Wednesday, June 30, 2010

DEA Serves Search Warrants On Physicians & Pharmacies Connected To San Diego Chargers & Padres

The Los Angeles Times reported today that U.S. Drug Enforcement Administration agents served 10 search warrants on June 29, 2010 on physicians and pharmacies affiliated with the San Diego Padres baseball and San Diego Chargers football teams. According to the article which cited unnamed federal authorities, the agents were checking the records of controlled substances, which physicians and pharmacies are required to maintain under law.There are currently no criminal or administrative charges, but the investigation is ongoing, said Amy Roderick, DEA spokeswoman in San Diego.

The article can be found at:

DEA serves search warrants on doctors, pharmacies connected to San Diego Chargers, Padres [Updated]

Attorney Commentary:  For the physicians and pharmarcies who were served with search warrants, this is the opportune moment for them to do everything they can to avoid any criminal or administrative charges or fines. There are record keeping requirements that the DEA imposes and it is critical to have an organized response to the warrants and any subpoenas or inspections. 

Posted by Tracy Green, Esq.  Any questions should be directed to Tracy Green, a very experienced Los Angeles physician attorney and Los Angeles health care attorney. You can email her at tgreen@greenassoc.com or call her at 213-233-2261.  Green and Associates is located at
801 South Figueroa Street #1200, Los Angeles, CA 90017.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing health care providers and physicians in California and throughout the country. Their website is: http://www.greenassoc.com/

Tuesday, June 29, 2010

Ventura Man Sentenced to Probation & Lost Professional License for Smog Testing Fraud: Undercover Sting By Bureau of Automotive Repair

The California Department of Consumer Affairs, Bureau of Automotive Repair (BAR) has conducted undercover investigations some of which have lead to criminal convictions for fraud and administrative sanctions such as losing licenses. 

In 2008, BAR conducted an undercover investigation to determine if technicians or shops were committing “clean piping” fraud. “Clean piping” occurs when a technician enters data into the official Emissions Information System verifying registration and test data results for a car that is not the car used for the actual test. 

On June 4, 2008, BAR conducted an undercover investigation which revealed that Jesus Jimenez Lopez (DOB 9/9/1962) was engaged in a “clean piping” scheme. The BAR investigation determined that Mr. Lopez entered data into the Smog Analyzer system that did not match the vehicles actually being tested at the time of the tests on three separate occasions at Ventura Smog and Test Only located in Ventura, California.  Submitting false certificates and fraudulent smog test certificates are felony offenses.

Mr. Lopez was arrested and charged due to this alleged clean piping fraud. On March  25, 2010, Lopez pled guilty to three felony counts: (1) a violation of Health and Safety Code Section 44059, (2) perjury by submitting false information through the Bureau of Automotive Repair's Emissions Information System, and (3) Vehicle Code section 4463(a), filing a false registration document. 

On June 16, 2010, the Honorable Edward F. Brodie sentenced Mr. Lopez to three years probation and 120 days in the Ventura County jail for pleading guilty to these three felony charges. In addition, pursuant to the terms of his probation, Mr. Lopez is not allowed to operate any smog testing equipment without being licensed and cannot be on the premises of any smog testing station unless his personal vehicle is being tested, or he is otherwise licensed to conduct such business by the California Bureau of Automotive Repair. 

Prior to the resolution of this criminal case, Mr. Lopez's license to conduct smog inspections was previously revoked by the Bureau of Automotive Repair in administrative proceedings. 

Attorney Commentary: This is the type of case where there is an administrative case and criminal case running parallel. In this case, the administrative case finished before the criminal case. Often the administrative boards will wait until the criminal case in concluded before taking action against a license. The loss of the license can often be an equal or greater penalty than the criminal sanction. If there is an arrest that relates to one's license or profession, it is important to consult an experienced California board attorney for strategy and representation. In many cases, the licenses can be saved. The value of those licenses can be significant over a 10 or 20 year period.

Posted by Tracy Green, Esq. Any questions or comments should be directed to Tracy Green, a very experienced Bureau of Automotive Fraud attorney and automotive repair fraud attorney at tgreen@greenassoc.com. Green and Associates is located at 801 South Figueroa Street #1200, Los Angeles, CA 90017.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed businesses such as automotive repair shops and technicians before the California Bureau of Automotive Repair. Their website is: http://www.greenassoc.com/

Friday, June 25, 2010

Sexual Misconduct Cases For Professionals Can Be The Most Problematic: Case Study Of California Attorney Who Had Sex With Two Clients

Sexual misconduct cases for professionals are among the most problematic and often require going to a full administrative hearing in California in order to achieve a complete dismissal or exoneration. This is true whether it is for attorneys, physicians, psychologists or other therapists.  Even if the allegations are false, the various Boards are reluctant to dismiss sexual allegations outright or have concerns about the settlements not requiring probation. The Boards seem to want to have some jurisdiction over the licensee.

