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Five Medical Providers Suspended for Fraud

 

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 Superior Court to 16 counts of insurance fraud.

  • Robert Alva Rose, a physician in Irvine who pled guilty in Orange County Superior Court on September 15, 2015 to two misdemeanors related to his qualifications as a medical provider.

  • Paul Barkal, a physician in San Diego who surrendered his license to the Medical Board of California on October 17, 2005.

AB 1244 (Gray and Daly) requires the DWC Administrative Director to suspend any medical provider, physician or practitioner from participating in the workers' compensation system in cases in which one or more of the following is true:

  • The provider has been convicted of a felony or misdemeanor involving fraud or abuse of the Medi-Cal or Medicare programs or the workers' compensation system, fraud or abuse of a patient, or related types of misconduct;

  • The provider has been suspended due to fraud or abuse from the Medicare or Medicaid (including Medi-Cal) programs; or

  • The providers license or certificate to provide health care has been surrendered or revoked.

The Department of Industrial Relations (DIRs)  fraud prevention efforts  are posted online, including frequently updated lists for physicians, practitioners and providers who have been issued  notices of suspension , and those who have been  suspended pursuant to Labor Code 139.21(a)(1) . The department recently added a new web page with information on  lien consolidations and the Special Adjudication Unit .

DIR protects and improves the health, safety and economic well-being of over 18 million wage earners, and helps their employers comply with state labor laws. DIR's Division of Workers' Compensation  monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits.

 

 

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