More Cases Emerge From FBI's California "Spinal Cap" Investigation | Orthopedics This Week
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More Cases Emerge From FBI’s California “Spinal Cap” Investigation

Image created by RRY Publications, LLC / Source: Wikimedia Commons

The 2002 California law that required workers’ compensation carriers to pay 100% of a hospital’s documented cost of spinal hardware set in motion a number of schemes to try to maximize the amount of money being collected for spine surgery. As a result, the U.S. Attorney’s office announced a new round of cases complete with lurid allegations of bribes, inflated billing practices, unapproved devices and lethal pain cream compounds to alleviate back pain—all under an FBI investigation called “Spinal Cap.”

Spinal Cap

Michael Dorbot
Michael Dorbot

“Spinal Cap” netted its first big fish when Michael Drobot, the former owner and operator of Pacific Hospital of Long Beach and various distribution and pharmaceutical companies, admitted to compensating physicians to refer patients to his hospital and bribing a state senator to keep the workers’ comp law on the books.

The investigation uncovered one of the largest workers’ comp fraud cases in California’s history, involving more than 150 insurance companies. The investigation also resulted in the law being wiped off the books.

When Drobot pled guilty to criminal fraud charges in February 2014, Eric Weirich, deputy commissioner of the enforcement branch of the California Department of Insurance, said in a joint press conference with the U.S. Attorney’s Office, “I assure you, this is the first in many cases to come.”

Those cases are now landing in the laps of numerous grand juries, triggering civil lawsuits, more criminal prosecutions and petitions and complaints to the California Medical Board.

Unapproved Devices

Jack Akmakjian,  M.D.
Jack Akmakjian, M.D.

Citing the Drobot case, Arthur Golia filed suit on June 13, 2014, in the Superior Court of California County of Los Angeles, accusing, Jack Akmakjian, M.D., a spine surgeon, a distributor and a mom-and-pop machine shop of putting seven non-FDA approved devices into his spine.

Golia is suing Akmakjian, the Parkview Community Hospital Medical Center in Riverside, California, and Spinal Solutions, LLC et al. for engaging in a "systematic pattern of fraud and deceit, fueled by the payment of illegal kickbacks, designed to illegally profit from grossly inflating the charges for implantable medical hardware used in connection with spinal fusion surgeries."

Golia claims he is only one of thousands of patients in Southern California who received such, non-FDA approved hardware.

Dr. Akmakjian, Spinal Solutions et al.

Akmakjian performed lumbar fusion surgery on Golia in January 2010 at the Parkview Medical Center. Golia claims that Akmakjian knew that Spinal Solutions and other defendants, including Roger Williams, Jeff Fields and Mary Sisler Williams, were producing "knock-off" implants, consisting of screws, rods and cages. Akmakjian also allegedly knew the hardware was being distributed by Michael McGrath through Comprehensive Intra-Operative Services, Inc. McGrath allegedly entered into agreements with hospitals, like Parkview to sell the devices produced by Spinal Solutions and William Crowder, the owner and operator of Crowder Machine & Tool Shop in Temecula, California.

Parkview Community Medical Center
Parkview Community Medical Center

Crowder served as a contractor for Spinal Solution. An attorney for the machine shop’s owner reportedly denied the allegations, saying it is impossible that the elderly machinist mass-produced the hardware.

Golia further claims that Akmakjian was paid by Spinal Solutions in the form of cash, plane travel and other perks to use the unapproved implants. He accuses Akmakjian of participating in a wider fraud scheme involving kickbacks paid by hospitals and vendors and overbilling payers including insurance companies.

According to a report by the Center for Investigative Reporting on July 3, 2014, a woman identifying herself as Akmakjian’s office manager said there would be no comment. Parkview Community Hospital did not respond to questions.

Workers’ Comp Free-For-All

The lawsuit outlines how the now changed California law, which reimbursed 100% of the documented costs of implantable hardware, had rewarded hospitals for entering into contracts with third-party "marketers" who would, in turn, refer or steer spinal fusion candidates to their facility. The marketers, including McGrath, were allegedly paid "referral fees" by the hospitals. The hospitals also allegedly paid “referral fees” to chiropractors and physicians.

