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ARGUS WEST SIU CRIMINAL FILING
Dishwasher | Felony Insurance Fraud Charges Filed
Los Angeles County, Calif., April, 2018 --- This claim involves a 62-year-old male Dishwasher who filed a workers’ compensation claim alleging cumulative trauma injuries to multiple upper and lower extremities, his trunk, internal injuries and injuries to his eyes as a result of performing work from April 15, 2015 to April 15, 2016.
The claimant last worked for the insured on or about April 15, 2016 but then simply abandoned his job with no explanation. At no point during the course of his employment did he report sustaining any work-related injuries, but approximately two months after he stopped showing up for work, the claimant retained counsel and filed this claim.
To his treating physicians, the QME and during the deposition, the claimant consistently denied having prior work-related injuries, including prior problems with or treatment to the body parts alleged in the claim. Argus West was called in to assist with this case. In direct contrast to his reported history, Argus West identified and obtained records from the WCAB, which revealed the claimant had a prior workers’ compensation claim involving the same body parts. Argus West also identified a prior non-industrial slip and fall injury deemed to be severe, which resulted in multiple surgeries and permanent disability.
The QME issued a very favorable report to the defendants that found no evidence of an industrial injury and opining the claimant is not credible, since his issues were obviously pre-existing.
Argus West SIU issued a full Documented Referral Package to the Los Angeles County District Attorney’s Office on March 22, 2017. Felony insurance fraud charges were filed on April 9, 2018, and the arraigned took place on May 18, 2018. The final restitution figure is pending conviction and is estimated to be approximately $25,900.
Janek Hunt, Brother-In-Law of Dr. Munir Uwaydah, Arrested In Chicago. Felony Complaint Filed Against Hunt By Riverside County District Attorney.
By Lonce Lamonte - December 14, 2018
Janek Hunt, the brother-in-law of Dr. Munir Uwaydah, was arrested for workers’ compensation fraud and booked into custody on November 25th 2018 in Chicago, Cook County, Illlinois.
Nine counts were filed against him of insurance billing fraud under Penal Code Section 550 (a) (6) with an aggravated white collar crime enhancement on November 16th 2018 in the county of Riverside, California by the Riverside County District Attorney’s office. Janek Hunt is operating Blue Oak Medical Group with Dr. Uwaydah.
The fraudulent billings occurred out of the multiple Blue Oak clinics in San Bernardino, Riverside, San Diego, Orange, and Los Angeles counties.
On November 13th 2018, the U.S. Customs Department informed a Riverside County D.A. Investigator, David Jones, that Janek Hunt had just arrived in the United States on a flight presumably landing in Chicago. Why he was landing in Chicago is not known.
Investigator David Jones filed for an expedited walk-through arrest warrant stating the defendant was scheduled to fly out of the U.S. on November 23rd 2018 and back to Estonia. Janek Hunt is Estonian, lives in Estonia where he runs the Blue Oak Medical Group billing system, and travels to the United States which includes California, as needed.
It can be presumed that since fugitive Munir Uwaydah cannot return to the United States due to the warrant out for his arrest which was issued in September 2015, he has been sending his brother-in-law, Janek, as his surrogate. Fugitive Wendee Luke, who is also under indictment along with Dr. Uwaydah from the Los Angeles District Attorney’s office since September 2015, lives in Estonia working and also running the Blue Oak billing department.
November 13th 2018 is two days before the Riverside County District Attorney’s office wrote the Complaint against Hunt and three days before it was even filed. Why U.S. Customs already had Hunt in their sights even before the complaint was filed is also not known.
The case against Janek Hunt came as a combined effort from workers’ compensation insurance payer investigators, including but not limited to: Gordon Oard, of Berkshire Hathaway; Noelani Mars, from Argus West; and Vic Beyer of ICW Group.
On September 15, 2015, the Los Angeles District Attorney’s office announced the indictment of 15 individuals. One of them was Dr. David Johnson, who was arrested. He was doing business as Firstline Health Inc. aka U.S. Health and Orthopedic. His arrest was supported by overprescribing, overbilling, and billing for services not provided. Further investigation by ICW Group found invoicing submitted by U.S. Health & Orthopedic for alleged treatment by Dr. Johnson while he was incarcerated. This discovered fact was expressed in open court in the downtown Los Angeles criminal court proceedings in the first several weeks of the case. Dr. Johnson was released early on because of health reasons and then appeared in court in a wheel chair.
