research from Kaiser Permanente published last year reveals that its hospital-at-home program was scaled successfully, creating hospital capacity; however, the program’s care quality as it was being scaled could not be determined. Published in The American Journal of Managed Care, the study aimed to assess the feasibility of scaling a hospital-at-home program within an integrated healthcare delivery system.
Such programs are well established in England, Canada, Israel, and other countries where payment policies encourage - or at least do not discourage - the provision of health care services in less costly venues.
In Victoria, Australia, for example, every metropolitan and regional hospital has a hospital at home program, and roughly 6 percent of all hospital bed-days are provided that way. For specific conditions, the use of at-home care is significantly greater: nearly 60 percent of all patients with deep venous thrombosis (DVT) were treated at home in 2008, as were 25 percent of all hospital patients admitted for acute cellulitis.
A 2018 study by the Cincinnati Veterans Affairs Medical Center examined hospital readmissions, costs, mortality, and nursing home admissions of veterans who received Hospital-in-Home (HIH) services. Average per person costs were $7,792 for HIH services and $10,960 for traditional inpatient care (P
And a recent article in Forbes said that Since 2020, hospital-at-home programs have gained substantial traction as a patient-centered alternative to hospital care. Although available in the U.S. since the 1990s, these programs - delivering acute medical care in a home setting through care coordination, telehealth and remote patient monitoring (RPM) - are on the rise.
Forbes reports that with the Centers for Medicare & Medicaid Services' waiver, over 350 hospitals across the U.S. have implemented or are planning to launch HaH programs. While high initial costs and implementation challenges remain, research shows that HaH care is 32% less expensive than inpatient care. As hospitals increasingly adopt these programs, evidence continues to support HaH as an affordable, viable model for acute care delivery.
Traditional hospital care requires substantial resources to maintain inpatient beds, utilities and facility management. Operating a hospital involves constant operational costs - from electricity and water to the cleaning and upkeep of facilities. HaH programs alleviate much of this financial burden by shifting care to the home setting and minimizing the need for expensive infrastructure.
- Former Insurance Agent Arraigned in $900K Long-Term Care Fraud Schemeon December 11, 2024 at 4:52 PM
54 year old Jingjin "Kathy" Bian, who lives in Cupertino, was arraigned on felony charges of insurance fraud after a California Department of Insurance investigation revealed she allegedly received over $900,000 in undeserved long-term care insurance benefits for her and her father.
Bian, a former insurance agent, was in a car accident in August 2018, resulting in a back injury and her filing claims to enact her long-term care benefits on her life insurance policy.
The benefits were approved by her insurance company in January 2019 and she ended up receiving over $300,000 in benefits including for caregiver reimbursement.
The Department of Insurance began its investigation after her insurance company suspected fraud. Through surveillance she was observed performing activities independently, with no caregiver present, directly contradicting her claimed disabilities and reasons needing for caregiver reimbursement.
Bian was also the legal representative for her 81-year-old father, who lived with her and also had a life insurance policy with the same insurance company.
In February 2018 Bian’s father was diagnosed with Parkinson’s disease and he filed a claim to enact the long-term care benefits on his insurance policy. The claim stated he required hands on assistance and required a walker when going outside. Bian’s father’s claim application for benefits was approved by the insurance company in February 2019 and he received over $600,000 in benefits.
Surveillance observed Bian’s father performing activities independently, with no caregiver present, directly contradicting his claimed disabilities. The investigation found that Bian was listed as her father’s legal representative in all correspondence and that all of her father’s policy correspondence, care provider scheduling, and billing were handled by Bian.
Bian’s alleged actions resulting in a loss of $900,000 to the insurance company. Bian is out on bail and is scheduled to return to court on April 16, 2025. The Santa Clara County District Attorney’s Office is prosecuting this case.
- New L.C. Whistleblower Attorney Fee Law Applies to Pending Caseson December 18, 2024 at 2:05 PM
Harold Winston is "an African-American male" with "over 30 years of service" with the County of Los Angeles. Winston worked in the Department of Treasurer and Tax Collector as the supervising deputy public conservator administrator in the public administration branch.
Winston sued his employer L.A. County alleging race-based discrimination, retaliation, and failure to maintain a discrimination free environment under the California Fair Employment and Housing Act (FEHA) (Gov. Code, § 12900 et seq.) and whistleblower retaliation in violation of Labor Code section 1102.5.
