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FINAL 2018 CAPA Syllabus

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FINAL 2018 CAPA Syllabus


Excellence Through Education


INSERT Picture


Welcome to CAPA’s 30th Annual June Conference! This year we have gathered in
beautiful Orange County to bring you another stellar conference with high quality speakers and
very timely content in our ever changing legal landscape! We are honored to have Dr. Michael
Moodian of the Commission for Judicial Performance (CJP) and the Honorable Eric V. Isaac as
our keynote speakers to discuss how the work of the CJP, established by the California
Constitution, protects the public and Etiquette in the Courtroom.

This conference is brought to you by CAPA and its conference committee chaired by our
VP Administration, Nancy A. Logue, ACP (PASCCO). The hard work of the conference
committee and executive committee has paid off in a large way! The conference committee
consists of Dana Fischel, ACP, CAS, CCP (ICAP), Paula Delp, ACP (LAPA), Alison Greenlee
(SDPA), and Andrea Hendrickson (FPA). Thank you all for your hard work in putting together
this fantastic lineup of speakers we are offering today!

2018 has been a year of firsts for CAPA! We launched the California Certified Paralegal
(CCP) exam in February at MTI College in Sacramento. We will administer it here in Orange
County on June 22, 2018, and we have booked dates of September 8, 2018 at City College in San
Francisco and November 2, 2018 at De Anza College in Cupertino. Please visit our website and
social media pages for further details! Another first for CAPA is the launch of our own
conference app. It gives you the conference information all in the palm of your hand! We hope
you will enjoy it and use the tools it offers to keep in touch with the contacts you meet today. It
offers you the ability to opt out of the directory if you desire as well as the opportunities to plan
your day and stay in contact with your colleagues.

Most importantly, we would like to thank each and every one of our exhibitors,
sustaining members, speakers, and sponsors for their contributions and support! We cannot
thank them enough for their support. We cannot offer these yearly educational conferences to
you without their support. Visit all of the exhibitors’ tables and find out how these companies
can make your work as a paralegal easier! Don’t forget to have your BINGO card initialed and
entered into the drawing for a prize.

Mingle with each other, build connections, and enjoy the presentations offered today!

Victoria Falcon-Alonzo, CAPA President

Garden Ballroom
2nd Floor

(kitchen located

Bougainvillea & Pa


Friday Evening Social Event


DATE: JUNE 22, 2018
TIME: 7:00 P.M. TO 8:30 P.M.
PLACE: Atrium Hotel’s “iLum Poolside Lounge”**






Provider: California Alliance of Paralegal Associations Telephone: 844-367-2272
373 E. Shaw Ave. #104, Fresno, CA 93710
Date: June 23, 2018 Location: Irvine, CA
1 hr. ethics
KEY NOTE: How the California Commission on Judicial Dr. Michael Moodian
8:30-9:30 a.m. Performance Protects the Public From 1 hr. general
9:45-10:45 a.m. Judicial Misconduct Jim Umholtz, Esq. 1 hr. general
Employment/Labor: Where The Money Goes
11:00-12:00 p.m. – Wrong! Deborah Rummelhart 1 hr. general
Advanced Litigation: Fact or False: How to Practice Aligned Resources LLC 1 hr. general
KEY NOTE: evaluate the accuracy of information from 1 hr. general
12:00-2:00 p.m. the internet and avoid costly errors Trevor Jefferies, Disco 1 hr. general
e-Tech: Future of Legal 1 hr. ethics
Technology/Software as a Service Lori Ann Fox, Esq. (CT Corp) 1 hr. ethics
Corporate Law: Alternative Entities Emma Luevano, Esq. 1 hr. ethics
Employment/Labor: New California
Wage/Employment Laws Edye Hill, Esq. and
Advanced Litigation: Writing Motions—The Geoffrey Hill, Esq.
Nitty Gritty Details Hon. Mitch Dembin
e-Tech: Technology Competency
Requirements Carole J. Buckner, Esq.
Corporate Law: Legal Ethics-Attorney
Discipline Hon. Eric V. Isaac
Etiquette in the Courtroom

2:15-3:15 p.m. Employment/Labor: Identifying & Cesar Portillo, 1 hr.

Addressing Biases in the Selection Process Director HR CSUSB Elimination
of Bias

Advanced Litigation: Who/What/Why/How Toni Marsh, JD, Director 1 hr. ethics
of Paralegals with examples of UPL George Washington University Paralegal

e-Tech: Trial Director Update Jeff Bennion, Esq 1 hr. general

Corporate Law: Mergers & Acquisitions Eric Sloan, Esq, Ari Lanin, Esq.,

Ben Ross Esq, Taylor Hathaway-Zepeda, Esq.

3:30 -4:30 p.m. Employment/Labor: Me Too/Sexual Blake Bertagna, Esq. 1 hr. general
Harassment & Responding to Complaints

Advanced Litigation: Tips & Tricks for Lenden Webb, Esq. 1 hr. general
Collecting on Judgments

e-Tech: Electronic Surveillance/Social Media Brent Sims, Digistream 1 hr. general

Corporate Law: ERISA 101: Fiduciary Marc Schector, Esq. & 1 hr. general
Investment Basics & Compliance Kristine Custodio, ACP

TOTAL California MCLE ours for the CAPA conference are 6.0 hours of participatory credit, including these subfields: legal Ethics and
Elimination of Bias. Check the boxes to indicate which classes were attended.

Bottom portion of form to be completed by the participant after attendance in the above=reference activity.

By signing below, I certify that I participated in all, or some* of the activity described above and am therefore entitled to claim the following

MCLE credit hours. You may not claim credit for the following subfield unless the provider is granting credit in those areas above. * Partial

participation hours must be prorated, rounded to the nearest ¼ hour.

Total MCLE Credit Hours: _______________________________ Including the following subfields:
Legal Ethics: ____________ Recognition and Elimination of Bias: ____________

Print your name: ________________________________________________________ State Bar No.: ___________

Signature: _____________________________________________________________
REMINDER: Keep this Certificate of Attendance for 4 years. If you are audited by the State Bar, you may be required to submit this
Certificate of Attendance to the State Bar. You must sign each of the official CAPA Record of Attendance forms for each session you


California Business & Professions Code Section 6450(d):

Every two years, commencing January 1, 2007, any person that is working as a paralegal shall be required to certify
completion of four hours of mandatory continuing legal education in legal ethics and four hours of mandatory continu-
ing legal education in either general law or in an area of specialized law. All continuing legal education courses shall
meet the requirements of Section 6070.

Certification of these continuing education requirements shall be made with the paralegal's supervising attorney. The
paralegal shall be responsible for keeping a record of the paralegal's certifications.

Date MCLE Course Description No. of Hours

General Law/Specialized Area of Law (minimum 4 hours required)

Compliance Period:

Legal Ethics (minimum 4 hours required)
Compliance Period:


I,_______________________________, hereby certify to ___________________________, my supervising attorney,
that I have completed the MCLE requirements in legal ethics and general/specialized law as mandated by Business and
Professions Code Section 6450, et seq., for the period specified above.

Dated:___________________________ Signature:_________________________________________________

Provided courtesy of the California Alliance of Paralegal Associations (CAPA)

Ethics Guidelines


Providing A Voice of Leadership in Promoting Education, Voluntary Examination, and
Advancement of the Paralegal Profession

Ethics Guidelines

A paralegal shall maintain the highest standards of professional and ethical conduct.
A paralegal shall participate in continuing education in order to ensure the highest[6/9/2018 3:03:19 PM]

Ethics Guidelines

degree of professional competence.

A paralegal shall always disclose his/her status as a non-lawyer.

A paralegal shall not establish an attorney-client relationship, set fees, sign documents
which require an attorney’s signature, or appear in court on behalf of a client, unless
authorized by law.

A paralegal shall preserve and protect the confidences, secrets, and information written
or oral of a potential, current or prior client and/or attorney which have been disclosed to
the paralegal.

A paralegal shall preserve and protect as privileged all communications of the attorney
and the client which have been disclosed to the paralegal.

A paralegal shall avoid conflicts of interest and immediately disclose in writing any
potential conflicts.

A paralegal shall exercise great care and professional judgment in determining the
extent to which a client may be assisted without requiring the presence of a licensed

A paralegal may communicate legal advice authorized by the attorney to a client so long
as they do not interpret or expand upon that advice

Quick Links

RECAP Newsletter
CAPA Connection
CCP Directory Lookup
Register for June Conference

Upcoming Events Category: KCPA Events
Category: Events
Mon Jun 11, 2018

Awards and Installation of Officers

Sat Jun 23, 2018

CAPA 30th Annual June Education Conference

Wed Jul 11, 2018[6/9/2018 3:03:19 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore



With so many newer tract houses, malls, and freeways,
Orange County doesn’t appear at first glance to be a very
historical place. But everywhere in the county there are places
with stories to tell that most locals don’t even know. The
history of interesting people and events in Orange County
actually goes all the way back to prehistoric times.

1. Laguna Woman: The Oldest Woman in
the West

In 1933, a 17-year-old amateur archaeologist in Laguna
Beach chipped a skull out of the ground on St. Ann’s Drive.
This female skull was considered to be over 17,000 years old.[6/9/2018 3:22:04 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore

For decades, Laguna Woman was known as the First Woman
in the Western Hemisphere. No similar remains were ever
found nearby, so the skull may have washed down from local
Since the Laguna Woman find, older remains have been
found in other parts of the Western Hemisphere. But Laguna
Woman shows that even the very earliest settlers of this part
of the world knew a prime beach town when they saw it.

2. Blunderbuss Canyon, or the Meaning
of Trabuco Canyon

Oh, that’s what you call a trabuco.

In 1769, Gaspar de Portola rode through the hills of Orange
County while searching for good places to build missions for
Spain. While traveling through a local canyon, someone in
the group lost his blunderbuss – a type of short shotgun. This
led to them naming this canyon and the creek with the
Spanish name for a blunderbuss, trabuco. The Bowers
Museum in Santa Ana has a centuries-old gun that may be
the actual “trabuco” lost so long ago. Who knows what other
treasures they dropped along the way.[6/9/2018 3:22:04 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore

Trabuco Canyon can be reached from the 241 Toll Road by
taking Santa Margarita Parkway to Trabuco Canyon Road in
the foothills of the Santa Ana Mountains.
The Bowers Museum has many other exhibits of early
Orange County history, along with the found trabuco.

3. The Orange County 76’ers

George Washington never slept here, but he sure could have!
In 1776, local Acjachemen natives found Junipero Serra and
his group starting the building of San Juan Capistrano
Mission. While Washington and the Founding Fathers were
starting their war against England, the changes here were just
as revolutionary as Spain claimed Southern California (and
everyone already living there) as its own.
Mission San Juan Capistrano is open year-round for tours and

4. Home Sweet Home: The Rios Adobe

When Spanish soldier Feliciano Rios built his home near
Mission San Juan Capistrano where he was based, he surely
had no idea how long his family would call the place home.[6/9/2018 3:22:04 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore

He built his adobe home for his Juaneno wife in 1794 and his
descendants have lived there ever since. San Juan Capistrano
was apparently the first to allow the Native American
workers to live outside of the mission. His family has
honored their Spanish, Californio, and Juaneno heritage for at
least 10 generations. From the front, the place looks as if it
hasn’t changed much in all of those years as the family have
carefully added on without making changes that would take
away from the original spirit of their family home.

The Rios Adobe is on Los Rios Street in San Juan Capistrano,
but please remember this is still a private home and view its
beauty from the street.

5. Orange County’s Only Real Pirates

San Juan Capistrano Pirate by Nancy Doyle[6/9/2018 3:22:04 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore

If you think that drunken pirates looting and burning towns
only happened in Orange County amusement parks, then you
must not know about Hippolyte Bouchard.
In 1818, Bouchard sailed down the coast of California, trying
to claim land for Argentina. By the time they arrived in the
area of Dana Point, they were out of supplies, including the
pirate staple, rum. People in San Juan Capistrano knew that
Bouchard was on his way and hid what valuables they could,
especially the artifacts in the chapel of the mission. The
soldiers who were based at the mission went to meet the
pirates as they arrived and tried to scare them off by saying
they had a huge army defending the town. Being pirates,
Bouchard and his crew quickly called their bluff and went to
town to load up on supplies at the local shops (who needs
money when you’re a pirate!). The locals and the soldiers
fired a few warning shots and then headed to the hills.
Bouchard sent 100 men in to take over the town, but the
attack wasn’t as terrible as it could have been. Mostly the
pirates drank all the wine and rum they could find until many
of them had to be carried back to the ship. Legend has it that
there is still treasure hidden in the nearby hills that the
drunken pirates never found.