Our office has handled a number of sexual conduct allegations where even where the allegations clearly could not be proven by clear and convincing evidence and there were serious credibility issues with the complainants, the Boards wanted the professional to be on probation and required the matters to go to hearing.

A recent case involving the State Bar shows how an attorney's sexual misconduct case has been pending for six years and how the Chief Trial Counsel's Office wanted a harsher discipline than was originally rendered and appealed what seemingly was a fair decision for the attorney.  The attorney now faces potential disbarment.

Both the California Rules of Professional Conduct and the ABA Model Rules of Professional Conduct prohibit lawyers and clients from engaging in “sexual relations” unless they predated the representation. Even then, however, other ethics rules may apply to the extent that sexual involvement may adversely impact the attorney-client relationship.

On June 17, 2010, a State Bar Court judge has recommended disbarment for Hollister, California lawyer Patrick Earl Marshall (age 63) – who had sexual relations with two incarcerated clients when he was a contract public defender.  This recommendation followed arguments from the State Bar prosecutor’s office that a stayed suspension  and probation was too lenient. Mr. Marshall will be placed on involuntary inactive enrollment effective June 18 pending approval by the California Supreme Court of the disbarment recommendation.

This case has a lengthy history. In  May 2004, Mr. Marshall was charged by the Chief Trial Counsel’s Office  with engaging in sexual misconduct with two female clients who were incarcerated in San Benito County at the time. Over the objections of the Chief Trial Counsel’s Office, Mr. Marshall was admitted to the State Bar’s Alternative Discipline Program, which allows for substance abuse or mental health treatment before a case is decided. Mr. Marshall entered into an agreement to assist in his recovery process from depression disorder, sexual disorder, narcissistic personality disorder and obsessive compulsive disorder.

When he completed the program in 2007, the State Bar Court Hearing Department imposed a one-year stayed suspension and two years’ probation for his misconduct. The Chief Trial Counsel’s office appealed the decision to the Supreme Court, which, in 2009, ordered the State Bar Court to conduct further hearings.

On appeal, the decision was not favorable for Mr. Marshall. “Despite respondent’s successful completion of the ADP and LAP [Lawyer Assistance Program] and years of therapy,” State Bar Court Judge Lucy Armendariz wrote in her disbarment decision. The judge argued that since Mr. Marshall argued that the sex was consensual, it was apparent that he “has not fully grasped the egregiousness of his offenses and the extreme harm he had caused the administration of justice and integrity of the legal profession.” Judge Armendariz noted that Marshall went so far as to argue that a mitigating factor should be that his misconduct accounted for no more than “an hour’s total duration.” Thus, the judge used Mr. Marshall's arguments to show that he was not accepting full responsibility for his behavior. This can be a fine line in administrative cases.

“Violation of one’s professional and ethical duties is not measured by the length of time,” Judge Armendariz wrote. “Having improper sexual relations with a client breaches the basic notions of trust and integrity and endangers public confidence in the legal profession, irrespective of its duration . . . His persistent claims that the sexual relations were consensual and that [one woman] never told him to stop are indeed troubling and adversely reflect on his fitness to practice law.” The judge referred to an Iowa Supreme Court decisions which stated that “‘the professional relationship renders it impossible for the vulnerable layperson to be considered ‘consenting.’”

Sexual misconduct can encompass a variety of intimate relationships. The California rule defines “sexual relations” as “sexual intercourse or the touching of an intimate part of another person for the purpose of sexual arousal, gratification or abuse.” This can cover even kissing or hugging depending on the circumstances. If one can look at the issue before anything occurs, the experienced professional will keep his or her personal life out of the office. A professional's reputation for honesty and integrity will remain intact by keeping professional relationships professional.
 
If you are the subject of a sexual misconduct complaint, it is important to seek counsel at the earliest possible time. If you are asked to be interviewed by any Board investigator it is key to consult an experienced Los Angeles administrative attorney, Los Angeles Medical Board attorney, Los Angeles State Bar attorney, or an attorney experienced with your particular board or agency. 

