California Workers’ Comp Division Suspends 21 Medical Providers for Fraud

November 8, 2017

The California Division of Workers’ Compensation has suspended 21 more medical providers from participating in California’s workers’ comp system, bringing the total number of providers suspended this year to 73.

The suspensions were made possible by the passage last year of Assembly Bill 1244, which requires the DWC administrative director to suspend any medical provider convicted of a crime involving fraud or abuse of the Medi-Cal or Medicare programs or the workers’ comp system, a patient, or related types of misconduct.

DWC Administrative Director George Parisotto issued Orders of Suspension against the following providers:

  • Christopher King of Beverly Hills, owner of medical-billing and medical-management companies, and his wife headed a $40 million conspiracy to commit medical insurance fraud along with over two dozen doctors, pharmacists and business owners. More than 13,000 patients and at least 27 insurance carriers were victims in the scheme. King pled guilty in Orange County Superior Court on April 26 to two felony counts of conspiracy to commit medical insurance fraud and felony insurance fraud.
  • Marisa Schermbeck Nelson of Torrance pled guilty on July 26 in Los Angeles County Superior Court for her involvement in a fraudulent $150 million workers’ comp insurance billing and capping conspiracy with orthopedic surgeon Munir Uwaydah. Nearly two dozen patients were deceived by Dr. Uwaydah and his staff into undergoing surgeries they were told would be performed by Dr. Uwaydah, but were instead performed by a physician’s assistant who has never attended medical school. The scheme included payments of up to $10,000 a month for illegal referrals.
  • Marlon Songco of Burbank, president of Rehab Dynamics Inc., pled guilty in federal court on Jan. 8, 2015 for paying illegal kickbacks as part of a Medicare fraud scheme along with co-conspirators Joseff Sales and Danniel Goyena.
  • Dolphus Dwayne Pierce II, chiropractor in Lemoore, was found guilty in Kern County Superior Court on Jan. 8, 2016 of conspiracy to commit insurance fraud for billing insurance companies for services that were unnecessary, not rendered or double billed.
  • Julio Diaz, physician in Santa Barbara and Orange Counties, was found guilty in August 2015 on 79 counts of writing prescriptions for narcotics without a legitimate medical purpose.
  • Edward Balbas, physician in Rancho Cucamonga, pled guilty on May 5 in Riverside County Superior Court to two felony counts of insurance fraud for submitting more than 165 fraudulent bills over a three-year period. As part of his plea agreement, Balbas was required to pay multiple insurance companies restitution of over $650,000.
  • Randall William Tonelli, pharmacist in San Mateo, pled guilty in federal court on July 11, 2016 to knowingly offering to sell and trade a prescription drug sample and misbranding drugs for sale with the intent to defraud and mislead. Tonelli surrendered his pharmacist license on Oct. 13, 2016.
  • Candelaria Valdez, medical services provider in Hemet, pled guilty in September 2016 in Riverside Superior Court to misdemeanor battery relating to abuse of a patient.
  • Bennie Johnson, osteopathic physician in Encinitas, had his license revoked by the osteopathic board on March 6. The board determined he had committed repeated acts of gross negligence in his treatment of multiple cancer patients.
  • Helen Chang, physician in San Diego, was disciplined by the Medical Board of California for incompetence and gross negligence in her treatment of a patient. She surrendered her medical certificate on Nov. 1, 2015.
  • Raffiel Arvon Norwood of Rosamond, former vocational nurse, pled guilty in federal court on Oct. 22, 2009 to felony possession of child pornography. Nor-wood surrendered his medical license on July 7, 2016. He was suspended from the Medi-Cal program last April.
  • Mark Anderson, dentist in Woodland, was found guilty in March 2009 on felony counts of sexual battery.
  • Jerry Tabuyo, operator of a community care facility for the elderly in San Jacinto, pled guilty in January to operating without a license.
  • William Richard Bailey, osteopathic physician in San Diego, had his medical li-cense revoked following conviction for tax evasion in 2016. He was sentenced to more than three years in federal prison and required to pay over $500,000 in restitution and fines.
  • James Francis Murphy of Encinitas, osteopathic physician, was convicted on federal charges of income tax fraud and evasion. He was sentenced to four years in prison commencing on Feb. 24, 2015 and ordered to pay $447,528 in restitution. His medical license was revoked on Oct. 24, 2016.
  • David Anderson, chiropractor in San Diego, pled guilty to mail and income tax fraud in 1997. He was suspended from participation in the Medicare and Medi-Cal programs on Sept. 20, 2001.
  • Robert Craig Taylor, former chiropractor in Los Angeles, was convicted in March 2007 of misdemeanor burglary and identity theft, in September 2007 of felony possession of a controlled substance for sale and grand theft and in December 2007 of receiving stolen property, identity theft and commercial burglary. His chiropractic license was revoked effective October 25, 2009.
  • Matthew Cole, Newport Beach physician, pled guilty Dec. 15, 2015 to federal charges of conspiracy to obtain controlled substances by misrepresentation, fraud, forgery deception and subterfuge. He was barred from participating in the Medi-Cal program following his conviction.
  • Joanne Benzor, Riverside physician, pled guilty in 2009 to two counts of driving under the influence of alcohol. Her medical license was revoked between May 18, 2012 and June 16, 2017, at which time it was reinstated subject to limitations.
  • Virginia Garrett of Sarasota, Florida, former registered nurse, was convicted on Aug. 20, 2008 in Los Angeles Superior Court for reckless driving while under the influence of alcohol and drugs, with a prior conviction for driving with a blood alcohol content exceeding the legal limit. Her medical license was revoked by the Board of Registered Nursing on Jan. 27, 2012.
  • Kenneth R. Geiger, physician in Sonoma, surrendered his medical license on April 2, 2008 following an evaluation that he suffers from an illness that impairs his ability to safely practice medicine.

AB 1244 requires the DWC administrative director to suspend any medical provider, physician, or practitioner from participating in the workers’ comp system in cases in which any of the following is true: They were 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 misconduct; they were suspended due to fraud or abuse from the Medicare or Medicaid programs; or the provider’s license to provide health care has been surrendered or revoked.

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Latest Comments

  • November 10, 2017 at 5:57 pm
    Agent says:
    Lots and lots of crooks trying to game the system in California.
  • November 10, 2017 at 12:34 pm
    mvc says:
    When will SISC Kern County WC workers be investigated for manipulating and lying; sending mail late and claiming denial, and injured worker not having any rights? When will i... read more
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