6. Orange County Wine Country[6/9/2018 3:22:04 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore

Wine bottling in Anaheim from Anaheim Public Library

Orange County might have been called Grape County if
things had gone differently over 150 years ago. In 1857, a
group of German immigrants set up a colony they named
after the Santa Ana River combined with the German word
for home (heim): Anaheim. Their goal was to grow grapes
and make wine. For over 25 years, Anaheim was the largest
wine producing area in California. At one point there were at
least 50 different wineries in the area. It was so successful
that they built Anaheim Pier, near present-day Seal Beach, so
they could ship the wine to San Francisco. Disaster struck in
the late 1880s when a grape blight killed nearly all of the
vines in the area. Fortunately, the area’s climate and fertile
soil was still fruitful for many other crops, including our
famed citrus which eventually took over most other local
crops, including lima beans, strawberries, celery and sugar

7. The Wild West in the OC

Horse thieves, prison escapes, marauding desperados, and
deadly shootouts were the talk of Orange County in 1857.
Juan Flores was a famous outlaw in the days when stolen
horses and stagecoach robberies were the big crimes in
Orange County. After escaping from San Quentin Prison,[6/9/2018 3:22:04 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore

Juan Flores called up his gang and back South. The gang
headed to San Juan Capistrano where they robbed and looted
local stores and murdered a local merchant. Sheriff James R.
Barton gathered up a posse and caught up with Flores and his
gang on a hill that now bears his name in Irvine. The sheriff
and his posse were ambushed and Barton his men were
killed. General Andres Pico led a huge posse to capture the
outlaws and caught up with them in Modjeska Canyon. But
Flores managed to escape again and escaped on his horse
down the steep face of what is now known as Flores Peak. It
took eleven more days to catch him and thousands came from
all around to watch his hanging.
Barton Mound is near the 405 between the 133 and Sand
Canyon in Irvine. There is no marker there, but it is officially
California Historical Landmark #218.
Flores Peak is located in the Santa Ana Mountains above
Modjeska Canyon. It is California Historical Landmark #22.

8. Making Aviation History in Newport
Beach[6/9/2018 3:22:04 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore

Standing on the Balboa Pier today, you probably don’t even
notice those airplanes passing overhead as they take off from
the airport. But if you were standing there on May 10, 1912,
an airplane was a rare and very new novelty.
Glenn L. Martin built his own plane in his shop in Santa Ana
and decided to pull off the very first water to water flight.
Realizing that he had the Catalina Channel right in his
backyard, Martin also was determined to beat the record set
for longest overwater flight that had been set over the English
Channel. With a stack of newspapers and mail to deliver (he
had to earn money for the trip!), Martin set off from the surf.
His assistants pushed him into the waves and he sailed into
the air, landing in Avalon’s harbor. By the time he returned to
Newport’s sandy beach, he had not only taken off and landed
in the water, but covered 68 over-water miles, shattering the
previous record of 22 miles across the English Channel set by
aviation pioneer Louis Bleriot in 1909. This came less than 10
years since the Wright Brothers had their 30 second first
flight on the sandy beach of Kitty Hawk, thousands of miles
away. Martin went on to form his own company and produce
the famous China Clipper planes. His company is still around
and you’ve probably heard of it – Lockheed Martin.

9. A Presidential Past[6/9/2018 3:22:04 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore

Orange County’s political history is pretty vivid (maybe
you’ve heard Reagan’s infamous quote about us?), and
includes more than a few major political players.
Richard Milhous Nixon is now more famous for having to
leave the presidency, than how he got there or what he did as
president. We can’t brag about Watergate, but we can be
proud that our 37th president was a self-made Orange County
boy. Visiting his birthplace in Yorba Linda is a window into
an earlier time in Orange County. He was born in 1913 in this
small house that his father built from a catalog kit. This local
boy went on to be the first president to make a phone call to
the moon when he spoke with Neil Armstrong in 1969 right
after that famous first step for mankind. Nixon is also buried
at his library, making him the only president who was both
born and buried in Orange County and in all of California.
Visit the Richard Nixon Library, Museum, Birthplace, and

10. Why is a Buffalo Standing on a
Corner in Newport Beach?[6/9/2018 3:22:04 PM]

10 Little-Known Facts of Orange County History - OC ExploreOC Explore

On the corner of MacArthur Blvd. and Bonita Canyon, there
is an immense statue of a buffalo, (or bison to be correct).
Not far away, you can drive down Bison Ave. No, these
aren’t reminders of a long-lost local species. In the 1950’s
this was the site of Buffalo Ranch located in what is now
Newport Beach. Families could drive their cars through hills
of grazing buffalo. There was a petting zoo, Indian Village,
and even buffalo burgers. But the ranch was only open for a
few years as more people wanted to build houses there and
more tourists spent their money at a newly opened place
called Disneyland. The barn and silo, along with some
buffalo remained there until 1994 when the silo was moved to
the Centennial Farm at the OC Fair Grounds! The Buffalo
statue and plaque are at the corner of MacArthur and Bonita
Canyon Drive.




ORANGE COUNTY HISTORY[6/9/2018 3:22:04 PM]

CT Corporation

When you have
to be right

We invite you to join CT’s 949.230.4630
Lori Ann Fox, Esq., as she presents:
818 West Seventh Street
Alternative Entities Suite 200
Los Angeles, CA 90017
9:45 - 10:45 am

CAPA’S 30TH Annual Educational Conference

Conference Bags

Speaker Gifts

Poster Boards (VDS)
Valley Document Services Litigation Support

Schedule: June 23, 2018

7:30 a.m. to
8:30 a.m. REGISTRATION & Breakfast Garden Ball- Ethics
room 1
8:30 a.m. to Key Note Morning: How the California Commission on Judicial Performance Protects
9:30 a.m. the Public From Judicial Misconduct
Speaker: Dr. Michael Moodian
9:30 a.m. to
9:45 a.m. BREAK

9:45 a.m. to Employment/Labor: Where The Money Goes—Wrong! Garden Ball- General
10:45 a.m. Speaker: Jim Umholtz, Esq. room 4

Advanced Litigation: Fact or False: How to Evaluate the Accuracy of Information on the Hibiscus General
Internet and Avoid Costly Errors

Speaker: Deborah Rummelhart (Practice Aligned Resources LLC)

e-Tech: Future of Legal Technology/Software as a Service Bouganvilla General
Speaker: Trevor Jefferies, (CS Disco Inc.)
Garden Ball- General
Corporate Law: Alternative Entities room 5
Speaker: Lori Ann Fox, Esq. (CT Corp)

10:45 a.m. to BREAK ROOM MCLE
11:00 a.m. Category
EVENT Garden Ball-
TIME room 4 General
Employment/Labor: New California Wage/Employment Laws
11:00 a.m.—12:00 Speaker: Emma Luevano, Esq.
Advanced Litigation: Writing Motions: The Nitty Gritty Details
Speaker: Edye Hill, Esq. and Geoffrey Hill, Esq. Hibiscus General

e-Tech: Technology Competency Requirements Bouganvilla Ethics
Speaker: Hon. Mitch Dembin

12:00 p.m. to Corporate Law: Legal Ethics-Attorney Discipline Garden Ball- Ethics
2:00 p.m. Speaker: Carole J. Buckner, Esq. room 5

2:00 pm—2:15 pm Keynote Lunch-Etiquette in the Courtroom Garden Ball- Ethics
Speaker: Hon. Eric V. Isaac room 1
2:15 p.m. to
3:15 p.m. Exhibitor Drawing & Paralegal of the Year Award Garden Ball- Elimination
room 4 of Bias
Hibiscus Ethics
Employment/Labor: Identifying and Addressing Biases in the Selection Process
Speaker: Cesar Portillo, Director HR CSUSB Bouganvilla General

Advanced Litigation: Who/What/Why/How of Paralegals with examples of UPL Garden Ball- General
Speaker: Toni Marsh, JD Director George Washington University Paralegal Studies room 5

e-Tech: Trial Director Update
Speaker: Jeff Bennion, Esq.

Corporate Law: Mergers & Acquisitions
Speaker: Eric Sloan, Esq. with Ari Lanin, Esq., Ben Ross, Esq. and Taylor Hathaway-

Zepeda, Esq.

Schedule: June 23, 2018

3:15 p.m. to BREAK
3:30 p.m. Garden Ball- General
Employment/Labor: Me Too/Sexual Harassment & Responding to Complaints room 4 General
3:30 p.m. to Speaker: Blake Bertagna, Esq. Hibiscus General
4:30 p.m. General
Advanced Litigation: Tips & Tricks for Collecting on Judgments Bouganvilla
4:30 p.m. to Speaker: Lenden Webb, Esq.
6:00 p.m. Garden Ball-
e-Tech: Electronic Surveillance/Social Media room 5
Speaker: Brent Sims, Digistream
Garden Ball-
Corporate Law: ERISA 101: Fiduciary Investment Basics & Compliance room 1
Speakers: Marc Schechter, Esq. & Kristine Custodio, ACP

No Host Cocktail Hour/Drawing

Keynote: Commission Judicial Performance

Speaker: Dr. Michael Moodian

Dr. Michael Moodian PRESENTATION: This presentation will
describe the work the California Commission
on Judicial Performance does. Topics will in-
clude the commission’s mandate and how the
judicial disciplinary process works. It will also
include examples of punishment for ethical vi-

Dr. Michael A. (Mike) Moodian was ap-
pointed to the commission as a public member
by the Governor July 16, 2015 and reappointed
February 2017; his term ends February 28, 2021.

He resides in Rancho Mission Viejo.

Dr. Moodian is a faculty member for Chapman University’s College of Educational
Studies, and he serves as chair of the Santa Margarita Catholic High School Consultative
School Board and a member of the UC Irvine Olive Tree Initiative Advisory Board. He
edited a textbook in 2009 that examines the application of cultural comprehension to
organizations and the measurement of intercultural competence. The book is cited by the
Association of American Colleges & Universities in establishing national learning standards.
He was one of 18 Americans (and the only California resident) selected by the European
Union to travel to Brussels in 2012 as a citizen diplomat to discuss education policy with EU

Dr. Moodian earned a Doctor of Education degree in Organizational Leadership from
Pepperdine University, and a Master of Arts degree in Communications and Bachelor of
Arts degree in Communications and Sociology from California State University, Fullerton.


 How the Commission Protects the Public  LEARN ABOUT CJP



 Constitutional body established in 1960  Maintaining public confidence in integrity of
 Eleven Members – three judges, two judiciary

attorneys, six public members  Enforcing rigorous standards of judicial
 Jurisdiction – over every California Supreme conduct

Court Justice, Court of Appeal Justice,  Protecting the public
Superior Court Judge

Multiple Levels of Discipline  Litigant/Family/Friend ……………………..88%
 Attorney ………………………………………….5%
 Removal  Judge/Court Staff ………………………………1%
 Censure  All Other Complaints ………………………….3%
 Public Admonishment  Source Other Than Complaint ………........3%
 Private Admonishment
 Advisory Letter (2015 Statistics)




 Litigant/Family/Friend …………………….30%  Judge has duty to be patient, dignified, and
 Attorney ……………………………………….26% courteous to litigants, jurors, witnesses, lawyers,
 Judge/Court Staff ……………………………..5% and others with whom the judge deals in an
 All Other ………………………………..………..2% official capacity (canon 3B(4)).
 Source Other Than Complaint ………......37%

 “Sometimes I can’t protect people from an  DA made oral motion to continue
attorney that is giving them the wrong misdemeanor trial when she discovered that
advice. What I can tell you…is that this is just witness, whose availability had been
stupidity and arrogance.” confirmed two days previously, was not
available on morning of trial.
 “Perhaps it’s time you start picking up the
books and figuring out what you’re doing.”  In open court, the judge accused the DA of
“malpractice” and told the DA if she
 “To do anything other than take this offer … continued to “proceed this way … you’re not
is akin to malpractice, in my view.” going to be welcome any longer in this

 The judge contended that his remarks were A judge shall not, in the performance of judicial
justified because the conduct of the attorney duties, engage in speech, gestures, or other
was incompetent. conduct that would reasonably be perceived as
bias or prejudice, including but not limited to
 The commission stated, “Irrespective of whether bias or prejudice based upon race, sex, gender,
the attorneys in question were acting in a religion, national origin, ethnicity, disability,
competent manner, Judge Mills’s demeaning age, sexual orientation, marital status,
and insulting comments … in open court were socioeconomic status, or political affiliation.
inappropriate …” and interfered with the Canon 3B(5)
attorney-client relationship.
Public Admonishment of Judge Bruce Mills (2006)




 Judge commented in open court that he  The judge referred to a domestic violence
guessed the only thing that would make the case as a “crazy waste of court time.”
defendant take a plea bargain is if the judge
came out in a white sheet and a pointy white  In another case of domestic violence, the
hat. judge stated, “Is this another case where
we’re going to ruin the relationship between
 Both defendants were African-American. the victim …”

Public Admonishment of Judge Harvey Giss Public Admonishment of Judge Christine K.
(2011) Moruza (2008)

13 14

 A judge is not subject to discipline based on legal “No more fragile rights exist under
error alone. our law than the rights of the
indigent accused; consequently
 However, a judge who commits legal error which, in these rights are deserving of the
addition, clearly and convincingly reflects bad faith, greatest judicial solicitude.”
bias, abuse of authority, disregard for fundamental
rights, intentional disregard of the law, or any
purpose other than the faithful discharge of judicial
duties is subject to discipline.

