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Yahoo
3 days ago
- Business
- Yahoo
Fresno hospital system quietly cuts hundreds of nursing supervisor roles
In the Spotlight is a Fresno Bee series that digs into the high-profile local issues that readers care most about. Story idea? Email tips@ Fresno's largest healthcare system discreetly slashed hundreds of nursing supervisor positions in recent weeks as part of a staffing shakeup. Nearly 300 clinical nursing supervisors employed by Community Health System were informed that they had to decide whether to take a pay cut, apply for a leadership position or accept a severance package. A March 4 letter obtained by The Bee confirms CHS notified Fresno city and county officials about plans to eliminate 285 positions due to the hospital system 'restructuring its operations.' The letter said the layoffs impacted 180 positions at Community Regional Medical Center, as well as 19 positions at Fresno Heart & Surgical Hospital and 86 positions at Clovis Community Medical Center. The layoffs at CHS took effect May 3, weeks before news broke that the health system agreed to settle a federal probe and pay a $31.5 million fine, raising questions for some staff members. Last month, CHS entered a massive settlement agreement announced last month by the U.S. Attorney's Office. The settlement addresses allegations that CHS was involved in a multi-year kickback scheme in which hospital executives provided expensive wine, liquor, cigars and meals to physicians in exchange for patient referrals. CHS denies the settlement was the reason for the staffing changes. 'Community frequently evaluates our care model to assure that we have the right staffing mix to meet changing patient care needs,' Daniel Davis, R.N. division president of hospitals for CHS, said in a statement. 'This shift was driven solely by clinical best practice and patient care needs and was not designed to achieve cost savings,' Davis said. Any company with 75 or more employees must file a WARN notice if it lays off 50 or more employees in a 30-day period, according to state law. Hospital spokesperson Mary Lisa Russell said a WARN notice was sent out in early March, as required by law. However, a spokesperson for the state's Employment Development Department said they had no record of a WARN notice from CHS. Two nurse supervisors said the 285 impacted employees were forced to apply to new leadership positions, or take a demotion, with the majority taking big pay cuts. 'We were told that these changes had nothing to do with finances. That is incredibly hard to believe,' said one former nursing supervisor who spoke on condition of anonymity due to fear of professional retaliation. The nursing supervisor said rumors started circulating in February about the elimination of clinical nursing supervisor roles. She said affected staff met individually with human resources to explore their options — either applying for assistant nurse manager, charge nurse or clinical nurse ladder positions, or accept a severance package. CHS also offered two-year retention bonuses. Most positions offered lower pay than the eliminated supervisor role. Another nursing supervisor who had worked at Community for more than a decade — who said she loved her job and had no discipline record — accepted a severance package after her position was eliminated. The supervisor said she thinks the restructuring was a cost-saving measure. She said employees and patient care were sacrificed to pay for leadership's actions. Clinical supervising nurses who accepted other nursing positions have to be retrained on charting and other bedside nurse responsibilities, she said. 'I loved working here, I love my team,' she said. Davis said CHS developed a new job description for assistant nurse manager, which is a model of clinical leadership and staffing followed by other local hospitals like Kaiser, Kaweah Health and Sutter Health. 'Based on those needs and industry best practice to support nursing at the bedside, we transitioned away from Clinical Nursing Supervisors and toward a combined Assistant Nurse Manager and Charge Nurse model,' Davis said. Davis said that 247 of the 285 affected nurses transitioned to new roles. 'Only a small percentage chose to separate,' he said. He also said in the coming months, 'nearly 95% of our workforce will see compensation increases as we continue to implement an organization-wide set of adjustments to align with California's new healthcare minimum wage.' A new state law signed by Gov. Gavin Newsom in 2023 requires an increase in the minimum wage for workers at several eligible healthcare facilities.
