Interpreting services in the workers' compensation system has been criticized at times as being overused and abused ancillary service. However, it was handled in lien negotiations with insurance carriers handling those services separately.
State criminal charges have been filed against nine people alleged to be part of an interpreting service company specializing in providing interpreting services to workers' compensation patients in medical clinics.
In an apparent political move, this case is being filed just around the time that there are hearings relating to disputes between carriers and the rights of non-English speaking workers to have the right to interpreting services with certified interpreters. This case may also be used to challenge the liens by this company and the insurance carriers have a lot of power in determining who gets charged criminally in state court cases.
The prosecution allegeds that G&G billed for interpreting services that were not needed or not provided in seven different counties in Southern California. The "victims" are alleged to be insurance carriers and numerous companies that are self-insured. The alleged fraudulent billing is claimed to be more than $24.6 million from 2008 to 2012.
The Department of Insurance investigated the case for several years. Los Angeles County District Attorney's Office has filed charges against the alleged two owners and seven employees of G&G Interpreting Services. G&G is considered a large player in the system providing Spanish-language interpreting services for injured workers receiving healthcare services through the workers' compensation system. G&G is alleged to have about 200 employees.
The Department of Insurance is publicizing the case and asking patients to contact them if an interpreter shows up in a medical clinic and the patient does not need an interpreter. This case is being used to send a warning to interpreting services and to gain political leverage.
This case has several components. One allegation is "ghost billing" claims with billing for services not provided. For example, detectives claim that G&G Interpreting billed workers' compensation insurers more than $422,000 for the services of an interpreter who was actually incarcerated in state prison during the time the company claimed she was providing interpreting services. Another allegations is that the claims must be false since 83,411 interpreting service events exceeded 12 hours in a day -- more hours than the clinics were actually open.
Another challenge is the alleged provision of unnecessary services. It is claimed that G&G Interpreting billed for translation services provided to clinics where the majority of the clinic staff spoke Spanish and there was no need for translation services. In other cases, the company billed for services to clinics where 13 treating physicians spoke fluent Spanish and there was no need for translation.
The charges are currently against alleged owners Francisco Javier Gomez, Jr., and Angela Rehmann, 38; and seven others (Cynthia Gomez, Melissa Navarro, Gloria Sandoval, Arnulfo Reyes III, Amber Anguiano, Crystal Garcia, and Jamilett Ortega. They are all presumed to be innocent and criminal charges are not evidence.
There may be good defenses to these claims. For example, since a Spanish speaking physician does not mean that there is no need for a translator since there are other portions of the history and exam where a physician is not present. There may be errors or mistakes and other defenses but that can only be determined by an examination of all the discovery to be produced by the government.
Posted by Tracy Green, Esq.