While Winston’s case was pending, Labor Code section 1102.5 was amended, effective January 1, 2021, to add a provision - subdivision (j) - authorizing courts to award reasonable attorney fees to whistleblower plaintiffs who prevail against their employer under section 1102.5.
Trial began on November 17, 2021. On November 24, 2021, the jury returned a verdict on the three causes of action submitted to them. It found in favor of L.A. County and against Winston on the causes of action for retaliation under FEHA and failure to prevent discrimination/ harassment under FEHA. The jury found in Winston’s favor on his cause of action for whistleblower retaliation under section 1102.5. It awarded him damages totaling $257,000.
After the jury found in Winston’s favor on his retaliation claim under section 1102.5, Winston filed a motion for attorney fees and requested $1,854,465 as the prevailing party based on section 1102.5’s recently enacted subdivision (j).
The trial court denied the motion, ruling that the fee provision does not apply to Winston’s case because it was not in effect in 2019 when the complaint was filed and because it found no legislative intent supporting retroactive application.
The Court of Appeal reversed in the published case of Winston v. County of Los Angeles - B323392 (December 2024).
On appeal, Winston argued section 1102.5, subdivision (j) applies to his case "because [his] case was still in action at the time the provision became effective." He contends the trial court erroneously denied his motion based on "no legislative intent demonstrating retroactive application of [the statute]." The Court of Appeal agreed with Winston and reversed.
The law invoked here, section 1102.5, is "California’s general whistleblower statute." When Winston filed this case, section 1102.5 did not include a one-way fee-shifting provision "authoriz[ing] an award of attorney fees to a worker who prevails on a claim of retaliation for blowing the whistle on workplace legal violations." The California Legislature amended the law by passing Assembly Bill No. 1947, which allows discretionary recovery of reasonable attorney fees to a prevailing whistleblower plaintiff.
Effective January 1, 2021, section 1102.5, subdivision (j) provides: "The court is authorized to award reasonable attorney’s fees to a plaintiff who brings a successful action for a violation of these provisions." (§ 1102.5, subd. (j).)
Under California law, the general rule is that absent a clear, contrary indication of legislative intent, courts interpret statutes to apply prospectively. However, "the California Supreme Court and many, many Courts of Appeal have treated legislation affecting the recovery of costs, including attorney fees, as addressing a ‘procedural’ matter that is ‘prospective’ in character and thus not at odds with the general presumption against retroactivity." (USS-Posco Industries v. Case (2016) 244 Cal.App.4th 197, 217-218)
"Neither party points to a California decision directly addressing the issue of whether section 1102.5, subdivision (j) applies to cases pending at the amendment’s effective date and we have found none."
"We conclude the statute authorizes an award of attorney fees to Winston because his action was pending when section 1102.5, subdivision (j), became effective. For that reason, we reverse." - Cal/OSHA Cites City of Los Angeles Animal Services Center $563Kon December 18, 2024 at 2:05 PM
The California Division of Occupational Safety and Health (Cal/OSHA) has issued $563,250 in penalties to Harbor Animal Services Center (A department of the City of Los Angeles that provides animal services and volunteer opportunities for people who live in the city of Los Angeles) based in San Pedro, California, for failing to evaluate and correct overcrowding at their animal shelter, which resulted in animal attacks and bites on employees.
An employee was mauled on May 31, 2024, and according to Cal/OSHA it was due to the employer’s (the City of Los Angeles) willful violations of safety regulations. Kennel supervisor Leslie Corea was attacked by a pitbull mix that day after opening the dog's cage for a rescue group. According to a report by Fox 11, he dog isn't new to the the Harbor shelter and neither is Corea. She's spent 24 years at the city shelter.
Her right leg was severely damaged and she needed extensive physical therapy and unfortunately, the dog was euthanized. Workers said the attack spotlights the growing crisis of overcrowding at local shelters because of illegal breeding, COVID returns, housing restrictions and situations like this.
L.A. Animal Services acknowledged the severity of the attack and issued the following statement, "LA Animal Services has already launched an investigation into this incident. Due to the open investigation status of this incident and to protect the privacy of the staff involved, no further details are available at this time."
Cal/OSHA, found that the employer had significant safety and training lapses, which put employees of Harbor Animal Services Center in harm’s way and resulted in a serious injury to the worker, whose leg was badly mauled, requiring hospitalization.
What Cal/OSHA Chief Debra Lee said: "This incident underscores the severe consequences that arise when employers fail to take proper measures to protect their staff from preventable risks. While we cannot undo the harm caused, we can hold employers accountable. Every employee deserves a workplace that prioritizes their health and safety."
