Sunday, June 24, 2012

Recent Nursing Trend: Nurses Going Back To College For 4-Year Degree To Meet New Requirements

The New York Times' article "More Stringent Requirements Send Nurses Back to School" (June 23, 2012) highlights more stringent requirements that hospitals and other employers are requiring of R.N.s in today's world. Hospitals which often pay the best, especially teaching hospitals, are beginning to require a 4-year degree for hiring. It is time to consider more education in order to stay competitive in the marketplace.

I have also been encouraging my nurse clients with 4-year degrees to consider becoming advanced practitioners such as Nurse Practitioners or Certified Nurse Midwifes since that gives them the ability to practice more independently under a physician's supervision. It makes practice in a private setting more rewarding as well.

Posted by Tracy Green, Esq. Please email Ms. Green, a very experienced nurse attorney, at or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.

Saturday, June 23, 2012

Indiana Doctor Pleads Guilty To Excessive Prescribing - Is Your Practice Complying With State And Federal Laws And Guidelines?

On June 22, 2012, an Indiana doctor Ray Howell plead guilty to charges that he excessively prescribed narcotics and his plea agreement included surrendering his medical license. Indiana officials claimed that Dr. Howell issued over 11,000 prescriptions in a year. Howell plead guilty to 5 felonies including unlawful distribution of oxycodone. The DEA and state law enforcement are concerned that in some parts of the country prescription drug abuse has overshadowed methamphetamine and other unlawful drugs.

Howell's case is a reminder to physicians of what can go wrong in pain management. For those physicians who dispense pain medications as part of their practice it is important to learn from such cases without being fearful of prescribing narcotics. There is a legal way to prescribe controlled substances for intractable pain.

The law in California is that "No physician and surgeon shall be subject to disciplinary action by the board for prescribing or administering controlled substances in the course of treatment of a person for intractable pain."  Cal. Bus. Prof. Code Section 2241.5(c). How do you as a physician ensure that you fall within this law?

The first place to start is to review the California Medical Board's Guidelines for Prescribing Controlled Substances for Pain. This is a summary of the standard of care for managing pain patients. It has detailed advice that you are expected to know before you prescribe narcotics for pain management.

Second, review and comply with the DEA's Practitioner Manual to ensure you are complying with federal rules and regulations. It is usually the DEA who sends in undercover patients and initiates investigations when the CURES reports show a large number of prescriptions from a physician. There are more cases of state and local law enforcement getting involved in undercover operations as well but the DEA is in the forefront.

Third, seek legal and expert advice to make sure that your practice is compliant with existing laws, regulations and medical standard of care. If you did not comply with the existing rules in the past, it is not too late to change your practices and become compliant.

Posted by Tracy Green, Esq. Please email Ms. Green at or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.

Any questions or comments  should be directed to Tracy Green, a very experienced California physician attorney at tgreen@greenassoc.comThe 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 throughout the country. Their website is:

Wednesday, June 20, 2012

Owner of Sports Bars Charged With Under-Reporting Payroll Faces Felony Charges For Unemployment And Workers’ Compensation Insurance Fraud And Filing False Tax Return With EDD

Everyone has always known that underreporting payroll or paying employees cash under the table could result in tax issues or civil liability if a worker is injured. However, now such actions can result in criminal charges. Therefore, paying an employee cash off the books can be a serious liability risk for companies and its owners.

In a recent case, not only was the owner of a California business charged with unemployment and workers’ compensation insurance fraud but she was also charged with filing a false tax return with the California Employment Development Department (EDD).

Renee Anne Vicary, age 51 years, allegedly owned and operated four businesses: Angels Sports Bar and Gentleman’s Club in Corona; Angels Sports Bar and Grill in Anaheim; Angels Roadhouse in Yucaipa; and Angels Roadhouse in Apple Valley. Angels Sports Bar in Corona was featured on an episode of the Spike TV show “Bar Repair” in July 2011 during which it was renamed Racks Billiards and Bourbon.

According to the the Riverside County District Attorney’s (RCDA) Office, the investigation began nearly two years ago after they received information that Ms. Vicary was underreporting her employee payroll at the Corona location. It is common that investigations begin by someone reporting the wrongdoing (often former employees).

