Dietary Supplements Are Subject to FDA Investigation. GNC Entered Into Agreement with Department of Justice to Keep Potentially Illegal Dietary Supplements Out of the Marketplace.

Nutritional supplements are often recommended or sold by practitioners such as chiropractors, naturopathic doctors and other providers. Determining what ingredients are in the products is difficult and a recent settlement shows that retailers will be held responsible for selling products with misbranded supplements or that promise to treat or cure a disease. 

All providers who sell supplements should ensure that the products do not include unlawful dietary supplements to the extent possible. How can a retailer determine if supplements are from natural plants or are synthetic? 

On December 7, 2016, the world’s largest dietary supplement retailer, GNC Holdings Inc. (GNC), entered into a wide-ranging agreement with the Department of Justice to reform its practices related to potentially unlawful dietary ingredients and dietary supplements, and has further promised to embark on a series of voluntary initiatives designed to improve the quality and purity of dietary supplements.

The non-prosecution agreement resolves GNC’s liability for selling certain dietary supplements produced by a firm currently under indictment.  As part of the agreement, GNC has agreed to pay $2.25 million to the U.S. government and cooperate in dietary supplement investigations conducted by the government.

A lengthy investigation conducted by the U.S. Food and Drug Administration (FDA), the U.S. Attorney’s Office for the Northern District of Texas, and the Consumer Protection Branch of the Department of Justice’s Civil Division resulted in allegations that GNC’s practices related to ensuring the legality of products on its shelves were lacking. 

According to an agreed-upon statement of facts that accompanies the non-prosecution agreement, GNC admitted it engaged in acts and omissions that allowed a misbranded supplement— OxyElite Pro Advanced Formula, a product of Dallas-based USPlabs LLC (USP Labs)—to be sold at GNC locations nationwide in 2013.  The statement of facts notes that GNC sold the product based on representations from USP Labs that ingredients contained in the product complied with the law.  It further notes that GNC did not undertake additional testing or require additional certifications to confirm such representations or to verify that the ingredients in the product were as represented. 

USP Labs was indicted in November 2015 and is awaiting trial.  The indictment alleges, among other things, that USP Labs engaged in a conspiracy to import ingredients from China using false certificates of analysis and false labeling, and then lied about the source and nature of those ingredients after it put them in its products.  According to the indictment, USP Labs told some of its retailers and wholesalers that it used natural plant extracts in some of its products, when in fact it was using synthetic stimulants manufactured in a Chinese chemical factory.

Former California Resident Sentenced to 30 Months in Federal Custody for Sale of Unapproved “Energy Wave” (Rife) Medical Devices

Former California resident David Perez was sentenced in federal court on April 4, 2016 to 30 months in custody for conspiracy to commit mail fraud (18 U.S.C. Section 371) selling unapproved “Energy Wave” medical devices (non FDA approved) over the Internet and mailing them to customers throughout the United States. These are known as "Rife" machines.

According to admissions in his plea agreement, Mr. Perez marketed the “Energy Wave” device using the website www.myenergywave.com[external link].

Rife machines have been around for years and some alternative practitioners use them. I had an unlicensed practice of medicine criminal case in which a Rife machine figured prominently. While I obtained not guilty verdicts on the multiple counts, my client was not the one who offered the Rife treatment. You can find many Rife machines for sale to this date. This particular "Energy Wave" device allegedly consists of a micro-current frequency generator with a digital readout, two stainless steel cylinders, two personal application plates with connectors and lead wire for the cylinders and plates.  

What caused Mr. Perez legal trouble was that allegedly when he sold them to users, his company also provided users with an operating manual and a list of Auto Codes that set forth over 450 digital settings for the device, directed to treat specific conditions from abdominal pain, AIDS and diabetes to stroke, ulcer and worms.  The Auto Codes and Manuel advised users to connect the cylinders or plates to the machine, and touch them to the body for a recommended run time to treat each condition. 

David Perez admitted selling each device for approximately $1,200-$1,500, and receiving gross proceeds of approximately $271,000.  He also acknowledged in his plea agreement that he intended to defraud and mislead the Food and Drug Administration by attempting to evade the agency’s oversight of medical claims made regarding the Energy Wave device by maintaining a separate website (rifecodes.com) to which he referred customers who needed to obtain the auto codes that allegedly were used to treat the various medical conditions.  Mr. Perez admitted that he knew or should have known a number of his customers were vulnerable because they had purchased the device in an attempt to cure cancer, and that they were marketing the device without the proper FDA approvals.