Cal/OSHA has cited Los Angeles City Animal Services operating as Harbor Animal Services Center for six violations, including one general, two willful serious, and three willful serious accident-related in nature. Cal/OSHA’s key findings of the employer’s failure to protect its employees included:
- - Overcrowding of Animals: The employer failed to evaluate and mitigate risks caused by overcrowding, which led to employee injuries from animal attacks.
- - Inadequate Training: Employees and supervisors received insufficient training in handling animals or using personal protective devices.
- - Personal Protective Equipment: Proper assessment and provision of personal protective equipment were not conducted.
- - Emergency Communication: The lack of an effective communication system delayed critical emergency response and treatment for injuries.
Representatives for the Los Angeles Animal Services Department, Mayor Karen Bass and City Councilman Tim McOsker, who represents the area where the shelter is located, did not immediately respond to a request by Fox 11 for comment. - First Pharmaceutical "Consultant" Based Opioid Criminal Case Settles for $650Mon December 17, 2024 at 3:57 PM
McKinsey & Company Inc., a global management consulting firm based in New York, has agreed to pay $650 million to resolve a criminal and civil investigation into the firm’s consulting work with opioids manufacturer Purdue Pharma L.P. The resolution pertains to McKinsey’s advice to Purdue concerning the sales and marketing of Purdue’s extended-release opioid drug, OxyContin, including a 2013 engagement in which McKinsey advised on steps to "turbocharge" sales of OxyContin.
This resolution marks the first time a management consulting firm has been held criminally responsible for advice resulting in the commission of a crime by a client and reflects the Justice Department’s ongoing efforts to hold actors accountable for their roles in the opioid crisis. The resolution is also the largest civil recovery for such conduct.
Additionally, a former McKinsey senior partner who worked on Purdue matters has been charged with obstruction of justice in federal court in Abingdon, Virginia. Martin E. Elling, 60, a U.S. citizen currently residing in Bangkok, Thailand, has been charged with one count of knowingly destroying records, documents and tangible objects with the intent to impede, obstruct and influence the investigation and proper administration of a matter within the jurisdiction of the Justice Department. Elling has agreed to plead guilty and is expected to appear in federal court in Abingdon to enter his plea and for sentencing at later dates.
As part of the government’s resolution with McKinsey, the company has entered into a five-year deferred prosecution agreement (DPA) in connection with a criminal Information filed in U.S. District Court for the Western District of Virginia against McKinsey’s U.S. subsidiary (McKinsey & Company Inc. United States. The information charges McKinsey U.S. with one felony count of knowingly destroying records, documents and tangible objects with the intent to impede, obstruct, and influence the investigation and proper administration of a matter within the jurisdiction of the Justice Department; and one misdemeanor count of knowingly and intentionally conspiring with Purdue and others to aid and abet the misbranding of prescription drugs, held for sale after shipment in interstate commerce, without valid prescriptions.
McKinsey has agreed to pay a penalty of over $231 million, a forfeiture amount of over $93 million (reflecting all money it was paid by Purdue from 2004 to 2019) and a payment of $2 million to the Virginia Medicaid Fraud Control Unit to resolve the criminal allegations. McKinsey also has entered into a civil settlement agreement in which it will pay over $323 million to resolve its liability under the False Claims Act for allegedly providing advice to Purdue Pharma L.P. that caused the submission of false and fraudulent claims to federal healthcare programs for medically unnecessary prescriptions of OxyContin, as well as allegedly failing to disclose to the U.S. Food and Drug Administration (FDA) conflicts of interest arising from McKinsey US’s concurrent work for Purdue and the FDA. This brings the total payments under the global resolution to $650 million.
Today’s filing includes a 71-page Agreed Statement of Facts, which provides a detailed account of McKinsey’s work with Purdue relating to OxyContin. As part of the resolution, McKinsey has agreed to implement a significant compliance program, including a system of policies and procedures designed to identify and assess high-risk client engagements. As part of this compliance program, McKinsey will implement new document retention procedures and training for all partners, officers and employees who provide or implement advice to clients. This compliance program is in addition to the provisions negotiated between McKinsey and the Department in a concurrent resolution with McKinsey & Company Africa that was announced on Thursday, Dec. 5.
