- Fresno Health System to Pay $31.5 M to Resolve Kickback Caseon May 15, 2025 at 10:26 AM
Community Health System and its affiliate Physician Network Advantage Inc. have agreed to pay $31.5 million to the United States to resolve allegations that they violated the False Claims Act based on financial benefits provided to referring physicians. Community Health System operates in Fresno County and includes hospitals Community Regional Medical Center and Clovis Community Medical Center.
The civil settlement resolves allegations that Community Health System and Physician Network Advantage Inc. (PNA) provided several types of extravagant benefits to induce physicians in the Fresno area to refer their patients to Community facilities for medical services, in violation of the False Claims Act. PNA is a health care technology business formed and funded by Community to support Fresno-area physicians’ adoption of the electronic health records platform used by Community. The United States contends that PNA also played a key role in securing business for Community by unlawful means. In a custom-built lounge located on premises at PNA’s offices, known as HQ2, PNA provided expensive wine, liquor, cigars, and meals to referring physicians, with the knowledge and funding of Community.
The settlement also resolves allegations that Community and PNA provided financial subsidies for electronic health records technology and equipment used by certain physicians in their private offices in return for the referral of governmental health care program patients to Community. Further, the settlement resolves allegations that Community paid bonuses to certain physicians ostensibly for participation in clinical integration activities, when the real purpose of the bonuses was to reward referrals.
The United States contends that these financial benefits violated the federal Anti-Kickback Statute, resulting in false claims for the medical services referred by physicians receiving the benefits, that were submitted to governmental health care programs. The United States also contends that the conduct described above created financial relationships with referring physicians under the Physician Self-Referral Law (known as the “Stark Law”). The Stark Law seeks to safeguard the integrity of the Medicare program by prohibiting a hospital from billing for certain services referred by physicians with whom the hospital has a financial relationship, unless that relationship satisfies one of the law’s statutory or regulatory exceptions, which the United States contends were not met.
In connection with the settlement, Community entered into a five-year Corporate Integrity Agreement with HHS-OIG that requires, among other conditions, 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 annually assess the policies and systems to track arrangements with some referral sources.
The settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by relator Michael Terpening. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery from that action. The qui tam case is captioned United States ex rel. Terpening v. Fresno Community Hospital and Medical Center, et al., 1:19-CV-01699 (E.D. Cal.). As part of the settlement announced today, Mr. Terpening will receive approximately $5 million.
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 and HHS-OIG with assistance from the Federal Bureau of Investigation and the U.S. Postal Service Office of Inspector General. Assistant U.S. Attorney David Thiess handled the case for the U.S. Attorney’s Office.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
- Ventura County Unlicensed Physician Re-Arrested for Practicingon May 15, 2025 at 10:26 AM
The Ventura County District Attorney Erik Nasarenko announced that Nitun “Nate” Dayalghai Ahir (DOB 06/17/81), of Thousand Oaks, was arraigned for practicing medicine without a license, in violation of Business and Professions Code section 2052.
Ahir was out on bail in case number 2024030574, in which he is alleged to have practiced medicine without a license and represented himself as a doctor at Regen Spine & Nerve, in Ventura, when the District Attorney’s Office received complaints that Ahir was continuing to practice medicine without a license.
In his new case, Ahir is alleged to have unlawfully provided medical services to victims only days after being arraigned in case 2024030574. He is further charged with using the term “Doctor” and the prefix “Dr.” to imply he is a licensed medical professional when he is not. Judge David Hirsch explicitly made a condition of Ahir’s bail that he may not practice medicine, solicit medical business, attempt to treat patients, or receive compensation for any form of medical work, or he faces remand into custody.
According to the California Department of Consumer Affairs, Ahir is not licensed in any capacity – as a doctor, surgeon, nurse, nurse practitioner, chiropractor, or otherwise – in the State of California, nor is he a licensed physician in any other state.
The District Attorney requests that any member of the public who Ahir has attempted to treat contact Investigator Eric Jensen at Eric.Jensen@ventura.org or by calling 805-662-1739. The public is urged to review the licensure status of any medical professionals they are considering seeing by visiting the Department of Consumer Affairs' professional
This case was investigated by the Department of Consumer Affairs, Health Quality Investigations Unit. Both of Ahir’s cases are set for early disposition conference on June 25, 2025, at 1:30 p.m. in Courtroom 12 of the Ventura County Superior Court. He remains out of custody on $50,000 bail.
- Jury Trial Rights Attach to Claim for Unruh Civil Rights Act Damageson May 14, 2025 at 1:43 PM
Plaintiff Theresa Brooke is a woman with disabilities who uses a wheelchair. Along with her husband, she frequents California hotels to test their compliance with disability access laws. On one such testing trip in August 2023, Brooke and her husband visited the Ramada by Wyndham Burbank Airport, a hotel in Burbank, California. When they arrived, however, architectural barriers allegedly deterred Brooke from entering.
Brooke sued the hotel’s owner, Defendant Tsay JBR, LLC, asserting violations of Title III of the Americans with Disabilities Act (ADA), 42 U.S.C. § 12181 et seq., and California’s Unruh Civil Rights Act, Cal. Civ. Code § 51 et seq. (West 2025).
The California The Unruh Act similarly creates a private right of action for people with disabilities, along with other enumerated groups, who are denied “full and equal” access to California businesses. See Cal. Civ. Code § 51(b). As part of those protections, the Unruh Act provides that any violation of the ADA is also a violation of its provisions. See id. § 51(f).
Although private parties can obtain only injunctive relief under the ADA, they can recover actual and statutory damages under the Unruh Act. Id. § 52(a); see Arroyo v. Rosas, 19 F.4th 1202, 1206 (9th Cir. 2021) (explaining that the Unruh Act effectively creates a state-law “damages remedy that is not available under the ADA”).
Accordingly, Brooke sought injunctive relief under the ADA, statutory damages under the Unruh Act, and declaratory relief and attorney’s fees under both.
The district court granted in part and denied in part a motion for summary judgment brought by Brooke. The court concluded that Tsay JBR had violated the ADA because the hotel’s passenger loading zone - an area for vehicle pickup and drop-off - lacked an access aisle for disabled guests. As a remedy, the court ordered Tsay JBR to paint a blue access aisle in front of the loading zone.
Because Brooke established an ADA violation, she also necessarily established an Unruh Act violation. But not all Unruh Act violations automatically entitle a plaintiff to statutory damages. When a violation is construction-related, the Unruh Act only permits statutory damages if the plaintiff personally encountered the violation or was deterred by it. Id. § 55.56(a)–(b). The district court determined that Brooke had not established that fact on summary judgment.
With only that factual issue left, the court converted the scheduled jury trial to a bench trial, concluding that the jury- trial right did not attach to claims for statutory damages under section 52(a) of the Unruh Act.
Tsay JBR petitioned the Court of Appeals for the 9th Circuit for a writ of mandamus, asking it to direct the district court to conduct a jury trial on the issue of Brooke’s entitlement to statutory damages. The panel held that the Seventh Amendment entitles parties in federal court to a jury trial on a claim for statutory damages under § 52(a) of the Unruh Act in the published case of Tsay JBR LLC v United States District Court for the Central District of California - 24-5234 (May 2025).
The Seventh Amendment to the United States Constitution provides that in “[s]uits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved.” In this case the Court of Appeals considered whether a defendant in an action for statutory damages under section 52(a) of California’s Unruh Civil Rights Act is entitled to a jury trial.
"So long as a case involves a legal claim, the right to a jury trial attaches, even if the case also seeks equitable relief. See Curtis v. Loether, 415 U.S. 189, 196 n.11 (1974) (“The [jury-trial] right cannot be abridged by characterizing the legal claim as ‘incidental’ to the equitable relief sought.”); Dairy Queen, Inc. v. Wood, 369 U.S. 469, 473 n.8 (1962)."
"The statutory damages in section 52(a) of the Unruh Act are thus a legal remedy. Because both the historical analog and the nature of the remedy reveal that Brooke’s claim is legal, the Court of Appeals held that the Seventh Amendment entitles parties in federal court to a jury trial on a claim for statutory damages under section 52(a) of the Unruh Act."
- NCCI Report: Workers’ Comp System Remains Strongon May 14, 2025 at 1:43 PM
The performance of the workers compensation system remains strong according to the 2024 metrics that the National Council on Compensation Insurance (NCCI) just released.
Workers compensation premium decreased 3% in 2024. Private carriers produced their 11th consecutive year of underwriting profitability with a Calendar Year 2024 combined ratio of 86. It is the 8th consecutive year with a combined ratio below 90 for the workers compensation insurance market.
"Workers compensation is a product where compassion and analytics work hand-in- hand - protecting and caring for employees while also leveraging data to make the entire system more effective and sustainable," said NCCI President and CEO Tracy Ryan.
NCCI’s State of the Line Report and the State of the Line Guide include key insights:
- - Workers compensation net written premium decreased 3% in 2024. There are two contributing factors: payroll and rate on payroll, mostly represented by the loss cost. Payroll growth is slowing, reverting back to the long-term average. Loss costs continue to decline, but more moderately.
- - The Calendar Year 2024 combined ratio for workers compensation is 86%, a sign of underwriting strength for the system. Workers compensation (WC) has one of the lowest combined ratios among property/casualty. In fact, 2024 was the 8th consecutive year with a combined ratio under 90% and the 11th consecutive year of underwriting gains.