Oberholzer v. CJP (1999) 20 Cal.4th 371, 398 Geiler v. Commission on Judicial Performance
(1973) 10 Cal.3d 270, 286

15 16

 The defendant expressed a desire to plead  tjWuadkhgienengstaahiledo:dnegfteinmdeantot cgoemt epvliadinenedcearbeotuetstheids,PtDhe
guilty on the judge’s terms but PD refused to  “You get what you pay for. If you really want
agree to the plea (for a variety of legitimate
reasons). good service, then you pay an attorney $10,000
to do this.”
 Judge removed the PD’s office as counsel and (P2u0b0li8c)Admonishment of Judge Christine Moruza
appointed private counsel to take the plea
without compensation. 18

Geiler v. CJP (1973) 10 Cal.3d 270




 Defendant rejected “no time” plea bargain  Without notice, representation by counsel, or
offer and requested jury trial in DUI case. advisement of rights, the judge found
defendant in violation of probation for failing
 Judge privately told DDA that he would teach to complete required AA meetings.
defendant’s attorney a lesson by sentencing
defendant to 30 days jail if convicted.  Defendant was immediately sentenced and
remanded to custody.
 Following conviction, defendant was
sentenced to 30 days. Inquiry Concerning Judge Jose A. Velasquez
(2007) 49 Cal.4th CJP Supp. 175
 “Such conduct by a judge chills the exercise
of the constitutional right to trial by jury.” 20

Ryan v. CJP (1988) 45 Cal.3d 518


 After the judge dismissed a small claims  A petition for a restraining order had not
action and the plaintiff left the courtroom, been filed.
the judge overheard three women who had
testified for the defense express concern for  The commission found that the judge abused
their safety. his authority and became embroiled in the
matter to the extent that he issued orders
 The judge ordered the bailiff to bring the that were neither requested nor legally
plaintiff back into the court and ordered him proper.
not to have contact with the women and to
stay away from the credit union where they Inquiry Concerning Judge Joseph W. O’Flaherty
worked. (2010) 50 Cal.4th CJP Supp. 1.

21 22

 The judge arbitrarily ordered the remand of a  Judge tried to replace public defender with
public defender who refused to have her another attorney.
client plead guilty.
 When PD tried to make a record that there
 The judge failed to follow any of the was no conflict and that PD was prepared to
procedures for imposition of contempt. represent the defendant, the judge
threatened the PD with contempt.
Cannon v. CJP (1975) 14 Cal.3d 678, 686-695
Censure of Judge William M. Ormsby (1996)



 Defendant: I was wondering if I can get [the
number of AA meetings] reduced even more
because I work full time.

 Judge: I’ll take your license if you keep talking
that way.

25 26

 Judge: So you’re going to be remanded.You’ll  The judge ordered an attorney “not to appear
be released on Monday. in my court again, either as public or private
 Defendant: My baby’s in the back –
 The judge told the attorney’s supervisor that
 Judge:You want 30 days? I’ll give you 30 if the attorney appeared in court, the judge
days. would warn him to leave and have him
arrested if he did not.
Inquiry Concerning Judge Jose A. Velasquez
(2007) 49 Cal.4th CJP Supp. 175 Censure of Judge William M. Ormsby (1996)

27 28

 Comments suggesting prejudgment
 Commending or criticizing jury on verdict
 Use of bail for improper purpose (to coerce 30

plea, out of anger) 5
 Blanket sentencing policy
 Failure to disclose/disqualify
 Ex parte communications


Toll Free: 833.359.4228
Local: 949.359.4228
Email: [email protected]

Jim Umholtz, Esq.Employment/Labor:

Fraud Trends in Workers Comp. : Speaker: Jim Umholtz, Esq.

PRESENTATION: “Where the Money Goes . . .
Wrong!” Any time money changes hands, there is
a potential for fraud. Workers Compensation is no
different. Fraud appears in many forms. This dis-
cussion will highlight several forms of workers
compensation fraud and discuss methods for
identifying and fighting fraud.

James E. Umholtz is a partner of The Law Offices of Schlossberg & Umholtz, where his
practice consists of defending workers’ compensation claims in the Corporate Office, head-
quartered in Orange County.

Mr. Umholtz began his career in claims working first as a claims examiner and later be-
ing promoted to supervisor, where he created the special investigation unit for his employer.
His practice focuses on defending self-insured employers, insurance companies, Third-Party
Administrators and municipalities against workers’ compensation claims. He is dedicated en-
tirely to California workers’ compensation claims, including Labor Code Section 132a, and seri-
ous and willful complaints. Mr. Umholtz speaks extensively to employers and provides training
to claims administrators on many current topics in workers compensation.


Presented by Orange County Office
3050 Saturn Street, Suite 100 THIS GUIDE IS NOT LEGAL ADVICE.
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All Rights Reserved

Understanding the System The Groundwork . . .

So what is Workers’ Compensation? Labor Code §3202 Liberal construction of Divisions 4 and 5.
“This division and Division 5 (commencing with Section 6300) shall be liberally construed by the
 A no-fault, Constitutionally mandated, benefits delivery system courts with the purpose of extending their benefits for the protection of persons injured in the
designed to ensure that employees who are injured or disabled while course of their employment.”
working in the course of their employment, are provided with prompt
medical care, paid for lost wages, and return to work as quickly as Labor Code §5402(b) Employer’s knowledge . . .
possible. “Knowledge of an injury, obtained from any source, on the part of an employer, his or her
Who is Covered? managing agent, superintendent, foreman, or other person in authority, or knowledge of the
assertion of a claim of injury sufficient to afford opportunity to the employer to make an
 All employees who are injured or investigation into the facts, is equivalent to service under Section 5400.
become ill because of their employment. (b)If liability is not rejected within 90 days after the date the claim form is filed under Section
5401, the injury shall be presumed compensable under this division. The presumption of this
 This “No Fault” system creates an subdivision is rebuttable only by evidence discovered subsequent to the 90-day period.”
Exclusive Remedy in which employees
receive prompt and specific benefits in Labor Code §3208 “Injury”.
exchange for waiving tort liability against their “‘Injury’ includes any injury or disease arising out of employment, including injuries to artificial
employers. members, dentures, hearing aids, eyeglasses, and medical braces of all types . . . [as long as]
injury to them is incident to an injury causing disability.”
 Workers’ compensation is the sole remedy
available to injured employees. Labor Code §3208.1 Specific and cumulative injury.
“An injury may be either: (a) ‘specific,’ occurring as the result of one incident or exposure which
causes disability or need for medical treatment; or (b) ‘cumulative,’ occurring as repetitive
mentally or physically traumatic activities extending over a period of time, the combined effects
of which causes any disability or need for medical treatment.” 3 4

Primary Benefits How premium is calculated

TEMPORARY DISABILITY (Labor Code §4656) Premium is calculated based upon payroll. A “pure premium rate” for
each occupation is multiplied by an employer’s Experience Modifier.
Payments while the employee is medically unable to work.
Experience Modifier – What is It?
MEDICAL TREATMENT (Labor Code §4600)
“To cure or relieve from the effects of an industrial injury” It is a formulaic modifier that adjusts annual premiums based on previous loss
PERMANENT DISABILITY (Labor Code §§4453, 4658) Illustrated as a ratio: Experience Modification = Actual Losses
Expected Losses
Payment for loss of work capacity.
Developed to:
 Compare employer's claims and payroll to expected industry averages.
§4658.5  Reward employers who promote safety.
 Penalize employers who don’t!!
DEATH BENEFITS (Labor Code §4700 Why is it Important?

 General indicator of safety program effectiveness.
 May affect pre-qualification requirements for job bidding in some industries.
 Impacts workers’ compensation insurance premium.
 May trigger CAL/OSHA Target Inspection program (125%). 5 6


How premium is calculated Primary Players

Example: BROKER – Selling coverage to employers.
EMPLOYER – Requires coverage.
Class P.P. Class P.P. Class P.P. Class P.P. Class P.P. Class P.P. Class P.P.
Code Rate* Code Rate* Code Rate* Code Rate* Code Rate* Code Rate* Code Rate* THE POLICY – The contract under which coverage is provided.

0005 5.80 2108 7.25 3022 5.80 3643 3.62 4362 1.66 5130 1.41 5633 5.83 EMPLOYEE – The beneficiary of the system.
0016 8.36 2109 6.07 3030 10.23 3647 5.75 4410 8.22 5140 2.37 5650 8.76 CLAIMS ADMINISTRATOR – Either an insurance company or other
0034 7.48 2111 5.21 3039 2.82 4420 9.79 5146 6.26 5951 0.81
0035 5.96 2113 10.99 3040 7.67 3651 0.95 4432 3.07 5160 2.25 6003 13.39 agency providing benefits on behalf of an employer.
0036 9.14 2116 4.46 3060 8.03 3681 1.41 4470 3.45 5183 6.97 6011 8.68
7.17 3682 CLAIMS EXAMINER – The person responsible for providing benefits

Each “Class Code” represents a different occupation and the “P.P. Rate” is the and notices regarding a claim.
premium rate payable per $100 payroll.
MEDICAL PROVIDERS – Anyone providing “treatment” under the
(Example: Class Code 0005 - $100,000/$100 payroll x 5.80 = $5,800)
Labor Code.
Then the Experience Modification is applied:

Manual Premium Employer #1 Employer #2 Employer #3
Experience Modification $100,000 $100,000 $100,000
Standard Premium x 0.65 x 0.90 x 1.75
$65,000 $90,000 $175,000 7 8

Broker Fraud . . . Broker Fraud . . .

Not having a license to write insurance. Monday, January 8, 2018
Not using premiums to buy insurance.
Misrepresenting the nature of the insurance Former Insurance Agent Gets Year in Jail for Stealing Premiums

purchased. A former California insurance agent was sentenced to one year in jail and ordered to pay $100,363 in
restitution Friday after pleading guilty to felony theft and securities fraud charges, the Riverside County
District Attorney’s Office announced.
Frederick D. Rollins, 42, pleaded guilty in December to three felonies — grand theft, securities fraud
and acting as a securities broker without a license — and admitted to an aggravated white-collar crime
The District Attorney’s Office said Rollins told businesses in the county that he could get them good
rates on workers’ compensation insurance. He pocketed premiums and provided employers with fake
certificates of coverage.

The California Department of Insurance said it launched an investigation into Rollins after receiving
multiple complaints. In one case, an insurance carrier reported that a company attempted to file a
claim under what turned out to be a non-existent policy number. In another, a business owner filed a
complaint after learning the company did not have valid comp or general liability coverage.
“The investigation revealed that Rollins, while working as a licensed agent at an insurance agency,
collected premium payments from several clients for workers’ compensation and commercial general
liability coverage, but failed to place coverage with any insurance carrier,” the department said. 9 10

Employer Fraud . . . Employer Fraud . . .

Failing to secure workers’ compensation Monday, February 26, 2018

insurance. Former Councilman, Motel Owner Sentenced to 364 Days in Jail

Failing to report/under-reporting payroll. A former city councilman in Red Bluff who pleaded guilty to workers’ compensation fraud and other
Failing to report proper job classifications. felonies relating to a hotel he owned in the Northern California city was sentenced to just under one
Failing to report injuries. year in jail, the Redding Record Spotlight reported.