McKinsey has also agreed that it will not do any work related to the marketing, sale, promotion or distribution of controlled substances during the five-year term of the DPA. The resolution requires McKinsey’s Managing Partner to certify, on an annual basis, the firm’s compliance with its obligations under the DPA and federal law.
"For the first time in history, the Justice Department is holding a management consulting firm and one of its senior executives criminally responsible for the sales and marketing advice it gave resulting in the commission of crime by a client," said U.S. Attorney Christopher R. Kavanaugh for the Western District of Virginia. "This ground-breaking resolution demonstrates the Justice Department’s ongoing commitment to hold accountable those companies and individuals who profited from our Nation’s opioid crisis." - Ventura County Physician to Serve 2 Years for $3M Healthcare Fraudon December 17, 2024 at 3:56 PM
A Ventura County physician who worked for two Pasadena hospices was sentenced to 24 months in federal prison for defrauding Medicare out of more than $3 million through claims for medically unnecessary hospice services.
Dr. Victor Contreras, 69, of Santa Paula, was sentenced by United States District Judge André Birotte Jr., who also ordered him to pay $3,289,889 in restitution.
Contreras pleaded guilty on July 24 to one count of health care fraud.
From July 2016 to February 2019, Contreras and co-defendant Juanita Antenor, 62, formerly of Pasadena, schemed to defraud Medicare by submitting nearly $4 million in false and fraudulent claims for hospice services submitted by two hospice companies: Arcadia Hospice Provider Inc., and Saint Mariam Hospice Inc. Antenor controlled both companies.
Medicare only covers hospice services for patients who are terminally ill, meaning that they have a life expectancy of six months or less if their illness ran its normal course.
Contreras falsely stated on claims forms that patients had terminal illnesses to make them eligible for hospice services covered by Medicare, typically adopting diagnoses provided to him by hospice employees whether or not they were true. Contreras did so even though he was not the patients’ primary care physician and had not spoken to those primary care physicians about the patients’ conditions. Medicare paid on the claims supported by Contreras’ false evaluations and certifications and recertifications of patients.
In total, approximately $3,917,946 in fraudulently claims were submitted to Medicare, of which a total of approximately $3,289,889 was paid.
According to Medical Board of California records, Contreras is a licensed physician in California, but has been on a 10 year probation with the Board since 2015 and is subject to limitations on his practice. On August 6, 2024 the Medical Board filed a Petition to Revoke his Probation. The expiration of his ten year probation is extended until there is a resolution of this Petition.
Antenor remains at large. Co-defendant Callie Black, 66, of Lancaster, who allegedly recruited patients for the hospice companies in exchange for illegal kickbacks, has pleaded not guilty and is scheduled to go to trial on March 4, 2025.
The United States Department of Health and Human Services Office of Inspector General, the FBI, and the California Department of Justice investigated this matter.
Assistant United States Attorneys Kristen A. Williams of the Major Frauds Section and Aylin Kuzucan of the General Crimes Section are prosecuting this case. - Physician Admits $3M SIBTF Fraud Naming O.C. Judge as Co-Conspiratoron December 16, 2024 at 3:30 PM
According to the California Medical Board records, Kevin Tien Do M.D.was born in Saigon, Vietnam and came to the United States in 1982, when he was 16 years old. He graduated from USC Medical School in 1991 and completed his residency in Physical Medicine and Rehabilitation at UCLA on June 30, 1995.
After about eight years following completion of his UCLA Residency, Dr. Do was convicted, on on August 15, 2003, following his plea of guilty, of violating Title 18, United States Code, sections 2 and 1347 (aiding and abetting health care fraud) in the United States District Court for the Eastern District of California, Case Number 2:02CR00338-01, entitled The United States of America v. Kevin Tien Do,
He was sentenced to 12 months in federal prison, commencing October 15, 2003, and ordered to pay an assessment of $100 and restitution of $366,031.24
From April of 1997 through December 31, 1998, he aided and abetted a billing company named "Medi-Syn" in a scheme to defraud Medi-Cal. He permitted Medi-Syn to use hisr Medi-Cal provider number to submit claims requesting payment for services purportedly rendered by him which he did not provide and which were never provided by anyone else. Do Medi-Syn opened a joint account under the name "Premier Health Providers Network" into which the Medi-Cal checks were deposited. Do provided 80 percent of these funds to Medi-Syn and kept 20 percent for himself. As a result of the scheme, Medi-Cal was defrauded out of $366,031.24.
