People Ex Rel. Monterey Mushrooms, Inc. v. Thompson

38 Cal. Rptr. 3d 677, 136 Cal. App. 4th 24, 71 Cal. Comp. Cases 35, 2006 Daily Journal DAR 1223, 2006 Cal. App. LEXIS 112
CourtCalifornia Court of Appeal
DecidedJanuary 4, 2006
DocketH026396
StatusPublished
Cited by11 cases

This text of 38 Cal. Rptr. 3d 677 (People Ex Rel. Monterey Mushrooms, Inc. v. Thompson) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
People Ex Rel. Monterey Mushrooms, Inc. v. Thompson, 38 Cal. Rptr. 3d 677, 136 Cal. App. 4th 24, 71 Cal. Comp. Cases 35, 2006 Daily Journal DAR 1223, 2006 Cal. App. LEXIS 112 (Cal. Ct. App. 2006).

Opinion

Opinion

ELIA, J.

After a court trial, defendants Steven P. Thompson, Aster Kifle-Thompson, and the corporations they had formed were found to have violated Insurance Code section 1871.7, subdivision (b), by submitting fraudulent claims for compensation proscribed by Penal Code section 550. On *27 appeal, defendants contend that the case should have been dismissed because (1) it belonged exclusively in a workers’ compensation forum, (2) the People failed to meet the statutory prerequisites for bringing the lawsuit, and (3) defendants’ conduct was not unlawful. Defendants further contend that the trial court should have applied a “clear and convincing evidence” standard of proof, that joint and several liability was inappropriate on the facts of the case, and that the damages imposed were unauthorized and excessive. We find no error and affirm the judgment.

Procedural History

The People 1 initiated this action against defendants for restitution, civil penalties, and an injunction under Insurance Code section 1871.7 of the Insurance Frauds Prevention Act and under Business & Professions Code section 17200 et seq. The People alleged that the individual defendants— Steven Thompson; his wife, Aster Kifle-Thompson; Charles Salzberg, M.D.; Joseph Greenspan, M.D.; and Julius Mueller, M.D.—had participated in a scheme in which they submitted false claims for workers’ compensation payments from relator Monterey Mushrooms, Inc., a self-insured employer. 2 According to the complaint, Thompson, who had been convicted in 1997 of seven counts of filing false workers’ compensation claims (Ins. Code, § 1871.4, subd. (a)(2)), had organized two corporations, Peninsula Medical Group, P.C. (PMG), and Integrated Family Medical Group, P.C. (IFMG), using Salzberg and Greenspan, respectively, as medical directors. Contrary to laws governing the structure of medical corporations and medical practice, these physicians exercised “absolutely no control, supervision or management” of the corporations they purported to own and operate. Meanwhile, Thompson and Kifle-Thompson represented these corporations and their affiliated clinics to the public and to Monterey Mushrooms as providers of medical services. In biffing for treatment of Monterey Mushrooms employees, defendants prepared fraudulent claims for workers’ compensation payments for unnecessary and excessive chiropractic treatment, frequently submitting “at least two, and often three” separate claim forms for a single patient visit. Meanwhile, Thompson and Kifle-Thompson maintained control of PMG and IFMG, respectively, through their management corporation, Nevada Practice Management Systems, Inc., in order to “siphon off the profits” earned by PMG and IFMG.

Defendants demurred, asserting lack of jurisdiction and collateral estoppel. They argued that (1) Insurance Code section 1871.7, subdivision (h)(2)(A), *28 barred the action; (2) the Workers’ Compensation Appeals Board (WCAB) had exclusive jurisdiction over the claims asserted; and (3) the issue of entitlement to benefits as to one employee had already been decided by the WCAB, and therefore the issue as to any employee was precluded by collateral estoppel.

The trial court overruled the demurrers, and defendants answered. Both sides then moved for summary judgment or, alternatively, summary adjudication. The court denied summary judgment but limited plaintiff’s claims to Insurance Code section 1871.7, subdivision (b). The cause of action for violation of Business and Professions Code section 17200 was determined to be preempted by the Workers’ Compensation Act (WCA).

A court trial on liability took place between September 11 and 24, 2002. The court granted nonsuit in favor of Mueller, and both Greenspan and Salzberg settled with plaintiff. However, Thompson, Kifle-Thompson, and the corporate defendants were found to be liable for having “set up sham corporations, with medical doctors as ostensible owners, that presented to the public as full-service medical clinics. In reality, the medical doctors were essentially a series of absentee figureheads who gave no consideration for their ownership interests and, for the most part, had no meaningful role in the direction of patient care or general clinic operation.” The purpose of these corporations was to allow these defendants to “acquire patients and refer them for chiropractic treatment and to present fraudulent claims for services to third-party payors.” The result was that patients were “inevitably being directed to chiropractic ‘treatment,’ where they were grossly over[-]treated. Bills were generated for these patient visits, and in some cases more than one claim was made for a single session.” The court found this to be a “sophisticated, formalized and well-concealed strategy” that enabled Thompson and Kifle-Thompson to “maximize the number of patients and the amount [that] could be billed for visits, without due regard for patient care and needs.”

Trial on the remedies portion of the litigation was held on November 6, 2002. On December 3, 2002, the court ruled that the Thompson defendants 3 were jointly and severally liable for civil penalties in the amount of $479,115.29. The court also granted plaintiff’s request for injunctive relief and subsequently awarded plaintiff attorney fees in the amount of $1,230,040.

*29 Discussion

1. Workers’ Compensation as an Exclusive Remedy

Citing Labor Code sections 3602, 3820, and 5300, defendants first renew their argument that the trial court lacked jurisdiction over this lawsuit because all of the issues of “alleged billing fraud” arose from a workers’ compensation claim and had to be resolved by the WCAB. 4 Defendants rely on Charles J. Vacanti, M.D., Inc. v. State Comp. Ins. Fund (2001) 24 Cal.4th 800 [102 Cal.Rptr.2d 562, 14 P.3d 234] (Vacanti), where the Supreme Court set forth a two-part analysis to help determine whether a cause of action is barred by the exclusivity of the WCA. A court is called upon first to determine “whether the alleged injury falls within the scope of the exclusive remedy provisions.” (Vacanti, at p. 811.) If the injury “is collateral to or derivative of a personal ‘injury sustained and arising out of the course of employment,’ ” then a cause of action arising from that injury may be subject to the exclusivity bar. (Id. at p. 812.) Secondly, the court will consider “whether the alleged acts or motives that establish the elements of the cause of action fall outside the risks encompassed within the compensation bargain.” (Id. at pp. 811-812.) “Where the acts are ‘a “normal” part of the employment relationship’ [citation], or workers’ compensation claims process [citation], or where the motive behind these acts does not violate a ‘fundamental policy of this state’ [citation], then the cause of action is barred” by the exclusivity provisions of the WCA. (Vacanti, at p.

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Bluebook (online)
38 Cal. Rptr. 3d 677, 136 Cal. App. 4th 24, 71 Cal. Comp. Cases 35, 2006 Daily Journal DAR 1223, 2006 Cal. App. LEXIS 112, Counsel Stack Legal Research, https://law.counselstack.com/opinion/people-ex-rel-monterey-mushrooms-inc-v-thompson-calctapp-2006.