Posted by Tracy Green, Esq.  Any questions should be directed to Tracy Green, a very experienced California administrative board attorney, California board attorney and California license attorney. You can email her at treenassoc.com">tgreen@greenassoc.com or call her at 213-233-2261.  Green and Associates is located at 801 South Figueroa Street #1200, Los Angeles, CA 90017.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing health care providers, attorneys and other licensed professionals in administrative actions in California and throughout the country. Their website is: http://www.greenassoc.com/

Tuesday, June 22, 2010

Power Wheelchair Fraud Investigations Continue: Recent Los Angeles Case Illustrates What Type Of DME Investigations Go Criminal


There are a number of investigations in Southern California regarding Medicare fraud involving power wheelchairs. The task force by the Health and Human Service's Office of Inspector General (OIG) began in 2003 with "Operation Wheeler Dealer" and now the criminal investigations and prosecutions are in full bloom. It takes years for these cases to be investigated and prosecuted.

A recent Los Angeles case involving a DME billing Medicare for power wheelchairs shows what type of investigations can end up in a criminal courtroom.

Some DME companies mistakenly take the position that if there was a physician prescription and the wheelchair was delivered -- there can be no fraud case.  This recent Los Angeles federal criminal case illustrates why that approach alone may not be a sound defense at trial unless there is medical necessity and valid physician prescriptions. If there was marketing directed to patients or Medicare beneficiaries, that causes additional concerns that need to be addressed at the investigative level.

This recent case also shows what the government is investigating in a number of these cases. On March 25, 2010, U.S. District Judge John F. Walter of the Central District of California sentenced the owner and operator of a Los Angeles-area durable medical equipment (DME) company, Leonard Nwafor (age 44) in absentia to nine years in prison for an alleged power wheelchair fraud.

Mr. Nwafor was convicted by a jury at trial in September 2008 of conspiracy to commit health care fraud and health care fraud. After his conviction, Nwafor fled the jurisdiction and is considered a fugitive. After over 18 months, the court decided to sentence him "in absentia" meaning while he is absent.

In addition, Nwafor was ordered to serve three years of supervised release following his prison term, pay $526,243 in restitution and $25,000 in fines, and forfeit more than $526,000 in stolen Medicare funds to the U.S. government.

At trial, the evidence produced by the government was that Mr. Nwafor, through his company, Pacific City Group Inc., aka Pacific City Medical Equipment, submitted $1,109,438 in claims to Medicare, primarily for expensive, high-end power wheelchairs and wheelchair accessories for 170 Medicare beneficiaries. The government alleged that these wheelchairs were not needed by these beneficiaries.

The trial focused on the marketing used to recruit Medicare beneficiaries and how there was no "medical necessity" for the wheelchairs. At trial, elderly and disabled Medicare beneficiaries (who could walk without a wheelchair) testified that individuals known as “marketers” approached them on the street, at home or in church and encouraged the beneficiaries to give the marketers their Medicare numbers and other personal information in exchange for "free" power wheelchairs. The government next presented evidence at trial established that Mr. Nwafor's company billed Medicare for power wheelchairs for 170 beneficiaries for up to $7,000 per wheelchair.

The testimony included one blind beneficiary or patient, who testified that he could not see to operate the wheelchair and never used it. The same beneficiary also testified that a delivery driver working for Mr. Nwafor and the delivery driver’s girlfriend paid him $200 to refer them to other Medicare beneficiaries.

Another beneficiary testified about the aggressive techniques marketers used to recruit her and her husband into obtaining a "free" wheelchair.  This beneficiary testified that an individual purporting to be from Medicare, but who was actually associated with Mr. Nwafor and his co-conspirators, threatened to terminate the Medicare benefits of the beneficiary and her husband unless they accepted two power wheelchairs that the beneficiary and her husband did not need.

The government also had Los Angeles area physicians testify that they did not write many of the prescriptions or orders for wheelchairs that were in the files of Mr. Nwafor's company. The physicians testified that the prescriptions were forged. One of these physicians, a psychiatrist, testified that he does not prescribe power wheelchairs as part of his practice, and had never written a prescription for one. Other physicians testified that the prescriptions bearing their names were phony and that their handwriting was not on any of the prescriptions.

After his conviction, Mr. Nwafor admitted in sentencing documents he filed with the court that he purchased the prescriptions and documents he used to support his false claims to Medicare from a co-conspirator for approximately $1,300 per prescription. One of Mr. Nwafor’s alleged co-conspirators, Ajibola Sadiqr (owner of Cooper Medical Supply), admitted that he purchased fraudulent prescriptions and documents from Mr. Nwafor to perpetrate his own fraudulent power wheelchair Medicare fraud scheme. Mr. Sadiqr pleaded guilty and was sentenced in May 2010 to 55 months plus three years of supervised release by Judge Walter.