On September 28th 2015, ICW Group investigator Vic Beyer went to the U.S. Health & Orthopedic clinic at 10832 Laurel Street in Rancho Cucamonga where alleged treatment had occurred and spoke to the office manager, Rosa Bernal. Bernal was uncooperative and told Vic Beyer that their attorney advised them not to speak with him. Attorney Matthew Rifat claimed to represent U.S. Health & Orthopedic by sending Vic Beyer an email claiming representation. But he failed to provide a letter of representation when subsequently contacted by ICW Special Investigations Unit (ICW SIU).
In November 2015, ICW Group began to notice Blue Oak Medical Group had taken over and replaced U.S. Health & Orthopedic. A first clue occurred when Blue Oak Medical Group submitted a September 8, 2015 initial examination invoice for claimant Teodoro Beltran. Galal Goubran M.D. did the examination.
But claim records showed ICW Group that Dr. Goubran at U.S. Health & Orthopedic had initially examined Beltran at the exact same location for the same claim and alleged injuries on July 8, 2014. Vic Beyer’s further investigation found Blue Oak Medical Group is operating out of several clinic locations previously owned by U.S. Health & Orthopedic.
Some of those locations are 44-75 Jackson Street in Indio, 1011 Devonshire Avenue #200 in Hemet, 212 S. Grand Avenue in Santa Ana, 10832 Laurel Street Suite 102 in Rancho Cucamonga, and 3602 Inland Empire Boulevard Suite 120 in Ontario. Two physicians’ assistants, Jose Trujillo and David Franke, along with Galal Goubran, M.D. are all former employees under U.S. Health & Orthopedic and continue to see and treat the same patients under Blue Oak Medical Group.
Blue Oak Medical Group filed as a California Corporation on January 1, 2015 with Robin Chorn, M.D. listed as the owner. In 2016, Blue Oak changed ownership with the California Medical Board and listed Shannon Moore as the point of contact. Shannon Moore was an employee and representative of U.S. Health & Orthopedic.
In 2016, Blue Oak filed Secretary of State documents and listed Edwin Mirzabeigi, M.D. as CEO, Secretary, and CFO. In 2017, new documents were filed again and the CEO, Secretary, and CFO switched back to Robin Chorn, M.D.
Dr. Munir Uwaydah was not listed as any officer on any documents. This pattern and practice is clear from eight plus years of investigations that have revealed Uwaydah puts his name on no document but runs his companies with an iron fist in spite of names on documents. He pays straw owners, officers, and representatives.
On the 2017 California Secretary of State documents, Matthew Rifat is listed as the person who completed the form as counsel for Blue Oak. All checks issued by ICW Group to Blue Oak for payment of alleged treatments were being endorsed and deposited by Parkside Solutions into California Bank and Trust accounts.
Matthew D. Rifat, the attorney for U.S. Health & Orthopedic and Blue Oak Medical Group, is the “Registered Agent” for Parkside Solutions, LLC. Matthew D. Rifat is also on corporate records returns listed as the Secretary for Blue Oak. Documents submitted to the ICW Group indicate Firstline/U.S. Health & Orthopedic was in the process and/or planning to operate as Blue Oak Medical Group around early 2015. Review of invoicing and reports submitted by Blue Oak identified the same pattern and practice identified with U.S. Health & Orthopedic to include suspected ongoing over prescribing, overbilling, and billing for services not rendered.
Vic Beyer of ICW spoke with ICW claimant Michelica Cannon on August 1, 2016. Blue Oak billed ICW $34,390.40 for allegedly prescribing 16 containers of cream and 42 bottles of pills/tablet medication to Cannon. Blue Oak treated Michelica Cannon between the dates of September 2, 2015 and April 4, 2016. She stated she only received three containers of cream and six bottles of pills-tablet medications. This quantity of medications should have been billed at $5,573.48.
Claimant Michelica Cannon showed ICW investigator Vic Beyer the bottles of medications which showed the cream medications (Keloprofen) were prescribed by Dr. Edwin Mirzabeigi. The bottles had labels which read Talca Pharmaceuticals, Inc. with an address of 768 Calle Plano, Suite B, in Camarillo, California, CA 93012.
Numerous other ICW claimants testified to the same types of scenarios: the quantities of medications they were dispensed were billed to ICW at numerous times the quantities dispensed. Some claimants were also egregiously overprescribed.