Suren Patel, 44, pleaded guilty in November to not carrying workers’ compensation coverage at his
hotel. He also pleaded guilty to failing to pay about $20,000 in taxes he owed to the city, illegally
charging $6,000 to the credit card of a hotel customer and falsifying documents so two of his
employees could qualify for welfare benefits.

Patel faced up to seven years and eight months in prison.

On Thursday he was given a five-year, eight-month suspended sentence. He was ordered to serve
364 days in jail, perform 80 hours of community service and serve five years of probation.

He was also ordered to pay $12,500 in restitution, which Tehama County District Attorney Gregg
Cohen said has already been satisfied, according to the Record Spotlight. 11 12


Employer Fraud . . . Employer Fraud . . .

Tuesday, December 12, 2017 Friday, January 19, 2018

Investigation Into Double Electrocution Leads to Fraud Charges Clothing Retailer Sentenced to Two Years for Payroll, Tax Fraud

Prosecutors in Southern California have filed workers’ compensation fraud charges against the The owner of a chain of clothing stores throughout Southern California was sentenced to two years in
employer of two men who were electrocuted on the job, alleging he underreported payroll and prison for evading payment of $5.6 million in taxes and $353,792 in workers’ compensation premiums,
misclassified his employees to make it appear they were in less dangerous positions, according to a state Attorney General Xavier Becerra announced.
report by The Desert Sun.
From 2010 to 2016, Jeong Kim failed to report $7 million in wages paid to workers at more than 50
The Riverside County District Attorney’s Office has asked for an arrest warrant against Carlos stores he owned in Los Angeles, Orange, San Diego, San Bernardino and Ventura counties, the
Valencia, owner of Valencia Trimming in La Quinta. Court papers allege that Valencia shortchanged attorney general announced. The unreported wages resulted in his underpaying workers’
State Compensation Insurance Fund out of $100,000 in premiums and cost the state more than compensation premiums by more than $350,000.
$35,000 in unreported payroll taxes between 2012 and 2017, the newspaper reported.
Kim also failed to report to the state more than $29 million in taxable sales, more than $39 million in
Valencia Trimming employees Osvaldo Ceron and Ernesto Hurtado were electrocuted in March 2016 taxable income and more than $8 million in wage payments.
while working from a boom to pollinate palm trees in Thermal. The boom came in contact with a power
line, shocking both men. Ceron fell to the ground and was found dead. Hurtado remained in a bucket Kim in July 2017 pleaded guilty to four counts of fraud in a complaint filed with the Los Angeles County
attached to the boom, where he was electrocuted and burned. Superior Court. He has already paid $7.6 million in restitution.

State Fund told the newspaper it paid death benefits to Ceron and Hurtado’s beneficiaries. The carrier
said Valencia reported his payroll under the landscaping classification, not tree trimming, which
lowered the company’s insurance rates.

Valencia also underreported employee wages to State Fund and state tax authorities, according to the
District Attorney’s Office. Valencia told State Fund investigators that Hurtado had earned $15,000
annually and Ceron $11,000 annually, but he had reported to State Fund that his company paid no
wages during the time both men were working. 13 14

Employer Fraud . . . Employer Fraud . . .

Tuesday, November 21, 2017 Thursday, May 3, 2018

Farm Labor Contractors Sentenced to 250 Days in Jail for Owner of Pizza Shop Pleads No Contest to Fraud Charges
Premium Fraud
The owner of a pizza shop in Northern California pleaded no contest to a misdemeanor charge of
The father-and-son owners of a Monterey County farm labor contracting business were sentenced to workers’ compensation fraud for underreporting payroll, the Daily Republic reports.
250 days in jail and ordered to pay $382,951.59 in restitution after pleading guilty to four felony counts Piero Tropeano, the 62-year-owner of Evelyn’s Big Italian Pizzeria & Ristorante in downtown Fairfield,
of insurance fraud. agreed to pay $250 in restitution to cover the difference in what he would have paid for premiums had
he properly reported all payroll data. He also agreed to pay the state for the cost of the investigation,
Jaime Rosario Del Real, 61, and his son Israel Del Real, 37, owned Del Real Produce Packing. The according to the Daily Republic.
company offered farm labor to growers in Monterey County and Yuma, Arizona.
Wednesday, April 25, 2018
The Del Reals told State Compensation Insurance Fund that they had no employees, but SCIF
became suspicious when three workers submitted injury claims. The Department of Insurance opened Salinas Contractor Sentenced to Probation for Premium Fraud
a criminal investigation and served search warrants on the men’s home in Salinas. Scheme

Investigators found evidence that the Del Reals misrepresented payroll information to obtain lower A roofing contractor in Northern California was sentenced to five years of felony probation after
workers’ compensation premiums, and also failed to pay payroll taxes and failed to accurately report pleading guilty to two counts of workers’ compensation premium fraud.
employee wages to the Employment Development Department from Oct. 1, 2011, to Oct. 1, 2014. The Monterey County District Attorney’s Office announced that Juan Luis Lopez Garcia of Salinas was
also ordered to pay State Compensation Insurance Fund $18,843 in restitution.
What’s more, the Del Reals concealed work injuries and conspired to commit insurance fraud from Garcia is a licensed contractor and owner of Gold Shield Roofing. The District Attorney’s Office said
Oct. 1, 2011, through April 18, 2016, the Department of Insurance said. Garcia reported having no employees at Gold Shield, but an investigation found that the company had
workers at several job sites. The workers contradicted payroll reports Garcia provided to State Fund.
A Monterey County Superior Court judge suspended imposition of a prison sentence on the Del Reals
but sentenced the father and son to 250 days in county jail, and 10 years of felony probation. The Del
Reals must also pay restitution to State Fund and the Uninsured Employers’ Trust Fund. 15 16

Employer Fraud . . . Employer Fraud . . .

Tuesday, April 10, 2018 Tuesday, April 17, 2018

Business Owner Pleads Guilty to Underreporting Payroll Report: Tesla Failed to Report Workplace Injuries

The owner of a Southern California janitorial company pleaded guilty to underreporting payroll by more Electric car manufacturer Tesla failed to report numerous workplace injuries at its Northern California
than $1 million in an effort to reduce his workers’ compensation premiums, the Ventura County District factory as part of what some workers told the Centers for Investigative Reporting was a company-wide
Attorney’s Office announced. culture that prioritized productivity over safety.

Victor Vega, 53, faces up to 10 years in prison and could be ordered at a June 5 sentencing hearing to CIR said its review of internal documents found Tesla classifying many injuries as “personal medical”
pay $428,867 in restitution. cases. The automaker said it is legally required to report only injuries that are related to work, and the
personal medical cases were not occupational in nature.
Vega, the owner of Vega’s Cleaning Service, pleaded guilty to four felony charges of making false
statements to reduce the cost of work comp insurance. County prosecutors in a statement said Vega The Centers for Investigative Reporting said workers were exposed to toxic adhesives that caused
systematically underreported more than $1 million in payroll between December 2010 and February headaches, dizziness and breathing difficulty. An anonymous source said Tesla claimed reactions to
2015. the adhesives were personal issues because exposure levels in the plant were within workplace safety
Wednesday, March 14, 2018
The report claims Tesla also failed to report sprains, strains and repetitive stress injuries in an effort to
Owner of Staffing Firm Convicted of Underreporting $2.8M in make the production facility appear safer than it really is.
The Centers for Investigative Reporting also said the company’s founder, Elon Musk, dislikes the color
The owner of a Central California staffing company was convicted of underreporting payroll to yellow and warning signs, and discouraged their use.
fraudulently avoid paying more than a half-million dollars in workers’ compensation premiums.
Tesla defended its safety record at the production plant in Fremont, saying it was the same as the
Aileen Ramirez, 31, in February pleaded no contest to charges that she knowingly made false overall average for the auto industry. The company also sent pictures of guardrails painted yellow, and
statements to State Compensation Insurance Fund, the Stanislaus County District Attorney’s Office said critics of its safety records are part of an ongoing unionization effort.

Ramirez, owner and chief executive officer of Quality Employment Services LLC in Modesto, 17 18

underreported $2.8 million in payroll between February 2012 and August 2014, reducing her work

comp premiums by $525,253.


Employer Fraud . . . Employer Fraud . . .

Thursday, December 21, 2017 In other words, employers who make knowingly false or misleading statements on workers’
compensation forms, in violation of Penal Code Section 550(b)(1), can find themselves on the hook for
Case Shows New Avenue to Go After Bad-Actor Employers three times the amount of benefits they pay to a worker.

An opinion out of the 4th District Court of Appeals shows a method attorneys can use to go after The court also has the power to order a bad-actor employer to pay attorneys’ fees and a civil penalty
employers who lie on workers’ compensation forms: through a civil suit under California’s Insurance of between $5,000 and $10,000, and it can grant “other equitable relief, including temporary injunctive
Frauds Prevention Act, said the applicants’ attorney who filed the case. relief, as is necessary to prevent the transfer, concealment or dissipation of illegal proceeds, or to
protect the public.”
The act allows the state to combat a wide range of insurance fraud. But it also contains qui tam
provisions, which allow private citizens to file civil suits on behalf of the state. That's a much more significant punishment than the $10,000 maximum penalty employers can be
assessed for unreasonably delaying or refusing benefits under California Labor Code Section 5814.
Applicants’ attorney Juan Armenta filed such a lawsuit against Gerald Hebb and Sunline Transit This is the route applicants’ attorneys typically take when they’re pursuing an employer they believe
Agency, alleging Hebb made false statements on a document that resulted in the initial denial of lied during the workers’ compensation process — if they pursue the employer at all, Armenta said.
Mahmoud Alzayat’s workers’ compensation claim.
When filing an IFPA action, attorneys first must make a material disclosure to their local district
On Tuesday, the 4th District Court of Appeals’ Second Division allowed Armenta’s IFPA claim to attorney’s office and to the Department of Insurance. The state then determines if it wants to “assume
proceed, determining it was not barred by the exclusive remedy provision of the Workers’ primary prosecutorial authority” over the case or let the person who’s bringing the case assume that
Compensation Act. authority.

“A lot of (IFPA) cases focus on bad-acting doctors, but I thought it was important to let the legal If the DA intervenes and wins, between 30% and 40% of the assessment ultimately taken from the
community know that employers that deny injuries falsely are also subject to the Insurance employer goes to the “relator,” or the person who filed the case.
Frauds Prevention Act,” Armenta said.
If the DA doesn’t intervene but the relator still wins, the relator — in this case, the injured worker and
“The IFPA was in large measure designed to prevent workers’ compensation insurance fraud,” the 4th his attorney — receives between 40% and 50% of the assessment.
DCA wrote. “Application of the litigation privilege would thwart, rather than promote, the legislative
purpose behind the IFPA.” In Alzayat v. Hebb, supervisor Hebb was accused of forcing employee Alzayat to lift a 90-pound bag of
concrete mix despite Alzayat’s request to break down the bag or get help from another employee.
The IFPA holds that employers that violate Sections 549 through 551 of the Penal Code — sections (Alzayat had previously suffered a spine injury.)
that concern insurance fraud — shall be subject to an assessment of “not more than three times the
amount of each claim for compensation.” 19 20

Employer Fraud . . . Claims Examiner Fraud . . .

The two men had argued, and ultimately Alzayat complied with Hebb’s order. Immediately upon lifting Accepting “kickbacks” from providers.
the bag, Alzayat felt intense pain in his lumbar spine and partially collapsed. He filed a workers’
compensation claim the next day, and Hebb allegedly wrote in an injury report that he didn’t witness And more . . .
Alzayat’s accident. He repeated his claim later during a deposition.
A coworker witnessed the incident and later testified that Hebb had lied. A claims adjuster also
testified that the claim would have gone differently if Hebb had not lied, Armenta said. Alzayat
ultimately received workers’ compensation benefits. 21 22

Claims Examiner Fraud . . . Claims Examiner Fraud . . .