Posted by Tracy Green, Esq.  Any questions should be directed to Tracy Green, a very experienced health care fraud attorney, Medi-Cal fraud attorney and Medicare fraud attorney. You can email her at tgreen@greenassoc.com or call her at 213-233-2261.  Green and Associates is located at
801 South Figueroa Street #1200, Los Angeles, CA 90017.

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  Ms. Green's office at Green and Associates is located at 801 South Figueroa Street #1200, Los Angeles, CA 90017.

Tracy Green is a very experienced California health care fraud attorney, power wheel fraud attorney, California Durable Medical Equipment attorney, and California DME attorney.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in California and throughout the country. Their website is: http://www.greenassoc.com/

Friday, June 18, 2010

New York DME Health Care Fraud Case: 17 Individuals Charged and 12 DMEs Searched In Federal Criminal Case Involving "No Fault Insurance" Billing

On June 15, 2010, four indictments were unsealed in the Eastern District of New York charging 17 individuals for their participation in alleged health care fraud and money laundering schemes in the Eastern District of New York. In addition, 12 durable medical equipment (DME) retail companies located in South Brooklyn that were operated by the charged individuals were searched.

Four of the DME businesses in Brooklyn that were searched were Kristar, Inc., Promed Supply Co., Inc., Dorsi Medical Supply Inc.,
DB Supply Inc./Avgur. The government also seized assets from bank accounts maintained by the retail DME companies owned by the charged individuals.

It must be remembered that the charges announced by the U.S. Attorney's Office today are merely allegations, and the defendants are presumed innocent unless and until proven guilty.

According to the indictments, the DME company owners and operators filed fraudulent claims with private insurance companies with no-fault insurance plans. Specifically, it is alleged that the DME companies   submitted false invoices for durable medical equipment to the insurance companies in two ways: (1) by charging prices well in excess of the price paid by the companies, and (2) by billing for equipment that was never obtained.

There is a money laundering allegation as well since the indictments allege that the charged individuals engaged in financial transactions to conceal the identity, source, and destination of the fraudulent proceeds by “laundering” them through checks they issued to the same wholesale companies. The checks were then negotiated at check cashing stores and the resulting cash was delivered back to the defendants.

The charged individuals are: Aleksandr Afanasev (age 44), Leksandr Afanasev (age 44), Eduard Budrunov (age 49), Grigory Branfenbrener (age 57), Gennadiy Bronshteyn (age 51), Lyubov Groysman (age 56), Vladimir Khmelnitski (age 45), Iliya Mugerman (age 46), Bela Rud (age 38), Viktor Semerik (age 44), Arkadi Shapiro (age 59), Denis Zagladko (age 29), Igor Shturman (age 48), Mariya Gomelskaya (age 27), Igor Vetukh (age 50), Andrei Kozlovski (age 42), Igor Ladanov (age 28) and Artem Yuryev (age 31).

Attorney Commentary

In New York, there is no fault accident insurance. Health care fraud prosecutions are now proceeding beyond Medicare and Medicaid and are targeting private insurance companies. What appears to be alleged in this case is that the DME companies alleged that the price to the wholesale companies was more than charged, that the DME companies issued false invoices, the insurance companies sent checks to the wholesale companies, and then the wholesale companies cashed the checks at check-cashing stores. At that point, it is alleged that the cash funds were delivered back to the individuals charged.

How does the government prove such a case? Usually through  subpoenaed bank records and a forensic accounting probe. This means that witnesses are not necessary and it becomes a paper case. In order to evaluate the liability or exposure on such a case, analysis of these records by defense counsel is necessary.

The mark-up allegations are aggressive and are usually charged as a means of showing how kickback or other fraudulent schemes exist.  Large mark-up is not in and of itself against the law but is a factor that is considered on whether there is health care fraud. In some occasions, the large mark-up is used to explain how the extra money made is used for kickbacks or referral fees. 