After the passage of the law in 2002, hardware distributors allegedly began to dramatically increase the cost of spinal hardware, knowing that workers' compensation carriers were required to pay 100% of the hospital's documented cost, plus $250. By 2009, claims Golia, a pedicle screw that could be purchased for between $300 and $500 wholesale would end up on a hospital bill at approximately $12, 500. Profits soared.

The defendants in this case, allegedly, started to produce the implants in 2007.

Parkview, claims Golia, paid Akmakjian rebates, refunds, commissions, or other compensation to perform surgeries at Parkview. He said Parkview knew that Akmakjian was prescribing unapproved hardware, but turned a blind-eye as part of the consideration paid to the surgeon.

In a similar lawsuit filed in January 2014, David Solomon, a Los Angeles man who had implants from the Crowder machine shop put in his back in 2011, claims one of the screws broke, requiring him to undergo a second surgery in 2013. He has ongoing pain and loss of movement, his lawsuit says.

In January 2012, the FDA sent Spinal Solutions a Warning Letter citing a variety of quality control violations. On April 22, 2013, the agency announced that the company was recalling spinal implants because problems with the products “could cause patient harm due to implant breakage, movement, or inadequate sterilization."

An FDA spokeswoman told the Center for Investigative Reporting that the agency could not comment on ongoing litigation or confirm the agency is investigating.

Akmakjian’s Medical Board Pain

In addition to his patient, Arthur Golia, Akmakjian has other problem.

On April 14, 2014, the Attorney General for the State of California, on behalf of the executive director of the Medical Board of California, filed a motion accusing Akmakjian of gross negligence, prescribing dangerous drugs without an appropriate prior examination or medical indication; excessive prescribing and failure to maintain adequate and accurate records. The state wants Akmakjian’s license revoked or suspended.

Tragedy Strikes

The Golia lawsuit against Akmakjian isn't the only link to the Spinal Cap investigation.

On June 14, 2014, AP reported that 15 doctors, pharmacists and other medical professionals in Southern California were charged in a $25 million workers’ compensation scheme that prosecutors said was linked to the death of a baby.

One of the pharma professionals charged was, you guessed it, Michael Drobot, the managing partner of Industrial Pharmacy Management.

Drobot, Andrew Jarminski, M.D., Healthcare Pharmacy, Allied Medical Group and Industry are also all being sued by Priscilla Lujan, the mother of a five-month-old child who died after coming in contact with a transdermal cream prescribed by Jarminski for Lujan’s back and knee pain.

Dangerous Compound

According to the lawsuit, Lujan went to Jarminski’s Long Beach office in February 2012 for treatment of injuries she suffered while working at Goodwill Industries. Medical records reportedly showed Jarminski prescribed Lujan a compound transdermal cream comprised of the antidepressant amitriptyline, the pain reliever tramadol and the cough suppressant dextromethorphan.

Lujan went home and applied the cream to her knee and back. After using the medication, she took care of her baby, including preparing a bottle for him and bouncing him on her knee and holding him over her shoulders, according to her attorney.

She put the baby to sleep in her bed and awoke in the morning to find him unresponsive. He died an hour later "as a result of multiple drug intoxication, " according to the autopsy report. The report also stated that the baby had high levels of three drugs in his system—the same drugs in the compound cream prescribed by Jarminksi. Tramadol and dextromethorphan were present at lethal levels, the coroner found.

Involuntary Manslaughter

The death was ruled a homicide by the coroner, who said medication residue was found on one of the baby’s bottles. Lujan was arrested for her son's death, but the Los Angeles District Attorney declined to file charges because of insufficient evidence, according to spokeswoman Jane Robison.

Jarminski is being charged with involuntary manslaughter by the Orange County grand jury.

The cream Jarminski prescribed for Lujan was costly. Workers' compensation records show Jarminski’s office billed $1, 700 for the initial 25-day supply of the cream.

According to Lujan’s attorney, when she was informed the cream was linked to her son’s death, she said she didn’t want any more of the cream. But, according to the lawyer, Jarminski continued to send her more cream by mail and bill workers' comp for it.

"Compounds and the prices charged for them by compounding pharmacies are a growing problem for the health care system, " said Riddhi Trivedi-St. Clair, a senior manager with Express Scripts Inc., which manages prescription benefits for thousands of employers, including Los Angeles County.

According to data provided by Express Scripts, the number of injured California workers filing a prescription for at least one compounded medicine increased by 157% last year, compared with 2012.

