Friday, December 18, 2015

Interpreting Service Company G&G's 2 Owners and 7 Employees Charged With Workers' Compensation Fraud in Providing Translating Services to Medical Clinics' Patients

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.


DISCLAIMER: Green & Associates' articles and blog postings are prepared as a service to the public and are not intended to grant rights or impose obligations. Nothing in this website should be construed as legal advice. Green & Associates' articles and blog postings may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents and contact their attorney for legal advice. The primary purpose of this website is not the commercial advertisement or promotion of a commercial product or service and this website is not an advertisement or solicitation. Anyone viewing this web site in a state where the web site fails to comply with all laws and ethical rules of that state, should disregard this web site.

The information provided on this website is for informational purposes only. It is not intended to create, and does not create, a lawyer-client relationship with Green & Associates, Attorneys at Law. Sending an e-mail to Tracy Green does not contractually obligate them to represent you as your lawyer, or create any type of client relationship. No attorney-client relationship will be formed absent a written engagement or retainer letter agreement signed by both Green & Associates and client and which specifies the scope of the engagement.

Please note that e-mail transmission is not secure unless it is encrypted. E-mail messages sent to Ms. Green should not include confidential or sensitive information.