In order to obtain leniency in the 2003 case against him, Do agreed to act as an undercover operative and to cooperate with the FBI in its investigation of Edgemont Hospital a psychiatric hospital in Los Angeles, and in a third investigation regarding podiatrist Gary Feldman and the West Pico Medical Clinic where Do worked. He participated in 43 undercover operations from December of 1998 through May of 1999. He also provided additional assistance in 2000. Respondent's cooperation led to the conviction of Dr. Feldman.
Do began serving his federal prison sentence in the 2003 case on October 15, 2003, and was officially released from custody on October 13, 2004. He remained on federal probation until October of 2007.By 2004, Do had paid in full the $366,03 1.24 restitution ordered by the criminal court.
The Physician's and Surgeon' s Certificate No. G 76640 issued to Kevin Tien Do was revoked in late 2005 after an Accusation was filed against him by the California Medical Board. However, the revocation was stayed and he was placed on probation for ten years under several terms and conditions.
On October 26, 2016 the Medical Board concluded that Dr. Do had "completed probation in Case No. 06-2002-136106, is entitled to full restoration of the Physician's and Surgeon's Certificate." It was therefore ordered that his medical license "be fully restored to renewed/current status and free of probation requirements, effective September 22, 2016."
Now, more than two decades after his 2003 conviction,,Kevin Tien Do, M.D., who is now 59 years old and lives in Pasadena, worked for an Inland Empire medical company, and has now agreed to plead guilty - in new case - to conspiring to defraud California’s workers’ compensation fund of millions of dollars by continuing to work on workers’ compensation matters after being suspended due to a prior health care fraud conviction. He agreed to plead guilty to one count of conspiracy to commit mail fraud and one count of subscribing to a false tax return. .
Beginning in 2016, Do began to work for Liberty Medical Group Inc., a Rancho Cucamonga-based medical company, for which he would draft SIBTF-related medical reports that Liberty would then bill to the California SIBTF program. In October 2018, California suspended Do from participating in California’s workers’ compensation program, which included the SIBTF, because he had previously been convicted of federal health care fraud in 2003. Despite his suspension, Do continued to work for Liberty on SIBTF-related workers’ compensation matters.
To conceal that Do was unlawfully continuing to participate in the workers’ compensation SIBTF program after his suspension, Liberty’s owner came up with a plan. That plan was that Do would continue to author the SIBTF-related reports, which Liberty would then continue to mail to the California SIBTF for payment. rather than listing Do’s name on the billing forms and the attached medical reports mailed to the California SIBTF, like they had had done before Do’s suspension, Liberty instead fraudulently listed other doctors’ names on the billing forms and attached medical reports, even though Do had drafted and compiled the reports.
Do admitted that Liberty was paid more than $3 million by California SIBTF for such reports that Liberty mailed to the California SIBTF for payment after Do’s October 2018 suspension.
Do’s plea agreement also details that Liberty’s owner edited Do’s medical reports, even though that co-conspirator was not a doctor or other licensed medical professional.
Under California law, shareholders/owners of a medical corporation must be licensed in the practice of medicine or other related medical fields, such as a psychologist, registered nurse, or licensed physician assistant. In his plea agreement, Do admitted that real owner of Liberty and Do’s co-conspirator was another person who was not a doctor or other medical professional, but rather, was a California attorney then employed as a prosecutor for the Orange County District Attorney’s Office, and who later became an Orange County Superior Court judge during the conspiracy.
According to the Orange County Register, the Orange County Superior Court Judge named in the plea agreement is Israel Claustro, Claustro has served as a Senior Deputy District Attorney and an Assistant Head of Court at the Orange County District Attorney’s Office since 2020, where he has served in several roles since 2002. He served as a Law Clerk at the Orange County District Attorney’s Office from 2001 to 2002. Claustro earned a Juris Doctor degree from the Western State College of Law.
And MSN reports that the plea agreement with Do refers to the judge only as "co-conspirator #1," but an investigation by the Southern California News Group has identified the jurist as Israel Claustro, who was appointed to the bench in 2022..
A reporter’s request for comment from Claustro was relayed to him through Orange County Superior Court officials. In response, court spokesperson Kostas Kalaitzidis said, "The court cannot discuss any case pending before any court, as ethical rules prohibit any such discussion."