Yahoo
17-05-2025
- Business
- Yahoo
Fresno hospital kickback scheme was fueled by wine, cigars and Vegas strip clubs
In the Spotlight is a Fresno Bee series that digs into the high-profile local issues that readers care most about. Story idea? Email tips@ One of the most brazen — and costliest — hospital kickback schemes involving the region's largest hospital group took place inside a nondescript, palm tree-lined medical plaza in north Fresno. That's where a healthcare technology company founded with money from Community Regional Medical Center built an exclusive wine and cigar lounge, complete with private humidor lockers for cigar storage, a state-of-the-art smoke ventilation system, and luxury wines and liquors valued at about $1 million. Only a select few executives and physicians had access to the office-turned-lounge near First Street and Alluvial Avenue, known as 'HQ2.' It was a place where doctors, healthcare executives and physician group leaders were generously rewarded for using the company's electronic health record system and fraudulently referring patients in violation of several federal laws, according to a 2019 unsealed federal whistleblower lawsuit. The alleged conspirators planned to build a grander 'ranch' luxury retreat using funds generated from the kickback scheme, according to the complaint, which was unsealed Wednesday. The scheme came to light only after a 2017 building fire at the medical plaza revealed a cache of a thousand bottles of wine,arousing suspicions from the whistleblower, an accountant, of improper spending. The U.S. Attorney's Office announced Wednesday that Community Health System and healthcare technology affiliate Physician Network Advantage Inc. (PNA) have agreed to pay $31 million to the federal government to settle allegations that it violated the False Claim Act. Community Health System (CHS), Fresno's largest healthcare group, owns downtown Fresno's Community Regional Medical Center and the Clovis Community Medical Center, as well as a health plan and physician network. Community Medical Centers (CMC) is the name of the group that includes the hospitals and clinics under the CHS umbrella. PNA is a health care technology business founded and funded by CMC to support Fresno-area physicians' adoption of the electronic health records platform used by Community, according to federal prosecutors. PNA's CEO Chris Roggenstein is a 'longtime friend' of former CHS CEO Craig Castro, according to the lawsuit. At the heart of the complaint is a scheme that PNA provided lavish benefits to doctors and physician group executives in exchange for enrolling in CMC's electronic health record technology known as 'Epic EHR.' The lawsuit also alleges physicians and medical groups who joined the network made fraudulent referrals to CMC facilities in violation of the Anti-Kickback Statute. The kickback scheme involves several major players in Fresno's medical system, from hospital executives to medical records companies to some of the largest physician groups in the Central Valley. Some of the 17 luxury gifts, trips and donations listed in the lawsuit included: A trip to Paris, France for Castro and his family totaling approximately $63,000. A private plane for Timothy Joslin, former CEO of CRMC, to go to Las Vegas. Strip clubs and meals for CMC executives and physicians during a Las Vegas medical conference in January 2016. A $9,400 trip to Spain for Scott Wells, president of Santé Health and Santé Foundation, as well as Joyce Fields-Keene CEO of Central California Faculty Medical Group, or CCFMG (now known as Inspire Health Medical Group). 'The whistleblower lawsuit makes claims regarding personal choices that don't reflect our high standards as a non-profit health system, or the values of our current leadership team and board. And a number of elements in the 2019 lawsuit reflect either inaccurate or incomplete information,' said Michelle Von Tersch, senior vice president and chief of staff for CHS. In a statement, PNA said it cooperated with the Civil Division of the U.S. Attorney's Office in Sacramento in its review of Community Health System's electronic medical records program that began nearly 15 years ago. 'The settlement brings this matter to a conclusion without any determination or admission of legal liability for PNA,' the statement said. Thirty-five doctors were known to have received payment from CHS, according to the settlement agreement. According to the complaint, CMC embarked on the seven-year, $75 million quality improvement initiative in or around 2010 to replace their business and clinical data system with new technology — the Epic EHR system. CHS Board Chair Roger Sturdevant said that, in 2009, the federal government directed the healthcare industry to transition to electronic health records, which CHS did to provide patients with a 'robust, consistent, and secure electronic health records system.' 