Posted by Tracy Green, Esq. Any questions or comments should be directed to Tracy Green, a very experienced California health care fraud attorney, DME fraud attorney, California insurance fraud attorney, and California white collar criminal defense attorney at tgreen@greenassoc.com. Green and Associates is located at 801 South Figueroa Street #1200, Los Angeles, CA 90017.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in California and throughout the country. Their website is: http://www.greenassoc.com/

Thursday, June 17, 2010

Olive View-UCLA Hospital Staffers Allegedly Accepted Gifts From Nursing Home Employees - L.A. Times Article


Healthcare: Olive View-UCLA staffers allegedly accepted gifts from nursing home employees - latimes.com

The Los Angeles Times reported on June 2, 2010 that Los Angeles County officials are investigating allegations that Olive View-UCLA Medical Center staff accepted gifts from nursing home employees in exchange for placing Medi-Cal and Medicare patients at their facilities, a possible violation of the county's code of ethics, as well as state and federal anti-kickback laws. Olive View is one of four hospitals that the Department of Health Services operates in Los Angeles County.

According to the article, three staff members at the county hospital in Sylmar — a clinical social worker and two medical case workers — have been accused of receiving gifts in exchange for referring Medi-Cal and Medicare patients to at least three local nursing homes.

Any allegations need to be investigated carefully and it cannot be assumed that the Los Angeles Times' sources are correct. Last month, the Los Angeles Times published several articles about Olive View that contained outrageous allegations about a beauty salon existing in the Neonatal Intensive Care Unit. Los Angeles County health officials investigated and in their written response they said they found "little about the allegations" to be correct.

In the last investigation, County health officials addressing an anonymous complaint to an accreditation agency said seven of 11 allegations made could not be substantiated. Officials found that hospital staff provided and received cosmetic services at Olive View, but said "the investigation has dispelled the claim that an organized cosmetic operation on the scale of a 'beauty salon' has existed in the NICU."


The new allegations will undoubtedly be investigated and they are serious allegations that could jeopardize the facility's Medi-Cal provider number and could result in significant audits and demands for overpayment if there is any truth to them. However, allegations are only allegations. Former or current employees could have their own agendas in reporting these "allegations" and a thorough investigation is needed before unsubstantiated allegations are assumed to have any validity.

Posted by Tracy Green, Esq. Any questions or comments should be directed to Tracy Green, a very experienced Los Angeles kickback attorney and Los Angeles hospital attorney at tgreen@greenassoc.com. Green and Associates is located at 801 South Figueroa Street #1200, Los Angeles, CA 90017.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and facilities in California and throughout the country. Their website is: http://www.greenassoc.com/

Tuesday, June 15, 2010

Medi-Cal Update: June Fee-for-Service Provider Payment Delay

The California Department of Health Care Services (DHCS) recently announced it will delay payments for one week at the end of June and pay those claims out of the 2010-2011 fiscal year budget. This means that the last checkwrite in June 2010 will be delayed until the start of the next fiscal year that begins July 1, 2010. Providers should make cash flow plans and plan for potential budget problems in California.

The delay of the checkwrite payment normally scheduled for June 24, 2010, will impact providers that render services to the following programs:
  • Medi-Cal
  • Healthy Families
  • Child Health and Disability Prevention
  • California Children’s Services
  • Expanded Access to Primary Care
  • Genetically Handicapped Persons Program
  • Abortion Services
Because this year’s budget is so contentious, it is possible that physicians will be subject to additional payment delays if the Legislature’s budget talks go well beyond the constitutional June 15 deadline. According to the State Controller’s office, a budget impasse would not immediately affect Medi-Cal providers. Medi-Cal payments would continue until the state’s cash reserves are completely exhausted. Claims for services provided under the other programs listed above may, however, be further delayed if a new budget is not in place by July 1.

The last checkwrite in June 2010 will be delayed until the start of the next fiscal year that begins July 1, 2010. The delay of the checkwrite payment normally scheduled for June 24, 2010, will impact providers that render services to the following programs:


The electronic funds transfer (EFT) settlement date for those affected by the checkwrite delay will be July 2, 2010. Providers that render services for Cancer Detection Programs: Every Woman Counts will not be affected by the checkwrite delay and will receive payments as normally scheduled.

 Posted by Tracy Green, Esq.  Any questions should be directed to Tracy Green, a very experienced Los Angeles physician attorney, Los Angeles Medi-Cal attorney and Los Angeles health care attorney. You can email her at tgreen@greenassoc.com or call her at 213-233-2261.  Green and Associates is located at
801 South Figueroa Street #1200, Los Angeles, CA 90017.  

