Orange County’s system for regulating private ambulance companies is woefully inadequate, even allowing those with a criminal record to slip into emergency services, interviews and documents show.
Today, more than 550 private ambulances from 31 companies based throughout Southern California are licensed to roll through Orange County. But the county’s weak laws limit the ability of officials to thoroughly vet and control the growing number of firms operating here.
This shortcoming potentially puts patients at risk of being served by a firm with questionable management, substandard equipment or fraudulent financial practices.
“A mushroom cloud of fly-by-night ambulance companies” is threatening to rain problems on Orange County, opined Patricia Barker, a senior investigator for ambulance licensing in Los Angeles, where many firms are based.
Consider the following ambulance company issues:
- Alpha Ambulance Service, which operates in Orange County, was denied a permit last month to provide service in Los Angeles County after a federal Medicare fraud strike force in May raided its Los Angeles office. Alpha also failed to carry required insurance and operated outside approved zones in Los Angeles, documents say.
- The general manager of PROCare Mobile Transport LLC of Los Angeles was convicted of grand theft last year as his firm was applying to operate in Orange County. PROCare conceivably could win an OC permit after a recent ownership restructuring.
- Lifeline Ambulance Service of Montebello was co-founded a decade ago by a drug dealer involved at the time in an $8-million Ecstasy ring. He continues today to direct the firm’s marketing after completing probation and having his felony conviction expunged.
County health officials are aware of the regulatory deficiencies,which date back decades, and are seeking to improve oversight.
“Our goal is the highest quality emergency system,” said Michael Noone, a paramedic directing ambulance licensing for the Orange County Health Care Agency and chairman of a multicounty working group on ambulance fraud.
A new ambulance ordinance is needed for better “documentation on ambulance company owners, past practices and financial viability,” he said. Prior to his tenure, Noone said ambulance companies successfully defeated efforts to upgrade the ordinance.
Los Angeles County faces similar risks, but a tough law enacted last year helps officials root out questionable operations. Consequently the stricter Los Angeles County measure pushed dubious actors to other parts of Southern California.
“As we have tightened restrictions, questionable firms have been flowing into Orange County,” said Barker.
Thus the focus of the working group, which includes officials from Los Angeles and Riverside counties, is better regional regulation. Specifically, they are trying to prevent abuse of governmental programs like Medicare and Medi-Cal after federal agents last winter highlighted ambulance-related fraud schemes.
In Orange County, the private ambulance companies provide basic life-support services, not the more advanced paramedic-level care provided by ambulance staff working under the authority of hospitals and in fire departments.
Staffed by emergency medical technicians, the basic ambulances transport patients from facilities like those for skilled nursing to specialized medical appointments like kidney dialysis or serve as standby for events like athletic competitions.
There are no private ambulance companies staffed by paramedics in Orange County. Only municipal or county fire fighting agencies have paramedics. Among ambulance companies with Orange County permits for basic service, there are a number of large firms that also offer paramedic care elsewhere.
But basic ambulance service presents opportunities for huge profits, authorities say, especially if illegal tactics like kickbacks are used. Thus the industry has attracted shoestring operators with little pre-hospital care experience, in particular entire families originally from countries like Russia, Ukraine or Armenia.
Sometimes with shadow owners who are debarred from government programs or are felons, such firms engage in Byzantine business practices that are difficult to police and can bleed fortunes from taxpayer-supported programs.
Before the Los Angeles County crackdown, health officials say, there were about 60 private ambulance companies operating with little scrutiny.
“People with no medical experience were dispatching ambulances,” said Cathy Chidester, director of emergency services for Los Angeles County. “There were a lot of odd things going on. We had complaints but no authority to act.”
The Raid on Alpha
Alpha Ambulance is an example of the type of firm that is facing more scrutiny in Los Angeles County but can operate with relative impunity in Orange County.
On July 18, Chidester’s agency denied Alpha Ambulance Service a permit to operate in Los Angeles County. A county report detailed Alpha’s failure.
The federal raid of Alpha’s offices was part of a nationwide crackdown in which more than 100 arrests were made from Orange County to the East Coast. Federal officials declined to discuss the ongoing probe.
Emergency service officials say that under Orange County's ambulance ordinance enacted in 1984 they cannot now restrict Alpha operations here.
Alpha operates from a small office in a three-story building a few blocks south of The Grove shopping center in Los Angeles. No one opened the office doors when a reporter visited on July 25, nor would anyone answer the phones. There were reports Alpha was moving.
