Southern California prosecutors have filed a new round of charges against medical providers who care for the state’s injured workers, raising further questions about state oversight of the program that covers 15 million people.
The cases push the tally of medical providers facing criminal charges close to 100. A Reveal investigation found that more than 100,000 injured workers have encountered the providers who are facing fraud charges, mostly in Southern California. The affected workers range from those debilitated by kickback-fueled spinal surgeries to people whose needs went unmet by allegedly profit-focused medical mills.
The cost of questionable medical care also hits employers who pay for workers’ compensation insurance. In the case of public employers, taxpayers foot the bill.
“I’d equate it to taking the lunch money out of the kids’ pocket,” said Martin Brady, executive director of Schools Insurance Authority, which handles injury claims for dozens of public school districts.
The latest round of charges expand a Riverside County case against Peyman Heidary, a chiropractor accused of masterminding a legal and medical scheme to maximize profits by recruiting injured workers and giving them a one-size-fits-all battery of medical treatments.
While Heidary and three associates were initially charged in July 2014, prosecutors recently filed charges against an additional six people, including three physicians. One of them, Tushar R. Doshi, pleaded guilty to four felony counts of insurance fraud and agreed to drop demands for payment on workers’ cases.
Heidary ran an operation that paid people referred to as “cappers” $100 per patient to recruit injured workers who were provided the same medical care regardless of their injuries, charging documents say.
The case accuses doctors Quynam Nguyen and Jason H. Yang of referring patients for unnecessary care to justify billing for “med-legal” reports, costing about $1,000 each.
Denise Rivera, an injured worker featured in Reveal’s investigation, testified to the criminal grand jury that considered the case. In the interview with Reveal, Rivera recounted a lengthy series of medical treatments including shockwave therapy and acupuncture that did little to help her injured knee. Medical providers in her case, who include each of the indicted doctors, sought $95,000 in payment for her care.
Heidary has pleaded not guilty in the case filed in 2014.
In Orange County, prosecutors refiled insurance fraud charges this month against Landmark Medical Management chief executive Kareem Ahmed, bringing the total to 21 people accused of paying or accepting kickbacks to supply injured workers with expensive medicated pain creams.
The charges against Ahmed include involuntary manslaughter related to the death of an infant who ingested the pain cream. Court records show that Ahmed’s firms ran up bills in excess of $100 million, including the $59,000 charged to insurers for pain creams sent to the mother of the deceased baby.
Ahmed’s attorney, Benjamin Gluck, succeeded in getting most of the initial indictment against Ahmed dismissed in March. Gluck, whose client previously pleaded not guilty, said he expects his client to do to the same as the latest case proceeds.
The new charges say Ahmed’s firm continues to demand $58 million in payments for pain creams in workers’ compensation courts, “despite a judge’s order” to disclose whether his firm paid alleged kickbacks to doctors.
Christine Baker, director of California’s Department of Industrial Relations, told Reveal in March that she was concerned about the amount of liens – or medical provider demands for payment – filed in the state’s network of 24 workers’ compensation courts, given how many of the providers face accusations of fraud.
Baker has since provided Reveal with the state’s own analysis of the providers filing the most liens in 2015.
The list summarizing more than 110,000 demands for payments includes Ahmed’s firm, as well as a company owned by Dr. Ronald Grusd, who was indicted in 2015 for bribing a doctor to send injured workers to his California Imaging treatment centers for MRIs, shockwave therapy and nerve tests. Grusd filed 10,000 demands for payment in the courts, making him the second-busiest filer.
Also on the list is Dr. Philip Sobol, who signed a guilty plea in November 2015 to accepting bribes of up to $100,000 per month to send his patients to other physicians who performed invasive and risky spinal surgeries.
Sobol’s plea made him among the first physicians to concede to conspiring with hospital executive Michael Drobot, who admitted in 2014 to paying at least $25 million in kickbacks to bring 4,400 injured workers to undergo spine surgeries into the now-defunct Pacific Hospital of Long Beach. Sobol’s medical group filed 797 demands for payment late in 2015.