'However, it is clear we needed stronger oversight measures to assure that both Community and our vendor partner maintained appropriate compliance at all times.' Sturdevant told The Bee in a statement. 'While we are confident that physician referrals were driven by Community Health System's position as a leading provider of hospital-based and specialty services, we recognize that even the appearance of inappropriate incentives must be addressed.' In 2010, Physician Network Alliance, Inc. was formed with the sole purpose and business function of expanding defendant CMC's Epic EHR network of Fresno area medical practices — and to shelter the illegal kickback payments and elaborate gifts, the lawsuit says. According to the complaint, as early as 2011 CMC and PNA started giving kickbacks to Fresno-area physicians in the form of cash, expensive wine, strip-clubs, trips with private planes, and free or heavily discounted access to the Epic EHR software. PNA would bring in physicians and doctors groups into the network, all of which were subject to approval by CMC. In or around 2014 and 2015, CMC and PNA changed their building model so that PNA could retain some of the money received from the physician group, licensing fees and other monthly fees for maintenance and support of the Epic EHR system. Defendant PNA was able to retain a cash surplus from the Epic EHR client fees, so PNA began to use the excess cash for extra gifts and travel for CMC executives and CMC network physicians, such as the European and Vegas trips. PNA allegedly provided jobs to family members of CMC executives at the request of CMC. The HQ2 cigar lounge was constructed sometime after 2014 with an estimated $1.1 million of CMC funds, the complaint said. Michael Terpening, the former controller for PNA, discovered the 'illegal activity' after a fire at PNA's headquarters in 2017, in which 40 to 50 boxes of wine — totaling 1,000 bottles — were found in a storage room. When Terpening approached his boss Roggenstein about the wine, he was told it was 'leftover from the holiday party.' Terpening and his attorney could not be reached for comment. Discovery of the wine surplus led Terpening to become suspicious of other large expenditures submitted as deductible 'business expenses' for PNA, the complaint said. But, according to the complaint, Roggenstein ignored Terpening's advice to cease the illegal activity, and instead 'redoubled his criminal efforts.' Roggenstein and CMC had plans to build out the 'HQ Ranch,' a luxury retreat for CMC executives and physician practices that would include a cigar and wine lounge 'large and grander in scale than HQ2,' a skeet shooting range and a small off-road vehicle course. 'Once he realized that neither Defendant Mr. Roggenstein, Defendant PNA, nor Defendant CMC had any intention of remedying the above conduct, and in an effort to quit the illegal conspiracy, Mr. Terpening resigned from his position as a Controller for Defendant PNA,' the complaint said. The lawsuit alleged the defendants violated three federal laws through its kickback scheme: the Anti-Kickback Statute, the False Claims Act and the Stark Law. The Anti-Kickback Statute makes it a crime to knowingly and willingly offer, pay, solicit or receive any remuneration to induce a person to refer to an individual for the furnishing of any item or service covered under federal healthcare program. Claims submitted knowingly and in violation of the Anti-Kickback Statute constitute a 'false or fraudulent' claim under the False Claims Act, according to the lawsuit. The Stark Law prohibits a physician or medical provider from referring Medicare patients for certain services to an entity with which a physician's immediate family has a financial relationship. The 2019 complaint lists several defendants, including: Fresno Community Hospital and Medical Center; Physician Network Advantage, Inc.; Santé Health System; Santé Health Foundation; Berj Apkarian; Craig Castro; Central California Faculty Medical Group; Timothy Joslin; Michael Muruyama; Grant Nakamura; Patrick Rafferty; Christopher Roggenstein; and Michael Synn. On Tuesday, summons were issued to the defendants. In court filings, the U.S. The Attorney's Office said it chose not to intervene at this time given the settlement with defendants Santé Health System, Inc., Santé Health Foundation, Central California Faculty Medical Group, Grant Nakamura and Michael Synn. But it has left open the possibility that it may take action pending further investigation. A scheduling conference is set for Aug. 21 at 11:30 am in the Yosemite Federal Courthouse with Magistrate Judge Helena M. Barch-Kuchta.
