California Firm Seeks Dismissal of $70 Million in Workers’ Comp Charges
As part an agreement to resolve criminal charges, Premier Medical Management Systems Inc. of Los Angeles is asking a California Workers’ Compensation Appeals Board judge to dismiss an estimated $70 million of medical bills Premier previously submitted for payment to workers’ compensation insurance carriers.
Premier had submitted several thousand allegedly fraudulent bills to the workers’ compensation insurance companies for services supposedly provided by more than 130 affiliated physicians and clinics.
The dismissal of Premier’s bills culminates seven years of investigation and litigation spearheaded by lead defense attorney Clifford D. Sweet III of Heggeness, Sweet, and Simington & Patrico, a Southern California law firm.
In the case, Sweet and his law firm represented Insurance Co. of the West, Explorer Insurance and The Travelers Cos. In court documents, Sweet claimed that Premier’s bills were the product of a complex “pay to play” cross-referral network of physicians preying upon unsuspecting injured workers to submit unlawful fraudulent bills for services never rendered. Sweet claimed that Premier was unlawfully practicing medicine, engaging in illegal fee-sharing, illegally referring business and fabricating medical charges.
A multiagency law enforcement task forced headed by Los Angeles County Deputy District Attorney Albert H. MacKenzie launched a criminal investigation of Premier and its executives David Wayne Fish and former attorney Birger Greg Bacino. A search warrant, based on the affidavit of California Department of Insurance Fraud Investigator Jodie L. Hope, was executed on Premier and others revealing widespread unlawful patient capping and referrals to multiple Southern California workers’ comp lawyers.
Premier and some of its affiliated physicians unsuccessfully filed two retaliatory lawsuits against Sweet’s clients and other participating insurance carriers, according to lawyers. Those claims were thrown out by the courts as improper SLAPP lawsuits (strategic lawsuit against public participation). The criminal investigation is ongoing.