The RCDA alleges that the insurance policy listed Ms. Vicary as employing four employees at each of the Corona and Anaheim businesses and three employees at each of the two San Bernardino County businesses. Investigators allege that Ms. Vicary actually employed more employees at each of the four locations than found on the insurance policy.

Following this discovery, search warrants were served at all four businesses as well as Ms. Vicary’s Corona home and several financial institutions. It took many months for EDD and three insurance companies used by Ms. Vicary to complete audits. Once those audits were done, it was alleged that losses were in excess of $340,000. She was then charged by the RCDA’s Office with the following felonies: (1) filing a false tax return with EDD, (2) failure to collect and pay tax to EDD, (3) willful misrepresentation to obtain insurance, and (4)  willful misrepresentation to obtain Worker’s Compensation Insurance.

Ms. Vicary was arraigned on June 13, 2012, in Dept. 41 at the Hall of Justice in Riverside, following her surrender in court on an arrest warrant that was issued last month. She entered not guilty pleas and has a felony settlement conference scheduled for August 13, 2012.

A felony complaint is only an accusation and is not evidence of guilt. Ms. Vicary is presumed innocent and is entitled to a fair trial at which the government must prove guilt beyond a reasonable doubt.  

If convicted as now charged, Ms. Vicary faces up to a maximum of 14 years, four months in prison even though such a high sentence is very unlikely in this case. Typically in these cases, the amount of restitution paid is a factor in plea negotiations. The case is being prosecuted by the RCDA’s Insurance Fraud Unit.

Attorney Commentary:  This case shows how small businesses can get into criminal trouble for bad business decisions that did not used to be prosecuted as crimes. Some employees may even ask to be paid cash for their own purposes (liens, support obligations, etc.) and employers have to be careful not to do “favors” for their employees and pay them cash. All it takes is one accident at work, one cash employee filing for unemployment or a disgruntled employee to create a criminal case. It’s simply not worth it in today’s world.

What is the fraud? The DA’s Office alleges that the business failed to put the employees on payroll to save money in workers’ compensation premiums and EDD insurance. Even if that was not the company’s motivation, the company would have submitted paperwork under penalty of perjury regarding total payroll to EDD and its workers’ compensation insurance carriers with payroll totals that do not reflect the amounts paid to cash employees.

The State runs EDD and collected the unemployment insurance premiums and has decided to criminalize this conduct rather than conducting audits and collecting the money. If you face an audit, it is important to engage an attorney early and avoid having these type of investigations escalating. It is not clear what went on during the years that Ms. Vicary’s businesses were being investigated but often if the audit is handled early in a professional manner with a repayment for premiums or cash employees, a criminal case can be avoided. Every case is different but it is important to understand that each county DA office has special units for these types of cases and there is a trend towards more aggressive prosecutions of these offenses.

We have represented many employers for issues with underreporting workers' compensation premiums including issues where employees where paid cash, misclassified as independent contractors or with lower risk job titles and related issues. The earlier counsel is obtained, the better since waiting until after the audit is completed and the case is referred out makes it more difficult to resolve. We evaluate the issues and seek to ensure that mistakes and errors do not appear to have the indicia of purporseful underreporting.  

Posted by Tracy Green, Esq. Please email Ms. Green at or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  

Tracy Green is a very experienced California insurance fraud attorney, worker's compensation premium fraud attorney and Los Angeles white collar criminal defense attorney.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil,administrative and criminal proceedings. They have a specialty in representing companies and individuals in insurance fraud related matters in California. Their website is:

Monday, June 11, 2012

Former Physician Charged With 2nd Degree Murder For Three Patients' Prescription Overdose Deaths - Preliminary Hearing Continues In Unusual L.A. Case

Luis Sinco/Los Angeles Times
The unusual case of Dr. Hsiu-Ying "Lisa" Teng (who surrendered her license) continues in downtown Los Angeles today June 11, 2012 where a preliminary hearing is being held to determine if there is probable cause to charge her with second degree murder in the death of three patients who overdosed on prescription drug in 2009. A Los Angeles Times article "Former Patients Tells of Easily Getting Drugs From Doctor" covered the preliminary hearing on June 9 which has lasted a week.

The prosecution on Friday called a former patient of Tseng's and there were a number of patient witnesses who said Tseng failed to adequately examine and diagnose them and prescribed addictive narcotics despite warning signs that they were abusing prescriptive drugs. However, this former patient admitted that he lied to the then doctor about having fibromyalgia so he could get the drugs he wanted.