A search warrant issued on May 17th 2017 upon California Bank & Trust to search bank account information in the name of Parkside Solutions provided records from September 8th 2015 through April 30th 2017. DA Investigator David Jones of Riverside County saw two authorized signers on Parkside Solutions’ accounts. They are Matthew Rifat, the attorney for Blue Oak Medical Group, and Tracey Rifat, presumably his wife.
The records include deposits consisting of checks issued by Liberty Mutual, Church Mutual, Zurich American, State Compensation Insurance Fund, Farmers, State Farm, Citizens Insurance Company of America, and other insurance carriers. Each of the checks was deposited into Parkside Solutions bank accounts and written out to Blue Oak Medical Group.
As Riverside County DA investigator, David Jones, concluded at the end of his report, Matthew Rifat, Shannon Devane (aka Shannon Moore), Janek Hunt, and Munir Uwaydah are engaged in a conspiracy to defraud ICW Group, Berkshire Hathaway, Zenith, Farmers, and other workers’ compensation insurance companies by billing for services and drugs not rendered. They also inflate the drug prices by having Blue Oak Medical Group buy drugs from a pharmaceutical company, like Talca Pharmaceuticals, in which Blue Oak has a financial interest.
Lonce Lamonte, journalist; firstname.lastname@example.org
All credit to AdjusterCom.com
The article can be found at http://www.adjustercom.com/modules.php?mop=modload&name=News&func=article_view&adj_article_id=2661
ARGUS WEST SIU CRIMINAL FILING
Farm Laborer | Felony Insurance Fraud Charges Filed
San Joaquin County, Calif., July, 2018 --- This claim involves a 48-year-old male seasonal farm laborer who worked for the insured harvesting olives from September 26, 2016 to November 12, 2016, after which time the season ended. On January 6, 2017, the Claimant retained counsel and filed a claim alleging multiple injuries sustained on his last day of work. The employer disputed any knowledge of the injuries or any previous reporting. The claim was denied, but EDD provided disability benefits.
Throughout the course of the claim, the claimant consistently reported high levels of pain and physical limitations. He also denied engaging in any employment activities to his medical providers and during the deposition.
In direct contrast to his statements, presentations and testimony, Argus West surveillance investigations found the claimant traveling to a private vineyard field where it appeared he was employed on multiple dates. In addition to the apparent misrepresentations about employment and physical activities, the claimant also misrepresented his true medical history when he denied prior injuries to the QME and during the deposition, for which records were obtained reflecting significant prior relevant injuries.
Argus West SIU prepared a full Documented Referral Package to the San Joaquin County District Attorney’s Office on December 7, 2017. Felony insurance fraud charges were filed on June 28, 2018 and the Claimant is set to be arraigned on July 11, 2018. The final restitution figure is pending conviction but requested at approximately $23,867.
ARGUS WEST SIU CRIMINAL FILING
Plumber Claimant | Felony Insurance Fraud Charges Filed
Napa County, Calif., September, 2018 --- This case involves a 57-year-old male plumber who worked for the insured from August 2016 until approximately July 2017. The claimant filed a workers’ compensation claim for an injury to his back, which was sustained when he struck it against a slab of marble at a jobsite. Although he initially declined treatment, he later requested treatment, and the claim was reported to the carrier. Benefits were then initiated, since the insured did not dispute the claim.
After a period of no reported improvement, claimant consistently reporting highly subjective complaints, and the claimant’s failure to return to modified duty work that the insured was making available, Argus West was called in and a surveillance investigation was initiated. Surveillance conducted on multiple days in August and October of 2017 found the claimant engaging in contractor-type employment activities, including visiting numerous private residences where construction was taking place and wearing work attire while carrying and using various tools and equipment.
In direct contrast to surveillance, medical reporting reflected the claimant denied working, demonstrated significant limitations, and reported constant pain. In addition, during his December 6, 2017 deposition, the claimant testified he had not performed any work or employment activities for anyone since approximately June/July 2017.
Argus West SIU prepared a full Documented Referral Package to the Napa County District Attorney’s Office on January 22, 2018. Felony insurance fraud and perjury charges were filed on September 13, 2018 and the claimant’s arraignment is pending. The final restitution figure is pending conviction and is estimated at approximately $25,261.
ARGUS WEST SIU CRIMINAL FILING
Hair Stylist Claimant | Felony Insurance Fraud Charges Filed
Los Angeles County, Calif., April 10, 2018 --- This case involves a 21-year-old female hair stylist, who is alleging a specific injury to her back. The claim was accepted and TTD benefits were paid.
