DWC Suspends 16 Providers

Friday, December 22, 2017 | 0

The Division of Workers’ Compensation announced the suspension of 16 more medical providers, bringing to 131 the number of practitioners prohibited from treating workers injured in California since the start of the year.

Lawmakers last year passed AB 1244, requiring the division to suspend providers who have been convicted of defrauding workers’ compensation carriers or other health care payers, or for crimes relating to the practice of medicine, as well as those who surrendered or had their professional licenses revoked.

The DWC said it suspended Dr. James Lemus of Commerce, who owned and operated Lemus Medical Center and was convicted in 2011 of attempting to evade federal taxes. Lemus provided medical services to truck drivers and required them to pay in cash, and did not report the payments to the IRS. The division said the conviction is substantially related to his qualifications, functions or duties as a medical provider, in announcing the suspension.

Three providers were suspended following convictions relating to a kickback scheme to bill Medicare for home health services that were exaggerated or not provided, including:

• Hee Jung Mun of Gardena, also known as “Angela Mun,” a registered nurse and owner of Greatcare Home Health Inc. who pleaded guilty in federal court in 2011 to health care fraud. Mun paid illegal kickbacks to doctors and marketers in exchange for referrals of Medicare patients to Greatcare, and paid illegal kickbacks to patients to persuade them to sign up for home health services. She billed Medicare for patients who did not qualify for home health services, billed for services that were provided by unlicensed nurses, made false and exaggerated patient diagnoses to generate higher Medicare reimbursement, and created false medical records to support those claims submitted to Medicare. Mun was sentenced to 57 months in federal prison and ordered to pay more than $5.1 million in restitution. The Board of Registered Nursing revoked Mun’s license in 2016.
• Hwa Ja Kim of Harbor City, a registered nurse at Greatcare Home Health who pleaded guilty in federal court in 2012 to health care fraud. Kim participated in the scheme to defraud Medicare with Hee Jung Mun and others at Greatcare by signing forms that falsely claimed she assessed the condition of patients. She also made false claims that patients were unable or unwilling to administer their own medication and required skilled nursing services, then entered those false and exaggerated diagnoses. Kim was sentenced to 18 months in federal prison and ordered to pay more than $1 million in restitution. The Board of Registered Nursing revoked her license in 2014.
• Seonweon Kim of Arcadia, a physical therapist for Greatcare Home Health who pleaded guilty in federal court in 2012 to health care fraud. Kim signed false physical therapy evaluations, plan-of-care forms and discharge summaries for Medicare beneficiaries enrolled with Greatcare. His false statements for physical therapy services claimed that initial and discharge assessments were conducted, and plans-of-care were developed for those beneficiaries even though no services were actually provided. Kim was sentenced to 21 months in federal prison and ordered to pay $1.8 million in restitution. He surrendered his license in 2016.  

Two providers were suspended for participating in a kickback scheme to bill Medicare for physical therapy services that were not provided, including:

• Eddie Choi of Santa Clarita, a physical therapist and co-owner of California Neuro-Rehabilitation Institute Inc., who pleaded guilty to federal charges in 2013 of making illegal payments for health care referrals. Choi paid acupuncturist Won Suk Lee kickbacks for referring Medicare beneficiaries to his institute. Choi was sentenced to 15 months in federal prison and ordered to pay $935,149 in restitution. His license was revoked in 2015.
• Won Suk Lee of Huntington Park, acupuncturist and owner of Won Suk Lee Acupuncture & Herb Inc. and Variety Choice Inc., pleaded guilty in federal court in 2013 to health care fraud. Lee participated in a scheme with Choi to provide information on Medicare beneficiaries who received acupuncture and massages, which are not covered by Medicare. Choi then billed Medicare for physical therapy services that had not been provided. Lee was ordered to pay more than $1 million in restitution, and his license was canceled in 2016.

The division suspended another 10 providers whose licenses have been suspended or revoked, including:

• Gonzalo Flores Ruiz, a Lamont physician whose license was revoked in 2016 following a 2012 guilty plea to charges of dispensing controlled substances.
• Purnima Ravi Sreenivasan, a Walnut Creek physician whose medical license was revoked in 2016 for violating multiple terms of the Medical Board’s probation, including practicing medicine while a cease-practice order was in effect. Sreenivasan was initially placed on probation due to inadequate record-keeping, and gross negligence and incompetence in her treatment of three patients.
• Los Angeles physician Moosa Heikali, whose medical license was revoked in 2015. Heikali failed to complete a Physician Assessment and Clinical Education Program after he admitted that he engaged in gross negligence and repeated negligent acts, demonstrated incompetence and made false representations of fact in his interactions with two patients.
• Naga Raja Thota, a physician in El Cajon who pleaded guilty in federal court in 2016 to distributing and dispensing controlled substances without legitimate medical purposes and was sentenced to 30 months in federal prison. Thota surrendered his medical license in March.
• John J. McGroarty, a North Hollywood physician whose medical license was revoked in 2015 for violating the terms of an Order for Practice Restriction issued by the Arizona Medical Board. The Medical Board also found that McGroarty’s cognitive functioning was impaired to the extent that he could no longer practice medicine safely.
• James Kieffer McDonnel, a Bakersfield physician whose medical license was revoked in 2016 for violating multiple requirements of his Medical Board probation related to substance abuse.
• David Wayne Bailey, a physician in Loma Linda whose medical license was revoked in 2015 for using alcohol and controlled substances in a manner dangerous to himself and others. He prescribed a controlled substance to another with the intention of using the substance himself and self-administered a controlled substance that he had prescribed in the name of another.
• Karla Lashun Clark of Chicago's medical license was evoked by the Medical Board of California in 2015. The State of Illinois suspended Clark’s license in 2014 following an arrest for driving while intoxicated and a state-ordered psychiatric evaluation concluded that her substance abuse impaired her ability to treat patients.
• Nenita Flores Iturzaeta, a Corona physician whose medical license was revoked in February due to significant impairments in her neuropsychological functioning that precluded her from being able to practice medicine safely.
• Paul Loftus, a Napa physician whose medical license was revoked in 2015, as he was unable to practice medicine safely due to a mental or physical illness that affected his competency.

A list of suspended providers and suspension orders, as well as providers facing suspension, is here.