- - Workers compensation’s Accident Year 2024 combined ratio is 99% with prior years continuing to experience downward reserve development.
- - NCCI estimates a redundant industry reserve position of $16 billion. That’s a decrease from the $18B estimated redundancy in 2023. While still a strong financial position, this is the first year with a slight reduction in the estimated redundancy.
- - Lost-time claim frequency declined by 5% in 2024. The latest year’s frequency decline outpaces the long-term average, although not to the extent of the prior year. More than half of this decrease is due to the reduction in number of claims.
- - Severity grew in 2024 with increases of 6% for medical claim severity and 6% for indemnity claim severity. Indemnity severity grew faster than wages, and medical severity grew faster than the Workers Compensation Weighted Medical Price Index (WCWMI). For medical, price is only one part of the story. The other part is utilization, and this year utilization contributes to a majority of the increase.
"The workers compensation system continues an era of exceptional performance with strong results and a financially healthy line," said Donna Glenn, FCAS, MAAA, Chief Actuary, NCCI. "And while there are early indications of potential headwinds on the horizon, the industry is positioned well to navigate these challenges."
- Six Month Delay in Requesting Arbitration Constitutes "Waiver"on May 13, 2025 at 4:10 PM
Stephen Hofer is a licensed attorney who founded Aerlex Law Group (the Group), which specializes in aviation law. In 2008, Hofer was the sole partner of the Group and hired Vicky Boladian as a part-time contract attorney. Hofer and Boladian dispute whether their professional relationship became a romantic relationship between 2011 and 2017.
In 2013, Hofer and Boladian formed Aerlex Tax Services, LLC (the tax LLC), which would provide “tax-related services” to the Group’s clients and “others within the aviation industry.” Hofer had a 55 percent equity interest in the tax LLC; Boladian, a 45 percent interest. In 2017 and 2018, Hofer and Boladian had a falling out, which resulted in litigation. In September 2020, they agreed to settle the pending litigation by executing three agreements: 1) Settlement Agreement, 2) Amended and Restated Operating Agreement for the tax LLC and 3) Amended and Restated Buy-Sell Agreement of the tax LLC. These agreements contained provisions to arbitrate disputes.
In March 2023, Boladian asked Hofer to change the business form of the tax LLC to an LLP to avoid the potential of having a limited liability company engaged in the unauthorized practice of law. In August 2023, Hofer and Boladian dissolved the tax LLC and shifted its assets to Aerlex Tax Services, LLP (the tax LLP)—with the same 55/45 percent split of ownership. Two weeks later, Boladian formed the Boladian Aviation Law Group, APC (BALG). She then withdrew from the tax LLP, removing what she represented to be 45 percent of the physical office furniture and nearly all of the tax LLP’s clients.
On September 19, 2023, Hofer sent Boladian a letter exploring a possible settlement before “commencing formal litigation” and asserting his “free[dom] to seek a judicial resolution” of their disputes. The parties discussed mediation, but could not agree on a mediator.
On October 16, 2023, Hofer, the Group, the tax LLC and the tax LLP (collectively, the Hofer plaintiffs) filed a lawsuit against Boladian and BALG. The Hofer plaintiffs alleged 13 causes of action and sought compensatory damages, injunctive and equitable relief, treble damages, punitive damages, and attorney fees. Although Hofer had, prior to filing the complaint, “agree[d] to file in arbitration” if Boladian consented to BALG participating in arbitration, the Hofer plaintiffs in the complaint nowhere mentioned arbitration under any of the three agreements and did not pray for an order compelling arbitration.
On October 31, 2023, the Hofer plaintiffs applied ex parte for a temporary restraining order (TRO) seeking to prevent Boladian and BALG from performing any work for the clients of the tax LLP or the Group, from using any of the tax LLP’s employees, and from removing or using any tangible property or data taken from the tax LLP. Nowhere in the application did they mention arbitration under any of the agreements. The trial court denied the application
On November 16, 2023, the Hofer plaintiffs moved for a preliminary injunction, trying to remedy the defects with their earlier TRO application. Once again, the Hofer plaintiffs argued their lawsuit had merit and nowhere mentioned arbitration.
In the midst of these motions, the Hofer plaintiffs inquired whether Boladian and BALG would “be seeking to move this case into arbitration”; counsel responded that they had “no plans” to do so and this communication shed no light on the Hofer plaintiffs’ intent to do so.
On December 8, 2024 (while the Hofer plaintiffs’ motion for a preliminary injunction was still pending), Boladian and BALG demurred to nine of the 13 causes of action. On January 29, 2024, the Hofer plaintiffs propounded a total of 734 discovery requests to Boladian and BALG. The Hofer plaintiffs also subpoenaed a number of third- party witnesses for depositions in February 2024. They also noticed the deposition of Boladian for March 2024.
In anticipation of the case management conference, the Hofer plaintiffs on March 14, 2024, filed a case management statement. In some respects, the Hofer plaintiffs’ case management statement acknowledged the possibility arbitrating the dispute. The Hofer plaintiffs also posted their jury fees.
On April 23, 2024, Boladian filed a cross-complaint against Hofer and the Group, alleging five causes of action. On April 26, 2024—more than six months after filing their complaint and more than four months after the denial of the preliminary injunction, but just three days after the filing of the cross-complaint - the Hofer plaintiffs filed a motion to compel arbitration, invoking the arbitration clauses in the settlement agreement, amended operating agreement, and amended buy-sell agreement.
The trial court denied the motion to arbitrate ruling that the Hofer plaintiffs had waived their right to compel arbitration. Applying the waiver standard articulated in St. Agnes Medical Center v. PacifiCare of California (2003) 31 Cal.4th 1187, the court found “that [the Hofer plaintiffs] waived the right to arbitrate by filing suit in this court and substantially and vigorously litigating it for over seven months,” concluding that this conduct was “fundamentally incompatible with the expediency, efficiency, and cost- effectiveness associated with utilizing arbitration” and that this conduct “prejudiced” Boladian and BALG.
The Court of Appeal affirmed the trial court's order in the published case of Hofer v. Boladian CA2/5 - B339542 (May 2025).
Under the California Arbitration Act (Code Civ. Proc., § 1280 et seq.) (the Act), a party with a contractual “right to compel arbitration” of a dispute may “waive[]” that right. (§ 1281.2, subd. (a).) In Quach v. California Commerce Club, Inc. (2024) 16 Cal.5th 562 (Quach), - decided a month after the trial court’s ruling - the Supreme Court overruled the arbitration-specific definition of waiver embraced in St. Agnes Medical Center v. PacifiCare of California (2003) 31 Cal.4th 1187 (St. Agnes) in favor of the “generally applicable” definition of waiver. (Quach, at p. 578.)
St. Agnes’s arbitration-specific definition of waiver called upon trial courts to evaluate six different factors - namely, “‘“(1) whether the party’s actions are inconsistent with the right to arbitrate; (2) whether ‘the litigation machinery has been substantially invoked’ and the parties ‘were well into preparation of a lawsuit’ before the party notified the opposing party of an intent to arbitrate; (3) whether a party either requested arbitration enforcement close to the trial date or delayed for a long period before seeking a stay; (4) whether a defendant seeking arbitration filed a counterclaim without asking for a stay of the proceedings; (5) ‘whether important intervening steps [e.g., taking advantage of judicial discovery procedures not available in arbitration] had taken place’; and (6) whether the delay ‘affected, misled or prejudiced’ the opposing party.”’” (Id. at p. 1196.)
"Quach applies retroactively to this direct appeal." Quach held that a waiver occurs under the Act if, by clear and convincing evidence, it is shown that a party has “intentionally relinquished or abandoned” its known right to compel arbitration. (Id. at pp. 569, 584.)
"In this case, the litigants seeking to compel arbitration initiated this lawsuit by filing a complaint in court and, while in the judicial forum, sought two forms of preliminary injunctive relief, opposed a demurrer, propounded more than 700 discovery requests, demanded a jury trial in their case management conference statement and represented they would be litigating substantive motions, and posted jury fees. It was not until the opposing party filed a cross-complaint that the litigants filed the motion to compel arbitration - more than six months into the litigation in court."
The litigants’ conduct in this case constitute a waiver under Quach.
- AI Outperforms Radiologists' Detection of Breast Cancerson May 13, 2025 at 4:10 PM
A new study - "Mammographic Classification of Interval Breast Cancers and Artificial Intelligence Performance" - conducted at the University of California, Los Angeles (UCLA) and published in in the Journal of the National Cancer Institute, investigates interval breast cancers (IBCs) - cancers diagnosed within 12 months after a negative screening mammogram - in a U.S.-based annual screening program.
The research aimed to classify IBCs based on their mammographic visibility and evaluate the performance of an artificial intelligence (AI) tool in detecting these cancers, particularly in a setting that uses both digital mammography (DM) and digital breast tomosynthesis (DBT).
The study analyzed 184,935 screening mammograms (65% DM, 35% DBT) from 49,244 women screened between 2010 and 2019 at a U.S. tertiary care academic center participating in the Athena Breast Health Network. From this cohort, 148 IBCs were identified in 148 women (mean age 61 ± 12 years), defined as ductal carcinoma in situ (DCIS) or invasive carcinomas diagnosed within 12 months of a negative mammogram (BI-RADS 1 or 2).