Jarminski is reportedly associated with Allied Medical Group, as is Daniel Capen, M.D., who was also indicted by the grand jury on fraud charges.

More to Come

We have likely not seen the last of the California Spinal Cap investigations. The State Compensation Insurance Fund, which oversees workers’ comp claims for the state, wants to recoup some of the $160 million it paid over the past dozen years. Other public and private payers are no doubt examining potential false claims. Then there are the possible kick-back violations if any physicians are found guilty of taking money to refer patients to hospitals.


43 thoughts on “More Cases Emerge From FBI’s California “Spinal Cap” Investigation

  1. Dr. Akmakjian is a fine surgeon. I don’t believe he would ever do anything illegal or endanger anyone’s life. I have been a patient for many years and will stand by this doctor no matter what.

    1. Maybe if you were one of the patients affected by these counterfeit screws and suffer daily with excruciating pain, you would feel differently! I can not believe this man has not had his license for practicing medicine!! Unbelievable!! This makes our HealthCare system very scary!! I am a patient of multiple back fusions! I’m fused from the T6 to the S1! I couldn’t imagine something like this being done to me. I’d be infuriated! I really feel for the patients that are suffering from this doctors hands. He should be ashamed and should retire from practice!!

  2. Dr. Akmakjian has been robbing the public (tax payers) and doing unnecessary surgeries using screws and other tools not approved by FDA. The evidence on public records is damming and irrefutable. He has been running his medical center for distribution of dangerous narcotic based medication. FBI and DEA should take this guy into custody to protect unsuspecting members of the community. The greed of his wife Christina Akmakjian for living the life of “Rich and Famous” has been a big source of negative influence on Dr. Akmakjian for crimes of fraud, medical malpractice, and drug dealing. My advise is to stay away from Akmakjians and their clinic.

  3. Another doctor did surgy L4.5 with hard where it all came loss and all most Killed me. Thank God for U C L A. Dr Rick Delamater. That had to re due the mess…I.m much better but still have nerve damge from it.

  4. Dr. Akmakjian has ruined my mothers life! He should not be practicing or doing surgeries! My mother is now facing a life of pain and the possibility of being completely paralyzed! I am angry and mad at the system and this doctor! My mother now needs a surgeon to go in and try to help her and fix his life changing mistake on my mother! I would NOT go to him or trust him with my health or life!

  5. Dr. Akmakjian made it possible for me to afford an MRI & has always been cautious in prescribing medication. I continue to trust him & think he is a compassionate doctor

  6. How far back does this fraud go? I had a surgery in 2000 that resulted in hardware removal in 2001 due to the excessive pain and apparent allergic reaction from the hardware which caused demylenation of the nerves and now I live with neuropathy. I’m wondering if these were used in my case as I’m not allergic to surgical steel. It’s horrific how this can happen in this country!!

    1. Lesli,
      U dont need any mkney to hire an attorney, they will work on a contingency basis, which means they will take their fees out of any settlement u receive, just thought id try and help u
      Good luck

  7. Who cares about this company their loss and what’s to come??? You have missed the point once more with your article. What about all the patients whom received the unapproved devices, the unapproved creams, etc…..? We already know work comp is just as broken, over priced and corrupt as any other business involved with pain and suffering of others. What about the humans it actually affects? Why wasn’t I notified about this? I Am most certainly affected, unable to walk or work any longer, on the verge of being homeless, don’t have the finances to sue anyone anymore. Makes me sick.

  8. Dr Akmakjian ruined my wife’s back. He rushed from one procedure to the next. He wanted to fuse her back, but after a life threatening infection, she said no. Thank god for that. It’s been roughly 10 years and she has been having lesions all over her body, continuos pain and now they are finding fluids in her spine. I pray that Kaiser Docs can fix her. Akmakjian is a horrible dr. Anyone who thinks otherwise is delusional and probably felt they were benefitting from his excessive drug prescriptions. Don’t let this man touch you!

  9. My husband, father and Uncle all had surgery by Dr. Akmakjian. They all recuperated nicely and had outstanding outcomes. I worked for Dr. Akmajian for 10 years. He comforted me during the time of my husbands surgery ( 10 mm disc protrusion) . He canceled his plans one evening, ( on a urgent request by me) just to help my husband out of his misery and pain. I felt so blessed when my husband awoke without his terrible pain. As Dr Akmakjians employee, I always felt that he was ethical and professional. I’m sure not everyone heals the same, but I know from my experience that he’s a good man. My husband, Dad, and uncle would tell you the same.