Given the loss amount and lack of prior criminal history, the 30 months is a high sentence and those selling or marketing non-FDA approved devices that are suggested to be used to cure any diseases (especially cancer) need to be mindful of the FDA's aggressive stance on such marketing and sales.

Posted by Tracy Green, Esq.

Physician And Non-Physician Sentenced In San Diego For Submitting False Bills To Private Insurance Companies For Alternative Cancer Treatments

A recent health care fraud case in San Diego relates to alternative cancer and health care treatments and billing of insurance carriers. I expect to see an increase in the prosecution of health care fraud cases relating to the billing of private insurance companies and not just Medicare and Medi-Cal (Medicaid).
On February 8, 2010, William R. Fry and Dr. Geronimo Rubio in Case No. 04cr1276, were sentenced in federal court in San Diego by the Honorable John A. Houston, United States District Court Judge, to serve 14 months and 12 months in custody, respectively, followed by three years of supervised release following their release from prison.
Mr. Fry and Dr. Rubio each pled guilty to health care fraud and federal income tax felonies in June 2007. Judge Houston also ordered that, for their health care fraud convictions, Mr. Fry and Dr. Rubio were to pay $63,237 in restitution to insurance providers. Mr. Fry was also ordered to pay the Internal Revenue Service (IRS) $314,159 in back taxes plus interest and penalties for tax years 1997 through 2003. Dr. Rubio was ordered to pay the IRS $356,311 in back taxes plus interest and penalties for tax years 1998 through 2003.
According to court records, Dr. Rubio and Mr. Fry jointly owned and controlled a business called “American Metabolic Institute,” in Bonita, California. The defendants operated a health care clinic called “Hospital San Martin,” in Tijuana, Mexico. The clinic, under the direction of Dr. Rubio, offered alternative medicines and treatments to patients, many of whom were diagnosed with cancer. In their pleas, the defendants admitted that they submitted false bills to American insurance companies and that each defendant substantially under-reported his true income on his individual federal income tax returns.
It appears that the American Metabolic Institute had numerous complaints regarding the cost of treatment from patients. There were many supporters of the alternative care but when alternative treatment do not "cure" cancer or other diseases, there will be complaints. Law enforcement can take a view that the alternative provider is preying upon desperate people with cancer. Alternative providers need to be very careful and create systems and protocols that document informed consents and the nature of the alternative treatment.
Alternative health care providers need to realize that their websites and publications will be scrutinized carefully. One bad result or unhappy patient can result in a complaint to a Medical Board or governmental agency. The website will be one of the first things an investigator reviews. For example, Dr. Rubio still has a website that has success stories of cancer going into remission with immunology treatment. These treatments are different than traditional oncology and the websites should also be reviewed by a health care attorney.
Now a brief comment about the tax fraud counts. For those who bill private insurance companies and the government, you will always be under scrutiny and subject to audit and review. This also means that if there are allegations of wrongdoing, your tax returns will also be under a microscrope. The threat of a tax fraud prosecution which is document based -- black and white, no issue of medical necessity -- can often be the hammer that forces a guilty plea. This is also something that as a licensed professional or health care provider you need to consider when operating your business. Part of your compliance with rules and regulations should include compliance with taxes (federal and state) since there is exposure there as well.
Should you have any questions regarding your own situation or this post, you can email physician attorney Tracy Green at tgreen@greenassoc.com. Green & Associates is located in downtown Los Angeles, California and focuses their practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing alternative health care providers. Ms. Green is a naturopathic doctor attorney and is a member of the Board of Directors of the California Naturopathic Doctors Association. The firm website is: http://www.greenassoc.com/

Lesson for Alternative Health Care Practitioners: L.A. Physician Charged With Federal Mail And Wire Fraud Charges For Selling Chinese Herb Treatments To Cancer Patients

On October 8, 2009, a Los Angeles doctor Christine Daniels was arrested and charged by federal prosecutors with two counts of wire and mail fraud after allegedly claiming that her herbal treatments could cure cancer. Prosecutors allege that Dr. Daniels claimed her "C-Extract" was an alternative to chemotherapy and other medical cancer treatments.

