Physical Therapist and Son Charged with Insurance Fraud

San Francisco Bay Area pair also charged with grand theft and practicing medicine without a license

A licensed physical therapist and her son, who holds no license, have been charged with felonies after allegedly receiving $4.5 million from insurance companies for false claims.

Paula Skinner, of Glen Ellen, and her son Matthew Skinner, of Pleasanton, have each been charged with 34 felony counts related to crimes that allegedly occurred at their South San Francisco businesses, Pacific Occupational Health Clinic and Action Therapeutics.

The pair will appear in San Mateo County Superior Court on September 29, 2017, to set a date for their upcoming preliminary hearing.

The Skinners have each been charged with 10 counts of preparing and filing false insurance claims, 10 counts of conspiring to make fraudulent insurance claims, 10 counts of grand theft, and four counts of practicing medicine without a license. Most of the charges include enhancements because the crimes were aggravated white collar crimes with excessive losses.

The criminal complaint filed by the San Mateo County District Attorney’s Office alleges that between 2010 and 2017 the Skinners committed crimes against Liberty Mutual, Traveler’s Insurance, Hartford Insurance, State Compensation Insurance Fund (SCIF) and Intercare Insurance.

Since their arrests, more insurance carriers have come forward to report additional losses. It is alleged that the Skinners billed over $15 million and received payments of over $4.5 million.

The investigation found that the Skinners co-owned and operated Pacific Occupational Health Clinic as a medical corporation. Medical corporations must be majority-owned by physicians and laypersons cannot have any ownership.

The Skinners allegedly hired physicians to act as the medical directors of Pacific Occupational Health Clinic, but the Skinners continued to run the business, including hiring and firing the medical staff and making medical decisions for patients. Pacific Occupational Health Clinic specialized in treating injured workers and billing worker’s compensation health plans.

The Skinners also allegedly referred patients to their other business, Action Therapeutics, for unnecessary physical therapy and chiropractic care.

The charges are the result of an investigation conducted by the San Mateo County District Attorney’s Office, with assistance from the Department of Consumer Affairs’ Division of Investigation (DOI), and the FBI.  Investigators from DOI’s Investigation and Enforcement Unit, DOI’s Enforcement Support Unit, DOI’s Health Quality Investigation Unit and Operation Safe Medicine worked with San Mateo County District Attorney inspectors over the course of several months.

Paula Skinner’s physical therapy license is currently inactive. The Physical Therapy Board of California is reviewing the case and will take disciplinary action against her license as appropriate.

Any insurance company that believes it was a victim of the Skinners is asked to contact San Mateo County District Attorney Inspector Steve Sysum at (650) 877-5446.

 



Clovis Vocational Nurse Arrested and Charged with Theft from an Elder Adult

Licensed vocational nurse Michael Anthony Larkins, of Clovis, was arrested June 9, 2017, on one felony charge of theft from an elder adult.

Larkins’ alleged crime was discovered when a credit card company reported suspicious credit card activity to the California Department of Consumer Affairs’ (DCA) Division of Investigation (DOI).

Investigators from the Division’s Investigation and Enforcement Unit, Central Valley Field Office, learned that Larkins used a credit card belonging to a 92 year old patient who lived at the acute care center where Larkins worked.

Larkins is believed to have used the credit card to withdraw money from ATMs 11 times over a six day period in October 2016 and to make online purchases four times in the following two weeks, resulting in over $3,000 of fraudulent charges.

DOI investigators obtained surveillance video showing Larkins using some of the ATMs where the money was withdrawn.

The Fresno County District Attorney’s Office charged Larkin with one felony charge of theft from an elder adult.

DOI investigators booked Larkins into Fresno County Jail without incident and he was arraigned on June 23, 2017, when he pleaded not guilty to the charge.  His next court date is scheduled for July 28, 2017.

The Board of Vocational Nursing and Psychiatric Technicians have completed a review of the case and are pursuing disciplinary action against Larkins’ license.



Unlicensed Body Sculpting Business Agrees to Pay $121K

The Orange County and Los Angeles County District Attorney’s Offices have reached a civil settlement agreement with Sculptor Body Molding, Inc. and its owners Steven and Monica Ferguson on charges that they engaged in unlawful business practices and false and misleading advertising at their health clinics.

The filing of the civil complaint was the result of an investigation conducted by the Department of Consumer Affairs’ Division of Investigation after it was discovered that the defendants were advertising to perform various medical procedures. One of the procedures was called SculptorBody which the company described as a weight-loss “lipo-sculpting” program.