Throughout the course of her medical treatment, the claimant reported significant complaints of pain and injury, causing her treating physician to deem her Temporarily Totally Disabled. The claimant denied working activities to the QME and PTP.
Argus West surveillance and social media investigations revealed that the claimant was actually working for a new employer, doing the same type of work that she did for the insured. Subpoenaed records from the subsequent employer found the claimant had filled out the new-hire paperwork the same day she resigned from the insured. Despite this, the claimant continued to collect TTD benefits and report significant pain and limitations.
Argus West SIU prepared and submitted a full Documented Referral Package to the Los Angeles County DA’s Office on March 9, 2017. Criminal charges were filed on April 10, 2018 and an arrest warrant is pending. The final restitution figure is pending conviction but is estimated to be upwards of $49,395.71.
ARGUS WEST SIU CRIMINAL FILING
Sewing Machine Operator | Felony Insurance Fraud Charges Filed
Los Angeles County, Calif., April 11, 2018 --- This case involves a 44-year-old female Sewing Machine Operator, who is alleging a cumulative trauma injury to her back, shoulder, knee, ankle, hand, hips, and other multiple body parts, and also stress. The claim was denied.
Throughout the course of her medical treatment, the Claimant reported significant complaints of pain and injury, causing her treating physician to deem her Temporarily Totally Disabled.
Argus West Surveillance found the claimant to be active and engaging in employment activities, doing work similar to what she did for the insured. Subpoenaed records and further investigation confirmed suspicions that the claimant was engaging in employment activities, which overlapped the period of EDD-SDI benefits she was receiving. Throughout the course of the claim, the claimant consistently denied engaging in employment activities prior to being released from care. She further denied prior injuries and treatment to the same body parts, despite repeated questioning regarding that issue from treating physicians and the QME. The claimant testified at four depositions, changing her story each time. Ultimately, the QME found the Claimant lacked credibility and found no periods of disability and no need for future medical care.
Argus West SIU prepared and submitted a full Documented Referral Package to the Los Angeles County DA’s Office on May 3, 2017. Criminal charges were filed on April 11, 2018 and an arrest warrant is pending. The final restitution figure is pending conviction, but is estimated to be upwards of $90,000.00.
ARGUS WEST SIU CRIMINAL FILING
Maintenance Worker | Felony Insurance Fraud Charges Filed
Los Angeles County, Calif., January 3, 2018 --- This case involves a 48-year-old male maintenance worker who filed a workers’ compensation claim alleging a specific right knee injury sustained as a result of carrying a dresser down some stairs while working. The claim was immediately reported and benefits initiated.
After a period of time, with no indication of improvement, fairly significant ongoing subjective complaints, and a tip from the insured suggesting the claimant might be working as a contractor, Argus West was called in to initiate a surveillance investigation. Surveillance conducted over the course of several days found the claimant engaging in physical activities inconsistent with medical reporting. The claimant was exceeding restrictions and also performing work as a painter. He was found repeatedly traveling to a private residence where he used tools, went up and down ladders, and painted exterior fixtures.
In direct contrast to the surveillance evidence, the claimant told the insured he was in too much pain to return to work. He told his medical providers he had significant symptoms and was not working. He also told the field investigator who interviewed him that he had not performed any work of any type since his injury.
Argus West SIU prepared a full Documented Referral Package to the Los Angeles County District Attorney’s Office on January 3, 2018. Felony insurance fraud charges were filed on September 7, 2018 and the claimant’s arraignment is pending. The final restitution figure is pending conviction but estimated at approximately $21,982.
ARGUS WEST SIU - CRIMINAL FILING
Farm Laborer Felony Charges Filed
Tulare County, Calif., February 13, 2018 --- This claim involves a 53-year-old male Farm Laborer who was first hired by the insured on April 14, 2014. In the late morning of May 13, 2016, the Farm Laborer sustained significant injuries to his face, including contusions, lacerations and a nasal fracture. He was transported by ambulance to the hospital where he was admitted and remained for six days before his release.
Argus West, Inc. was called to investigate the case and found there were some variations and inconsistencies in the exact description that the Farm Laborer told the insured and all initial medical providers. He said that his injuries were sustained as a result of tripping and falling while walking in the orchard at work. In direct contrast, interviews with other workers and witnesses revealed that the Farm Laborer had been drinking the morning of the injury incident and was antagonizing another worker, which resulted in a physical altercation with the other worker.