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing health care providers   in California and throughout the country. Their website is: http://www.greenassoc.com/

Saturday, June 12, 2010

New Emphasis On Prosecuting Fraud In IHHS, Med-Cal And CalWorks Programs: 9 Arrested In Los Angeles County

In Los Angeles County and California, there have been increased prosecutions for public benefits fraud. The Department of Health Services and the District Attorney's Office have targeted the In-Home Supportive Services (IHSS) Program since it is perceived that there is a significant amount of fraud by both the recipients (in failing to report all income) and the providers (many of whom are often family members or friends). CalWorks and Medi-Cal programs have also been targeted. The District Attorney's Office has a Public Assistance Fraud Division which specializes in these cases.

What is IHHS? IHSS provides services to persons who are over age 65, blind or have a disability to enable them to remain safely in their home.  IHSS lets family members and others to become providers and get paid for providing basic services (cleaning, cooking, laundry, shopping, etc.) to individuals who cannot safely perform their services themselves due to physical or mental incapacity.  Cal. Welf. & Inst. Code § 12300(a).  Basically, IHSS is an alternative for individuals who might otherwise be placed in a facility when they are unable to care for themselves in their own home.This is an excellent program which saves the state money in the long run since it is much less expensive to keep individuals in their own home than to pay for nursing homes.

Last year, there were grand juries in six California counties which pointed out the lack of safeguards to protect against fraud. In 2009, Governor Schwarzenegger contended that 25% of the IHSS program was fraud even though there were no real statistics to back up that claim. This has created a political climate where these programs will be targeted for fraud investigations. While no one endorses fraud, the government should be careful not to single out Californians who need assistance to live at home and the people who help them stay safe and healthy.

Recent Los Angeles County District Arrests

During the week of May 24, 2010, nine people were charged by the Los Angeles County District Attorney's Office as a result of investigations by the District Attorney’s Office, the Department of Health Services and the Los Angeles County Department of Public Social Services. Two of the cases involved alleged losses of $45,000 and $395,000 while the remaining seven cases were much smaller with losses ranging from approximately $700 and $15,500. Most of the smaller seven cases involved alleged IHHS fraud.

(1) Ms. Alicia Garcia, age 51 of Los Angeles was charged in case LASC Case No. BA370996 with (i) one count of false statements to receive healthcare, (ii) three counts of aid by misrepresentation and (iii) four counts of perjury by false application for aid. It is alleged that Ms. Garcia received more than $136,000 in welfare benefits from January 2002 to April 2010. During the aided period, Ms. Garcia allegedly failed to report her true income, ownership of property, vehicles and bank accounts and also failed to report a spouse in the home.

Ms. Garcia's bail was initially set at $45,000. It is the D.A.'s Office practice to initially set bail at the amount of the loss in a fraud case. The maximum punishment for these offenses is a maximum state prison term of nine years although sentences in these type of cases are generally much lower and probation is available even if there is a guilty plea. 


(2) Ms. Tangela Ridgeway, age 35 of Cerritos, allegedly received more than $60,000 in public assistance benefits from June 2004 to March 2010, and is accused of failing to disclose that she owned a business, property and several vehicles. Ms. Ridgeway allegedly failed to report employment, underreported income and failed to disclose bank accounts. In LASC Case No. BA371480, Ms. Ridgeway is charged with (i) one count of aid by misrepresentation, (ii) one count of perjury by false application for aid, and (iii) 14 counts of perjury by declaration. Ms. Ridgeway's bail was initially set at $395,000 - indicating a larger loss amount - and she faces a maximum term of 19 years in state prison which again is subject to negotiation between defense counsel and prosecutors.

In Ms. Ridgeway's case, the D.A.'s Office may have 1099 statements from employers and banks to substantiate its claims. For over 7 years, there was a lawsuit which precluded the County from receiving 1099 and W-2 information from the Franchise Tax Board in order to conduct audits. This issue was decided in favor of the County approximately two years ago and there are a number of audits being conducted to compare the 1099s and W-2 reports to what applicants reported to programs such as CalWorks, Medi-Cal and IHHS.


The loss attributed to the seven others charged ranges between approximately $700 and $15,500 from such public assistance programs as In Home Supportive Services and CalWorks. The majority of those arrested were participants in the IHSS system which permits providers to receive money for services to elderly or dependent adults.

Attorney Thoughts

If you or a family member are audited or asked to come in for an interview with any government program, you should consult a public assistance fraud attorney. If one receives assistance, there are a number of documents that are signed over time under the penalty of perjury. Similarly, if one is an IHHS provider, there are a number of timesheets that are completed over time. Even if you have received benefits, you still have your rights under the Fifth Amendment not to incriminate yourself. You should understand your rights and analyze whether there is any exposure before you meet voluntarily with government investigators.