Eight fellowship-trained breast radiologists, with 3–24 years of experience, retrospectively classified these IBCs into six categories adapted from European guidelines: missed-reading error (visible but missed), minimal signs-actionable (subtle signs potentially detectable), minimal signs-non-actionable (subtle signs not reasonably detectable), true interval (not present at screening), occult (not visible on mammography but detectable by other modalities), and missed-technical error (missed due to technical issues like positioning).
A deep-learning AI tool (Transpara v1.7.1, ScreenPoint Medical) assigned risk scores (1–10) to 131 of the 148 negative index mammograms (17 were excluded due to breast implants or file conversion issues). Exams scoring ≥8 were considered "flagged" for elevated risk. Radiologists assessed whether AI markings accurately localized the IBC site, comparing performance across IBC types and correlating with patient and tumor characteristics.
The AI tool flagged 76% of the 131 scored mammograms, with the highest flagging rates for missed-reading errors (90%), minimal signs-actionable (89%), and minimal signs-non-actionable (72%). These mammographically visible types also received higher mean AI scores (9.5, 8.9, and 8.3, respectively) compared to non-visible types like true interval (7.3) and occult (7.9). AI accurately localized the cancer site in 47% of flagged exams, with the highest accuracy for missed-reading errors (68%) and minimal signs-actionable (62%), but lower for occult (22%) and missed-technical errors (0%). Overall, AI flagged 56% of mammographically visible IBCs versus 20% of non-visible ones, suggesting a potential 30% reduction in IBCs if AI-supported detection were implemented.
The study highlights the potential of AI to enhance the detection of mammographically visible IBCs, particularly those missed or with subtle signs, in a U.S. annual screening program using both DM and DBT. Unlike European studies, the lower rate of true interval cancers (6%) underscores the benefit of annual screening in reducing IBCs. However, AI’s ability to flag occult and true interval cancers, despite lower localization accuracy, raises questions about its predictive value and clinical utility, as radiologists may struggle to act on flagged exams without visible abnormalities.
Limitations include the retrospective design, small sample sizes for some IBC subtypes, and the use of a single AI vendor, which may limit generalizability. The mix of DM and DBT reflects real-world practice but complicates comparisons. Selection bias from the Athena study cohort and technical issues with unscored exams are additional constraints. Importantly, the study does not confirm whether AI-flagged exams would lead to earlier detection in practice, as radiologist recall decisions remain uncertain.
The study was supported by the National Institutes of Health, the Agency for Healthcare Research and Quality, and Early Diagnostics Inc., with no reported conflicts of interest. The data are available upon request from the corresponding author, Tiffany T. Yu, MD.
- DOI For Coverage Mandatory Arbitration is Defined by LC 5412on May 12, 2025 at 1:21 PM
George Zeber filed a workers’ compensation claim for cumulative injury sustained during his employment with the New York Yankees from 1968 through 1978. Whether the New York Yankees had workers’ compensation coverage during this time was disputed by Travelers Indemnity Company.
After a three day trial, The WCJ found Zeber, while employed from June 1, 1968 through September 1, 1978 with the New York Yankees, sustained an injury arising out of and in the course of his employment. The WCJ, however, deferred any finding of permanent disability, apportionment or attorney fees pending development of the medical record.
The WCJ also found the New York Yankees had coverage provided by an insurer, now administered by Travelers. In light of that finding, the WCJ noted that disputes between the parties involving a right of contribution under section 5500.5 must be sent to arbitration pursuant to section 5275, subdivision (a)(2).
Travelers filed a petition for reconsideration, arguing (1) the “New York Yankees failed to prove the existence of workers’ compensation coverage from the period of April 5, 1977 to September 1, 1978,” and (2) Zeber’s “[s]ubmitted medical reports were not substantial medical evidence.” Subsequently, the WCAB partially granted the petition for reconsideration. On September 13, 2022, it amended the WCJ’s decision to (1) “defer the issue of insurance coverage which is subject to mandatory arbitration”; and to “[a]mend the award to clarify that it is against Travelers.”
On October 28, 2022, Travelers filed its first Petition for Writ of Review with the Court of Appeal. The petition argued the WCAB erred in deferring the issue of insurance coverage to mandatory arbitration because mandatory arbitration under section 5275, subdivision (a) applies only to injuries occurring on or after January 1, 1994 and Zeber’s injuries occurred long before 1994. It further argued that the New York Yankees failed to satisfy their burden of proof at trial that the New York Yankees were insured during Zeber’s last injurious year.
The WCAB filed an informal letter responding to the petition. It stated that after further review of the administrative record, it concluded no award could be issued against Travelers until the deferred insurance coverage issues are finally adjudicated. The WCAB asserted “the issue of whether the insurance coverage in this case is subject to mandatory arbitration under . . . section 5275 has not yet been raised or adjudicated below.” It requested this court annul the decision and remand the matter for the WCAB to issue a corrected reward.
On February 9, 2023, the Court of Appeal issued an order vacating the WCAB’s decision and remanding the matter for further proceedings. At that time it declined to address any issue raised in the petition.
Following remand, on March 1, 2024, the WCAB issued an opinion and decision. It reinstated and affirmed its September 13, 2022 decision but rescinded and deleted the award pending further proceedings. The WCAB returned the matter “to the trial level for further proceedings, including but not limited to mandatory arbitration of insurance coverage . . . .” (Zeber v. New York Yankees (Mar. 1, 2024, ADJ10857121.)
On April 15, 2024, Travelers filed its second Petition for Writ of Review, arguing arguing section 5275, subdivision (a)(1) applies only to cases involving injuries occurring on or after January 1, 1994. Because Zeber admitted he sustained his cumulative injury no later than 1978, Travelers argues the insurance coverage dispute must be determined by a workers’ compensation judge (WCJ), and not by an arbitrator.
The Court of Appeal annulled the WCAB’s decision, and remanded the case for further proceedings, including a finding of the date of injury for purposes of mandatory arbitration in the unpublished case of Travelers Indemnity Co. v. Workers’ Compensation Appeals Bd. CA4/3 - G064030 (May, 2025).
The WCJ never made a finding on the date of injury for purposes of section 5275. The WCAB suggests the Court of Appeal annul the challenged decision and remand for further proceedings, including a finding of the date of injury for purposes of section 5275.
"Travelers’ argument is based on its request for judicial notice of a stipulation by the parties. We deny the request because we cannot consider evidence outside of the certified record. (See § 5951 [“No new or additional evidence shall be introduced in [the reviewing] court, but the cause shall be heard on the record of the appeals board, as certified to by it”].) Nevertheless, the certified record contains a copy of the stipulation, so we consider Travelers’ argument."
"By using 'date of injury' as described in section 5275, subdivision (b), it can be inferred that the Legislature intended 'date of injury' to mean the same for section 5275, subdivision (a)(1). In sum, the 'date of injury' for purposes of mandatory arbitration in cases involving cumulative injury is the “date of injury” set forth in section 5412."
"As the WCAB and Travelers both noted, the WCJ never made a finding of the “date of injury” under section 5412 for the purposes of section 5275, subdivision (a)(1). Rather, the WCJ discussed the “date of injury” for statute of limitations purposes only, and found that “without appropriate knowledge, the claim cannot be barred pursuant to [section] 5412.” Because the “date of injury” is a factual question and a prerequisite for mandatory arbitration, we conclude the WCAB acted in excess of its authority to send the insurance coverage dispute to mandatory arbitration."
- Public Insurance Adjusters Face Deceptive Practices Allegationson May 12, 2025 at 1:21 PM
The California Department of Insurance filed a First Amended Accusation and Statement of Issues on May 2, 2025, against Respondents Aleksandr Yefim Guldshtadt (aka Alex Gold or Alex Guld), Nationwide Insurance Claim Advocates Inc. (NICA), and Evghenia Gajiu.
The case, File No. LA202000454, alleges multiple violations of the California Insurance Code related to their activities as public insurance adjusters, including fraud, misrepresentation, conflicts of interest, and failure to comply with licensing and fiduciary duties. The Department seeks to revoke Guldshtadt’s and NICA’s licenses, deny Gajiu’s license application, impose penalties, and issue a cease-and-desist order for unfair or deceptive practices. Key Parties include:
- - Aleksandr Yefim Guldshtadt: Licensed public adjuster (License No. 2M52183, issued August 23, 2018) who also used aliases Alex Gold and Alex Guld. Associated with NICA and held ownership interests in related contractor entities.
- - Nationwide Insurance Claim Advocates Inc. (NICA): Licensed public adjuster entity (License No. 6000268, issued December 18, 2019), with Guldshtadt as a key figure and Gajiu as CEO, president, and director.
- - Evghenia Gajiu: Guldshtadt’s spouse and NICA’s CEO, who applied for a public adjuster license on March 20, 2024, but failed to meet requirements (application pending).
- - Related Entities: WD Contractor Services Company, Master Plumber Company (dba Calmaster Restoration), and Evolve Construction & Restoration, all linked to Guldshtadt and used in alleged misconduct.
The Department alleges that between 2020 and 2025, Respondents engaged in widespread misconduct, primarily targeting vulnerable clients, including Spanish-speaking individuals and seniors (over 65), in violation of multiple Insurance Code sections. Key allegations include:
- - Respondents used misrepresentations to solicit contracts, such as promising free repairs or exaggerated claim payouts (e.g., Victims S.D., J.G./M.G., S.H.).