Friday, February 9, 2018 Monday, January 29, 2018

Claims Adjuster Sentenced to 33 Months in $1.6 Million Fraud Ex-NFL Player's $1.6M Comp Scam Nets Him 2 Years in Prison
A former New York Giants football player was sentenced to two years in federal prison on Thursday
A former California claims adjuster who funneled nearly $1.6 million in payments for fraudulent after pleading guilty to money laundering associated with his California-based workers' compensation
medical claims to her lover, a professional football player, was sentenced to 33 months in federal claim.
prison Thursday.
Prosecutors accused Marcus Buckley, 46, of filing false invoices, false collection notices and false
U.S. District Court Judge Troy Nunley ordered Kimberly Jones, 52, to turn herself in and start serving physicians' statements to support claims he needed roughly $1.6 million in additional compensation
her nearly three-year sentence by March 19. Nunley last month ordered co-defendant and former New after settling his cumulative trauma claim for $300,000 in 2010.
York Giants linebacker Marcus Buckley to begin serving a 24-month prison sentence on March 19.
Buckley allegedly colluded with a Sacramento-based former claims adjuster for Gallagher Bassett
The judge on Thursday also ordered Jones to pay $1,588,466 in restitution jointly and severally with Services, 52-year-old Kimberly Jones, to receive the $1.6 million.
the 46-year-old Buckley.
Jones raised the reserve limit on Buckley's file in increments to evade a company policy that required
While working for Gallagher Basset in Sacramento in 2009, Jones was assigned to work the file for management to authorize reserve increases of more than $100,000, then issued him checks totaling
Buckley’s workers’ compensation claim against the Giants for the cumulative effect of injuries to his more than $1,588,000 — all in increments of less than $50,000 to avoid scrutiny, prosecutors said.

head, neck, back and shoulders he said were sustained over the course of his seven-year career in At his sentencing hearing on Thursday before Sacramento-based U.S. District Judge Troy Nunley,
the National Football League. The Giants were insured by Pennsylvania Manufacturer’s Association Buckley agreed to pay restitution of $1,588,466.32, with payment to begin immediately, plus a $100
Insurance Group, which contracted with Gallagher Basset for third-party administration services. special assessment.

Buckley and the Giants settled the claim for $300,000 in 2010. The compromise and release Nunley waived a fine against Buckley after finding the former football player did not have the ability to
pay it. Buckley faced a potential fine of up to $250,000 on the money laundering charge, accoding to
agreement covered claims for temporary disability and permanent disability, future medical treatment his indictment.
and self-procured medical care.

Starting in September 2010 and continuing through June 2011, Buckley submitted and Jones 23 24
arranged for payment on phony invoices for self-procured medical treatment purportedly provided
between 1999 and 2003. She also processed and issued checks in response to fictitious credit
collection notes Buckley submitted.


Claims Examiner Fraud . . . Claims Examiner Fraud . . .

Friday, April 1, 2011 Sandra Orozco, 25, Christian’s wife, pleaded guilty to one count each of grand theft and theft by
extortion. She served 17 days in county jail and was sentenced to 200 hours of community service.
Former TPA Employees, Wives Plead Guilty to Fraud Charges Orozco operated an investigative service, OnCall Investigation Services, which billed the county
$938,554, according to the Insurance Department.
The Los Angeles County District Attorney’s Office announced that three former employees of the third-
party administrator handling workers’ compensation claims for Los Angeles County and their wives Maria Ochoa, 48, wife of Javier, pleaded guilty to one count of grand theft and was given credit for 178
have all pleaded guilty to fraud charges related to a scheme prosecutors say bilked the county out of days already served in county jail. Ochoa owned Paramount Transportation Services, which billed the
more than $1.5 million. county for $321,200.

The California Department of Insurance said two brothers and their father used false identities to Dominique Boudreaux, the 26-year-old wife of Hugo, pleaded guilty Nov. 5 to one count each of claims
obtain employment with Tristar Insurance Group. The brothers directed business to companies adjuster fraud, theft by extortion and filing a false tax return. She will be sentenced May 10. The
operated by their wives, who then subcontracted to other vendors and billed the county at rates more District Attorney’s Office expects three years of felony probation and 200 hours of community service.
than twice what they paid. The father processed the payments. Boudreaux owned Transco Transportation Inc., which billed the county for $187,283.

The Los Angeles County District Attorney on March 25 announced that Christian Ramirez, 24, pleaded The Department of Insurance said a county audit showing an unusually high number of invoices from
guilty to one count each of false and fraudulent claim and claims adjuster fraud. The former claims the vendors led to an investigation that started in July 2009.
examiner for Tristar Risk Management was sentenced to two years in state prison. Christian Ramirez
owned Universal Transportation Services and billed the county for $56,676. The investigation found that Hugo and Christian Ramirez referred injured workers needing
transportation to Paramount, Transco or Universal and they would send investigative services to
Hugo Ramirez, 26, Christian’s brother and also a claims examiner for Tristar, pleaded guilty to one OnCall. These companies would hire subcontractors, who usually billed around $200 or $300, and
count of making a false and fraudulent claim and two counts of claims adjuster fraud. He was then submit invoices to the county for about $750, according to the Department of Insurance.
sentenced to 40 months in state prison.

Javier Ramirez, the 52-year-old father of Hugo and Christian and a former data-entry clerk for Tristar,
pleaded guilty to one count each of claims adjuster fraud and grand theft. Javier was sentenced to one
year in county jail and three years of felony probation. 25 26

Claims Administer Fraud . . . Employee Fraud . . .

California Ind. Ins. Co. v. WCAB Stipulated award set aside based on carrier fraud based Reporting false injury claims.
(Whiteley) (2011) 76 Cal. Comp. on finding that carrier failed to adequately assess Working while receiving workers’ compensation

Cases 1332, Second Appellate applicant’s disability, misrepresented level of disability, (temporary disability) benefits.
District, writ denied. and failed to provide appropriate treatment with rush
toward inadequate settlement constituting knowing Claiming an injury occurred at work that
and material misrepresentation, fraud, and
happened somewhere else.
overreaching. Carrier has a duty to fully and fairly
investigate the claim and to present the entire medical Exceeding claimed restrictions/exaggerating
picture when proposing settlement.

Failing to disclose pre-existing injuries. 27 28

Employee Fraud . . . Employee Fraud . . .

Thursday, May 24, 2018 Thursday, April 12, 2018

Landscaper Pleads Guilty to Double-Dipping Charge Salinas Woman Pleads Guilty to Fraud

A Southern California man pleaded guilty to one count of felony workers’ compensation fraud after A Northern California woman pleaded guilty to fraud for failing to report that she was working while
investigators discovered that he worked as a landscaper while receiving disability benefits for an receiving workers’ compensation benefits, the SFGate reports.
alleged injury that he suffered while working for another landscaping company, according to a report in
the Ventura County Star. Elizabeth Hernandez filed a claim for an injury she said happened while working as a caregiver for
ResCare HomeCare in September 2015. The Monterey County District Attorney’s Office opened an
Jose Alvizo-Rodriguez of Santa Paula will be sentenced on July 19. He faces a maximum of five years investigation after receiving a tip in July 2016 that Hernandez was working while receiving work comp
behind bars and a fine of $150,000, according to the newspaper. benefits.

Alvizo-Rodriguez, 46, filed a claim in July 2015 while working for Daley Landscaping in Ojai. He began She pleaded guilty April 4 to felony counts of insurance fraud and welfare fraud, and is scheduled to
receiving temporary total disability benefits form Pacific Compensation Insurance. be sentenced June 27.

Alvizo-Rodriguez went to work for Coastal Farm Labor in Oxnard in August 2016, while still receiving Thursday, April 12, 2018
TTD benefits, according to the Ventura County District Attorney's Office. He did not inform Coastal that
he was receiving benefits and did not inform his former employer that he was working, according to Ex-Deputy Gets 180-Day Sentence for Fraudulent Claim
the report.
A former San Diego County sheriff’s deputy was sentenced to 180 days in jail for filing a false claim for
a back injury, according to a report by the CBS affiliate in San Diego.

Matthew Tobolsky, 40, pleaded guilty in March to a felony charge of making a false statement to
obtain benefits.

County prosecutors said Tobolsky claimed that a back injury sustained while lifting 5-gallon water
bottles prevented him from returning to work, but he was observed working out with heavy weights
during the period in which he told his doctors his debilitating back pain rendered him unable to perform
light-duty assignments.

Tobolsky on Tuesday was sentenced to 180 days in jail and ordered to serve three years of probation.
He will return to court May 30 for a hearing over the county’s request for restitution totaling $84,494. 29 30


Employee Fraud . . . Employee Fraud . . .

Tuesday, March 20, 2018 Tuesday, May 15, 2018

Applicant Accused of Exaggerating Symptoms Worker Sentenced to 30 Days After Pleading Guilty to Fraud

A Southern California food service worker was arrested last week on charges that she exaggerated A Southern California man was sentenced to 30 days in county jail after pleading guilty to a workers’
the extent of her injuries in order to continue receiving workers’ compensation benefits, according to compensation fraud charge for misrepresenting his limitations, according to Probe Information
Intercare Holdings Insurance Services. Services.

Saba Teafaselase of Redlands was arrested March 13 and charged with five felony counts of workers’ Julio Cesar Gomez filed a claim for an injury he said he sustained while working for Silver Creek
compensation fraud and insurance fraud. Industries. Gomez said he was bending over removing nails and felt a strain as he straightened his
Teafaselase filed a workers’ compensation claim in July 2016 for a shoulder injury that she said she
sustained while working for Redlands Community Hospital when she slipped in a puddle of water and Gomez testified during a deposition that he had not performed yardwork, automotive repair work or
fell. Her treating physician limited her to no more than four hours of standing and walking each day but lifted anything weighing more than 15 pounds since the date of his injury. During a medical evaluation,
noted that he suspected she was exaggerating her symptoms. Gomez denied engaging in rigorous activities and said he was unable to work because of pain.

After Teafaselase told her employer that she was unable to drive, cannot grab or hold things with her Probe Information Services said it obtained surveillance footage of Gomez performing physically
left arm and cannot climb stairs, Intercare decided to conduct surveillance. demanding activities including digging holes with a shovel, climbing in and out of the holes, jumping
over a fence, installing a roof liner inside a vehicle, carrying a full tool bag and carrying automotive
Video showed Teafaselase driving, carrying bags in her left arm while shopping, standing for extended parts weighing more than 15 pounds.
periods of time while attending church services and walking in heels for extended periods of time,
Intercare said. A medical evaluator said there were substantial differences between Gomez’s subjective complaints
and what the video footage showed. Based on the video, the evaluator said Gomez didn’t require any
work restrictions and wasn’t entitled to benefits.

The Riverside County District Attorney’s Office filed three felony workers’ compensation fraud charges
against Gomez, who pleaded guilty to one count on May 3. He was sentenced to 30 days in jail and
ordered to pay restitution totaling $30,000. 31 32

Employee Fraud . . . Employee Fraud . . .

Friday, March 16, 2018 Wednesday, May 16, 2018

Hospital Worker Sentenced for Fraud Claim Filed Under False Name for Faked Injury Brings 1-Year Jail
A former Southern California hospital worker who now resides in Texas was sentenced to 60 days in
jail for filing a false workers’ compensation claim. A California man who used fake identification to file a claim for an injury that he was also faking was
sentenced Tuesday to a year in jail for felony workers’ compensation fraud, according to Intercare
Ventura County District Attorney Gregory D. Totten on March 6 announced that Michelle Cordero, of Holdings Insurance Services.
Nocona, Texas, was sentenced to two months in jail and ordered to pay $26,089 in restitution.
Juan Zendejas Barron, of Watsonville, pleaded guilty in March to two counts of insurance fraud, one
Cordero in July 2015 filed a claim for a shoulder injury that she said happened while moving a shelf for count of perjury and one count of using a false identity to file a claim, all felonies, Intercare said. The
Community Memorial Hospital in Ventura. Santa Cruz County Superior Court sentenced him Tuesday to one year in jail, a $1,200 fine and
She denied prior injuries to her right shoulder and claimed to have only one doctor. Totten’s office said ordered him to pay $124,027 in restitution in monthly installments.
“subsequent investigation” revealed that she was seeing multiple doctors seeking treatment for a
shoulder injury she said happened while moving boxes at her home. Barron filed a claim against Ramco Enterprises in September 2015 for an alleged injury to his groin,
legs, back and abdomen using the name and Social Security number of Octavio Guadarrama.
Codero filed a second claim against the hospital, claiming she contracted meningitis from one of the Prosecutors learned that he had used a false identify after the real Guardarrama showed up at a court
patients. She denied under oath having contact with anyone else who had meningitis. hearing wondering why he had been charged with fraud.
The District Attorney’s Office said an investigation discovered that her live-in boyfriend “had recently
been sick with meningitis and she intentionally concealed this fact from the insurer.” Investigators learned that Barron had also filed a claim under his own name for an injury to the same
body part against a different employer, Intercare said.