The business advertised that the SculptorBody treatment provided weight loss and body sculpting through the use of various medical devices and cosmetic machines including laser and ultrasound treatments. Customers were asked to pay thousands of dollars for the treatments and were told the program was approved by the Food and Drug Administration and “Members of [the] Medical Board.” Sculptor Body Molding, Inc. operated five clinics in Huntington Park, North Hollywood, Santa Ana, West Covina and Riverside. The company advertised heavily to the Spanish-speaking community.

The Division of Investigation’s Health Quality Investigation Unit, Operation Safe Medicine, conducted undercover appointments at Sculptor Body Molding and investigators were offered medical services including ultrasound weight loss treatments, oxygen injections, and “fat molding.”

These services were offered by staff referred to as “therapists” rather than by a licensed medical doctor or other licensed medical professional as required by law.  None of the weight loss treatments or health advice provided at the business were supervised by a licensed physician and neither of the Fergusons is a licensed health care professional. The civil complaint noted that the advertising and performance of these medical procedures constituted the unlicensed practice of medicine and false and misleading advertising.

As part of the settlement agreement reached on May 19, 2017, the defendants will pay $106,000 in civil penalties that will go into a fund that supports future consumer protection actions by the District Attorney’s Office.  They will also pay $15,000 in restitution to the Medical Board of California for the costs of the investigation conducted by the Division of Investigation.

The settlement includes an injunction which prevents the Fergusons from operating any business in violation of the California Medical Practice Act and from any advertising that includes false or misleading statements to consumers. They are also required to immediately sell or dispose of all ultrasound machines and other medical devices that can only legally be used by or at the direction of a licensed medical professional.


Southern California Physician Sentenced After Pleading Guilty to Drug Trafficking

Former Glendale doctor was charged federally for distributing medications illegally

A federal judge ordered that former physician Manasseh Nwaigwe, of Glendale, will serve one month of home detention and two years of federal probation after pleading guilty to one federal drug trafficking charge.

Nwaigwe, 73, was sentenced on June 1, 2017. As part of the plea agreement with the United States Attorney’s Office, Nwaigwe pleaded guilty to illegally distributing hydrocodone and had to forfeit more than $97,000 that was earned from issuing illegal prescriptions. Nwaigwe also agreed to surrender his medical license.

During an investigation conducted in May and June 2015, Nwaigwe wrote prescriptions for hydrocodone, clonazepam and promethazine with codeine to five U.S. Drug Enforcement Administration undercover investigators in exchange for cash. The prescriptions were written even though the undercover officers had no medical need for the drugs.

On March 8, 2016, the Medical Board of California filed an accusation against Nwaigwe that included allegations of sexual misconduct, prescribing without an appropriate prior exam and gross negligence.  The plea agreement with the United States Attorney’s Office resulted in the surrender of Nwaigwe’s medical license on June 1, 2016, which resolved that accusation. Criminal charges were never filed in the case of alleged sexual misconduct.

Investigators from the California Department of Consumer Affairs’ Division of Investigation, Health Quality Investigation Unit – Tustin Field Office assisted the U.S. Drug Enforcement Administration, Los Angeles Police Department, Los Angeles County Sheriff’s Department, Torrance Police Department and Redondo Beach Police Department with the investigation of Nwaigwe.

A copy of the Medical Board of California documents can be read HERE.

To view the March 2016 Medical Board news release, click HERE.

The United States Attorney’s Office press release can be read HERE.


Chico RN Charged with Felony Elder Abuse of Patient who Died While Under her Care

Registered Nurse Allison Joann Guster, of Chico, will be arraigned on June 2, 2017, in Butte County Superior Court.  She has been charged with one felony count of elder abuse following the death of a patient that was in her care.  The charge filed by the Butte County District Attorney’s Office includes a seven year enhancement due to the age of the patient. 

Guster was a night-shift nurse, assigned to care for a patient recovering from surgery.  The investigation revealed that after the patient was found dead in her room early the next morning, Guster allegedly made false entries in the patient’s medical record to indicate that she had been monitoring the patient throughout the night.  Video surveillance showed that Guster had not been in the patient’s room for over six hours.

The case was investigated by the California Department of Consumer Affairs’ Division of Investigation, Investigation and Enforcement Unit, Sacramento Field Office.

The Board of Registered Nursing is reviewing the case and will take disciplinary action against Guster’s license as appropriate.

Click HERE to view the Butte County District Attorney’s Office press release.


