California Division of Workers’ Comp Suspends 16 Medical Providers

The California Division of Workers’ Compensation has suspended 16 more medical providers from participating in the state’s workers’ comp system, bringing the total number of providers suspended this year to 131.

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.

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.

The following providers participated in an illegal kickback scheme to bill Medicare for services that were exaggerated or not provided:

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 healthcare fraud for illegal kickbacks to doctors and marketers in exchange for referrals of Medicare patients.
Hwa Ja Kim of Harbor City, registered nurse at Greatcare Home Health Inc., pled guilty in federal court in 2012 to healthcare fraud. Kim participated in a scheme to defraud Medicare with Hee Jung Mun and others at Greatcare
Seonweon Kim of Arcadia, physical therapist for Greatcare Home Health Inc., pled guilty in federal court in 2012 to healthcare fraud. Kim signed false physical therapy evaluations, plan of care forms and discharge summaries for Medicare beneficiaries enrolled with Greatcare.
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 healthcare referrals. Choi paid acupuncturist Won Suk Lee kickbacks in exchange for referrals of Medicare beneficiaries to his institute.
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 healthcare 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.

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 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.