Officials with the U.S. Attorney’s Office declined to comment. Additionally, the state Commission on Judicial Performance would not disclose whether it is investigating Claustro,
That true owner who was Do’s co-conspirator not only was a signatory on Liberty’s bank account, but also issued and signed Liberty’s checks to Do and others. The plea agreement specifies that much of the more than $3 million that the SIBTF paid Liberty during the years following Do’s suspension then flowed to another company controlled by Liberty’s owner and his wife, which totaled to more than $1.5 million.
Do also admitted that he failed to accurately report to the IRS all the money he had been paid by Liberty. Do admitted that on his 2021 tax return, he failed to report approximately $66,227 of the income that Liberty paid him.
Once Do enters his guilty plea, he will face a statutory maximum sentence of 20 years in federal prison for the mail fraud count and up to three years in federal prison for the tax fraud count.
The FBI, IRS Criminal Investigation, and the California Department of Insurance are investigating this matter. Assistant United States Attorneys Charles E. Pell of the Orange County Office and Ryan J. Waters of the Asset Forfeiture and Recovery Section are prosecuting the case. - Cal/OSHA Issues $276,425 Citation for First Serious Willful Heat Violationson December 16, 2024 at 3:30 PM
The California Division of Occupational Safety and Health (Cal/OSHA) has issued $276,425 in penalties to Parkwood Landscape Maintenance, based in Van Nuys, California, for willfully violating state heat illness prevention regulations. Cal/OSHA, a division of the Department of Industrial Relations (DIR), determined that the employer deliberately and knowingly failed to follow heat protection requirements, marking its first willful heat violation citation.
This investigation began on June 6, 2024, when the Cal/OSHA Van Nuys District Office received a complaint about employees working outdoors without access to water or heat illness training provided by their employer.
The company failed to provide employees with required protections, such as access to water, shaded areas, and proper training on preventing heat-related illnesses. Additionally, they lacked written procedures for addressing work conditions in high temperatures, which often exceeded 95 degrees Fahrenheit. Employees also had to purchase their own drinking water, a breach of California's heat illness prevention standard.
This citation follows a previous violation in 2022, in which the company was cited under Title 8 Section 3395(i) for failing to meet heat safety requirements. Despite being provided with model heat illness prevention procedures, Parkwood Landscape Maintenance did not implement the necessary preventive measures to ensure worker safety.
Cal/OSHA investigates heat-related incidents and complaints of hazards at both indoor and outdoor worksites in industries such as agriculture, landscaping, and construction among others. These investigations ensure compliance with the heat illness prevention standard, the injury and illness prevention standard, and indoor heat illness protections.
Cal/OSHA’s Heat Illness Prevention special emphasis program includes enforcement of the heat regulation as well as multilingual outreach and training programs for California’s employers and workers. Details on heat illness prevention requirements and training materials are posted on Cal/OSHA’s Heat Illness Prevention web page and the 99calor.org informational website. A Heat Illness Prevention online tool is also available on Cal/OSHA’s website.
Cal/OSHA helps protect workers from safety and health hazards on the job in almost every workplace in California. Employers who have questions or need assistance with workplace health and safety programs can call Cal/OSHA’s Consultation Services Branch at 800-963-9424.
Employers with Questions on Requirements May Contact: InfoCons@dir.ca.gov, or call your local Cal/OSHA Consultation Office. - CEO of Large Vocational Center Faces 23 Counts of SJDB Insurance Fraudon December 12, 2024 at 3:49 PM
CEO of one of California’s largest vocational return to work counseling centers, Hazel Ortega, 53, of La Habra, appeared in court after being charged with 23 felony counts including insurance fraud, theft, and forgery.
A Department of Insurance investigation found Ortega allegedly defrauded at least four insurance companies by forging documents on behalf of unknowing injured workers.
The Department’s investigation began after receiving multiple referrals from insurance companies alleging Ortega, owner of Ortega Counseling Center, a motivational speaker, and author of "From Bounced Checks to Private Jets," was referring injured workers to schools which were not approved and not eligible to receive the voucher funds through the Supplemental Job Displacement Benefit (SJDB) program, which provides an allowance of $6,000 to $10,000 for educational retraining or skill enhancement for qualifying injured workers to provide them a marketable skill to re-enter the workforce after a workplace injury. This benefit is provided as a voucher that can be used at state-approved or accredited schools.
The Department of Insurance is urging any injured workers who believe they may have been victimized by Ortega or the Ortega Counseling Center to contact Detective Kuhlman or Sergeant Jimenez at the Department of Insurance by phone at (909) 919-2200.