Posted by Tracy Green, Esq.  Any questions should be directed to Tracy Green, a very experienced IHHS fraud attorney, Medi-Cal fraud attorney and California public benefits fraud attorney. You can email her at tgreen@greenassoc.com or call her at 213-233-2261.  Green and Associates is located at
801 South Figueroa Street #1200, Los Angeles, CA 90017.


The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing health care providers  in health care fraud and other types of fraud and overbilling allegations in California and throughout the country. Their website is: http://www.greenassoc.com/

Friday, June 11, 2010

6th Doctor Sentenced In Federal Health Care Fraud Case Involving Board And Care Facilities In Southern California: 17 Defendants Sentenced In Case Pending For 6 Years

On May 24, 2010, after six years of litigation, Xinming Fu, M.D., an Irvine physician -- as well as the 17th and final defendant in a complex Medicare fraud case -- was sentenced to 30 months in federal prison in U.S. District Court in Santa Ana, California by Judge James V. Selna. This sentence followed Dr. Fu's guilty plea to conspiracy to pay kickbacks and health care fraud. Out of the 17 defendants, 6 were physicians.

As part of his plea agreement, Dr. Fu admitted that he was part of a scheme that defrauded Medicare out of $15 million for respiratory treatments that were unnecessary, not performed in accordance with Medicare rules, or not performed at all. 

The 17 defendants were named in a criminal information and three indictments returned by federal grand juries as far back as 2004. Three of the cases involved a scheme in which the owner of a respiratory treatment program, Herman Thomas, recruited Medicare patients who were housed at board-and-care facilities throughout Southern California. It was alleged that from 2000 through 2006, Mr. Thomas and doctors that he recruited paid illegal kickbacks to marketers, who in turn paid illegal kickbacks to the owners and administrators of the board-and-care facilities, who provided access to mentally ill and elderly residents. 

It was further alleged that on a monthly basis, the doctors ordered respiratory treatments, which typically were unnecessary and were performed by respiratory therapists on a daily or almost daily basis without any physician supervision, in violation of Medicare rules requiring that a physician be on-site when respiratory treatments are performed. The government contended that the respiratory treatments also violated Medicare rules because the treatments should have been performed at a doctor’s office or in a mobile medical unit, instead of at the board-and-care facilities. 

In a scintillating allegation, the government contended that treatments were often performed in the facilities’ smoking rooms. It was also alleged that the mentally ill and elderly residents of the board-and-care facilities were enticed to undergo the respiratory treatments with soda, candy, donuts and even cigarettes. There were also some ghost billing allegations in that it was contended that some residents were not present at the board-and-care facilities because they were off-site receiving treatment at local hospitals, but Medicare was billed for respiratory treatments anyway.

The fourth case in this investigation arose from a respiratory therapist/marketer who previously worked for Mr. Thomas and recruited a doctor to run a separate, but similar respiratory program. 

