The Division of Workers Compensation (DWC) has suspended 21 more medical providers from participating in Californias workers compensation system, bringing the total number of providers suspended this year to 73.
DWC Administrative Director George Parisotto issued Orders of Suspension against the following providers:
Christopher King of Beverly Hills, owner of medical-billing and medical-management companies, and his wife were the masterminds in a $40 million conspiracy to commit medical insurance fraud along with over two dozen doctors, pharmacists and business owners. More than 13,000 patients and at least 27 insurance carriers were victims in the scheme. King pled guilty in Orange County Superior Court on April 26 to two felony counts of conspiracy to commit medical insurance fraud and felony insurance fraud. King, co-owner of Monarch Medical Group, King Medical Management and One Source Laboratories, recruited doctors and pharmacists to prescribe unnecessary treatment for pa...
The Division of Workers’ Compensation (DWC) has suspended three more medical providers from participating in California’s workers’ compensation system, bringing the total number of providers suspended this year to 49.
DWC Acting Administrative Director George Parisotto issued Orders of Suspension against the following providers:
Samuel H. Albert of Tustin, psychiatrist, pled guilty in the U.S. District Court for the Central District of California on June 20, 2016 to conspiracy to commit health care fraud. Albert had submitted over $4.2 million in fraudulent claims to the Federal Office of Workers’ Compensation Programs.
Barry Julian Broomberg of San Diego, physician and owner of La Jolla Medical Associates, pled guilty in the U.S. District Court for the Southern District of California on September 4, 2013 to visa fraud, and surrendered his Physician’s and Surgeon’s Certificate on September 9, 2014. Broomberg knowingly made false statements under penalty of perjury on...
The Department of Industrial Relations and their director, Christine Baker, are being sued by three former qualified medical evaluators (QMEs) for allegations that each violated the state's medical-legal fee schedule (doctors Timothy Howard, Meera Jani, and Benjamin Simon). In addition, the lawsuit also names George Parisotto in his capacity as director of the DWC and Dr. Raymond Meister as Executive Medical Director of the DWC as defendants.
The former QMEs allege the department used "underground regulations" to deny them their livelihood. They also accuse the department of circumventing the necessary rule-making process by establishing new criteria for who can serve as a QME, implementing new standards for determining when QMEs can address the issue of medical causation and changing different complex factors that are applied in determining proper billing codes. They claim this will result in the DIR permanently eliminating the hourly billing code without ever announcing regulation...
The Division of Workers' Compensation (DWC) has suspended five more medical providers from participating in Californias workers' compensation system, bringing the total number of suspended providers to 32.
DWC Acting Administrative Director' George Parisotto' issued Orders of Suspension against the following providers:
Leovigildo Sayat, a physical therapist in Lompoc who in October 2015 pled guilty in US District Court for the Central District of California as a co-conspirator in a $15 million scheme to defraud Medicare by billing for physical therapy services never provided.
Alexander Kiev Martinez, a durable medical equipment provider in El Centro, who in April 2016 pled guilty in San Diego Superior Court for referring patients in a bribery scheme involving $25 million in improper claims for medical services and devices billed to California workers' compensation insurance companies.
Robert Gogatz, a chiropractor in Murrieta who last May pled guilty in Riverside Super...
Deadline for Lien Claimants to File Labor Code Section 4903.05(c) Declaration
The Division of Workers' Compensation (DWC) is reminding lien claimants that they are required to file a declaration for any lien filed between January 1, 2013 and December 31, 2016 for which a filing fee was paid. Labor Code section 4903.05(c) provides: lien claimants shall have until July 1, 2017. DWC recommends that lien claimants complete their submission by 5 p.m. on Friday, June 30 in order to ensure a timely filing.
Senate Bill 1160, which became effective January 1, requires all lien claimants who filed a lien between January 1, 2013 and December 31, 2016, and paid a filing fee, to file the "Supplemental Lien Form and 4903.05(c) Declaration" form. Labor Code section 4903.05(c)was amended as part of the bill's reform measures to combat fraud in the workers' compensation system. To comply with...
The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have suspended Pasadena psychiatrist Jason Hui-Tek Yang from participating in California’s workers’ compensation system. Dr. Yang was convicted in Riverside County Superior Court for his involvement in an insurance fraud conspiracy that referred patients for unnecessary care to justify workers’ compensation billing. DWC issued a Notice of Suspension, which Yang appealed. The appeal was heard in April by Hearing Officer William E. Gunn, who issued a recommended determination and order on May 25. The recommended decision was adopted by DWC Acting Administrative Director George Parisotto and the suspension confirmed on June 1st. Dr. Yang has over 2,000 active workers’ compensation liens with an estimated total claim value of more than $13.7 million.