Vocational Nurse Faces Discipline Following Conviction

Trista Sos, a licensed vocational nurse from Redding, faces disciplinary action by the Board of Vocational Nursing and Psychiatric Technicians after she pleaded no contest and was found guilty of one misdemeanor count of obtaining controlled substances by fraud and one misdemeanor count of petty theft.

Investigators from the Investigation and Enforcement Unit Sacramento Field Office within the Department of Consumer Affairs’ Division of Investigation investigated Sos after receiving information that she had been stealing narcotics from a convalescent home in Chico where she worked.

The investigation found that in May 2015, Sos received narcotics from staff who had worked the shift prior to hers, but at the end of her shift the narcotics were missing. The Butte County District Attorney’s Office initially charged Sos with three counts of obtaining controlled substances by fraud and one count of petty theft.

The Board of Vocational Nursing and Psychiatric Technicians has filed an accusation against Sos, alleging that she made false, incorrect, inconsistent or unintelligible entries in hospital records during her employment in Chico and also at a second employer in Red Bluff in October 2015.  The accusation also alleges that Sos self-administered marijuana without a physician’s recommendation from approximately 2014 to 2016.

The Accusation can be read here: Sos Accusation


Investigation Uncovers Unlicensed Physicians Operating Medical Clinic

Man and woman treated patients at a Los Angeles urgent care facility.

Charges were filed in Los Angeles Superior Court last month against two unlicensed people accused of diagnosing and treating patients at an urgent care clinic in Los Angeles.

Betzabe Wintermute and Chendri (no first name) have each been charged with three felony counts of practicing medicine without a license following an undercover investigation. The investigation revealed the two had been treating patients and prescribing medications at WR Balboa Urgent Care, 937 South Alvarado St., #1D in Los Angeles, even though neither has any professional health care licenses.

Investigators from Operation Safe Medicine, in the Division of Investigation’s Health Quality Investigation Unit, worked with the Health Authority Law Enforcement Task Force (HALT), within the Los Angeles County Department of Health Services to conduct a thorough investigation. HALT Investigators conducted undercover investigations that found both Wintermute and Chendri were diagnosing and treating patients. Chendri also prescribed medications to the undercover operatives.  Investigators from Operation Safe Medicine then assisted HALT Investigators in serving a search warrant at the business.

The investigation also showed that Wintermute, who owned WR Balboa Urgent Care, would hire licensed physicians on a temporary basis in order to obtain their medical license numbers and DEA numbers.  She would allegedly use that information to bill insurance companies and prescribe medications to patients without the physicians’ knowledge.

Investigators found that neither Chendri or Wintermute has ever held a professional license in California.   Wintermute was issued a six-month Interim Permit by the Board of Registered Nursing, but it expired in 2007, and she never obtained a license.

Wintermute has pleaded not guilty and is scheduled to appear in court on May 19, 2017.  An arrest warrant has been issued for Chendri, but he is believed to be out of the country.


Health Center Owner Convicted of Aiding the Unlicensed Practice of Medicine

Physician Michael Zadeh of Encino pleaded no contest to one misdemeanor count of aiding and abetting the unlicensed practice of medicine following his arrest in February. One of Zadeh’s employees, Siranush Mkrtchyan, also pleaded no contest to one misdemeanor count of practicing medicine without a license.

Recently, two more of Zadeh’s employees entered pleas with the Los Angeles County District Attorney’s Office. Rebecca Merzlak and Lyndi Loomis each pleaded no contest to one misdemeanor count of practicing medicine without a license. A fourth employee, Amanda Farrar, has pleaded not guilty to one felony count of practicing medicine without a license. Her next court date is scheduled for October 4, 2017.

Zadeh is the owner of Z Center for Cosmetic Health in Sherman Oaks. The center was investigated by Operation Safe Medicine, a specialized unit within the California Department of Consumer Affairs’ Division of Investigation Health Quality Investigation Unit after receipt of an anonymous complaint about the business.

Undercover investigators made appointments at the center and scheduled treatments that required examination by a doctor or nurse practitioner. One investigator was scheduled for laser hair removal without having been properly examined, while a second investigator was diagnosed with a skin condition and was prescribed a bleaching ointment without having received a proper examination.

Merzlak is a licensed esthetician and Farrar is a registered nurse. Mkrtchyan and Loomis were both unlicensed.

The Board of Registered Nursing, the Board of Barbering and Cosmetology and the Medical Board of California will take action, as appropriate, against Farrar, Merzlak and Zadeh, respectively.