The defendants previously sentenced as a result of this investigation were:
  1. Dr. Aziz Awad, 47, formerly of Anaheim and Pasadena, was sentenced to 15 years in prison and ordered to pay $2,625,722 in restitution. This sentence was harsh compared to the other sentences since Dr. Awad was sentenced after trial. Obviously if one wins at trial there is no sentence, but there is a tax imposed for going to trial and losing.  
  2. Herman Thomas, 51, of Bellflower, who was convicted at trial with Awad, was sentenced to 88 months imprisonment (a little over 7 years) and ordered to pay $2,625,722 in restitution.
  3. Dr. Paul Arnold Lessler, 71, of West Hills, was sentenced to two years in custody and ordered to pay nearly $1.1 million in restitution after pleading guilty to conspiracy to commit health care fraud and health care fraud in a plea agreement.
  4. Dr. Gershon Walter Hepner, 72, of Los Angeles, was sentenced to 30 months in custody and ordered to pay $422,400 in restitution after pleading guilty to conspiracy to commit health care fraud and pay kickbacks, and health care fraud in a plea agreement.
  5. Dr. Aginah M. DeBerry, 57, of Rancho Cucamonga, was sentenced to one year in prison and ordered to pay $707,800 in restitution after pleading guilty to conspiracy to commit health care fraud and pay kickbacks in a plea agreement.
  6. Glen Garcia Madrid, 46, of Yorba Linda, a marketer, was sentenced to one year in prison and ordered to pay $1,566,977 in restitution after pleading guilty to conspiracy to pay kickbacks and health care fraud in a plea agreement.
  7. Levi Raitchik, 49, of Los Angeles, a marketer, was sentenced to eight months in custody and ordered to pay $395,100 in restitution after pleading guilty to conspiracy to pay kickbacks and health care fraud in a plea agreement.
  8. Schmuel B. Fogelman, 49, of Los Angeles, a marketer, was sentenced to one year in custody and ordered to pay $693,000 in restitution after pleading guilty to conspiracy to pay kickbacks and health care fraud in a plea agreement.
  9. Barbara Sue Thrash, 60, of Corona, a board-and-care administrator, was sentenced to 15 months in custody and ordered to pay $495,019.05 in restitution after pleading guilty to conspiracy to receive kickbacks and health care fraud in a plea agreement.
  10. Teresita Cagudala Bolong, 62, of Rancho Palos Verdes, a board-and-care owner and administrator, was sentenced to six months in prison, ordered to pay a $17,000 fine, and ordered to pay $108,000 in restitution after pleading guilty to receiving kickbacks in a plea agreement.
  11. Dr. David Todd Asher, 42, of Fullerton, was sentenced to probation and ordered to pay $6,850 in restitution after pleading guilty to conspiracy to pay kickbacks in a plea agreement.
  12. Emilita Nunez Canenea, 50, of San Dimas, a board-and-care owner and administrator, was sentenced to probation, ordered to pay a $20,000 fine, and ordered to pay $18,000 in restitution after pleading guilty to receiving kickbacks in a plea agreement.
  13. Shahnaz Chadorbaf-Arastoo, 54, of Irvine, a board-and-care owner and administrator, was sentenced to probation, ordered to pay a $5,000 fine, and ordered to pay $4,000 in restitution after pleading guilty to receiving kickbacks in a plea agreement.
  14. Magdalena Gonzales, 57, of Denver, a board-and-care administrator, was sentenced to probation and ordered to pay $9,500 in restitution after pleading guilty to aiding and abetting a false claim in a plea agreement.
  15. Hamid Rafizadeh, 54, of Escondido, a board-and-care administrator, was sentenced to probation, ordered to pay a $5,000 fine, and ordered to pay $8,500 in restitution after pleading guilty to receiving kickbacks in a plea agreement.
  16. Alexander Tanciano Tagaro, 62, of Perris, a board-and-care administrator, was sentenced to probation and ordered to pay $7,500 in restitution after pleading guilty to receiving kickbacks in a plea agreement.
Posted by Tracy Green, Esq. Any questions or comments should be directed to Tracy Green, a very experienced Los Angeles health care fraud attorney and Los Angeles white collar attorney at tgreen@greenassoc.com. Green and Associates is located at 801 South Figueroa Street #1200, Los Angeles, CA 90017.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in California and throughout the country. Their website is: http://www.greenassoc.com/

    Thursday, June 10, 2010

    Reminder For All California Physicians: Beginning June 27, 2010 Your Office MUST Provide Notices Or Post Signs Informing Patients Of Medical Board's Contact Information


    Beginning June 27, 2010, all of the State of California's physicians must provide notices or post signs stating the following: "Notice to consumers, medical doctors are licensed and regulated by the Medical Board of California, (800) 633-2322, www.mbc.ca.gov."

    This is a new regulation (Title 16, California Code of Regulations section 1355.4), mandated by California Business and Profession Code Section 138. The purpose of this new requirement is to inform consumers where to go for information or with a complaint about California medical doctors. There are 3 ways that physician may provide this notice as described below.

    Physicians may provide this notice by one of three methods:

    (1)  Prominently posting a sign in an area of their offices conspicuous to patients, in at least 48-point type in Arial font.  This will be the easiest method and least paperwork intensive. You can cut and paste the notice below, make sure it is in the proper font and frame it in the office. 

    (2)  Including the notice in a written statement, signed and dated by the patient or patient’s representative, and kept in that patient’s file, stating the patient understands the physician is licensed and regulated by the board.

    (3)  Including the notice in a statement on letterhead, discharge instructions, or other document given to a patient or the patient’s representative, where the notice is placed immediately above the signature line for the patient in at least 14-point type.

      The information must read as follows:

      NOTICE TO CONSUMERS
      Medical doctors are licensed and regulated by the Medical Board of California
      (800) 633-2322
      www.mbc.ca.gov

      Any questions or comments should be directed to Tracy Green, a very experienced health care attorney, at tgreen@greenassoc.com. Tracy Green is a principal at Green & Associates. Green & Associates is located at 801 South Figueroa Street #1200, Los Angeles, CA 90017.

      The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers in California and in other states. Their website is: http://www.greenassoc.com/

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