- - Guldshtadt and NICA filed false claims, forged signatures, and submitted inflated or fabricated estimates (e.g., Victims R.H., L.W., N.I.).
- - They misled clients about claim statuses, denying approvals or withholding settlement funds (e.g., Victims M.M., F.O., D.S.).
- - Guldshtadt held financial interests in contractor firms (WD Contractor Services, Calmaster Restoration, Evolve Construction) that were recommended or engaged for claims NICA adjusted, violating Insurance Code §15028(b).
- - These firms often failed to complete repairs, leaving clients with damaged homes and financial losses (e.g., Victims J.G./M.G., E.J., J.D.H./J.H.).
- - Unlicensed agents (e.g., Viktor Skleruk, Morgan Nunez, Jorge Chavez) solicited clients, filed claims, and conducted adjuster activities without licenses, with Respondents’ knowledge or permission, violating Insurance Code §§15027(i), 15028(e).
- - Gajiu, as NICA’s CEO, failed to supervise these activities, aiding violations (Insurance Code §1668(n), (o)).
- - Respondents failed to use approved contracts, provide contracts in clients’ primary language (e.g., Spanish), or deliver original contracts and cancellation notices (Insurance Code §15027(a), (l), (s), (t)).
- - They withheld fiduciary funds, failed to deposit them in escrow, or did not provide required statements (Insurance Code §15028.7(b), (c)).
- - Guldshtadt refused to release clients from contracts or refund payments despite misrepresentations (Insurance Code §15027(m)).
- - Respondents engaged in deceptive advertising and solicitations, including unsolicited contacts outside permitted hours (Insurance Code §15027(e)).
- - They violated duties of honesty and fair dealing, particularly with seniors (Insurance Code §785(a)), and used unapproved fictitious names (Insurance Code §§14042, 15031).
- - Guldshtadt and NICA failed to notify the Department of disciplinary actions in Colorado (2024) and Utah (2024), violating Insurance Code §1729.2.
The document details 15 victim cases (e.g., S.D., J.G./M.G., S.H., R.H., E.J., M.M., D.M., F.O., F.S., D.S., H.S., J.D.H./J.H., N.V., L.W., N.I.), illustrating patterns of misconduct. Spanish-speaking clients (e.g., E.J., F.O.) were misled into signing English contracts under false pretenses. Seniors (e.g., J.G., R.H., N.V., L.W.) were exploited with deceptive promises. Clients suffered financial losses due to incomplete repairs, withheld funds, or fraudulent claims (e.g., F.O. lost settlement funds; J.D.H./J.H. paid out-of-pocket for storage).
The Respondents were Ordered to Show Cause why the penalties and other relief proposed by the Commissioner should not be imposed.
- California DOJ Publishes 5th Edition of Disability Rights Handbookon May 8, 2025 at 11:47 AM
The California Department of Justice's Disability Rights Bureau, announced the release of the fifth edition of “Legal Rights of Persons with Disabilities,” a publication that provides information regarding the rights of people with disabilities in California.
This handbook summarizes state and federal laws that protect the rights of individuals with disabilities in many arenas, including in the workplace and in accessing facilities open to the public. The handbook covers disability rights and obligations in a variety of contexts including businesses and places of public accommodation, employment, housing, K-12 education, healthcare, voting, and telecommunications, with chapters released on an ongoing basis since January 2024.
All chapters of the “Legal Rights of Persons with Disabilities” handbook are available at https://oag.ca.gov/civil/disability-rights including new and updated chapters on:
- - Introduction to State and Federal Disability Rights Laws: This chapter provides an overview of major California state and federal laws that protect the rights of people with disabilities.
- - Access to Businesses and Other Public Accommodations for People with Disabilities: This chapter discusses California and federal laws that prohibit disability-based discrimination in business establishments and other public accommodations. It also describes an individual’s options when they have experienced disability-based discrimination in business establishments and other public accommodations.
- - Access to Healthcare for People with Disabilities: This chapter describes the state and federal laws that protect the rights of people with disabilities to access healthcare services, including hospitals and other facilities, services, insurance plans, and information offered by doctors’ offices and other medical providers. It also describes an individual’s options when they have experienced disability-based discrimination in healthcare services.
- - Disability Rights in Employment: This chapter discusses major California and federal laws that protect people with disabilities from discrimination, harassment, and retaliation in employment. It also describes an individual’s options when they have experienced discrimination in employment because of their disability.
- - Disability Rights in Housing: This chapter discusses California and federal laws that protect persons with disabilities from public and private housing discrimination. It also describes options when persons with disabilities have experienced discrimination in housing because of their disability.
- - Disability Rights in K-12 Education: This chapter discusses the rights of students with disabilities in pre-school, primary, and secondary education under California state and federal law.
- - Access to Voting for People with Disabilities: This chapter discusses access to polling places and the voting process under federal and state election laws. Additionally, this chapter describes an individual’s options when they have experienced discrimination because of their disability while registering to vote or voting.
- - Access to Public and Private Buildings and Facilities for People with Disabilities: This chapter provides an overview of state and federal laws that set requirements for physical accessibility of both public and private buildings and facilities. In addition, this chapter provides information regarding options for individuals who have experienced discrimination regarding physical accessibility.
- - Access to Telecommunications for People with Disabilities: Telecommunications services are services that allow people to communicate through cable, radio, television, satellite, or wire equipment and include a variety of services like telephone and text message services. This chapter details state and federal laws regarding telecommunication services ensuring that people with disabilities have equal access to said service. It also provides information if there are concerns about accessibility of a product or service.
- - Benefits and Services for People with Disabilities: This chapter highlights state and federal benefits, programs, and services that are designed to assist people with disabilities.
- - Service Animals: This chapter discusses the rights of people with disabilities to use service animals and emotional support animals under both federal and California laws. This chapter also provides the various complaint options people have when their rights regarding service or emotional support animals have been violated.
Nearly one quarter of adults in California have a disability - 7,090,015 adults according to 2019 CDC data. The disability demographic is broken down into the following groups: - Mobility 11%: Serious difficulty walking or climbing stairs - Cognition 11%: Serious difficulty concentrating, remembering, or making decisions - ;Independent living 5%: - Serious difficulty doing errands alone, such as visiting a doctor's office - Hearing 5%: - Deafness or serious difficulty hearing - Vision 5%: Blind or serious difficulty seeing, even when wearing glasses - Self-care 4%: Difficulty dressing or bathing.
- California Legislators Take Steps to Clean Up "Rehab Riviera"on May 8, 2025 at 11:47 AM
The "Rehab Riviera" is a term used to describe a concentration of drug rehabilitation centers and sober living homes in Southern California, particularly in areas like Malibu, Orange County, and Costa Mesa.
While the Rehab Riviera includes legitimate facilities that help individuals recover, the term often carries a negative connotation due to the predatory practices of some operators. The profit-driven model, enabled by regulatory gaps and insurance fraud, has turned addiction into a lucrative industry, sometimes at the expense of vulnerable patients.
Body brokers play a central role in the darker side of the Rehab Riviera, acting as intermediaries who exploit vulnerable individuals with addiction issues for profit. Brokers lure patients with promises of free travel, rent, or “scholarships” to enter treatment, covering flights or bus tickets to Southern California.
Some offer cash, drugs, or gift cards to entice addicts, ensuring enrollment even if the individual isn’t ready for recovery. Once enrolled, patients are often cycled through facilities to maximize insurance billing, a practice known as “patient churning.”
Perhaps the California Legislature may be taking some steps to clean up the dark side of Rehab Rivera. Santa Ana State Senator Thomas Umberg announced that his package of three bills seeking to address fraud and abuse in California’s substance use disorder treatment system have all advanced through their numerous and respective policy committees in the Senate.
The three measures are:
- - Senate Bill 35 protects California’s vulnerable SUD population and its families by implementing statewide timelines and a local role to the mechanism by which facilities are held accountable when complaints are made by consumers.
- - Senate Bill 43 requires that addiction treatment programs and group advertising entities follow the same rules currently required for chiropractors, marriage family therapists, and dentists. These businesses can only advertise as individual business entities or with a group advertiser registered with their respective professional boards. In these health markets, consumers are protected from false advertisers, internet trolling that siphons people off to the highest bidder, and connections to incompetent and unethical marketing representatives.
- - Senate Bill 83 expands information that must be disclosed to the public by the California Department of Health Care Services about complaints and facility license suspensions and revocations on their website.
SB 35 passed the Senate Health Committee last April by a vote of 11-0 and the Senate Judiciary Committee in April on a unanimous vote. SB 43 passed the Senate Judiciary Committee unanimously, as well. SB 83 passed the Senate Health Committee by a vote of 11-0. All three measures are now awaiting consideration by the Senate Appropriations Committee.
According to the Senator's press release "Southern California’s “Rehab Riviera” is well known to be an area in which a network of rehab facilities exist in a quasi-medical realm where evidence-based care is rare, licensed medical staffers are optional, conflicts of interest are rampant, and regulation is stunningly lax. Senator Umberg's three measures directly address these pressing issues by adding local enforcement mechanisms and transparency for patients and families."