Division of Workers’ Compensation online records show that he filed a claim against Christopher
Ranch for injury to his respiratory system and skin in 2015, and against Silver Mountain Vineyards for
an injury to his head, brain, neck and back in 2012.

Barron was ordered to report to authorities by June 1 to begin his jail term. 33 34

Employee Fraud . . . Employee Fraud . . .

Monday, February 12, 2018 Thursday, January 18, 2018

Ex-Janitor To Spend 30 Days In Jail, Pay $40K Restitution Over 2nd DCA Upholds Worker's Conviction for Insurance Fraud,
Comp Fraud Attempted Perjury

A former janitor at the Sacramento City Unified School District will spend 30 days in county jail and five A California appellate court upheld a worker’s conviction and sentence for insurance fraud and
years on probation after pleading no contest to felony insurance fraud, the Sacramento County District attempted perjury after he lied about needing a cane because of a plethora of alleged on-the-job
Attorney announced Thursday. injuries.

Marcus Kelly reported an unwitnessed slip-and-fall on Sept. 9, 2014. At the end of the month, he told Luis Hernandez worked in the sanitation department for a Farmer John facility. In 2009, he reported an
his employer his condition had worsened. eye injury after he was splashed by a toxic liquid.

He was placed on no-work status, saying his back and leg pain was too severe for him to work, travel Farmer John sent him to an ophthalmologist for treatment, and in April 2013, the company informed
or socialize.
Hernandez that the doctor had concluded that the injury had resolved without any permanent
Surveillance footage, however, shows that Kelly was working as a dancer at a nightclub during this disability.
time. Footage shows him dancing on stage for several hours over several days.
In June 2013, the company received a letter from an attorney asserting that Hernandez had suffered
The Sacramento County District Attorney's Office Insurance Fraud Unit charged Kelly with felony compensable injuries to his spine, arms, wrists, hands and respiratory system. The attorney further
insurance fraud. He pleaded no contest to the charge in the Superior Court of Sacramento County. claimed that Hernandez had a work-related sleep disorder and problems with headaches.

Judge Lawrence Brown sentenced him to 30 days in county jail and five years of probation. During his deposition for his workers’ compensation claim, Hernandez testified that he needed to use
a cane at all times. He asserted that he used the cane “100% of the time,” and he never forgot.
He also ordered Kelly to pay restitution of $40,097.40.
After the deposition, Hernandez received a copy of the transcript for his review. He never made any
changes or signed the original deposition transcript.

Meanwhile, Farmer John had hired an investigator to conduct surveillance of Hernandez. The
investigator captured video footage of Hernandez walking without the use of a cane.

A jury found him guilty and sentenced him to three years and six months behind bars, although the

judge said the sentence could run concurrently with a sentence of 40-years-to-life for unrelated sex 35 offenses. 36


Employee Fraud . . . Employee Fraud . . .

Monday, December 4, 2017 Friday, November 11, 2011

Farmworker Ordered to Pay $3,500 in Restitution for Failing to Airline Worker Charged With Fraud
Disclose Prior Injuries
A former Southern California airline worker was charged with two counts of workers' compensation
A farmworker who failed to disclose two previous back injuries during an exam with a qualified medical fraud for allegedly lying about the extent of his injuries, according to the San Bernardino County
evaluator was ordered to pay $3,500 in restitution, perform 160 hours of community service and District Attorney's Office.
placed on probation for three years, according to investigative firm Probe Information Services.
Eric Hinkle, 43, was awarded benefits for an injury he sustained while working for a local airline
Charles Maldonado Romero, 49, was not convicted of filing a false claim or making a fraudulent loading and unloading aircraft on Jan. 6, 2009.
statement, however. He pleaded no contest and was convicted Nov. 27 to one count of false
impersonation, Probe said. Prosecutors say he lied to a claims examiner about the extent of his injury when he denied lifting large,
heavy items while moving from the San Bernardino area to Denver.
Romero filed a claim for a back injury he says he sustained while working for Foster Dairy Farms in
Fresno. During a meeting with a QME, he denied any previous injury to his thoracic or lumbar spine. In January 2011, members of the San Bernardino County District Attorney's Office Workers'
Compensation Fraud Prosecution Unit launched an investigation into Hinkle's claim. An arrest warrant
After the QME exam, Probe says it learned that Romero had filed two previous claims for back injuries was issued Oct. 19, 2011, for a single charge of insurance fraud.
under different names.
The arrest warrant was recalled on Nov. 2 when Hinkle voluntarily appeared for an arraignment in the
He filed the claim against Foster Farms using the name Charles Maldonado. The two previous claims Rancho Cucamonga Superior Court on one count of workers' compensation fraud and one count of
were filed under the name Charles Maldonado Romero and had a different Social Security number concealment of, or failure to, disclose material facts regarding insurance benefits. Hinkle was released
than what was used for the claim against Foster Farms, according to Probe. on his own recognizance and is scheduled to return for a preliminary hearing on Dec. 6.

“Both prior claims included injury to his back and resulted in compromise and releases including a
13% (whole person impairment rating) with a $20,000 settlement, and a 55% WHP with a $65,000
settlement,” Probe said.

The Stanislaus County District Attorney’s Office in March charged Romero with four felonies for
insurance fraud. He pleaded guilty to an amended count of false impersonation of another. 37 38

Employee Fraud . . . Employee Fraud . . .

Thursday, June 15, 2006 June 17, 2008

Worker for Employment Agency for Disabled Arrested San Diego Man Sentenced to Six Months for Fraud

An employee of a California company that employs disabled workers has been charged with workers' A San Diego man will pay $25,830.67 in restitution and serve 180 days in jail after being sentenced for
compensation fraud after investigators discovered he was working while collecting disability benefits, workers' compensation insurance fraud, the California Department of Insurance announced.
LWP Claims Solutions announced Wednesday in a press release.
On June 6, 2005, Ramon Romo fractured his thumb while on the job, and filed a workers’
LWP said Darren Stanton turned himself in on April 20 on three fraud-related charges. Stanton was a compensation claim with his employer, NASSCO. Several months later, he added claims for back,
long-term employee of PRIDE Industries, a staffing firm based in Roseville, Calif. that specializes in neck and right shoulder injuries, claiming the injuries occurred at the same time as his thumb injury,
placing disabled workers. the department said. In December 2005, Romo testified under oath that his additional injuries were
not preexisting. He repeated this claim during a qualified medical exam.
Stanton suffered an accepted injury to his right shoulder in March 2005 and underwent shoulder
surgery in August of that year, LWP said. While Stanton was receiving temporary disability benefits, an On two occasions in June 2006, Romo was videotaped lifting and carrying heavy materials, including
LWP examiner began to suspect that Stanton was working at the same time and referred the case to Sheetrock and insulation. He was also seen carrying a young child. In October 2006, Romo told his
LWP's special investigations unit, Probe Information Services. The investigation confirmed that medical examiner that he was unable to lift his two year-old child, and any objects exceeding 20
Stanton was working, LWP said. pounds.

After LWP referred the case to the Department of Insurance Fraud Division, the Sacramento County California Department of Insurance (CDI) Fraud Division investigators additionally discovered that
District Attorney's Office filed charges against Stanton. Romo had filed a workers’ compensation claim for neck and back injuries in 1998 with his previous
employer, Airline Interiors. Because of his injuries at that time, he reached a settlement in March 2003
If convicted, Stanton faces one year in county jail or state prison for two to five years and a fine of up and received $26,000 for his injuries.
to $150,000, LWP said.
As a result of this investigation by CDI, NASSCO, and the San Diego District Attorney’s Office, Romo
Source: LWP pled guilty to one count of insurance fraud, and ordered to pay $25,830.67 in restitution to NASSCO,
his employer. 39 40

Employee Fraud . . . Employee Fraud . . .

Friday, June 2, 2017 A month later, Snow told doctors she still was in pain, could not unload a dishwasher or do any lifting
without feeling pain. An agreed medical examiner assigned her a 3% whole-person impairment of her
Separate Lies by Applicant Warrant Separate Perjury Convictions, right arm, and a 15% impairment of her cervical spine.

Court Rules In an August 2012 deposition, Snow said she could not lift her 30-pound paddleboard but her friends
carried it to the water. She also said she needed assistance lifting her 15-pound surfboard even when
A California appellate court rejected an applicant’s argument that she should have been convicted of it was loaded chest-high in the back of her vehicle.
only one count of attempted perjury — not two — by a San Diego jury that watched a video of her
pulling a 30-pound paddleboard off the roof of her car and lugging it across a beach. If the AME’s permanent disability rating had been accepted, Trader Joe’s claims administrator
projected that Snow's claim would be worth $23,000. Trader Joe’s settled the claim, however, for a
Facts: Sara Charis Snow worked part time at a Trader Joe’s supermarket, stocking shelves, gathering “nuisance value” of $500.
shopping carts and serving customers. She filed a workers’ compensation claim in January 2011,
alleging that she had hurt her right wrist because of repetitive movement. Trader Joe’s paid temporary Procedural: After the settlement, San Diego County prosecutors charged Snow with insurance fraud
total disability benefits for three months. and perjury. A jury convicted her of two counts of attempted perjury — one for her statement that she
wasn’t able to pull her paddleboard off her car and another for saying she was unable to carry it. She
Snow’s doctor authorized her to return to work in late January 2011 on “transitional duty,” but Snow was sentenced to two years of confinement in county jail and one year of supervision after her release.
informed him that she was experiencing pain throughout her body. He rescinded his return-to-work
authorization and referred her to a specialist. Snow appealed, arguing that the dual conviction violated the double jeopardy clause of the U.S.
Constitution because the two separate a convictions were for the same offense.
Snow reported to work on May 24 and on that day filed a second workers’ compensation claim
alleging she had injured her back while collecting shopping carts from the parking lot. Her doctor Analysis: A panel of the 4th District Court of Appeals said that in its opinion, Snow’s false statements
returned her to work with restrictions against heavy lifting. After an investigation, Trader Joe’s denied clearly overlapped. One conviction was based on her statement that she couldn’t lift her paddleboard
Snow’s second claim. Snow told doctors that ordinary household chores such as washing dishes and off her car and another was for stating that she had to ask friends to carry it.
vacuuming hurt her back, and that she suffered from headaches, neck pain, back pain and pain
throughout her arms, legs, knees and ankles. Each statement, however, was separately material to Snow’s disability rating, the court said. The
AME, Dr. William Previte, testified that he assessed snow as having restricted ability to grip and grasp
In December 2011, a private investigator videotaped Snow pulling a 12-foot paddleboard off the roof of with her right hand, which is material to her statement that she could not carry the paddleboard.
her Toyota 4Runner and carrying it 150 feet down the beach to the water. After a 45-minute paddle Previte also testified that Snow was restricted from extreme neck movements and extreme pulling
trip, Snow carried the board back to her car and secured it to a rack on the roof. movements, which is material to her statement that she could not pull the paddleboard off the roof of
her car. 41 42


Kickback/Referral Schemes . . . Kickback/Referral Schemes . . .