Prosecutors also allege that some of those patients took "C-Extract" instead of getting conventional medical treatment. Prosecutors allege that she collected more than $1 million from patients from 2001 to 2004, some of whom later died of cancer or complications from the disease. The prosecutors further alleged that Dr. Daniels is also an ordained Pentecostal minister and that Dr. Daniels allegedly discussed her treatment on the TBN Christian cable channel and said the herbs had a “60% cure rate” and “people are living today because of our treatment.”

According to the Wall Street Journal, Dr. Daniel had already been investigated by the U.S. Attorney's Office and the Medical Board back in 2007 and that previously there was an article on the front page of the Wall Street Journal regarding the investigation.

An indictment is only an accusation is not evidence of guilt. Dr. Daniels as a defendant is presumed innocent and is entitled to a fair trial at which the government must prove guilt beyond a reasonable doubt. 

Attorney Comments: First, cases like this should remind alternative or complementary health care practitioners to remember to have any clients or patients sign consent forms that are quite specific as to what is being provided. For example, it is not illegal to sell Chinese herbal supplements to people that have cancer. However, if there are promises that it will heal, treat or cure a disease that can lead to issues with the FDA, Medical Board, and local law enforcement. Without written documentation signed by the patient or client, it can turn into a he said-she said situation.

Second, although I do not know the facts of this case, I am amused when the evidence showing that alternative treatments are part of a fraud is a statement by the prosecutor such as "Mrs. X took the Chinese herbs, which cost $10,000 and then died of cancer." Most conventional treatments do not truly "cure" cancer and there are many people who undergo chemotherapy and other treatments which cost $50,000 or more and then pass away from cancer.

There is a place for preventative, alternative and conventional treatments which help bolster the immune system and help one's body fight cancer cells without actually curing or treating the disease. Alternative practitioners need to be careful with the language used with clients or patients.

Third, alternative or complementary practitioners need to have their websites, brochures or public statements reviewed for compliance purposes. An attorney's opinion can help avoid future problems. Patients or clients who want conventional and alternative medicine often know what they seek and what is being promised. However, after someone passes away, the anger may come from the survivors who saw their loved one do everything to fight to live. There are some people who turn to alternative treatments when conventional medicine has failed them. Yet, when conventional medicine fails the patient, the physicians are not prosecuted.

Fourth, this case is not the typical case in that it is also a tax evasion case. Thus, there may be additional reasons why this doctor was selected for prosecution. 

The United States is a place where people have choice. As an alternative health care provider, however, you need to make sure that you protect yourself from false claims that you promised to "cure" cancer, diabetes or any other disease. 

Posted by Tracy Green, Esq. Any questions or comments  should be directed to Tracy Green, a very experienced California naturopathic doctor attorney, Los Angeles alternative health care attorney, and Los Angeles physician attorney at tgreen@greenassoc.com or call her at 213-233-2260

The firm focuses its practice on the representation of professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing health care providers including those in alternative and preventative medicine in structuring businesses, compliance audits, administrative board and discipline matters in California and throughout the country. Our website is: http://www.greenassoc.com/

Legal Issues Regarding Sales Of Dietary And Vitamin Supplements To Patients

As physician and health care provider income has decreased, we have seen increased questions regarding the sale of dietary and vitamin supplements in health care provider offices. This includes physicians such as dermatologists and plastic surgeons, chiropractors, acupuncturists, and other alternative health care practitioners.

Despite the mutual benefits for both the patient and physician, office dispensing continues to be controversial. For example, the American Medical Association is concerned that selling health-related goods in the office may compromise the patient-physician relationship.

In general, we believe that health care providers -- whether physicians or alternative health care practitioners -- should work on preserving the right to dispense dietary and vitamin supplements by conducting themselves in a highly professional and ethical manner with their patients.

As the Internet has become an increased means of doing business, there are also sales via the Internet from providers or companies that providers recommend. This can raise different issues, especially where the health care provider refers the patient to an Internet company and receives a percentage of the purchase price.

Here is one question that was posed to the California State Attorney General's Office in 2001 and helps provide a guideline on the rules.

Question: We are advised that an Internet distributor of naturopathic products proposes to enter into agreements with chiropractors in this state whereby the chiropractors would receive fees of 20 percent of the price of the products purchased by their patients from the company’s website. We are asked whether the proposed program would be prohibited under the provisions of section 650 of the Business and Professions Code.