Owner-operators of Alpha are listed as Alex Kapri and Aleksey “Russ” Muratov. A day after the May raid, Kapri told inquiring Orange County officials there was a misunderstanding that would be resolved.
Last week, vice president Muratov said the firm isn't moving but “restructuring.” The firm will appeal the Los Angeles County permit denial, he said, declining further comment.
Beginning a year ago, Los Angeles County health officials required each private ambulance service to apply for a permit. It is this process that Alpha failed. Because of few staff and many companies, it will take years for Los Angeles County to check and issue permits to all ambulance firms seeking to continue operating.
Holes in Orange County's System
In Orange County, limited emergency services staff is attempting to keep up with increasing number of ambulance operations. There are two new applications pending and several other firms inquiring.
Orange County Health Care Agency officials have had some success in keeping questionable operators at bay, but there are constant challenges.
For instance, county officials learned last year that PROCare’s general manager-part owner was facing a criminal charge. The agency’s emergency medical services officials put the application on hold, delaying PROCare’s move into Orange County. Details of events provide a snapshot of such an operation.
Last week, PROCare's general manager, Johnathan Shidlovitsky, 33, acknowledged in an interview that he was still general manager of the firm despite being convicted last November of grand theft.
Shidlovitsky pleaded guilty in Los Angeles County Superior Court to stealing a video camera inadvertently left at PROCare by an overnight delivery service, court records say. The high-end equipment was sold for $2,000 to a pawnshop, which in turn resold it.
After the new owner sent it to a Sony repair shop adjacent to PROCare, authorities linked Shidlovitzy to the equipment’s twisted trail. He declined to discuss those events.
Born in the Ukraine, Shidlovitsky said he has been in the U.S. since he was 2 years old. After six years of learning on the job, he now manages 41 ambulances for PROCare, .
After paying $22,500 in restitution, Shidlovitsky failed to complete 300 hours of community service ordered last November by Judge David M. Horowitz. In May, the judge granted a continuance until Shidlovitsky's December sentencing date to complete that service. The judge has said he may reduce the felony to a misdemeanor.
Noone said the PROCare case shows how the system can work, but also its shortcomings.
His office caught the filing of a criminal charge that prevented PROCare operations beginning in Orange County, he said. But state didn't notify the county of Shidovlitsky’s conviction; Noone learned of it from a reporter. He said he will examine the issue should PROCare apply again.
Another example is Lifeline Ambulance Service, which has operated for years with the former Ecstasy dealer in its front office.
At the time Lifeline was launched with five ambulances, co-founder Maxim “Max” Gorin was charged with selling 1,000-tablet “boats” of Ecstasy for as much as $10,000, according to court records. A Torrance police investigation throughout Southern California identified Gorin as a mid-level dealer in a ring led by Israeli nationals with 400,000 tablets of Ecstasy, which had a street value of $8 million.
Los Angeles County Superior Court records show Max Gorin was sentenced to 20 days in jail and placed on probation for three years as part of a plea bargain for felony drug sales.
Today, Max Gorin’s mother, Genia, is Lifeline’s “boss,” said Gendey Gorin, Max Gorin 's father, who is vice president. Max Gorin directs the firm's marketing to health plans, medical providers and event operators.
“He does everything,” says the father proudly, noting the son also served from 1996 to 1999 in the U.S. Army, which facilitated his citizenship. The Gorin family was born in the Ukraine, emigrating here in 1978 as refusenik Jews escaping the former Soviet Union.
With a satellite office in Garden Grove, Lifeline is permitted to run 49 ambulances in Orange County.
Lifeline ambulances appear first-rate, some with specialized equipment for transporting infants and adults with major illnesses. The company operates from its full-service facility in Montebello, which includes an elaborate mechanic shop.
Under California Highway Patrol regulations, felons are prohibited from being principals in ambulance companies, officials say. After Max Gorin’s conviction, CHP records and officials state he was allowed to continue the firm's marketing.
Acknowledging his earlier criminal conviction, Max Gorin said: “I was 25 and dumb. Now I’m 35, married and clean.”
Court records show the felony was expunged in 2007. In a letter to Voice of OC, Max Gorin's legal representative and brother, Dmitry Gorin, stated that a court "has dismissed the accusation after a not guilty plea was entered. From a legal position Max is no longer guilty nor convicted of this offense."
Noone said he will examine the situation to see whether there are any issues.
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