An undercover agent from the California Medical Board testified that he posed as a patient three times and that he told Tseng he was a former heroin user and he shared the pills with a friend and his sister.

Tseng is just one of a few doctors nationwide to be charged with murder related to prescription drugs. The murder charges could be hard to prove because the victims played a role in seeking out the drugs and taking them and then overdosing on them or other drugs. The defense will be sure to question where is the patient's responsibility who decided to lie to obtain the drugs and then to take them. However, the evidence needed to hold Ms. Tseng to answer at a preliminary hearing is quite low -- reasonable suspicion to believe a crime has occurred -- but this will give the defense a preview of the government's case.

Posted by Tracy Green, Esq. Please email Ms. Green at or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  

Sunday, June 10, 2012

California Medical Board Increases Investigations, Search Warrants And Arrests In Medical Spas And Practices Offering Laser Skin and Hair Procedures, Botox and Injectibles: Time To Make Sure Your Practice Is Compliant!

If your medical practice or medical spa offers laser hair removal, botox, injectibles, laser skin treatment, or sales of prescribed items such as Latisse or Retin A – it is time to make sure your practice is compliant. Why? The Medical Board of California is aggressively investigating the unlicensed practice of medicine. It has a separate department called “Operation Safe Medicine.” 

This investigation is not limited to backroom medical practices but includes practices owned by physicians where the level of medical supervision is not sufficient, nurses operate a laser for hair removal where there has not been a good faith or "directed" medical exam by a physician or advanced practitioners such as a physician assistant or nurse practitioner, and receptionists selling Latisse to patients without a good faith medical exam and prescription. Nurses who are used to hospital settings are often surprised at the requirements in a clinic setting for seemingly routine procedures such as laser hair removal. 

If you are a “medical director” for any practice offering these medical services or a plastic surgeon or dermatologist using nurses, it is critical that the practice is compliant since you could be charged with aiding and abetting the unlicensed practice of medicine.

I recently concluded a criminal case where a physician did a “favor” and agreed to be an unpaid medical director for a location offering laser hair removal but did not have any presence at the facility. This led to a criminal case being filed and disciplinary charges. The case was resolved where the physician kept her license but if there had been compliance and the physician understood the law at the beginning – the case never would have happened. 

I had another case where a plastic surgeon client allowed an independent contractor registered nurse to inject Botox without a good faith medical exam by the physician. The compliance changes I drafted were instituted immediately and the Medical Board investigation was closed without incident. I have had numerous cases where compliance was successfully instituted to avoid the possibility of any Medical Board complaints or investigations.

Why am I writing this article? Just in the last three weeks, I know of 3 cases where there have been search warrants and/or arrests. Apart from the cases I am handling, the Medical Board issued a press release on June 8, 2012 where it announced the arrests and felony charges against a non-medical owner of Laser Solutions in Beverly Hills, CA for practicing medicine without a license. 

In the past OSM has focused on a variety of unlicensed practices (selling contact lenses without prescriptions, unlicensed midwifes, etc.) but lately the cosmetic practices are targeted. The climate is not favorable for these practices and the Medical Board is sending in undercover agents. There have been hearings at the Medical Board about the level of supervision for nurses in medical spas and cosmetic practices and one of the outcomes of these hearings was increased enforcement. 

How do these cases get initiated? Often they are complaints from competitors or former employees. The complaints are rarely filed by patients. In my experience, I have seen physicians and nurses remain vastly ignorant of the rules and regulations and unintentionally violate the law. If your practice is not compliant or you are not sure, now is the time to change your practices and procedures. In some cases, ownership also needs to be modified. Seek experience counsel and become compliant. Do not fear that by making changes you will be admitting guilt. Just become compliant.

Attorney Information: Posted by Tracy Green, Esq. Please email Ms. Green at or call her at 213-233-2260 to schedule a complimentary telephonic or in-person 30-minute consultation.  

 Any questions or comments should be directed to Tracy Green a very experienced Medical Board attorney, health care litigation attorney, medical spa attorney, physician attorney, and nurse attorney. She is very familiar with the issues of ownership, corporate practice of medicine, unlicensed practice of medicine and related issues in cosmetic areas. The firm website is:


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