Answer: The State Attorney General's Office issued a written opinion concluding that the program would violate the statute. Thus, this arrangement would violate the law. In our opinion, the same analysis would apply to any licensed health care provider.

For the opinion in full, see: http://ag.ca.gov/opinions/pdfs/00-1002.pdf

In analyzing whether the sale of vitamin supplements to patients would constitute unprofessional conduct or subject our clients to increased liability, we analyze the following facts among others (remembering that each case is different):

■ How does the product relate to the practitioner's specialty?

■ Does the recommended product relate to the diagnosis and/or promoting the patient's wellness?

■ What is the markup and how does it compare to a general retail outlet?

■ Does the patient understand that he or she can buy the product elsewhere?

■ Is there pressure by the staff to sell the patient these products?

■ Does the practitioner provide anything in writing to let the patient know that there is no obligation to buy the product and the quality of care will not be affected by the patient's decision to purchase or not purchase products?

Before embarking on selling vitamin and dietary supplements to patients, consider seeking experienced legal advice on how to structure the sales, how to train your staff and the information to be provided to patients.

Any questions or comments should be directed to: tgreen@greenassoc.com. Tracy Green is a principal at Green and Associates, Attorneys at Law, in Los Angeles, California. They focus their practice on the representation of licensed professionals and businesses in civil, business, administrative and criminal proceedings, with a specialty in health care providers including alternative practitioners.

Practicing Medicine Without A License: Alternative Health Talk Show Host Arrested In San Diego

On April 9, 2009 San Diego County District Attorney’s Office charged Kurt Walter Donsbach, 73, of Bonita, with practicing medicine without a license and supplying patients with supplements containing non-FDA-approved drugs. An investigation led by the Federal Bureau of Investigation (FBI) in cooperation with the Food and Drug Administration (FDA) and District Attorney’s Office led to the arrest. Bail was initially set at $1.5 million.

Donsbach is charged with 11 felony counts including:

(A) 3 counts for treating patients without a license in violation of Business & Profession Code Section 2052(a);

(B) 2 counts of misbranding drugs for sale in violation of Health & Safety Code Section 111440;

(C) 2 counts of receiving or delivering a misbranded drug in violation of Health & Safety Code Section 111450;

(D) 1 count of fraudulent representations as to the method or treatment of cancer; and

(E) 1 count of grand theft in violation of Penal Code Section 487(a).

If convicted, he faces up to six years in state prison.

According to the arrest warrant declaration, Donsbach falsely identified himself as a “chiropractor and naturopathic doctor” in literature and online at http://www.letstalkhealth.com/. Through a weekly, online radio broadcast from Chula Vista, he claimed to offer “alternative,” “natural,” and “nutritional” remedies for many conditions and ailments including cancer and autoimmune disorders. Donsbach is not licensed as a physician, chiropractor, nor naturopathic doctor in the State of California.

An arrest warrant affidavit contains only allegations against an individual and all defendants must be presumed innocent unless and until proven guilty.
The arrest warrant declaration further stated that Donsbach’s clinic advised one patient to inject herself with “neuropeptides” to treat arthritis, saying it would “re-program” her body’s T-cells. FDA tests revealed the “neuropeptide” contained a steroid not disclosed on the packaging or labels. The patient paid thousands of dollars for the drugs and injected herself for six years, leading to severe bone density loss.

In another case, Donsbach allegedly claimed he had treated pancreatic cancer successfully about 60 percent of the time and provided a supplement to a patient. FDA tests of the supplement revealed the presence of the drug nimesulide, a non-steroidal anti-inflammatory not approved by the FDA. In Europe, marketing of nimesulide has been suspended because of high rates of liver failure that resulted in deaths and liver transplants.

Attorney Commentary: There are alternative health care treatments that can be done in a legal manner by non-licensed persons. Compliance with the federal and state law is necessary, however, in order to avoid criminal charges. There are numerous clients of Donsbach who have come to his defense. However, when there are non-FDA approved medications and false claims of being licensed, these will be red flags to law enforcement and regulatory agencies.

Any questions or comments should be directed to: tgreen@greenassoc.com. Tracy Green is a principal at Green and Associates in Los Angeles, California. They have represented those charged with the unlicensed practice of medicine (or the aiding and abetting of unlicensed practice) in internal investigations, disciplinary proceedings, search warrants and criminal matters.