- Fresno Health System to Pay $31.5 M to Resolve Kickback Caseon May 15, 2025 at 10:26 AM
Community Health System and its affiliate Physician Network Advantage Inc. have agreed to pay $31.5 million to the United States to resolve allegations that they violated the False Claims Act based on financial benefits provided to referring physicians. Community Health System operates in Fresno County and includes hospitals Community Regional Medical Center and Clovis Community Medical Center.
The civil settlement resolves allegations that Community Health System and Physician Network Advantage Inc. (PNA) provided several types of extravagant benefits to induce physicians in the Fresno area to refer their patients to Community facilities for medical services, in violation of the False Claims Act. PNA is a health care technology business formed and funded by Community to support Fresno-area physicians’ adoption of the electronic health records platform used by Community. The United States contends that PNA also played a key role in securing business for Community by unlawful means. In a custom-built lounge located on premises at PNA’s offices, known as HQ2, PNA provided expensive wine, liquor, cigars, and meals to referring physicians, with the knowledge and funding of Community.
The settlement also resolves allegations that Community and PNA provided financial subsidies for electronic health records technology and equipment used by certain physicians in their private offices in return for the referral of governmental health care program patients to Community. Further, the settlement resolves allegations that Community paid bonuses to certain physicians ostensibly for participation in clinical integration activities, when the real purpose of the bonuses was to reward referrals.
The United States contends that these financial benefits violated the federal Anti-Kickback Statute, resulting in false claims for the medical services referred by physicians receiving the benefits, that were submitted to governmental health care programs. The United States also contends that the conduct described above created financial relationships with referring physicians under the Physician Self-Referral Law (known as the “Stark Law”). The Stark Law seeks to safeguard the integrity of the Medicare program by prohibiting a hospital from billing for certain services referred by physicians with whom the hospital has a financial relationship, unless that relationship satisfies one of the law’s statutory or regulatory exceptions, which the United States contends were not met.
In connection with the settlement, Community entered into a five-year Corporate Integrity Agreement with HHS-OIG that requires, among other conditions, 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 annually assess the policies and systems to track arrangements with some referral sources.
The settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by relator Michael Terpening. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery from that action. The qui tam case is captioned United States ex rel. Terpening v. Fresno Community Hospital and Medical Center, et al., 1:19-CV-01699 (E.D. Cal.). As part of the settlement announced today, Mr. Terpening will receive approximately $5 million.
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 and HHS-OIG with assistance from the Federal Bureau of Investigation and the U.S. Postal Service Office of Inspector General. Assistant U.S. Attorney David Thiess handled the case for the U.S. Attorney’s Office.
The claims resolved by this settlement are allegations only, and there has been no determination of liability. - Ventura County Unlicensed Physician Re-Arrested for Practicingon May 15, 2025 at 10:26 AM
The Ventura County District Attorney Erik Nasarenko announced that Nitun “Nate” Dayalghai Ahir (DOB 06/17/81), of Thousand Oaks, was arraigned for practicing medicine without a license, in violation of Business and Professions Code section 2052.
Ahir was out on bail in case number 2024030574, in which he is alleged to have practiced medicine without a license and represented himself as a doctor at Regen Spine & Nerve, in Ventura, when the District Attorney’s Office received complaints that Ahir was continuing to practice medicine without a license.
In his new case, Ahir is alleged to have unlawfully provided medical services to victims only days after being arraigned in case 2024030574. He is further charged with using the term “Doctor” and the prefix “Dr.” to imply he is a licensed medical professional when he is not. Judge David Hirsch explicitly made a condition of Ahir’s bail that he may not practice medicine, solicit medical business, attempt to treat patients, or receive compensation for any form of medical work, or he faces remand into custody.
According to the California Department of Consumer Affairs, Ahir is not licensed in any capacity – as a doctor, surgeon, nurse, nurse practitioner, chiropractor, or otherwise – in the State of California, nor is he a licensed physician in any other state.
The District Attorney requests that any member of the public who Ahir has attempted to treat contact Investigator Eric Jensen at Eric.Jensen@ventura.org or by calling 805-662-1739. The public is urged to review the licensure status of any medical professionals they are considering seeing by visiting the Department of Consumer Affairs' professional
This case was investigated by the Department of Consumer Affairs, Health Quality Investigations Unit. Both of Ahir’s cases are set for early disposition conference on June 25, 2025, at 1:30 p.m. in Courtroom 12 of the Ventura County Superior Court. He remains out of custody on $50,000 bail. - Jury Trial Rights Attach to Claim for Unruh Civil Rights Act Damageson May 14, 2025 at 1:43 PM
Plaintiff Theresa Brooke is a woman with disabilities who uses a wheelchair. Along with her husband, she frequents California hotels to test their compliance with disability access laws. On one such testing trip in August 2023, Brooke and her husband visited the Ramada by Wyndham Burbank Airport, a hotel in Burbank, California. When they arrived, however, architectural barriers allegedly deterred Brooke from entering.
Brooke sued the hotel’s owner, Defendant Tsay JBR, LLC, asserting violations of Title III of the Americans with Disabilities Act (ADA), 42 U.S.C. § 12181 et seq., and California’s Unruh Civil Rights Act, Cal. Civ. Code § 51 et seq. (West 2025).
The California The Unruh Act similarly creates a private right of action for people with disabilities, along with other enumerated groups, who are denied “full and equal” access to California businesses. See Cal. Civ. Code § 51(b). As part of those protections, the Unruh Act provides that any violation of the ADA is also a violation of its provisions. See id. § 51(f).
Although private parties can obtain only injunctive relief under the ADA, they can recover actual and statutory damages under the Unruh Act. Id. § 52(a); see Arroyo v. Rosas, 19 F.4th 1202, 1206 (9th Cir. 2021) (explaining that the Unruh Act effectively creates a state-law “damages remedy that is not available under the ADA”).
Accordingly, Brooke sought injunctive relief under the ADA, statutory damages under the Unruh Act, and declaratory relief and attorney’s fees under both.
The district court granted in part and denied in part a motion for summary judgment brought by Brooke. The court concluded that Tsay JBR had violated the ADA because the hotel’s passenger loading zone - an area for vehicle pickup and drop-off - lacked an access aisle for disabled guests. As a remedy, the court ordered Tsay JBR to paint a blue access aisle in front of the loading zone.
Because Brooke established an ADA violation, she also necessarily established an Unruh Act violation. But not all Unruh Act violations automatically entitle a plaintiff to statutory damages. When a violation is construction-related, the Unruh Act only permits statutory damages if the plaintiff personally encountered the violation or was deterred by it. Id. § 55.56(a)–(b). The district court determined that Brooke had not established that fact on summary judgment.
With only that factual issue left, the court converted the scheduled jury trial to a bench trial, concluding that the jury- trial right did not attach to claims for statutory damages under section 52(a) of the Unruh Act.
Tsay JBR petitioned the Court of Appeals for the 9th Circuit for a writ of mandamus, asking it to direct the district court to conduct a jury trial on the issue of Brooke’s entitlement to statutory damages. The panel held that the Seventh Amendment entitles parties in federal court to a jury trial on a claim for statutory damages under § 52(a) of the Unruh Act in the published case of Tsay JBR LLC v United States District Court for the Central District of California - 24-5234 (May 2025).
The Seventh Amendment to the United States Constitution provides that in “[s]uits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved.” In this case the Court of Appeals considered whether a defendant in an action for statutory damages under section 52(a) of California’s Unruh Civil Rights Act is entitled to a jury trial.
"So long as a case involves a legal claim, the right to a jury trial attaches, even if the case also seeks equitable relief. See Curtis v. Loether, 415 U.S. 189, 196 n.11 (1974) (“The [jury-trial] right cannot be abridged by characterizing the legal claim as ‘incidental’ to the equitable relief sought.”); Dairy Queen, Inc. v. Wood, 369 U.S. 469, 473 n.8 (1962)."
"The statutory damages in section 52(a) of the Unruh Act are thus a legal remedy. Because both the historical analog and the nature of the remedy reveal that Brooke’s claim is legal, the Court of Appeals held that the Seventh Amendment entitles parties in federal court to a jury trial on a claim for statutory damages under section 52(a) of the Unruh Act."
- NCCI Report: Workers’ Comp System Remains Strongon May 14, 2025 at 1:43 PM
The performance of the workers compensation system remains strong according to the 2024 metrics that the National Council on Compensation Insurance (NCCI) just released.
Workers compensation premium decreased 3% in 2024. Private carriers produced their 11th consecutive year of underwriting profitability with a Calendar Year 2024 combined ratio of 86. It is the 8th consecutive year with a combined ratio below 90 for the workers compensation insurance market.
"Workers compensation is a product where compassion and analytics work hand-in- hand - protecting and caring for employees while also leveraging data to make the entire system more effective and sustainable," said NCCI President and CEO Tracy Ryan.
NCCI’s State of the Line Report and the State of the Line Guide include key insights:
- - Workers compensation net written premium decreased 3% in 2024. There are two contributing factors: payroll and rate on payroll, mostly represented by the loss cost. Payroll growth is slowing, reverting back to the long-term average. Loss costs continue to decline, but more moderately.
- - The Calendar Year 2024 combined ratio for workers compensation is 86%, a sign of underwriting strength for the system. Workers compensation (WC) has one of the lowest combined ratios among property/casualty. In fact, 2024 was the 8th consecutive year with a combined ratio under 90% and the 11th consecutive year of underwriting gains.