Through the course of the investigation, detectives located and interviewed injured workers who had SJDB and Vocational Return to Work counseling invoices submitted to insurance companies by Ortega and discovered Ortega was pressuring and coercing injured workers to attend these unapproved schools and not providing them with any other additional choices.
Ortega also submitted forms to insurance companies on the injured workers' behalf which they had not seen or reviewed. Multiple injured workers were shown documents submitted on their behalf which they had never seen and stated their signature had been forged. In one instance, detectives interviewed an injured worker for whom Ortega submitted an invoice to an insurance company alleging she provided nearly five hours of counseling services. When the injured worker was contacted, they confirmed they had never heard of Ortega nor met with her for counseling services.
Ortega was arraigned and charged previously in Los Angeles County for her participation in another nearly $1 million-dollar insurance fraud scheme. It is alleged Ortega and other vocational counselors received nearly $500,000 in illegal kick back payments for referring students to a fraudulent school in the Los Angeles area.
This case is being prosecuted by the Los Angeles County District Attorney’s Office. - Oroville Hospital Resolves Kickbacks and False Billing Claim for $10.25Mon December 12, 2024 at 3:49 PM
Oroville Hospital was founded in 1962 and is a 153-bed acute care facility that offers a variety of services, including inpatient and outpatient care, a radiology department, and multiple physician practices. It's a Level 3 Trauma Center, which means its Emergency Service Department treats all but the most severe neurological, pediatric, and burn patients. It is owned by OroHealth Corporation, a private, non-profit organization. OroHealth Corporation has two subsidiaries: Oroville Hospital, an acute care inpatient and outpatient facility, and OroLake Corporation, a regional sales and service organization. .
Oroville Hospital has agreed to pay $10.25 million to the United States and the State of California to resolve allegations that it violated the False Claims Act and the Anti-Kickback Statute, U.S. Attorney Phillip A. Talbert announced today.
The settlement resolves allegations that Oroville Hospital engaged in an illegal kickback and physician self-referral scheme by paying kickbacks to physicians for patients they admitted to the hospital, and that it knowingly submitted false claims to Medicare and Medi-Cal for medically unnecessary hospital admissions and claims that included false diagnosis codes. Oroville Hospital will pay $9,518,954 to the federal government and $731,046 to the State of California.
The settlement resolves allegations that, to increase hospital admissions, Oroville Hospital illegally paid kickbacks to its physicians who were responsible for deciding whether individuals should be admitted as inpatients. These physicians allegedly received a bonus based on how many patients they admitted, according to the settlement agreement.
The settlement also resolves allegations that Oroville Hospital admitted patients as inpatients when it knew inpatient care was not medically necessary. Oroville Hospital then submitted claims to Medicare and Medicaid for inpatient care, which is more expensive. Oroville Hospital further allegedly submitted claims to Medicare and Medicaid that included false diagnosis codes for systemic inflammatory response syndrome (SIRS), resulting in excessive reimbursement to the Hospital.
In connection with the settlement, Oroville Hospital entered into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) that requires, among other requirements, the implementation of a risk assessment and internal review process designed to identify and address evolving compliance risks. The Corporate Integrity Agreement also requires an independent review organization to, among other requirements, annually assess both the medical necessity and appropriateness of select claims billed to Medicare and policies and systems to track arrangements with some referral sources.
The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Cecilia Guardiola. Under those provisions, 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 ex rel. Cecilia Guardiola v. Oroville Hosp., Case No. 2:20-CV-1558 (E.D. Cal.). As part of the settlement announced today, Ms. Guardiola will receive approximately $1.8 million.
"Physicians should make decisions based the best interests of their patients, not their own personal financial interests," said U.S. Attorney Talbert. "Hospitals engaging in kickback schemes betray the trust placed in them by their communities and distort care decisions that should be untainted by illegal kickbacks. This settlement demonstrates my office’s commitment to preserving the integrity of public healthcare programs and ensuring that the well-being of patients remains paramount."
"Improperly billing federal health care programs depletes valuable government resources used to provide medical care to millions of Americans," said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. "We will continue to advocate for the appropriate use of Medicare and Medicaid funds, and we will pursue health care providers who defraud taxpayers by knowingly submitting false claims."
Assistant U.S. Attorney Steve Tennyson handled the case for the U.S. Attorney’s Office. The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the Eastern District of California, the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, the Department of Health and Human Services, Office of the Inspector General, and the California Department of Justice, Division of Medi-Cal Fraud and Elder Abuse.