The claim was denied on June 9, 2016. To date, the Farm Laborer has not litigated or contested the denial. Although no benefits were provided, the treating hospital filed a lien against the carrier for approximately $45K and, additionally, there are investigation costs and legal costs as a direct result of the misrepresentations made by the Farm Laborer.
Argus West SIU prepared and submitted a full Documented Referral Package to Tulare County District Attorney’s Office on November 21, 2016. Criminal charges were filed on February 13, 2018 and an arrest warrant is pending. The final restitution figure is pending conviction and is estimated to be approximately $4700. More significantly, the charges will provide a valid defense to contest paying the $45K hospital lien.
CA DIR Medical Fraud Prevention Heats Up
The top lien filers are responsible for roughly 75% of all lien claims filed. Many of these individuals filing liens are either being prosecuted for or had already plead guilty to fraud.
The state enacted two new laws addressing this lien problem. On January 1, 2017, SB 1160 and AB1244 became law. SB 1160 requires the CA DIR to automatically stay all liens owned by providers indicted or charged with a crime. Also, AB 1244 requires the AD to suspend any provider from participating in workers' compensation once they have been convicted of fraud.
The current list of providers whose liens are automatically stayed at the current time can be found at:
Our Provider Fraud Task Force Team is currently working on many of these high profile cases.
California bucks trend as workers comp claims increase
Employment Practices Workers Comp Coverage Claims Management Workers Comp Pricing California workers compensation claim frequency increased 3% from 2010 to 2014 despite an 11% fall in claim frequency in most other states during that time, according to the California Workers' Compensation Insurance Rating Bureau.
In a report released Thursday, Oakland, California-based WCIRB compared its comp claim frequency data with claim frequency in 35 states and the District of Columbia, where the National Council on Compensation Insurance Inc. acts as the workers comp ratemaker.
WCIRB said in the report that California workers have shifted toward more hazardous industries, such as construction and manufacturing, as those sectors have increased hiring in recent years.
California Has Highest Claim Frequency in Nation
Sacramento, CA (WorkersCompensation.com) - In the latest update to the Analysis of Changes in Indemnity Claim Frequency report, WCIRB researchers find that indemnity claim frequency increased in California by 3% from 2010 to 2014 while frequency for National Council on Compensation Insurance (NCCI) states declined by 11% over the same period. The WCIRB report reflects insurer unit statistical and aggregate financial call data submitted to the WCIRB through the third quarter of 2015, as well as other external data, in order to identify the key factors driving these recent frequency increases.
Workers' compensation executive pleads guilty in federal court
A former El Dorado Hills man has pleaded guilty in federal court to using business funds for personal expenses. Gregory J. Chmielewski, 46, of West Bend, Wisc., operated a business in Roseville and later Sacramento called Management Resources Group California LLC, which also went by the name Independent Management Resources. The company was supposed to sell and manage workers' compensation insurance for companies, eventually paying money for valid claims. But Chmielewski spent funds that were supposed to be reserved for claims, and the company couldn’t cover claims. On Friday he pleaded guilty in Sacramento to two counts of mail fraud for transferring business funds to his own personal use. According to the plea agreement, California workers' compensation insurance rates rose quickly in early 2003. Some entrepreneurs negotiated agreements with California Indian tribes to collaborate on business ventures to sell alternative insurance plans not subject to the state's insurance regulations because the ventures operated under the sovereign domestic nation status of the tribe. That’s what Chmielewski did.
Southern California Family Arrested in $24M Fraudulent Workers’ Comp Billing Scheme
California Department of Insurance detectives arrested nine individuals involved in a complex scheme allegedly targeting more than 230 workers’ compensation insurers and self-insured employers. Siblings Francisco Javier Gomez, Jr. and Angela Rehmann, owners of G&G Interpreting Services, allegedly fraudulently billed more than $24.6 million for interpreting services for injured workers with Latino surnames.
California Construction Company Owner Nabbed for Workers’ Comp Fraud
The owner of a Northern California construction firm was arrested Thursday on nine felony counts of workers’ compensation insurance fraud and tax evasion totaling $187,707 in losses. William Huffman, 47, of Sacramento, owner of Capitol City Contractors, allegedly underreported $755,899 in payroll to avoid paying workers’ comp premiums for dozens of employees.