Yahoo
02-03-2025
- Yahoo
Threats of ICE raids sweep through Fresno's flea markets. It's ‘fear mongering,' owner says
In the Spotlight is a Fresno Bee series that digs into the high-profile local issues that readers care most about. Story idea? Email tips@ It was only 9 in the morning and Librado Maya could tell already it would be a slow day for his flea market business. Other than the Latin music heard from a nearby loud speaker, there was little to no bustle at the usually popular Cherry Avenue Auction just off Highway 41 in south Fresno. Maya emerged from under his tent where he sells new athletic shoes to scope out the rest of the swap meet. It wasn't just his area that lacked customers. Hardly anyone was walking around or shopping. 'That's not normal for a Saturday morning,' said Maya, who has been selling at various flea markets the past two years. 'A lot of people usually show up early to check things out and kind of set the pace for the rest of the day. I know it was kind of cold. We were trying to figure out why there weren't as many people showing up.' Maya later learned there had been social media posts of immigration raids being conducted by the U.S. Immigration and Customs Enforcement in other spots in Central California. Was ICE targeting someone or many people among the heavily Latino-based clientele at Cherry Avenue Auction? What about at other popular local swap meets such as the Big Fresno Flea Market or Selma Flea Market? Was any of this true? Regardless, the general fear of being detained by ICE was very real. And the sharp decline of flea market business during the first few weeks of 2025 seemed to reflect such anxiety. 'All the markets are feeling it,' said Brian Parisi, who heads the Big Fresno Flea Market that's held on the Fresno Fairgrounds south-area parking lot. 'Rumors go around 'Hey, they're coming out looking for you. They're coming out to flea markets.' 'All the markets have had some impact. We talked to a few, and one in particular, his business was down 50%.' While much of the fears of ICE raids occurred in January, foot traffic at local flea markets has since increased as the weather warmed up. On back-to-back weekends in February, both the Big Fresno Flea Market and the Cherry Avenue Auction were filled with people of various ages and ethnic backgrounds throughout the day. Nonetheless, some folks expressed concern that ICE could show up at any time. As well as the possibility that agents could veer from the agency's priority to arrest noncitizens with pending criminal cases and/or prior criminal convictions, and start detaining anyone under a subjective notion that a person is considered 'a threat to public safety or national security.' 'The reality is (for) a private business like this, they would have to have a warrant,' Parisi said. 'We try to convince everyone that you're safe here. 'But again, we have no control over what the government is going to do.' Neil Burson and his brother have owned and operated the Cherry Avenue Auction since 2001, and had his team issue a social media post in late January to try to ease concerns about ICE targeting random people who are shopping. 'It's a lot of fear mongering,' Burson said. 'Someone said ICE will be out there on a certain day. Our demographic is a large Hispanic market. Some people were afraid and stayed away. I haven't seen ICE myself. It's a rumor that just becomes fear mongering. 'We care incredibly for our community, and the spread of false rumors is concerning.' Immigration attorney Sarwinder Singh Dhanjan said ICE typically goes after specific individuals — not conducting mass roundups to sort out who's in the country illegally. 'They're usually looking for someone with a criminal history,' Singh Dhanjan said. 'I don't think they're just going to raid the market — unless they feel someone is a danger to the public.' The Fresno-based lawyer said he gets one to two new clients a day who want help with their immigration status, and confirmed that immigration raids have occurred in Fresno County, just as they have throughout the United States. According to NBC News, ICE agents were told to meet a quota of 1,200 to 1,400 arrests per day. 'I do think to some extent it is fear mongering,' Singh Dhanjan said. 'People on social media make it seem like ICE is everywhere. ICE has been in Fresno. I haven't heard of ICE going to flea markets yet. But I do suspect it could happen. 'The bottom line is, criminal record or no criminal record, for someone who is here illegally, there always has been a possibility they could get picked up because of the simple fact that they were here illegally.' The long line of customers waiting to order Chinese chow mein noodles was one sign that business at the Big Fresno Flea Market was picking up in mid-February after the drop in attendance the previous month. Moms and dad pushed toddlers around in strollers while browsing from tent shop to tent shop and occasionally stopping to eat. Others searched for items that caught their attention like shiny, new gardening tools or antiques that may have been in storage for years. A few people were motivated to buy if only they found a good deal, such as soft blankets with sports teams logos for $30. That's part of the lure to attending any flea markets and swap meets: enjoying food, getting items at a lower price or spotting things that might be tougher to find. 