California's Division of Workers' Compensation Suspends 16 More Medical Providers Bringing The 2017 Total Suspensions To 131
By Lonce Lamonte and the California DIR's Newsline - December 21, 2017
The California Division of Workers’ Compensation (DWC) has suspended 16 more medical providers from participating in California’s workers’ compensation system, bringing the total number of providers suspended this year to 131. The providers were suspended for fraud or other criminal actions, or the loss of their licenses.
DWC Administrative Director George Parisotto issued suspension orders against the following providers:
· James Lemus of Commerce, physician and owner operator of Lemus Medical Center, was convicted in federal court in 2011 for attempting to evade or defeat tax payments. Lemus provided medical services to truck drivers and required them to pay in cash. He knowingly and willfully failed to report that cash to the IRS and pay taxes that were due. His conviction was found to be substantially related to his qualifications, functions or duties as a medical provider. Lemus was suspended by Medi-Cal in 2013.
The following providers participated in an illegal kickback scheme to bill Medicare for home health services that were exaggerated or not provided:
o Hee Jung Mun of Gardena, also known as Angela Mun, registered nurse and owner of Greatcare Home Health, Inc. pled guilty in federal court in 2011 to health care fraud. Mun paid illegal kickbacks to doctors and marketers in exchange for referrals of Medicare patients to Greatcare, and paid illegal kickbacks to patients to persuade them to sign up for home health services. She billed Medicare for patients who did not qualify for home health services, billed for services that were provided by unlicensed nurses, made false and exaggerated patient diagnoses to generate higher Medicare reimbursement and created false medical records to support those claims submitted to Medicare. Mun was sentenced to 57 months in federal prison and ordered to pay more than $5.1 million in restitution. The Board of Registered Nursing revoked Mun’s license in 2016.
o Hwa Ja Kim of Harbor City, registered nurse at Greatcare Home Health, Inc., pled guilty in federal court in 2012 to health care fraud. Kim participated in a scheme to defraud Medicare with Hee Jung Mun and others at Greatcare. Kim signed Outcome and Assessment Information Set forms for Greatcare patients that falsely claimed she had conducted assessments of their conditions. She also made false claims that patients were unable or unwilling to administer their own medication and required skilled nursing services, then entered those false and exaggerated diagnoses. Kim was sentenced to 18 months in federal prison and ordered to pay more than $1 million in restitution. The Board of Registered Nursing revoked her license in 2014.
o Seonweon Kim of Arcadia, physical therapist for Greatcare Home Health, Inc. pled guilty in federal court in 2012 to health care fraud. Kim signed false physical therapy evaluations, plan of care forms and discharge summaries for Medicare beneficiaries enrolled with Greatcare. His false statements for physical therapy services claimed that initial and discharge assessments were conducted and plans of care were developed for those beneficiaries even though no services were actually provided. Kim was sentenced to 21 months in federal prison and ordered to pay $1.8 million in restitution. He surrendered his license in 2016.
The following providers participated in an illegal kickback scheme to bill Medicare for physical therapy services that were not provided:
o Eddie Choi of Santa Clarita, physical therapist and co-owner of California Neuro-Rehabilitation Institute, Inc., pled guilty in federal court in 2013 to payment of illegal remuneration for health care referrals. Choi paid acupuncturist Won Suk Lee kickbacks in exchange for referrals of Medicare beneficiaries to his institute. Choi was sentenced to 15 months in federal prison and ordered to pay $935,149 in restitution. His license was revoked in 2015.
o Won Suk Lee of Huntington Park, acupuncturist and owner of Won Suk Lee Acupuncture & Herb, Inc. and Variety Choice, Inc., pled guilty in federal court in 2013 to health care fraud. Lee participated in a scheme with Eddie Choi to provide information on Medicare beneficiaries who received acupuncture and massages (services not covered by Medicare) at his clinic to Choi’s California Neuro-Rehabilitation Institute, which billed Medicare for physical therapy services that had not been provided. Lee was ordered to pay more than $1 million in restitution. His license was cancelled in 2016.
The following providers were suspended because their licenses were suspended or revoked:
· Gonzalo Flores Ruiz, Lamont physician, pled guilty in federal court in 2012 to illegally dispensing controlled substances. His medical license was revoked in 2016.
· Purnima Ravi Sreenivasan, Walnut Creek physician, had her medical license revoked in 2016 for violating multiple terms of the Medical Board’s probation, including practicing medicine while a cease practice order was in effect. Sreenivasan was initially placed on probation due to inadequate record keeping and gross negligence and incompetence in her treatment of three patients.
· Moosa Heikali, Los Angeles physician, had his medical license revoked in 2015. Heikali failed to satisfactorily complete a Physician Assessment and Clinical Education Program after he admitted that he engaged in gross negligence and repeated negligent acts, demonstrated incompetence and made false representations of fact in his interactions with two patients.
· Naga Raja Thota, El Cajon physician, pled guilty in federal court in 2016 to distributing and dispensing controlled substances without legitimate medical purposes and was sentenced to 30 months in federal prison. Thota surrendered his medical license in March.
· John J. McGroarty, North Hollywood physician, had his medical license revoked in 2015 for violating the terms of an Order for Practice Restriction issued by the Arizona Medical Board. The Medical Board also found that McGroarty’s cognitive functioning was impaired to the extent that he could no longer practice medicine safely.
· James Kieffer McDonnel, Bakersfield physician, had his medical license revoked in 2016 for violating multiple requirements of his Medical Board probation related to substance abuse.
· David Wayne Bailey, Loma Linda physician, had his medical license revoked in 2015 for using alcohol and controlled substances in a manner dangerous to himself and others. He prescribed a controlled substance to another with the intention of using that substance himself and self-administered a controlled substance that he had prescribed in the name of another. These actions violate the Medical Practice Act.
· Karla Lashun Clark of Chicago had her medical license revoked by the Medical Board of California in 2015. The State of Illinois suspended Clark’s license in 2014 following arrest for driving while intoxicated and a state-ordered psychiatric evaluation concluded her substance abuse impaired her ability to treat patients.
· Nenita Flores Iturzaeta, Corona physician, had her medical license revoked in February, due to significant impairments in her neuropsychological functioning that precluded her from being able to practice medicine safely.
· Paul Loftus, Napa physician, had his medical license revoked in 2015 as he was unable to practice medicine safely due to a mental or physical illness that affected his competency.
AB 1244, which went into effect January 1, requires DWC’s Administrative Director to suspend any medical provider, physician or practitioner from participating in the workers’ compensation system in cases in which one or more of the following is true:
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The provider has been convicted of a felony or misdemeanor involving fraud or abuse of the Medi-Cal or Medicare programs or the workers’ compensation system, fraud or abuse of a patient, or related types of misconduct;
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The provider has been suspended due to fraud or abuse from the Medicare or Medicaid (including Medi-Cal) programs; or
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The provider’s license or certificate to provide health care has been surrendered or revoked.
The Department of Industrial Relation’s (DIR’s) fraud prevention effortsare posted online, including frequently updated lists for physicians, practitioners, and providers who have been issued notices of suspension, and those who have been suspended pursuant to Labor Code §139.21(a)(1). The department recently added a new web page with information on lien consolidations and the Special Adjudication Unit.
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Lonce Lamonte, journalist, lonce@adjustercom.com, and the California Department of Industrial Relations, Division of Workers' Compensation; dir.ca.gov
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