DWC Suspends 21 Providers Under Anti-Fraud Law

Tuesday, November 7, 2017 | 0

The California Division of Workers’ Compensation announced Monday that it has suspended another 21 medical providers, the largest batch of suspensions announced since the division started enforcing a new anti-fraud law early this year. 

George Parisotto

The total number of providers barred from participating in the California workers’ compensation system is now 73. DWC Administrative Director George Parisotto issued suspension orders against:

Christopher King of Beverly Hills, owner of medical-billing and medical-management companies. The DWC said King and his wife were ringleaders in a $40 million insurance fraud conspiracy that involved two dozen doctors, pharmacists and business owners. Prosecutors said more than 13,000 patients and at least 27 insurance carriers were victims.

King pleaded guilty on April 26 in Orange County Superior Court to two felony counts of conspiracy to commit insurance fraud and felony insurance fraud. King, as co-owner of Monarch Medical Group, King Medical Management and One Source Laboratories, recruited doctors and pharmacists to prescribe unnecessary treatment for patients with workers’ compensation insurance, the division said.

Marisa Schermbeck Nelson of Torrance. She pleaded guilty on July 26 in Los Angeles County Superior Court, admitting involvement in a $150 million workers’ compensation insurance billing and capping conspiracy with orthopedic surgeon Munir Uwaydah. The DWC said nearly two dozen patients were deceived by Uwaydah and his staff into undergoing surgeries that were performed by a physician’s assistant who had never attended medical school. The patients were operated on under general anesthesia and without Uwaydah present in the operating room. The scheme included payments of up to $10,000 a month for illegal referrals, the DWC said.

Marlon Songco of Burbank, president of Rehab Dynamics Inc., pleaded guilty in federal court on Jan. 8, 2015, for paying kickbacks as part of a Medicare fraud scheme along with co-conspirators Joseff Sales and Danniel Goyena.

Dolphus Dwayne Pierce II, a chiropractor from Lemoore, was convicted on Jan. 8, 2016, of conspiracy to commit insurance fraud by billing insurance companies for services that were unnecessary, not rendered or double-billed, the division said. 

Julio Diaz, a physician who practiced in Santa Barbara and Orange counties, was found guilty in August 2015 on 79 counts of writing prescriptions for narcotics without a legitimate medical purpose. 

Edward Balbas, a physician from Rancho Cucamonga, pleaded guilty on May 5 in Riverside County Superior Court to two felony counts of insurance fraud for submitting more than 165 fraudulent bills over a three-year period. As part of his plea agreement, Balbas was required to pay multiple insurance companies restitution of more than $650,000. 

Randall William Tonelli, pharmacist in San Mateo, pleaded guilty in federal court on July 11, 2016, to knowingly offering to sell and trade a prescription drug sample, and misbranding drugs for sale with the intent to defraud and mislead. Tonelli surrendered his pharmacist license on Oct. 13, 2016. 

Candelaria Valdez, a medical services provider in Hemet, pleaded guilty in September 2016 in Riverside Superior Court to misdemeanor battery relating to abuse of a patient.

Bennie Johnson, an osteopathic physician in Encinitas, had his license revoked by the osteopathic board on March 6. The board determined that he had committed repeated acts of gross negligence in the treatment of multiple cancer patients.

Helen Chang, physician in San Diego, was disciplined by the Medical Board for incompetence and gross negligence in her treatment of a patient. She surrendered her medical certificate on Nov. 1, 2015.

Raffiel Arvon Norwood, of Rosamond, a former vocational nurse, pleaded guilty in federal court on Oct. 22, 2009, to felony possession of child pornography. Norwood surrendered his medical license on July 7, 2016. He was suspended from the Medi-Cal program in April.

Mark Anderson, a dentist in Woodland, was found guilty in March 2009 on felony counts of sexual battery.

Jerry Tabuyo, operator of a community care facility for the elderly in San Jacinto, pleaded guilty in January to operating without a license.

William Richard Bailey, an osteopathic physician in San Diego, had his medical license revoked following conviction for tax evasion in 2016. He was sentenced to more than three years in federal prison and required to pay more than $500,000 in restitution and fines.

James Francis Murphy of Encinitas, an osteopathic physician, was convicted on federal charges of income tax fraud and evasion. He was sentenced to four years in prison commencing on Feb. 24, 2015, and ordered to pay $447,528 in restitution. His medical license was revoked on Oct. 24, 2016.

David Anderson, a chiropractor in San Diego, pleaded guilty to mail and income tax fraud in 1997. He was suspended from participation in the Medicare and Medi-Cal programs on Sept. 20, 2001.

Robert Craig Taylor, a former chiropractor in Los Angeles, was convicted in March 2007 of misdemeanor burglary and identity theft; in September 2007 of felony possession of a controlled substance for sale; and grand theft and in December 2007 of receiving stolen property, identity theft and commercial burglary. His chiropractic license was revoked effective Oct. 25, 2009.

Matthew Cole, a Newport Beach physician, pleaded guilty on Dec. 15 to federal charges of conspiracy to obtain controlled substances by misrepresentation, fraud, forgery deception and subterfuge. He was barred from participating in the Medi-Cal program following his conviction.

Joanne Benzor, a Riverside physician, pleaded guilty in 2009 to two counts of driving under the influence of alcohol. Her medical license was revoked between May 18, 2012, and June 16, 2017, at which time it was reinstated, subject to limitations.

Virginia Garrett, of Sarasota, Florida, a former registered nurse, was convicted on Aug. 20, 2008, for reckless driving while under the influence of alcohol and drugs, with a prior conviction for driving with a blood alcohol content exceeding the legal limit. Her medical license was revoked by the Board of Registered Nursing on Jan. 27, 2012.

Kenneth R. Geiger, physician in Sonoma, surrendered his medical license on April 2, 2008, following an evaluation that he suffers from an illness that impairs his ability to safely practice medicine.

The suspensions were ordered under Assembly Bill 1244, which went into effect on Jan. 1. The law requires the DWC to suspend any medical provider convicted of offenses involving fraud or abuse of the Medi-Cal or Medicare programs, the workers' compensation system, fraud or abuse of a patient, or related misconduct.

The division is also required to suspend physicians whose license or certificate to provide health care has been suspended or revoked.