Chiropractor Scope Of Practice - Proposed Regulations On Manipulation Under Anesthesia

The scope of practice of chiropractors is presently being addressed with respect to chiropractors performing manipulation under anesthesia (MUA). MUA is the manipulation of a patient who is sedated by the administration of anesthesia by a physician and surgeon or other health care provider who is legally authorized to administer anesthesia; and is performed by a licensed chiropractor.

The California Board of Chiropractic Examiners has taken the position that MUA is within the scope of practice of a chiropractor. However, as currently written, the boards regulations do not contain the standard of care or conditions under which MUA shall be performed. The Chiropractic Board has therefore proposed regulations because not all settings are appropriate for the safe performance of MUA. The board determined that facilities licensed or approved by the entities listed in this subdivision have the necessary safety equipment and standards in place to protect consumers undergoing MUA. The Board has assumed that chiropractors can perform MUA but simply wanted to regulate where it would be performed.

Therefore, the Chiropractic Board proposed that Section 318.1 be added to Title 16, Division 4, of the California Code of Regulations. This would establish the standard of care or procedures in which MUA may be performed. The Board's reasoning is that adoption of this proposal is necessary to better protect consumers by requiring that chiropractors adhere to specific standards when performing MUA and that without any standards in place, consumers are at risk for serious injury.

Not surprisingly perhaps, the California Medical Association (CMA is opposing this regulation and the entire idea of chiropractors performing MUA on the ground that they interpret this regulation as expanding the chiropractic scope of practice. CMA submitted objections to proposed regulations that would allow chiropractors to perform MUA. CMA contends that MUA raises important patient safety concerns and the regulations, as proposed by the Chiropractic Board, would allow chiropractors to perform a procedure that is not authorized under current law. It is also CMA’s contention that because the use of anesthesia is integral to the technique itself, MUA is not explicitly authorized under current law. CMA's position is that chiropractors’ scope of practice is limited by the Chiropractic Act (an initiative measure passed by California voters in 1922) and that the scope of chiropractic practice can only be expanded through the initiative process. Here is the CMA's letter opposing the regulation: http://www.calphys.org/assets/applets/mua_comments_030909.pdf

Commentary: There continues to be tension between licensed physicians and surgeons and other licensed health care providers who are non-physicians. CMA's position highlights the conflict and striking divergent viewpoints. As attorneys who represent both physicians and non-physicians in California, we see that there is support for both positions. However, non-traditional methods have gained wide acceptance in California and there is also a populist viewpoint that people should be able to choose their practitioner and their method of treatment.

Any questions or comments should be directed to: tgreen@greenassoc.com. Tracy Green is a principal at Green and Associates. They focus their practice on the representation of professionals, particularly health care professionals including individual physicians, corporate providers and group practices.

Recent Arrests Spark Debate Over Assisted Suicide Debate

There have been two recent cases that resulted in arrests for assisted suicide. Neither case involved a physician but involved laypeople.

Arrests in Georgia. The first case involved arrests last week in Georgia. The case was addressed in a February 27, 2009 article in the Los Angeles Times entitled "Georgia Arrests Revive Assisted Suicide Debate." The article addresses recent arrests in Georgia for assisted suicide and the debate over assisted suicide and the right-to-die. The president of an organization known as Final Exit Network was one of the persons arrested.

Oregon and Washington allow physician assisted suicide for people judged to have no more than 6 months to live. In Montana the state is appealing a judge's decision to allow physician assisted suicide. Several other states are in the process of enacting legislation legalizing assistent suicide (New Hampshire, Massachusetts and New Mexico). In many states such as Georgia and California, assisting a suicide remains a criminal act punishable up to 5 years in prison.

See: http://www.latimes.com/news/printedition/front/la-na-assisted-suicide27-2009feb27,0,3727578.story

Arrest in California. On February 27, 2009, a woman in Lodi, California was arraigned in San Juaquin Superior Court and plead not guilty to charges that she assisted in the suicide of her brother who was a well-known blues musician in the Central Valley of California. The case has some facts that are similar to the case in Georgia in that a helium tank was used to assist the suicide and a copy of an instructional book by Derek Murphy, the chairman of Final Exit's advisory board. There is an article in February 28's Los Angeles Times about the case.

See: http://www.latimes.com/news/local/la-me-lodi-assisted-suicide28-2009feb28,0,5508597.story

Any questions or comments should be directed to: tgreen@greenassoc.com. Tracy Green is a principal at Green and Associates in Los Angeles, California.