AB 1244 (Gray and Daly) requires the DWC Administrative Director to suspend any medical provider, physician or practitioner f...
Largest number of attorneys charged in one case in Orange County history.
SANTA ANA, Calif. - Ten attorneys and six cappers were charged today for participating in a massive multi-million dollar workers' compensation insurance referral scheme that exploited persons in predominantly Spanish speaking communities. This is the first phase of filing resulting from a 3-year insurance fraud investigation by the Orange County District Attorney's Office (OCDA) Bureau of Investigation, Insurance Fraud Unit with assistance from the California Department of Insurance (CDI).
Charges were filed today, June 5, 2017, for multiple felony counts of:
Conspiring to refer clients for compensation
Referring patients/clients with reckless disregard for commission of fraud
Aggravated white collar crime over $500,000.00
Loss over $1,300,000.00
Maximum sentences range from seven years to twenty-five years...
San Francisco, CA - The 2016 minimum and maximum temporary total disability (TTD) rates will increase on January 1, 2016. The minimum TTD rate will increase from $165.49 to $169.26 and the maximum TTD rate will increase from $1,103.29 to $1,128.43 per week.
Labor Code section 4453(a) (10) requires the rate for TTD be increased by an amount equal to percentage increase in the State Average Weekly Wage (SAWW) as compared to the prior year. The SAWW is defined as the average weekly wage paid to employees covered by unemployment insurance as reported by the U.S.
Department of Labor for California for the 12 months ending March 31 in the year preceding the injury. In the 12 months ending March 31, 2015, the SAWW increased from $1,095.70 to $1,120.67-an increase of just under 2.2789 percent.
Under Labor Code section 4659(c), workers with a date of injury on or after Jan. 1, 2003 who are receiving life pensions (LP) or permanent total disability (PTD) benefits are also entitled to have their wee...
The Department of Industrial Relations quietly released the Physician's Guide to Medical Practice in the California Workers' Compensation System ("Physician's Guide"). This was the Fourth Edition of the Guide. The Physician's Guide was last revised in 2001. The Guide was intended to provide an overview of the Workers' Compensation system. The purpose of the Physician's Guide is to put practical and usable information in the hands of physicians who are caring for injured workers in California, and is not intended to replace clinical judgment. It is not meant to be a legal treatise or to include legal citations in support. That being said, the Physician's Guide is intended to be an educational tool and a convenient reference for information about the operation of the system.
The Audit and Enforcement Unit of the Division of Workers' Compensation (DWC) will be noticing more target audits in 2016 to address utilization review (UR) complaints.
All claims administrators are required by law to have a utilization review program that is governed by written policies and procedures and used to decide whether or not a treatment recommended by an injured worker's physician is medically necessary under evidence-based guidelines. All UR programs must have a medical director. Any medical decision that modifies or denies a medical treatment request must be made by a reviewing physician, and the services must be within that physician's scope of practice.
As a reminder, the UR time limit for responding to a treatment request begins when the request for authorization (RFA) is first received, whether by the employer, claims administrator, or utilization review organization (URO). The decision on an RFA submitted for prospective review must be made within five business days fro...
The Division of Workers' Compensation (DWC) ended its collection of lien activation fees at midnight on December 31, 2015. Any liens not activated by that time were dismissed by operation of law.
New liens are still required to pay a filing fee.
Lien fees are one of the components of Senate Bill 863's workers' compensation reforms. SB 863 requires a provider to pay a $150 filing fee for filing any new lien on or after January 1, 2013. For liens filed prior to January 1, 2013, prior to filing a Declaration of Readiness to Proceed (DOR) to request a lien conference or prior to appearing at a lien conference on or before January 1, 2014 were required to pay a lien activation fee. In addition any lien not activated by January 1, 2014 was to be dismissed by operation of law.
Litigation enjoined lien activation fees for two years until the U.S. Court of Appeals upheld the constitutionality of the fees. DWC resumed collection of the lien activation fees on November 9, 2015 before ending December...
DWC will no longer accept or process paper submissions postmarked after September 3, 2015. The new process requires parties in a represented case to submit initial QME panel requests online and immediately receive a QME panel. The requesting party will then serve the panel request form, any required documentation and the QME panel on all parties with a proof of service.
"Our goal for the new online process is to further reduce delays. In most cases the QME panel will issue immediately, allowing the injured worker to schedule an exam with a QME more quickly," said Christine Baker, Director of the Department of Industrial Relations (DIR). DWC is a division of DIR.
The DWC has posted an online QME Form 106 Panel Request training video and FAQs on the Medical Unit website. The video demonstration details the way in which represented initial pane...