'You can find just about anything you can think of,' said Parisi, who has headed the Big Fresno Flea Market since 2020. 'Home essentials. Fresh vegetables and fruits. Toys. Clothes. 'Some items might be used; some are brand new. And you get them at a better price.' While it's unknown how many customers and even vendors stopped coming out to swap meets due to the threat of raids, vendors said they noticed sales were down. Claudia Vanegas, who with her mother operates a toy store at the Cherry Avenue Auction on Saturdays and at the Big Fresno Flea Market on Sundays, said sales dropped 20% compared to a year ago. 'The majority of the customers are Spanish speakers and maybe even farm workers,' Vanegas said. 'Their money can go further at a flea market. So when they're not going, we notice.' Burson, who heads the Cherry Avenue Auction, said his flea market is starting to get back on track after a slow January. He highlighted how flea markets aren't just about the savings but the experience of seeing a vast amount of items for sale, and enjoying the food and beverages available, and music. 'We want to provide an experience,' Burson said. 'Come out with your family for a safe time of shopping. Spend money and buy stuff, or don't spend and just enjoy the atmosphere. 'The flea market culture is very dynamic; definitely not a boring industry.' Which is why Singh Dhanjan, the Fresno-based immigration attorney, strongly advised that those whose status in the United States is considered illegal to hire a lawyer to help with their paperwork and status to try to become legal citizens. 'You want to get an attorney beforehand, because now, the (government) is trying to expedite the process and remove you if you are arrested because of your immigration status,' Singh Dhanjan said. 'You might not have the time to get a lawyer before you're detained or deported. 'Here's the other thing. What's making people scared isn't that they're illegal. They've known they're illegal. They're not scared of that. They're scared because they don't have a plan if they're found out. A lawyer will help people come up with a plan. 'The other option is you never go out in public again, like to the flea market, and you're in constant hiding,' Singh Dhanjan added. 'But you can't hide and expect to have immigration benefits. You've got to pick and choose. 'And if you're choosing to be illegally out there, you better be more careful.' Meanwhile, vendors like Vanegas are crossing their fingers that business will continue to get better and make coming out to flea markets worthwhile. 'We need them,' Vanegas said. 'They're our customers. They're part of our community.'
Yahoo
08-02-2025
- Politics
- Yahoo
Central California cities are pursuing sanctuary policies. Here's what that means
In the Spotlight is a Fresno Bee series that digs into the high-profile local issues that readers care most about. Story idea? Email tips@ In the Central Valley, multiple municipalities are considering becoming sanctuaries to undocumented immigrants as the federal government pursues mass deportations. Though there is no single definition for these so-called sanctuary cities, they generally entail cities that pledge to welcome immigrants and prevent their local law enforcement from aiding in federal deportation efforts. But cities such as Madera and Kerman looking to make statements of public support for undocumented immigrants are also considering the possible repercussions. Local leaders are treading lightly on how they word official resolutions. The Trump administration already ordered a pause on federal funding to sanctuary jurisdictions. The president's team has also sued officials in Chicago, Illinois, arguing that the city's sanctuary policies block federal immigration enforcement operations. Trump took similar actions during the his first term. Those attempts failed in federal courts, but his new barrage of directives have created many unknowns for cities wondering how they can advocate for their undocumented residents. 'It's a fluid situation,' Madera City Manager Arnoldo Rodriguez told council members Wednesday. 'It seems like some of these rules are changing daily, and we're attempting our best to keep up with them.' Sign up here to receive our weekly newsletter centered around Latino issues in California. Livingston, in Merced County, became the Central Valley's first sanctuary city in 2017. The city of Huron, in Fresno County, became the second last month. Both cities did so through nonbinding resolutions rather than ordinances, which are generally reserved for more permanent government rulings. In Tulare County, the Lindsay City Council decided before Trump's inauguration to discuss sanctuary status at a future date. Some residents in Kerman and Madera want their lawmakers to take stances in support of immigrants. Some have called for a resolution that at least communicates that immigrants are valued, while others want a declaration of sanctuary status. But for local officials, there is too much uncertainty for sanctuary cities this early in Trump's presidency. In Madera, where about 25% of residents live below the poverty line, officials considered that the city currently has access to millions of dollars in federal funding. Madera City Attorney Shannon Chaffin said a lot has changed since Trump's first failed attempts at withholding federal funding from sanctuary cities. 