Alternative Heath Care Device Case -- Sale Of Unapproved Medical Device (Rife Machine) -- Attorney Commentary

On February 17, 2009, James Folsom was found guilty by a federal jury in United States District Court in San Diego of twenty-six felony counts relating to his sale of an unapproved medical device known as a Rife-type biofrequency device. For an article on the trial:
http://www3.signonsandiego.com/stories/2009/feb/18/bn18convict-medical-scam/?zIndex=55119

According to evidence presented at trial, from 1997 through 2008, James Folsom conspired with others to ship adulterated and misbranded Rife-type biofrequency devices in interstate commerce. The device, sold under names "NatureTronics," the “AstroPulse,” “BioSolutions,” “Energy Wellness,” and “Global Wellness,” consisted of a micro-current frequency generator with a digital readout, two stainless steel cylinders, two personal application plates with connectors and lead wires connecting the device to the cylinders and the plates. Users were provided with an operating manual that set forth hundreds of digital settings for the device, directed to specific conditions from AIDS, diabetes, stroke, and ulcers to worms. Users were advised to connect the cylinders or plates to the machine and touch them to the body for a recommended run time to treat each condition.

According to testimony at trial, the defendant purchased over 9,000 units, which he sold to distributors for approximately $1000-1200 and to retail customers for $1995, with sales of over $8 million. The devices were manufactured by the defendant and others in a San Diego location, which he failed to register with the Food and Drug Administration (FDA) as a device manufacturing establishment. There were other facts in this case that suggested fraud in that Folsom used the false name “Jim Anderson” when selling the device and used post office boxes, self-storage units, and bank accounts opened in the names of others to conduct his business, all in an alleged effort to avoid detection by the FDA. The defendant also marketed his device “for investigational purposes,” which the government alleged was to deceive consumers into the false belief that he possessed a valid investigational device exemption from the FDA.

The government’s theory at trial was that the devices were adulterated in that they were marketed without a valid investigational device exemption, without pre-market approval, and in violation of an electrical performance standard set by the FDA prohibiting lead wires that come into contact with patients from being able to come in contact with potentially hazardous voltages. The devices were also misbranded in that they were marketed without valid clearance from the FDA, did not bear the name and address of the manufacturer on the labeling, and were produced in an unregistered manufacturing establishment.

Related court documents and information may be found on the website of the District Court for the Southern District of California at http://www.casd.uscourts.gov/ or on http://pacer.psc.uscourts.gov/

Commentary: As attorneys who tried a case in November 2008 in Los Angeles involving a rife machine, other alternative health care issues and the alleged unlicensed practice of medicine, we have the following comments about the case.

First, if you are selling or using any type of "device" as part of alternative health care you need to be very careful about FDA regulation. Seek the advice of an attorney if you use, sell or market any device which could be under FDA regulation.

Second, if you are in alternative or complementary health care that you need to be careful about making any claims that a non-FDA approved device (or vitamins and supplements for that matter) can cure or treat any disease. One of the driving facts in Folsom's case was that marketing material found on several internet sites and promotional material said the device uses electrical frequencies to destroy diseased cells in the body. It also said the device was inspired by the work of San Diego inventor Royal Raymond Rife, who in the 1930s theorized that cells could be destroyed by directing precise radio frequencies at them. Rife believed cancers, viruses and other illnesses could be treated with the technology. Rife type machines have been used by alternative health care providers as an alternative method of promoting wellness for people with AIDS, cancer and other conditions . Seek the advice of an attorney if you are an alternative health care provider especially where you see persons with cancer and other diagnosed diseases.

Third, if you are engaged in alternative health care have all promotional material, including websites, reviewed by an attorney to ensure that there are no false claims and no claims to cure or treat any disease or condition.

Fourth, if you are investigated by the government assess the exposure you have at an early stage by a thorough analysis through counsel. Address the issues early and if the government contends that you are doing something illegal it is important to get an attorney involved immediately. In this case, we were informed that the government investigation went on for years and that early resolution of the case was rejected. Currently, Folsom is facing 15 years in prison.

Any questions or comments should be directed to: tgreen@greenassoc.com. Tracy Green is a principal at Green and Associates in Los Angeles. They focus their practice on the representation of individuals, businesses, licensed professionals, including health care professionals and providers.