Friday, November 17, 2017 .Wednesday, November 29, 2017

Union Boss Sentenced to 37 Months in Prison Attorney Convicted of Paying for Referrals Sentenced to House
A former Northern California union boss who pleaded guilty to fraud and money laundering in a case
that also involves a Bay Area applicants’ attorney was sentenced to 37 months in prison, the U.S. A Northern California applicants’ attorney facing up to two years in federal prison for crimes that
Attorney’s Office announced. included paying $400,000 in client referral fees to a union boss will be confined to his home for the
next three months.
Daniel Rush on Tuesday was also ordered to serve three years of supervised release and pay a fine
of $7,500. U.S. District Judge Haywood S. Gilliam Jr. on Monday sentenced Marc Terbeek to three months of
house arrest, followed by three years of supervised probation. Terbeek must also pay a $7,500 fine.
Rush pleaded guilty in June to one count of receiving an illegal payment as a union employee, one
count of honest services wire fraud, and one count of conspiracy to commit structuring and money Terbeek pleaded guilty in February to one felony count of making an illegal payment to a union
laundering. employee, and one misdemeanor for structuring bank transactions to avoid triggering financial
reporting requirements.
In his plea agreement, Rush admitted to conspiring with attorney Marc L. Terbeek to make a series of
small bank deposits — structuring — totaling $420,000 to avoid triggering financial reporting Rush pleaded guilty in June to one count of receiving illegal payment as a union employee, one count
requirements for deposits of more than $10,000, according to the U.S. Attorney’s Office. of honest services wire fraud and one count of conspiracy to commit structuring and money
laundering. He was sentenced to 37 months in prison on Nov. 13.
He also admitted to accepting kickbacks from Terbeek in exchange for establishing the Albany
applicants’ attorney as an approved provider of legal services for workers’ compensation cases at the Charging papers also say Terbeek arranged more than 40 transactions to deposit $420,000 Rush
Instituto de la Raza Laboral, where Rush was executive treasurer. received from the owner of a marijuana dispensary in Oakland. The smaller payments were intended
to avoid financial regulations requiring banks to report deposits of more than $10,000.
Terbeek in February pleaded guilty to one count of making an illegal payment to a union employee and
“Rush was Terbeek’s Alcoholics Anonymous sponsor between 2009 and 2010, which, perhaps not
one count of violating anti-structuring regulations, federal prosecutors said. He is scheduled to be coincidentally, was approximately when their secret financial arrangement began,” the government
sentenced Nov. 27. said in its sentencing recommendation. “Rush routinely told Terbeek that Terbeek would be nothing
without him, and that Terbeek owed his whole livelihood to Rush. Through one lens, Terbeek can be
Court papers unsealed in 2015 after Rush was arrested allege that Terbeek paid at least $110,000 in viewed as the victim of Rush’s extortion.”

charges Rush put on a credit card as part of the agreement to receive client referrals. Charging papers
said none of the payments appeared “extravagant or unusual” other than six transactions totaling
$11,366 for Verizon Wireless bills “for telephone services of Rush’s Hells Angeles motorcycle club
43 44

Kickback/Referral Schemes . . . Kickback/Referral Schemes . . .

Monday, November 20, 2017 The investigation appears to be focused almost entirely on Pacific Hospital of Long Beach. Although
Randall was charged only with paying kickbacks for referrals to Tri-City, the U.S. Attorney’s Office in a
Marketer Gets 15-Month Sentence in Kickback Scheme November 2015 press release claimed Randall also “facilitated the Pacific Hospital scheme” by
coordinating kickback arrangements with the former owner of the facility, Michael D. Drobot.
A federal judge on Friday sentenced former Pacific Hospital of Long Beach marketer Paul Randall to
15 months in federal prison for his role in a spinal surgery kickback scheme at another Southern Drobot pleaded guilty in 2014 to one count of conspiracy to defraud a federal health care program and
California hospital. one count of paying kickbacks for patient referrals. He is scheduled to be sentenced Jan. 12.

“Randall pleaded guilty in 2012 to a federal charge of conspiracy to commit mail fraud, and admitted to His son, Michael R. Drobot, pleaded guilty last year to the same federal conspiracy and kickback
paying physicians and chiropractors kickbacks ranging from $15,000 to $20,000 for referring workers’ charges, and is scheduled to be sentenced Feb. 16.
compensation patients to have spinal surgeries performed at Tri-City Regional Medical Center in
Hawaiian Gardens. James L. Canedo, former chief financial officer at Pacific Hospital, pleaded guilty in 2015 to a
conspiracy charge and is scheduled to be sentenced Feb. 2.
He also admitted to creating a distributorship company called Summit Medical Group that marked up
the price of spinal hardware sold to the hospital and used the proceeds from the inflated invoices to Dr. Philip Sobol, who prosecutors say received $5.2 million in kickbacks for referring patients to Pacific
pay the kickbacks. Hospital, pleaded guilty to a federal conspiracy charge in 2015 and is scheduled to be sentenced Dec.
He also admitted to paying $150 to $200 in kickbacks to physicians who referred work comp patients
for toxicology tests performed by another company he created, called Platinum Medical. Chiropractor Alan Ivar, who was accused of receiving $1.24 million in kickbacks as a result of the

Prosecutors said in a presentence recommendation filed with the court Sept. 14 that Randall should Pacific Hospital scheme, pleaded guilty to a conspiracy charge and is scheduled to be sentenced Jan.
serve 37 months in prison. The “sophisticated kickback scheme” was not a momentary lapse in 19.
judgement but a pattern of criminal acts committed over a 19-month period, the U.S. Attorney’s Office
argued. Dr. Mitchell Cohen, who allegedly received $1.64 million in kickbacks for patient referrals, pleaded
guilty to filing a false tax return for not reporting the payments as income. His sentencing date is Feb.
The U.S. Attorney’s Office also said Randall’s sentence should reflect the seriousness of his conduct 23.
and be sufficient to deter others from participating in kickback schemes. And the prosecution said
Randall was personally “in need of special deterrence” because he continued to engage in criminal Former state Sen. Ron Calderon, D-Montebello, was not involved in the kickback scheme but was
conduct despite two previous fraud convictions that led to 21-month and 18-month sentences. sentenced to 42 months in prison in 2016 for accepting bribes to kill legislation that would have made
it less profitable. Calderon pleaded guilty to a mail fraud charge for receiving $30,000 from the older
Drobot to fend off legislative efforts to repeal the pass-through provision that allowed hospitals to bill
workers’ compensation carriers separately for hardware used in spinal surgeries. 45 46

Kickback/Referral Schemes . . . Kickback/Referral Schemes . . .

Wednesday, January 31, 2018 In the deferred prosecution agreement, Iglesias admits that the referral scheme generated net income

Capper, Administrator Ordered to Forfeit $1.1 Million in Proceeds of more than $5 million over a two-and-a-half year period starting in 2013. He said the scheme
From Referral Scheme generated more than $9.5 million in bills for services sent to workers’ compensation carriers, and the
he netted $1.005 million in proceeds from running the companies.
A federal judge ordered a capper and his administrator to forfeit more than $1.1 million in criminal
proceeds from a Southern California referral scheme that generated at least $9.5 million in workers’ In addition to identifying Arguello and Morales as co-conspirators, Iglesias also said in the agreement
compensation claims. that Dr. Ronald Grusd, owner of California Imaging in Beverly Hills, and San Diego chiropractor
Steven Rigler participated in the referral scheme.
U.S. District Judge Cynthia Bashant on Thursday ordered Miguel Morales, an administrator at
Providence Scheduling, Prime Holdings International and Medex Solutions Inc., to pay $140,000 he Rigler pleaded guilty in November 2015 to charges in an indictment filed that month accusing him of
received from referring injured workers to doctors in exchange for kickbacks. soliciting patients from Iglesias and others. The indictment claimed that Rigler paid $3,000 a month to
Iglesias and Arguello, for which he received 40 patient referrals each month.
Two weeks earlier, Bashant on Jan. 12 ordered Fermin Iglesias, the chief executive officer of Prime
Holdings International, to forfeit $1.005 million in proceeds from the scheme. Iglesias also had an A federal jury in December convicted radiologist Grusd on 39 counts for his role in the scheme. A
ownership interest in Medex Solutions and Meridian Medical Resources Inc. grand jury indictment handed down in June 2014 accused Grusd of paying Rigler for referrals. The
indictment alleges Grusd paid $180 for each body part on which Rigler requested a magnetic
Morales pleaded guilty in April 2017 to a single count of conspiracy to commit honest services mail resonance imaging scan, and $350 for every electromyography or nerve conduction velocity test
and wire fraud, and Iglesias pleaded guilty in December 2016 to a single count of conspiracy to Rigler ordered. In 2014, Grusd further agreed to pay $50 per MRI for the first body part and $25 for
deprive patients of the right to the honest services of their doctors.
each additional body part, $75 for each EMG or nerve conduction test, and $50 for each shockwave
An indictment filed with the U.S. District Court for Southern California in June 2014 and unsealed in treatment he provided to patients referred through Iglesias and Arguello.
January 2017 alleges that Providence Scheduling, owned by Carlos Arguello, referred injured workers
to providers who in turn agreed to order a minimum number of procedures from companies, including Three months later, in June 2017, the Orange County District Attorney’s Office announced separate
Prime Holdings International, Medex Solutions and Meridian Medical Resources Inc. charges against Arguello and Providence Scheduling. District Attorney Tony Rackauckas said during a
press conference that Providence was at the center of a “fraud factory” that generated more than $300
Providers participating in the scheme were required to meet a quota for cross-referring patients to million in insurer losses.
receive imaging tests and durable medical equipment from the companies Iglesias owned or
controlled. The county alleges Arguello created a company called Centro Legal Internacional that used offshore
call centers to recruit predominantly Spanish speaking people to file workers’ compensation claims. He
referred the patients to at least 10 applicants’ attorneys in exchange for kickbacks, and also used

Providence to schedule appointments with doctors who agreed to pay illegal referral fees, the District
Attorney’s Office alleges.
47 48


Kickback/Referral Schemes . . . Kickback/Referral Schemes . . .

Monday, May 21, 2018 The complaint says prosecutors also talked to John Workman, who pleaded guilty to a federal
conspiracy charge in 2017 relating to kickbacks for shockwave treatments provided by Foremost
Riverside Chiropractor Accused of Participating in Capping Shockwave Solutions in Los Angeles. Workman’s plea agreement remains sealed, but charging
Scheme papers alleged he received a single $13,000 payment in 2010 for a patient of a doctor identified as “Dr.
H,” with the knowledge that the money was a kickback for referring the patient to Foremost.
The Riverside County District Attorney’s Office filed charges against a chiropractor accused of paying
for patient referrals as part of a widespread capping scheme being prosecuted in courts throughout Workman told an investigator for the district attorney that he used a company called Sunwest Medical
Southern California.
to help Montgomery conceal the referral payments to Providence Scheduling. Records from the
Prosecutors on Thursday filed a 47-count complaint accusing Riverside chiropractor Curtis W. Secretary of State’s website list Workman as president of Sunwest Medical Management Inc. as
Montgomery of paying illegal referral fees to Providence Scheduling. recently as Nov. 30, 2017.

The owners of Providence Scheduling pleaded guilty to federal conspiracy charges for referring Charges against Montgomery related to an alleged scheme were disclosed in January 2016 when the
patients to doctors in exchange for kickbacks. One of the owners of Providence, Carlos Arguello, is U.S. Attorney’s Office and the San Diego County District Attorney’s Office announced the indictment of
also facing charges in Orange County that he required applicants’ attorneys who were paying him 16 people as a result of an investigation called Operation Backlash. Providence Scheduling sits at the
referral fees for clients to also use the company to schedule appointments for medical services. heart of what prosecutors allege was a massive cross-referral scheme.

Court papers say investigators with the District Attorney’s Office first took an interest in Montgomery in According to court papers, Arguello and Fermin Iglesias, a co-owner of Providence, referred workers’
September 2011 after receiving a tip from an insurance company about possible fraud. Although the compensation patients to chiropractors and other providers who agreed to refer the patients to other
2011 investigation didn’t lead to criminal charges, when prosecutors had the opportunity to interview companies that Arguello and Iglesias controlled.
Arguello about his widespread scheme, they decided to ask about Montgomery.
Court papers say Arguello and Iglesias set a quota for the value of services that San Diego
“Because Curtis Montgomery had previously been investigated for unrelated fraud, the people chiropractor Steven Rigler was expected to prescribe to each patient sent to him. For example, each
questioned Carlos Arguello regarding his relationship, if any, with Curtis Montgomery,” the complaint magnetic resonance image that Rigler ordered was worth between $30 and $50.
says. “Carlos Arguello was the first knowledgeable, reliable witness to state that Curtis Montgomery
participated in the scheme.” But Rigler received credit against his quota only if the MRIs were performed by Medex Solutions or
Prime Holdings, which Arguello and Iglesias controlled. Rigler received credit for durable medical
equipment prescriptions only if they were fulfilled by Meridian Medical Resources, which was also
controlled by Arguello and Iglesias.

Rigler pleaded guilty to a conspiracy charge in May 2016 and is scheduled to be sentenced Oct. 11. 49 50

Kickback/Referral Schemes . . . Kickback/Referral Schemes . . .