'The greatest risk is declaring yourself a sanctuary city and attempting to thwart federal enforcement operations,' he told the council. 'You will run into problems, and California is on the radar.' Madera councilmembers will instead consider a resolution that identifies Madera as a place of 'unity' that is 'welcoming' to all. In Kerman, councilmembers will consider a resolution that informs residents that local police do not enforce federal immigration laws. Generally, a sanctuary city is a jurisdiction — a city, county or state — that decides 'it will not use its resources to engage in federal immigration enforcement,' said Bill Hing, professor of law and migration studies at the University of San Francisco. 'The idea of sanctuary jurisdictions is that you do your work, but you don't ask about immigration status,' said Hing, who is also the founder of the nonprofit Immigrant Legal Resource Center. This is so that, when the federal government inquiries about someone's immigration status, 'you don't know anything, then you just say you don't know anything.' Another main part of sanctuary ordinances is not contacting federal officials even when a jurisdiction knows someone is undocumented. Technically, local jurisdictions in California that don't have sanctuary ordinances are still subject to the state's sanctuary law that took effect in 2018. Known as the California Values Act, it prohibits local police from asking for someone's immigration status or using local resources to assist in federal immigration enforcement. There are exceptions in sanctuary cities and state law that allow officials to contact U.S. Immigration and Customs Enforcement iflocal law enforcement detains an undocumented immigrant charged with serious violent crimes, including murder, sexual assault and kidnapping, Hing said. Niels Frenzen, a professor at the USC Gould School of Law, said the California Department of Corrections and Rehabilitation routinely turns non-citizens with serious felony convictions over to ICE. 'So sanctuary does not protect non-citizens with serious felony convictions,' he said. Sanctuary cities also do not stop federal immigration agents from carrying out enforcement operations. Hing said that the term sanctuary can be misleading because it carries a social or religious connotation, such as churches that allow undocumented immigrants to seek refuge. 'It's not about standing guard at the border of Merced and saying ICE cannot come in here,' he said. 'That's not ever required of a sanctuary ordinance.' Both law professors also disputed the claim that sanctuary cities encourage crime, citing that several studies have provided empirical evidence for the opposite. Hing said sanctuary ordinances enhance public safety because they allow all residents, regardless of immigration status, to trust that they can call local police for help. 'The main reason for these ordinances is to make sure that victims and witnesses to crime actually come forward,' he said. 'If those witnesses or victims are from an immigrant community and they're worried that, 'If I report this I'm going to get deported because they're going to report me to ICE,' they won't come forward.' During his first term, Trump tried to block federal funding to sanctuary cities by conditioning federal funds with compliance, Hing said. Hing said federal courts have ruled that federal funding can have conditions, but that those conditions have to be included in legislation passed by Congress. For example, Hing said, federal highway funds require jurisdictions to enforce the federal speed limit. This time around, Hing said, the Trump administration could push Congress to approve amendments to federal grant legislation that include conditions against sanctuary cities. The federal government's attempts to penalize sanctuary cities are setting the stage for years of legal battles. 'I expect that blue states and blue municipalities and counties will be on the target list,' Frenzen said. However, Trump's crackdown on sanctuary cities could weigh against the 10th Amendment to the U.S. Constitution, Frenzen said. Using the 'anti-commandeering' doctrine, the Supreme Court has ruled that 'the federal government cannot commandeer states, cannot use state resources, for things that the federal government wants them to do,' he said. The Supreme Court cited the 10th Amendment when it struck down a requirement in the Affordable Care Act in 2012. 'The anti-commandeering statute doesn't mean that Trump isn't going to sue,' Frenzen said, 'but it doesn't mean that a city is going to lose.'