- - Workers compensation’s Accident Year 2024 combined ratio is 99% with prior years continuing to experience downward reserve development.
- - NCCI estimates a redundant industry reserve position of $16 billion. That’s a decrease from the $18B estimated redundancy in 2023. While still a strong financial position, this is the first year with a slight reduction in the estimated redundancy.
- - Lost-time claim frequency declined by 5% in 2024. The latest year’s frequency decline outpaces the long-term average, although not to the extent of the prior year. More than half of this decrease is due to the reduction in number of claims.
- - Severity grew in 2024 with increases of 6% for medical claim severity and 6% for indemnity claim severity. Indemnity severity grew faster than wages, and medical severity grew faster than the Workers Compensation Weighted Medical Price Index (WCWMI). For medical, price is only one part of the story. The other part is utilization, and this year utilization contributes to a majority of the increase.
"The workers compensation system continues an era of exceptional performance with strong results and a financially healthy line," said Donna Glenn, FCAS, MAAA, Chief Actuary, NCCI. "And while there are early indications of potential headwinds on the horizon, the industry is positioned well to navigate these challenges." - Six Month Delay in Requesting Arbitration Constitutes "Waiver"on May 13, 2025 at 4:10 PM
Stephen Hofer is a licensed attorney who founded Aerlex Law Group (the Group), which specializes in aviation law. In 2008, Hofer was the sole partner of the Group and hired Vicky Boladian as a part-time contract attorney. Hofer and Boladian dispute whether their professional relationship became a romantic relationship between 2011 and 2017.
In 2013, Hofer and Boladian formed Aerlex Tax Services, LLC (the tax LLC), which would provide “tax-related services” to the Group’s clients and “others within the aviation industry.” Hofer had a 55 percent equity interest in the tax LLC; Boladian, a 45 percent interest. In 2017 and 2018, Hofer and Boladian had a falling out, which resulted in litigation. In September 2020, they agreed to settle the pending litigation by executing three agreements: 1) Settlement Agreement, 2) Amended and Restated Operating Agreement for the tax LLC and 3) Amended and Restated Buy-Sell Agreement of the tax LLC. These agreements contained provisions to arbitrate disputes.
In March 2023, Boladian asked Hofer to change the business form of the tax LLC to an LLP to avoid the potential of having a limited liability company engaged in the unauthorized practice of law. In August 2023, Hofer and Boladian dissolved the tax LLC and shifted its assets to Aerlex Tax Services, LLP (the tax LLP)—with the same 55/45 percent split of ownership. Two weeks later, Boladian formed the Boladian Aviation Law Group, APC (BALG). She then withdrew from the tax LLP, removing what she represented to be 45 percent of the physical office furniture and nearly all of the tax LLP’s clients.
On September 19, 2023, Hofer sent Boladian a letter exploring a possible settlement before “commencing formal litigation” and asserting his “free[dom] to seek a judicial resolution” of their disputes. The parties discussed mediation, but could not agree on a mediator.
On October 16, 2023, Hofer, the Group, the tax LLC and the tax LLP (collectively, the Hofer plaintiffs) filed a lawsuit against Boladian and BALG. The Hofer plaintiffs alleged 13 causes of action and sought compensatory damages, injunctive and equitable relief, treble damages, punitive damages, and attorney fees. Although Hofer had, prior to filing the complaint, “agree[d] to file in arbitration” if Boladian consented to BALG participating in arbitration, the Hofer plaintiffs in the complaint nowhere mentioned arbitration under any of the three agreements and did not pray for an order compelling arbitration.
On October 31, 2023, the Hofer plaintiffs applied ex parte for a temporary restraining order (TRO) seeking to prevent Boladian and BALG from performing any work for the clients of the tax LLP or the Group, from using any of the tax LLP’s employees, and from removing or using any tangible property or data taken from the tax LLP. Nowhere in the application did they mention arbitration under any of the agreements. The trial court denied the application
On November 16, 2023, the Hofer plaintiffs moved for a preliminary injunction, trying to remedy the defects with their earlier TRO application. Once again, the Hofer plaintiffs argued their lawsuit had merit and nowhere mentioned arbitration.
In the midst of these motions, the Hofer plaintiffs inquired whether Boladian and BALG would “be seeking to move this case into arbitration”; counsel responded that they had “no plans” to do so and this communication shed no light on the Hofer plaintiffs’ intent to do so.
On December 8, 2024 (while the Hofer plaintiffs’ motion for a preliminary injunction was still pending), Boladian and BALG demurred to nine of the 13 causes of action. On January 29, 2024, the Hofer plaintiffs propounded a total of 734 discovery requests to Boladian and BALG. The Hofer plaintiffs also subpoenaed a number of third- party witnesses for depositions in February 2024. They also noticed the deposition of Boladian for March 2024.
In anticipation of the case management conference, the Hofer plaintiffs on March 14, 2024, filed a case management statement. In some respects, the Hofer plaintiffs’ case management statement acknowledged the possibility arbitrating the dispute. The Hofer plaintiffs also posted their jury fees.
On April 23, 2024, Boladian filed a cross-complaint against Hofer and the Group, alleging five causes of action. On April 26, 2024—more than six months after filing their complaint and more than four months after the denial of the preliminary injunction, but just three days after the filing of the cross-complaint - the Hofer plaintiffs filed a motion to compel arbitration, invoking the arbitration clauses in the settlement agreement, amended operating agreement, and amended buy-sell agreement.
The trial court denied the motion to arbitrate ruling that the Hofer plaintiffs had waived their right to compel arbitration. Applying the waiver standard articulated in St. Agnes Medical Center v. PacifiCare of California (2003) 31 Cal.4th 1187, the court found “that [the Hofer plaintiffs] waived the right to arbitrate by filing suit in this court and substantially and vigorously litigating it for over seven months,” concluding that this conduct was “fundamentally incompatible with the expediency, efficiency, and cost- effectiveness associated with utilizing arbitration” and that this conduct “prejudiced” Boladian and BALG.
The Court of Appeal affirmed the trial court's order in the published case of Hofer v. Boladian CA2/5 - B339542 (May 2025).
Under the California Arbitration Act (Code Civ. Proc., § 1280 et seq.) (the Act), a party with a contractual “right to compel arbitration” of a dispute may “waive[]” that right. (§ 1281.2, subd. (a).) In Quach v. California Commerce Club, Inc. (2024) 16 Cal.5th 562 (Quach), - decided a month after the trial court’s ruling - the Supreme Court overruled the arbitration-specific definition of waiver embraced in St. Agnes Medical Center v. PacifiCare of California (2003) 31 Cal.4th 1187 (St. Agnes) in favor of the “generally applicable” definition of waiver. (Quach, at p. 578.)
St. Agnes’s arbitration-specific definition of waiver called upon trial courts to evaluate six different factors - namely, “‘“(1) whether the party’s actions are inconsistent with the right to arbitrate; (2) whether ‘the litigation machinery has been substantially invoked’ and the parties ‘were well into preparation of a lawsuit’ before the party notified the opposing party of an intent to arbitrate; (3) whether a party either requested arbitration enforcement close to the trial date or delayed for a long period before seeking a stay; (4) whether a defendant seeking arbitration filed a counterclaim without asking for a stay of the proceedings; (5) ‘whether important intervening steps [e.g., taking advantage of judicial discovery procedures not available in arbitration] had taken place’; and (6) whether the delay ‘affected, misled or prejudiced’ the opposing party.”’” (Id. at p. 1196.)
"Quach applies retroactively to this direct appeal." Quach held that a waiver occurs under the Act if, by clear and convincing evidence, it is shown that a party has “intentionally relinquished or abandoned” its known right to compel arbitration. (Id. at pp. 569, 584.)
"In this case, the litigants seeking to compel arbitration initiated this lawsuit by filing a complaint in court and, while in the judicial forum, sought two forms of preliminary injunctive relief, opposed a demurrer, propounded more than 700 discovery requests, demanded a jury trial in their case management conference statement and represented they would be litigating substantive motions, and posted jury fees. It was not until the opposing party filed a cross-complaint that the litigants filed the motion to compel arbitration - more than six months into the litigation in court."
The litigants’ conduct in this case constitute a waiver under Quach. - AI Outperforms Radiologists' Detection of Breast Cancerson May 13, 2025 at 4:10 PM
A new study - "Mammographic Classification of Interval Breast Cancers and Artificial Intelligence Performance" - conducted at the University of California, Los Angeles (UCLA) and published in in the Journal of the National Cancer Institute, investigates interval breast cancers (IBCs) - cancers diagnosed within 12 months after a negative screening mammogram - in a U.S.-based annual screening program.
The research aimed to classify IBCs based on their mammographic visibility and evaluate the performance of an artificial intelligence (AI) tool in detecting these cancers, particularly in a setting that uses both digital mammography (DM) and digital breast tomosynthesis (DBT).
The study analyzed 184,935 screening mammograms (65% DM, 35% DBT) from 49,244 women screened between 2010 and 2019 at a U.S. tertiary care academic center participating in the Athena Breast Health Network. From this cohort, 148 IBCs were identified in 148 women (mean age 61 ± 12 years), defined as ductal carcinoma in situ (DCIS) or invasive carcinomas diagnosed within 12 months of a negative mammogram (BI-RADS 1 or 2).