The claims resolved by this settlement are allegations only, and there has been no determination of liability. - Kaiser Permanente Quadrupled Hospital at Home Care in 2024on December 11, 2024 at 4:52 PM
Kaiser Permanente's hospital-at-home program (HaH) has grown significantly in the past year, nearly quadrupling its capacity. The program's average daily census has increased from 22.5 to 80.6 across all regions. Some of the areas where Kaiser Permanente offers Care at Home services include: Northern California, Southern California, Georgia, Mid-Atlantic states, Northwest, and Washington state.
Kaiser Permanente has been developing infrastructure to support the program's growth, and building confidence in the program among patients and staff. The program is also encouraging more admissions from the emergency department and inpatients.
Research from Kaiser Permanente published last year reveals that its hospital-at-home program was scaled successfully, creating hospital capacity; however, the program’s care quality as it was being scaled could not be determined. Published in The American Journal of Managed Care, the study aimed to assess the feasibility of scaling a hospital-at-home program within an integrated healthcare delivery system.
Such programs are well established in England, Canada, Israel, and other countries where payment policies encourage - or at least do not discourage - the provision of health care services in less costly venues.
In Victoria, Australia, for example, every metropolitan and regional hospital has a hospital at home program, and roughly 6 percent of all hospital bed-days are provided that way. For specific conditions, the use of at-home care is significantly greater: nearly 60 percent of all patients with deep venous thrombosis (DVT) were treated at home in 2008, as were 25 percent of all hospital patients admitted for acute cellulitis.
A 2018 study by the Cincinnati Veterans Affairs Medical Center examined hospital readmissions, costs, mortality, and nursing home admissions of veterans who received Hospital-in-Home (HIH) services. Average per person costs were $7,792 for HIH services and $10,960 for traditional inpatient care (P
And a recent article in Forbes said that Since 2020, hospital-at-home programs have gained substantial traction as a patient-centered alternative to hospital care. Although available in the U.S. since the 1990s, these programs - delivering acute medical care in a home setting through care coordination, telehealth and remote patient monitoring (RPM) - are on the rise.
Forbes reports that with the Centers for Medicare & Medicaid Services' waiver, over 350 hospitals across the U.S. have implemented or are planning to launch HaH programs. While high initial costs and implementation challenges remain, research shows that HaH care is 32% less expensive than inpatient care. As hospitals increasingly adopt these programs, evidence continues to support HaH as an affordable, viable model for acute care delivery.
Traditional hospital care requires substantial resources to maintain inpatient beds, utilities and facility management. Operating a hospital involves constant operational costs - from electricity and water to the cleaning and upkeep of facilities. HaH programs alleviate much of this financial burden by shifting care to the home setting and minimizing the need for expensive infrastructure. - Former Insurance Agent Arraigned in $900K Long-Term Care Fraud Schemeon December 11, 2024 at 4:52 PM
54 year old Jingjin "Kathy" Bian, who lives in Cupertino, was arraigned on felony charges of insurance fraud after a California Department of Insurance investigation revealed she allegedly received over $900,000 in undeserved long-term care insurance benefits for her and her father.
Bian, a former insurance agent, was in a car accident in August 2018, resulting in a back injury and her filing claims to enact her long-term care benefits on her life insurance policy.
The benefits were approved by her insurance company in January 2019 and she ended up receiving over $300,000 in benefits including for caregiver reimbursement.
The Department of Insurance began its investigation after her insurance company suspected fraud. Through surveillance she was observed performing activities independently, with no caregiver present, directly contradicting her claimed disabilities and reasons needing for caregiver reimbursement.
Bian was also the legal representative for her 81-year-old father, who lived with her and also had a life insurance policy with the same insurance company.
In February 2018 Bian’s father was diagnosed with Parkinson’s disease and he filed a claim to enact the long-term care benefits on his insurance policy. The claim stated he required hands on assistance and required a walker when going outside. Bian’s father’s claim application for benefits was approved by the insurance company in February 2019 and he received over $600,000 in benefits.
Surveillance observed Bian’s father performing activities independently, with no caregiver present, directly contradicting his claimed disabilities. The investigation found that Bian was listed as her father’s legal representative in all correspondence and that all of her father’s policy correspondence, care provider scheduling, and billing were handled by Bian.
Bian’s alleged actions resulting in a loss of $900,000 to the insurance company. Bian is out on bail and is scheduled to return to court on April 16, 2025. The Santa Clara County District Attorney’s Office is prosecuting this case.