Workers Compensation Fraud By The Godfather What's Next



                       Peyman Heidary is a chiropractor known to call himself “The Godfather.”

Law enforcement authorities say Heidary is a crime boss beyond his alias, accusing him of masterminding one of the largest insurance fraud cases the Riverside County District Attorney’s Office has ever prosecuted.

Heidary, 44, of Riverside is charged with heading a criminal organization that established medical clinics in Riverside, Orange and Los Angeles counties and a law firm that submitted thousands of workers’ compensation claims for nonexistent or exaggerated injuries that billed insurance companies for at least $50 million, court records say.

Investigators from the Riverside County District Attorney’s Office and the State Fund had also been able to document a loss of $5 million to the State Fund as of July 23, court documents say.

District attorney spokesman John Hall said the amount that insurance companies actually paid to Heidary was less than $50 million.

The criminal complaint filed July 25 in Superior Court in Riverside lists Heidary’s aliases as Brian Heidary, The Godfather and Number One.

The District Attorney’s Office wouldn’t say how it learned of Heidary’s aliases, but a search of public records showed that Heidary indeed is the No. 1 person in many companies. He is listed as president of California Health Care Management in Corona, Anaheim and La Habra; The Best of California Promotions and Management in Corona, Fullerton and Orange; Heidary Chiropractic in Corona, Fullerton and Anaheim; Doctor’s Reports Inc. in Fullerton and La Habra; California Injury Lawyers in Corona; and California Lawyers Network in Industry.

Other records show Heidary as past managing member of Riverside Health Clinic, Corona Health Clinic and Santa Ana Health Clinic.

In Riverside, the Corona/Riverside Health Clinic on Riverwalk Parkway is shuttered. A notice from the landlord, to Riverside Health Care Management, orders the business to vacate. Delivery notices from UPS are stuck to the door.

Heidary is scheduled to be arraigned today in Superior Court in Riverside. Heidary and three of his employees have been charged with 22 counts each of making fraudulent claims for payment of a health care benefit in excess of $950.

Heidary and Cary David Abramowitz, 57, of Los Angeles were also charged with practicing medicine without certification. Heidary and Erica Torres, 31, of Riverside were charged with practicing law without a license. Heidary, Abramowitz, Torres, and Michael Angel Tuosto Jr., 62, of Long Beach all were charged with conspiracy to commit a crime. All charges are felonies.

Heidary is being held in lieu of $1.3 million bond. Abramowitz and Torres, who are scheduled to be arraigned Sept. 23, posted $50,000 bond and were released. Tuosto was being held in lieu of $50,000 bond and isto be arraigned today.

“Defendant is neither a medical doctor nor an attorney,” district attorney Senior Investigator William Hanley wrote in a court document. The medical clinics’ “main purpose is to milk money out of Workers’ Compensation Insurance Companies,” Hanley added.

The District Attorney’s Office investigated Heidary along with the State Fund and other state agencies, including the Franchise Tax Board, after State Fund investigators alerted the D.A.’s office to a suspected fraud, Hall said.

What Type of Injuries Qualify For Workmans Compensation??



If you are seeking workers' compensation benefits, you will have to show that your injury or illness is work-related. Usually, if you were doing something for the benefit of your employer, and you were injured or became ill as a result, then your injury or illness is work-related and you can receive benefits as long as you meet the other eligibility requirements.

Although the "work-related" requirement seems simple, it can get tricky. Some common situations are covered below. If your injury or illness falls into a gray area, you may want to consult with an attorney to find out whether you will be eligible for benefits.

Lunch Breaks

Typically, injuries or illnesses that happen on an employee's lunch break are not covered under workers' compensation. For example, if you sprained your ankle while walking into a deli to pick up your lunch (or lunch for your coworkers), then you probably cannot claim workers' compensation for that injury. However, if you were also picking up lunch for your boss, then the injury might be covered. If you sprained your ankle in a cafeteria on the company's premises, then your injury might be covered by workers' comp.

Company Events

Many companies sponsor special events like parties, picnics, or baseball games -- and injuries sustained at these events are usually covered by workers' compensation. For example, let's say To drinks too much wine at the company anniversary party and decides to twirl his coworker Kari above his head while they are dancing. Unfortunately, he drops Kari, and they both fall. Kari breaks her arm, and Tom suffers a  strained neck. Both injuries are probably covered by workers' compensation.

Travel

If you are injured on your commute to or from work, your injury probably isn't covered by workers' compensation. However, there are sometimes when injuries during travel are covered. For example, if you are traveling for work, but not to your fixed work site (on a business trip, for example), then your injuries will probably be covered. If you are a traveling salesperson with no regular work site, then injuries you sustain while driving to meet with a customer will probably be covered. Or, if you are injured during your regular commute but are driving a company vehicle, then your injuries will probably be covered.

Misconduct

If you were injured while breaking a workplace safety rule or while doing something else that your employer has prohibited (even a criminal act), your injury may still be covered by workers' compensation, depending on the level of your misconduct. This is part of the workers' compensation bargain: Employees do not have the right to sue their employer for work-related injuries, but those injuries are usually covered by workers' compensation, regardless of fault.

As an example of how injuries that stem from misconduct are usually still covered under workers' compensation, let's say Ann and Lee work on the assembly line at Widget World. One day, they decide to play catch with a two-pound metal ball that is part of the machinery. This is a direct violation of a safety rule, which prohibits playing with the equipment. While Ann is attempting to catch the ball, it slips through her hands and hits her in the head, knocking her unconscious and causing a minor brain injury. Her injury could still be covered by workers' compensation, even though she was violating a work rule when she got hurt, especially if the employer knew this type of horseplay occurred and condoned it.
There are some exceptions to this general rule. For example, if your injuries were self-inflicted, then they might not be covered.

Preexisting Conditions

If you have a preexisting condition, and your job aggravates or exacerbates it in a way that results in an injury or illness, then the injury is probably covered by workers' compensation. For example, when Bill was 30, a disc in his back ruptured. The injury resolved itself within six months and has not bothered him since. He is now 45 and works in a department store. One day, he ruptures the same disc while lifting a heavy object off a shelf. Although his job did not cause his initial injury, it certainly caused it to reoccur. The injury is now covered by workers' compensation.

Hearing Loss

People who work in noisy environments -- such as construction sites or manufacturing plants -- often suffer hearing loss over time. Unless there is some other obvious reason for the impairment, this injury is usually covered by workers' compensation.

Mental Conditions

Mental conditions that are job-related are covered by workers' compensation. For example, if you are traumatized by witnessing another employee injured or killed on the job, your trauma is compensable by workers' comp. Conditions caused by a stressful workplace environment can also be compensable. In addition, if you become depressed because you have suffered from a workplace injury, that depression is covered by workers' compensation.
Be warned, however, that it can be hard to prove that the mental condition actually exists and that it was caused by workplace events. This is a situation in which a consultation with a lawyer can help you decide how to proceed.

Diseases and Illnesses

If you have a disease or illness resulting from your work, then you are entitled to workers' compensation. For example, workers suffering from asbestosis, which is a disease caused by exposure to asbestos, can receive workers' compensation benefits, as can workers suffering from black lung disease, which is caused by inhaling coal dust. Except in the case of recognized environmental illnesses like these, however, it can be difficult to prove that a disease is work-related and not something that would have happened anyway.