Eight fellowship-trained breast radiologists, with 3–24 years of experience, retrospectively classified these IBCs into six categories adapted from European guidelines: missed-reading error (visible but missed), minimal signs-actionable (subtle signs potentially detectable), minimal signs-non-actionable (subtle signs not reasonably detectable), true interval (not present at screening), occult (not visible on mammography but detectable by other modalities), and missed-technical error (missed due to technical issues like positioning).
A deep-learning AI tool (Transpara v1.7.1, ScreenPoint Medical) assigned risk scores (1–10) to 131 of the 148 negative index mammograms (17 were excluded due to breast implants or file conversion issues). Exams scoring ≥8 were considered "flagged" for elevated risk. Radiologists assessed whether AI markings accurately localized the IBC site, comparing performance across IBC types and correlating with patient and tumor characteristics.
The AI tool flagged 76% of the 131 scored mammograms, with the highest flagging rates for missed-reading errors (90%), minimal signs-actionable (89%), and minimal signs-non-actionable (72%). These mammographically visible types also received higher mean AI scores (9.5, 8.9, and 8.3, respectively) compared to non-visible types like true interval (7.3) and occult (7.9). AI accurately localized the cancer site in 47% of flagged exams, with the highest accuracy for missed-reading errors (68%) and minimal signs-actionable (62%), but lower for occult (22%) and missed-technical errors (0%). Overall, AI flagged 56% of mammographically visible IBCs versus 20% of non-visible ones, suggesting a potential 30% reduction in IBCs if AI-supported detection were implemented.
The study highlights the potential of AI to enhance the detection of mammographically visible IBCs, particularly those missed or with subtle signs, in a U.S. annual screening program using both DM and DBT. Unlike European studies, the lower rate of true interval cancers (6%) underscores the benefit of annual screening in reducing IBCs. However, AI’s ability to flag occult and true interval cancers, despite lower localization accuracy, raises questions about its predictive value and clinical utility, as radiologists may struggle to act on flagged exams without visible abnormalities.
Limitations include the retrospective design, small sample sizes for some IBC subtypes, and the use of a single AI vendor, which may limit generalizability. The mix of DM and DBT reflects real-world practice but complicates comparisons. Selection bias from the Athena study cohort and technical issues with unscored exams are additional constraints. Importantly, the study does not confirm whether AI-flagged exams would lead to earlier detection in practice, as radiologist recall decisions remain uncertain.
The study was supported by the National Institutes of Health, the Agency for Healthcare Research and Quality, and Early Diagnostics Inc., with no reported conflicts of interest. The data are available upon request from the corresponding author, Tiffany T. Yu, MD. - DOI For Coverage Mandatory Arbitration is Defined by LC 5412on May 12, 2025 at 1:21 PM
George Zeber filed a workers’ compensation claim for cumulative injury sustained during his employment with the New York Yankees from 1968 through 1978. Whether the New York Yankees had workers’ compensation coverage during this time was disputed by Travelers Indemnity Company.
After a three day trial, The WCJ found Zeber, while employed from June 1, 1968 through September 1, 1978 with the New York Yankees, sustained an injury arising out of and in the course of his employment. The WCJ, however, deferred any finding of permanent disability, apportionment or attorney fees pending development of the medical record.
The WCJ also found the New York Yankees had coverage provided by an insurer, now administered by Travelers. In light of that finding, the WCJ noted that disputes between the parties involving a right of contribution under section 5500.5 must be sent to arbitration pursuant to section 5275, subdivision (a)(2).
Travelers filed a petition for reconsideration, arguing (1) the “New York Yankees failed to prove the existence of workers’ compensation coverage from the period of April 5, 1977 to September 1, 1978,” and (2) Zeber’s “[s]ubmitted medical reports were not substantial medical evidence.” Subsequently, the WCAB partially granted the petition for reconsideration. On September 13, 2022, it amended the WCJ’s decision to (1) “defer the issue of insurance coverage which is subject to mandatory arbitration”; and to “[a]mend the award to clarify that it is against Travelers.”
On October 28, 2022, Travelers filed its first Petition for Writ of Review with the Court of Appeal. The petition argued the WCAB erred in deferring the issue of insurance coverage to mandatory arbitration because mandatory arbitration under section 5275, subdivision (a) applies only to injuries occurring on or after January 1, 1994 and Zeber’s injuries occurred long before 1994. It further argued that the New York Yankees failed to satisfy their burden of proof at trial that the New York Yankees were insured during Zeber’s last injurious year.
The WCAB filed an informal letter responding to the petition. It stated that after further review of the administrative record, it concluded no award could be issued against Travelers until the deferred insurance coverage issues are finally adjudicated. The WCAB asserted “the issue of whether the insurance coverage in this case is subject to mandatory arbitration under . . . section 5275 has not yet been raised or adjudicated below.” It requested this court annul the decision and remand the matter for the WCAB to issue a corrected reward.
On February 9, 2023, the Court of Appeal issued an order vacating the WCAB’s decision and remanding the matter for further proceedings. At that time it declined to address any issue raised in the petition.
Following remand, on March 1, 2024, the WCAB issued an opinion and decision. It reinstated and affirmed its September 13, 2022 decision but rescinded and deleted the award pending further proceedings. The WCAB returned the matter “to the trial level for further proceedings, including but not limited to mandatory arbitration of insurance coverage . . . .” (Zeber v. New York Yankees (Mar. 1, 2024, ADJ10857121.)
On April 15, 2024, Travelers filed its second Petition for Writ of Review, arguing arguing section 5275, subdivision (a)(1) applies only to cases involving injuries occurring on or after January 1, 1994. Because Zeber admitted he sustained his cumulative injury no later than 1978, Travelers argues the insurance coverage dispute must be determined by a workers’ compensation judge (WCJ), and not by an arbitrator.
The Court of Appeal annulled the WCAB’s decision, and remanded the case for further proceedings, including a finding of the date of injury for purposes of mandatory arbitration in the unpublished case of Travelers Indemnity Co. v. Workers’ Compensation Appeals Bd. CA4/3 - G064030 (May, 2025).
The WCJ never made a finding on the date of injury for purposes of section 5275. The WCAB suggests the Court of Appeal annul the challenged decision and remand for further proceedings, including a finding of the date of injury for purposes of section 5275.
"Travelers’ argument is based on its request for judicial notice of a stipulation by the parties. We deny the request because we cannot consider evidence outside of the certified record. (See § 5951 [“No new or additional evidence shall be introduced in [the reviewing] court, but the cause shall be heard on the record of the appeals board, as certified to by it”].) Nevertheless, the certified record contains a copy of the stipulation, so we consider Travelers’ argument."
"By using 'date of injury' as described in section 5275, subdivision (b), it can be inferred that the Legislature intended 'date of injury' to mean the same for section 5275, subdivision (a)(1). In sum, the 'date of injury' for purposes of mandatory arbitration in cases involving cumulative injury is the “date of injury” set forth in section 5412."
"As the WCAB and Travelers both noted, the WCJ never made a finding of the “date of injury” under section 5412 for the purposes of section 5275, subdivision (a)(1). Rather, the WCJ discussed the “date of injury” for statute of limitations purposes only, and found that “without appropriate knowledge, the claim cannot be barred pursuant to [section] 5412.” Because the “date of injury” is a factual question and a prerequisite for mandatory arbitration, we conclude the WCAB acted in excess of its authority to send the insurance coverage dispute to mandatory arbitration." - Public Insurance Adjusters Face Deceptive Practices Allegationson May 12, 2025 at 1:21 PM
The California Department of Insurance filed a First Amended Accusation and Statement of Issues on May 2, 2025, against Respondents Aleksandr Yefim Guldshtadt (aka Alex Gold or Alex Guld), Nationwide Insurance Claim Advocates Inc. (NICA), and Evghenia Gajiu.
The case, File No. LA202000454, alleges multiple violations of the California Insurance Code related to their activities as public insurance adjusters, including fraud, misrepresentation, conflicts of interest, and failure to comply with licensing and fiduciary duties. The Department seeks to revoke Guldshtadt’s and NICA’s licenses, deny Gajiu’s license application, impose penalties, and issue a cease-and-desist order for unfair or deceptive practices. Key Parties include:
- - Aleksandr Yefim Guldshtadt: Licensed public adjuster (License No. 2M52183, issued August 23, 2018) who also used aliases Alex Gold and Alex Guld. Associated with NICA and held ownership interests in related contractor entities.
- - Nationwide Insurance Claim Advocates Inc. (NICA): Licensed public adjuster entity (License No. 6000268, issued December 18, 2019), with Guldshtadt as a key figure and Gajiu as CEO, president, and director.
- - Evghenia Gajiu: Guldshtadt’s spouse and NICA’s CEO, who applied for a public adjuster license on March 20, 2024, but failed to meet requirements (application pending).
- - Related Entities: WD Contractor Services Company, Master Plumber Company (dba Calmaster Restoration), and Evolve Construction & Restoration, all linked to Guldshtadt and used in alleged misconduct.