In December, a federal jury convicted radiologist Ronald Grusd on 39 counts relating to a kickback Friday, December 15, 2017
scheme that started with illicit payments to Rigler and later involved Providence Scheduling. Sometime
in 2012, Grusd agreed to pay $180 to Rigler for sending patients needing MRI scans. Jury Convicts Radiologist on 39 Counts in Kickback Case

In 2013, after Arguello and Iglesias agreed to send work comp patients to Rigler, Rigler was required Beverly Hills radiologist Ronald Grusd will return to court in March to learn his sentence after a federal
to send some of them to Grusd. Grusd, in turn, was paying Arguello and Iglesias $50 for every MRI jury convicted him on 39 counts relating to a kickback scheme that prosecutors say generated $25
that was sent his way, and $75 for each electromyography or nerve conduction velocity test that was million in fraudulent bills for services provided to injured workers in California.
A U.S. District Court for Southern California jury on Tuesday convicted Grusd and two companies he
Iglesias, who pleaded guilty to a single conspiracy charge in 2017, is scheduled to be sentenced Oct. owns, California Imaging Network Medical Group and Willows Consulting Co., on 18 counts of honest
10. He was ordered to forfeit $1 million in proceeds from the scheme in January. services mail and wire fraud, 14 counts of health care fraud, six counts of violating the U.S. Travel
Act, and one conspiracy charge.
Arguello, who pleaded guilty to a conspiracy charge in 2016, is also scheduled to be sentenced Oct.
10. The U.S. District Court for Southern California on May 4 ordered him to forfeit $1.2 million in Grusd in March rejected a plea agreement relating to an eight-count indictment handed down by a
proceeds from the kickback scheme. grand jury in June 2014 — which was unsealed in November 2015 after Grusd and co-defendants
were arrested — accusing him of paying marketers working for San Diego chiropractor Steven Rigler
Arguello, however, is also a defendant in a case in Orange County where prosecutors say Providence to set up referrals for ancillary services.
Scheduling once again played a role.
In July, the U.S. Attorney’s Office filed a superseding grand jury indictment fingering Grusd as a main
The Orange County case alleges that Arguello and Edgar Gonzalez used a company called Centro provider of diagnostic services in a larger scheme involving the use of an offshore call center to recruit
Legal Internacional to recruit predominantly Spanish-speaking workers to file claims. The patients injured workers who were auctioned off to providers — and allegedly 10 applicants’ attorneys —
were then sold to applicants’ attorneys, who also agreed to use services provided by other companies throughout Southern California.
Arguello controlled, including USA Photocopy, Professional Document Management and Providence
Scheduling. The superseding indictment included original charges that Grusd and Paredes in 2012 agreed to pay
Rigler a per-patient and per-body-part referral fee for prescribing magnetic resonance
imaging services.

Arguello and Iglesias agreed to send workers’ compensation patients to Rigler. In addition to paying a
monthly referral fee, Rigler was required to refer injured workers for a certain number of ancillary
procedures from specified providers, including Grusd. 51 52

Kickback/Referral Schemes . . . Kickback/Referral Schemes . . .

Wednesday, May 9, 2018 Dr. Philip Sobol, who pleaded guilty in 2015 to one conspiracy charge and one count of interstate
travel in aid of a racketeering enterprise, and was sentenced to 21 months in prison in February.
Chiropractor Gets 366 Days for Role in Spinal Kickback Scheme Sobol, who received $5.2 million in kickbacks for referring patients to Pacific Hospital, was ordered to
forfeit $2 million in criminal proceeds in January after Staton credited him for $3.2 million paid to settle
Southern California chiropractor Michael E. Barri, who pleaded guilty to a conspiracy charge in 2016 kickback allegations in a civil case.
for receiving $150,000 in kickbacks by referring patients to Pacific Hospital of Long Beach, was
sentenced to 366 days in federal prison. Court filings indicate that victims will have to prove the kickbacks resulted in unnecessary surgeries or
in providers over-charging carriers for the procedures and hardware.
U.S. District Court Judge Josephine Staton on Friday ordered Barri to turn himself in to start serving
his sentence by July 9 and recommended he be allowed to serve his sentence in Lompoc. Staton in January vacated a restitution hearing for Paul Randall, a marketer who pleaded guilty to a
participating in a kickback scheme at Tri-City Regional Medical Center in Hawaiian Gardens. Randall
On April 18, Staton ordered Barri to pay $206,505 in what is described in the personal money was sentenced to 15 months in prison as a result of pleading guilty to a conspiracy charge in which he
judgement of forfeiture as “restitution.” Court filings do not describe the victims who would be entitled admitted to paying $15,000 to $20,000 for each patient referred to have a spinal fusion performed at
to restitution from Barri. the hospital.

Barri will also be required to join his convicted co-conspirators during a restitution hearing set for June In granting the government’s motion to cancel Randall’s restitution hearing, Staton said prosecutors
29. The others to attend are: were not able to prove that the kickbacks resulted in unnecessary surgeries or that carriers paid more
for procedures occasioned by kickbacks. She also pointed out another potential obstacle to restitution
Michael D. Drobot, the former owner of Pacific Hospital who pleaded guilty to one count of conspiracy in saying that the complex issues surrounding restitution in Randall’s case “would complicate or
prolong the sentencing process to a degree that the need to provide restitution to any victim is
to defraud a federal health care program, and one count of paying kickbacks. Drobot was sentenced in outweighed by the burden on the sentencing process.”
January to 63 months in prison, a $500,000 fine and forfeiture of $10 million.
The U.S. Attorney’s Office March filing said prosecutors are working through some complicated issues
Michael R. Drobot, who was sentenced to 41 months in prison in March for operating a drug relating to restitution involving Drobot and the others ordered to appear at the June 29 hearing.
dispensing program used to pay kickbacks to providers who referred patients to his father’s hospital. Prosecutors said that in addition to the question of whether the scheme resulted in actual losses,
The younger Drobot was ordered to forfeit $1 million in criminal proceeds in February. they’re also wrestling with the amount of losses and which defendants should be held jointly and
severally liable.
James Canedo, former chief financial officer at Pacific Hospital, who was sentenced to 266 days in
prison and ordered to forfeit $633,091 in February. Canedo pleaded guilty to a single conspiracy
charge in 2015 and admitted to tracking referrals to ensure that providers received their referral
payments. 53 54


Kickback/Referral Schemes . . . The MEDICAL denial!

Wednesday, December 6, 2017 Never leave the decision to
the doctors!!
Ex-NBA Player Pleads Guilty in Charity-Donations-for-Client-
Referral Scheme

Former National Basketball Association big man Kermit Washington pleaded guilty to charges related
to a scheme through which he funneled professional athletes to a Southern California workers’
compensation attorney in exchange for donations to his charity, the U.S. Attorney’s Office for the
Western District of Missouri announced.

Washington on Thursday pleaded guilty to two counts of making a false statement in tax returns and
one count of aggravated identify theft, prosecutors announced.

The former power forward for teams including the Los Angeles Lakers, Golden State Warriors and San
Diego Clippers referred professional athletes to attorney Ron Mix, who would represent them in
workers’ compensation claims in California. In exchange for the referrals, Mix agreed to make
donations to Washington’s charity, the Sixth Man Foundation, which operated under the name Project
Contact Africa.
The U.S. Attorney’s Office says Washington received approximately $150,000 in donations from Mix,
which he diverted for personal use. He admitted that he failed to account for this income in tax filings.

Mix pleaded guilty in May 2016 to filing a false tax return. He admitted to claiming the referral fees he
paid to Washington as charitable contributions on tax returns from 2010 to 2013. 55 56

Medical Treatment

Labor Code §4600 Medical treatment provided by employer

(a) Medical, surgical, chiropractic, acupuncture, and hospital treatment,
including nursing, medicines, medical and surgical supplies, crutches, and
apparatuses, including orthotic and prosthetic devices and services, that is
reasonably required to cure or relieve the injured worker from the effects of
his or her injury shall be provided by the employer . . .

Including, depending on the severity of injury:

Ambulance and emergency treatment, mileage (to and from
every exam), pharmacy, psychiatric/psychological treatment,
acupuncture, home care, home modifications, and the list
goes on and on and on . . .

Medical treatment cannot be apportioned!! If employer is

liable for any treatment, employer is liable for 100% of
the costs for treatment. If non-industrial treatment is
needed to facilitate industrial treatment, we must provide
the non-industrial treatment. 57 58 59 60

10 61 62

Medical Control Medical Control

Utilization Review - It costs you!! It saves you!! Utilization Review - It costs you!! It saves you!!

 Must be timely (5 to 14 days after treatment request).  Cost of UR ranges from $140 to $200 per request (per RFA??).
 All other defects do not invalidate UR (Dubon II).  Failure to conduct UR may result in authorization of service.
 Paid for by employer.  Disputes regarding the timeliness of UR decisions are decided
 Not necessary for denied claims (prospectively). Post January
by the Appeals Board (usually at Expedited Trial).
1, 2018, not applied prospectively for 30 days after injury (with
some exceptions). Independent Medical Review
 Cost of IMR ranges from $420 to $515 per request.
Independent Medical Review
Conducted by independent review organization at employer’s  If overturned, defendant pays for another IMR.
How much do you want to pay to NOT provide treatment
Limited appeal (case law developing). to your employees??

How will your employees get better without treatment?? 63 64

The Price of Medical Control In conclusion!!

Medical costs have increased 40% since lawmakers made utilization review (UR) Fraud is a serious offense – unfortunately, it is easier to “spot” fraud
mandatory in 2003, the Rating Bureau said in its 2012 pure premium rate filing. than to prove “fraud” . . . especially in a “benefits delivery system”
which provides medical treatment.
Dave Bellusci, chief actuary for the Rating Bureau, said UR is a significant cost driver and
one of the most rapidly growing components of medical costs since 2005, but that Was the test reasonable?? Was the surgery necessary?? Is the
doesn't mean it isn't working. treatment in the best interests of the patient?? Is the doctor treating
for profit or to improve patient health. These issues should never
(Greg Jones, Rate Filing Leads to Questions about Whether UR is Worth the Cost,, September be a factor when considering an employee’s healthcare!!
30, 2011.)
In workers’ compensation, we have become extremely aware of fraud
Utilization review has been around forever, yet it is still misunderstood and controversial. and even implemented tools to limit fraudulent services. But these
Appropriately employed, UR can help ensure the care that is delivered is the right care tools do not impact all types of fraud and, unfortunately, these tools
for the claimant in the right setting at the right time. Used indiscriminately, it can be a can cut reasonable services as well as questionable services. Once
cost driver that infuriates physicians, delays necessary treatment, prolongs disability, and again, the health of the employee is put at risk.
does little to improve outcomes.
Fraud hurts everyone!! It impacts costs at every level. And ultimately,
(Joe Padua, Managed Care in Work Comp: Worth the Cost?,, July 2, 2012.) you and I are hurt for the profit of a few.

But carriers are also contributing to the problem by sending virtually all treatment
requests to utilization review, including for seemingly innocuous prescriptions such as
ibuprofen, she said.

(Greg Jones, Industry Experts Offer Thoughts, Analysis of IMR,, July 2, 2012.) 65 66


Thank you!!

Questions??? 67






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Advanced Litigation:

Fact or False: How to evaluate the accuracy of information on the internet
and avoid costly errors

Speaker: Deborah Rummelhart (Practice Aligned Resources LLC)

Deborah Rummelhart PRESENTATION: Fact or False? This presen-
tion will discuss how to evaluate the accuracy of
information on the internet and avoid costly er-

Deborah Rummelhart is the Legal
Technology Training Manager at Practice Aligned
Resources. Ms. Rummelhart is a matchmaker
between non-technical legal professionals and
digital solutions, and specializes in developing and
implementing entertaining

In-person and e-learning training programs
that enable people to learn quickly and immediately

apply what they learn.

After graduating from law school, Ms. Rummelhart spent three years practicing
corporate law, probate litigation, and estate planning. She then became the Director of the
Legal Research and Writing Program at Whittier Law School, where she developed an interest
in the advantages and limitations of electronic legal research.

Ms. Rummelhart was then recruited by LexisNexis, where she spent over 10 years train-
ing attorneys, paralegals, and legal secretaries on various legal applications. While at
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Ms. Rummelhart has a B.A. in Economics from UCLA and a J.D. from Harvard Law

FACT OR FALSE? 6/11/2018

©2017 Deborah Rummelhart


“A lawyer shall not: knowingly make a false
statement of fact or law to a tribunal or fail to
correct a false statement of material fact or law
previously made to the tribunal by the lawyer”




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