The Department alleges that between 2020 and 2025, Respondents engaged in widespread misconduct, primarily targeting vulnerable clients, including Spanish-speaking individuals and seniors (over 65), in violation of multiple Insurance Code sections. Key allegations include:
- - Respondents used misrepresentations to solicit contracts, such as promising free repairs or exaggerated claim payouts (e.g., Victims S.D., J.G./M.G., S.H.).
- - Guldshtadt and NICA filed false claims, forged signatures, and submitted inflated or fabricated estimates (e.g., Victims R.H., L.W., N.I.).
- - They misled clients about claim statuses, denying approvals or withholding settlement funds (e.g., Victims M.M., F.O., D.S.).
- - Guldshtadt held financial interests in contractor firms (WD Contractor Services, Calmaster Restoration, Evolve Construction) that were recommended or engaged for claims NICA adjusted, violating Insurance Code §15028(b).
- - These firms often failed to complete repairs, leaving clients with damaged homes and financial losses (e.g., Victims J.G./M.G., E.J., J.D.H./J.H.).
- - Unlicensed agents (e.g., Viktor Skleruk, Morgan Nunez, Jorge Chavez) solicited clients, filed claims, and conducted adjuster activities without licenses, with Respondents’ knowledge or permission, violating Insurance Code §§15027(i), 15028(e).
- - Gajiu, as NICA’s CEO, failed to supervise these activities, aiding violations (Insurance Code §1668(n), (o)).
- - Respondents failed to use approved contracts, provide contracts in clients’ primary language (e.g., Spanish), or deliver original contracts and cancellation notices (Insurance Code §15027(a), (l), (s), (t)).
- - They withheld fiduciary funds, failed to deposit them in escrow, or did not provide required statements (Insurance Code §15028.7(b), (c)).
- - Guldshtadt refused to release clients from contracts or refund payments despite misrepresentations (Insurance Code §15027(m)).
- - Respondents engaged in deceptive advertising and solicitations, including unsolicited contacts outside permitted hours (Insurance Code §15027(e)).
- - They violated duties of honesty and fair dealing, particularly with seniors (Insurance Code §785(a)), and used unapproved fictitious names (Insurance Code §§14042, 15031).
- - Guldshtadt and NICA failed to notify the Department of disciplinary actions in Colorado (2024) and Utah (2024), violating Insurance Code §1729.2.
The document details 15 victim cases (e.g., S.D., J.G./M.G., S.H., R.H., E.J., M.M., D.M., F.O., F.S., D.S., H.S., J.D.H./J.H., N.V., L.W., N.I.), illustrating patterns of misconduct. Spanish-speaking clients (e.g., E.J., F.O.) were misled into signing English contracts under false pretenses. Seniors (e.g., J.G., R.H., N.V., L.W.) were exploited with deceptive promises. Clients suffered financial losses due to incomplete repairs, withheld funds, or fraudulent claims (e.g., F.O. lost settlement funds; J.D.H./J.H. paid out-of-pocket for storage).
The Respondents were Ordered to Show Cause why the penalties and other relief proposed by the Commissioner should not be imposed. - California DOJ Publishes 5th Edition of Disability Rights Handbookon May 8, 2025 at 11:47 AM
The California Department of Justice's Disability Rights Bureau, announced the release of the fifth edition of “Legal Rights of Persons with Disabilities,” a publication that provides information regarding the rights of people with disabilities in California.
This handbook summarizes state and federal laws that protect the rights of individuals with disabilities in many arenas, including in the workplace and in accessing facilities open to the public. The handbook covers disability rights and obligations in a variety of contexts including businesses and places of public accommodation, employment, housing, K-12 education, healthcare, voting, and telecommunications, with chapters released on an ongoing basis since January 2024.
All chapters of the “Legal Rights of Persons with Disabilities” handbook are available at https://oag.ca.gov/civil/disability-rights including new and updated chapters on:
- - Introduction to State and Federal Disability Rights Laws: This chapter provides an overview of major California state and federal laws that protect the rights of people with disabilities.
- - Access to Businesses and Other Public Accommodations for People with Disabilities: This chapter discusses California and federal laws that prohibit disability-based discrimination in business establishments and other public accommodations. It also describes an individual’s options when they have experienced disability-based discrimination in business establishments and other public accommodations.
- - Access to Healthcare for People with Disabilities: This chapter describes the state and federal laws that protect the rights of people with disabilities to access healthcare services, including hospitals and other facilities, services, insurance plans, and information offered by doctors’ offices and other medical providers. It also describes an individual’s options when they have experienced disability-based discrimination in healthcare services.
- - Disability Rights in Employment: This chapter discusses major California and federal laws that protect people with disabilities from discrimination, harassment, and retaliation in employment. It also describes an individual’s options when they have experienced discrimination in employment because of their disability.
- - Disability Rights in Housing: This chapter discusses California and federal laws that protect persons with disabilities from public and private housing discrimination. It also describes options when persons with disabilities have experienced discrimination in housing because of their disability.
- - Disability Rights in K-12 Education: This chapter discusses the rights of students with disabilities in pre-school, primary, and secondary education under California state and federal law.
- - Access to Voting for People with Disabilities: This chapter discusses access to polling places and the voting process under federal and state election laws. Additionally, this chapter describes an individual’s options when they have experienced discrimination because of their disability while registering to vote or voting.
- - Access to Public and Private Buildings and Facilities for People with Disabilities: This chapter provides an overview of state and federal laws that set requirements for physical accessibility of both public and private buildings and facilities. In addition, this chapter provides information regarding options for individuals who have experienced discrimination regarding physical accessibility.
- - Access to Telecommunications for People with Disabilities: Telecommunications services are services that allow people to communicate through cable, radio, television, satellite, or wire equipment and include a variety of services like telephone and text message services. This chapter details state and federal laws regarding telecommunication services ensuring that people with disabilities have equal access to said service. It also provides information if there are concerns about accessibility of a product or service.
- - Benefits and Services for People with Disabilities: This chapter highlights state and federal benefits, programs, and services that are designed to assist people with disabilities.
- - Service Animals: This chapter discusses the rights of people with disabilities to use service animals and emotional support animals under both federal and California laws. This chapter also provides the various complaint options people have when their rights regarding service or emotional support animals have been violated.
Nearly one quarter of adults in California have a disability - 7,090,015 adults according to 2019 CDC data. The disability demographic is broken down into the following groups: - Mobility 11%: Serious difficulty walking or climbing stairs - Cognition 11%: Serious difficulty concentrating, remembering, or making decisions - ;Independent living 5%: - Serious difficulty doing errands alone, such as visiting a doctor's office - Hearing 5%: - Deafness or serious difficulty hearing - Vision 5%: Blind or serious difficulty seeing, even when wearing glasses - Self-care 4%: Difficulty dressing or bathing. - California Legislators Take Steps to Clean Up "Rehab Riviera"on May 8, 2025 at 11:47 AM
The "Rehab Riviera" is a term used to describe a concentration of drug rehabilitation centers and sober living homes in Southern California, particularly in areas like Malibu, Orange County, and Costa Mesa.
While the Rehab Riviera includes legitimate facilities that help individuals recover, the term often carries a negative connotation due to the predatory practices of some operators. The profit-driven model, enabled by regulatory gaps and insurance fraud, has turned addiction into a lucrative industry, sometimes at the expense of vulnerable patients.
Body brokers play a central role in the darker side of the Rehab Riviera, acting as intermediaries who exploit vulnerable individuals with addiction issues for profit. Brokers lure patients with promises of free travel, rent, or “scholarships” to enter treatment, covering flights or bus tickets to Southern California.
Some offer cash, drugs, or gift cards to entice addicts, ensuring enrollment even if the individual isn’t ready for recovery. Once enrolled, patients are often cycled through facilities to maximize insurance billing, a practice known as “patient churning.”
Perhaps the California Legislature may be taking some steps to clean up the dark side of Rehab Rivera. Santa Ana State Senator Thomas Umberg announced that his package of three bills seeking to address fraud and abuse in California’s substance use disorder treatment system have all advanced through their numerous and respective policy committees in the Senate.
The three measures are:
- - Senate Bill 35 protects California’s vulnerable SUD population and its families by implementing statewide timelines and a local role to the mechanism by which facilities are held accountable when complaints are made by consumers.
- - Senate Bill 43 requires that addiction treatment programs and group advertising entities follow the same rules currently required for chiropractors, marriage family therapists, and dentists. These businesses can only advertise as individual business entities or with a group advertiser registered with their respective professional boards. In these health markets, consumers are protected from false advertisers, internet trolling that siphons people off to the highest bidder, and connections to incompetent and unethical marketing representatives.
- - Senate Bill 83 expands information that must be disclosed to the public by the California Department of Health Care Services about complaints and facility license suspensions and revocations on their website.
SB 35 passed the Senate Health Committee last April by a vote of 11-0 and the Senate Judiciary Committee in April on a unanimous vote. SB 43 passed the Senate Judiciary Committee unanimously, as well. SB 83 passed the Senate Health Committee by a vote of 11-0. All three measures are now awaiting consideration by the Senate Appropriations Committee.
According to the Senator's press release "Southern California’s “Rehab Riviera” is well known to be an area in which a network of rehab facilities exist in a quasi-medical realm where evidence-based care is rare, licensed medical staffers are optional, conflicts of interest are rampant, and regulation is stunningly lax. Senator Umberg's three measures directly address these pressing issues by adding local enforcement mechanisms and transparency for patients and families."