  10. Dr. Akmajian’s office is run like a mill. A poorly run mill. The phone system I believe is purposely is screwed up so that lawyers can not reach him. Desperate patients will call any dept in his office just to get anybody to answer the phone so that they can be transferred to the needed line. Dr Akmajian bragged to my husband about how well and fast he could do the particular surgery that my husband needed and did get by the Dr. Since the surgery my husband has been in more pain than before the surgery and more pain than he could ever believe possible. Before the surgery in 2013 I heard about the lawsuit regarding the substandard hard ware. At the time there was very little information available. I point blank asked the Dr if this had anything to do with him as I am aware that when there is a medical lawsuit everyone is sued whether they were negligent or not. The Dr looked me in the eye and told me that it had nothing to do with him. After the surgery Dr. Akmajian preened about how fast he had done the surgery. He said it was his quickest time yet. Well great! My husband is taking the brunt of his land speed record. Six months after the surgery when my husband still complained to him about the pain Dr Akmajian said my husband was just a baby and that the pain couldn’t really be that bad. Now 4 years later. Nothing has changed and my husband is in constant pain and can only stand for a few minutes at a time. We are relocating to AZ to get to a climate that somewhat lessens my husbands pain. He is living on pain pills that now because of Obama the Dr’s are refusing to prescribe. Those without pain have no understanding that pain pills taken in the proper dosages do not get you high. They just make the pain tolerable. I said all that to say this. My husband and I rue the day we ever walked in Dr. Akmajian’s office. I hope he answers to God someday for his greed.

    1. You obviously need to do your homework on this doctor!! He should be behind bars for what he’s done to patients in ruining their lives with implanting phony hardware in spinal fusions!!
      Very scary!! The Healthcare system sucks, obviously! This man should be behind bars or at the very least, has his license for practicing medicine revoked!!

  11. If you can find an episode from Crime Watch Daily about how poor the case is against these doctors and hospitals, watch it. There is a hand written work order from a machine shop with Jack Akmakjian’s name on it

  12. Dr. AKMAJIAN HAS ALWAYS BEEN A GREAT DOCTOR TO ME. I WAS SADDENED THAT HE RETIRED WITHOUT INFORMING ME. I HAVE BEEN HIS PATIENT SINCE 1997 AND NOW DO NOT KNOW WHO TO GO TO. THE SURGERY HE GAVE ME HELPED ALOT. THOUGH I STILL TAKE PAIN PILLS TO HELP AT LEAST I can function with them as before the surgery nothing helped. With the surgery and medication I am now able to work again. I am concerned that another doctor may not help me the way dr. AKMAJIAN did. Happy retirement doctor.

  13. Dr Akmajian did my back surgery in 2010 he did an amazing job! I want him to finish my surgery, but i cant find him?? Did he already retire😞

    1. I tried looking for him as well as I tried to hire an attorney nobody wants to touch the case I don’t know why he boxed my back two times when he took out my Hardware I asked him for it and I have two rods with no serial numbers on them and still I cannot get an attorney to help me

  14. Dr. Akmakjianlm did my back surgery on June 26, 2006. He did a fusion of L4 L5. Then on January 8, 2008 He did another surgery to remove hardware from my spine. He did an excellent job. I do not take any type of pain pills. He never insisted that I NEED TO TAKE ANY MEDS. MY BACK GETS STIFF. ALL I HAVE TO DO IS A LITTLE WALKING. HE WAS AN EXCELLENT DOCTOR TO ME. I WAS FORTUNATE TO HAVE HIM AS MY SURGEON. I FEEL BLESSED. I AM SORRY TO HEAR SO MANY HAD ISSUES WITH HIM.

  15. I hope this horrible practice of preying on unknowing patients ends. With his office manager Christina Akmakjian at his side, Dr. Akmakjian ruined my life. We need more oversight, so that fake hardware is not put into patients again.

  16. I was going to jack for years , my spine is horrible, but before surgery I fell out of bed and it corrected the problem; and he agreed it wasn’t necessary for surgery now . He could have said the opposite as I had full insurance coverage. He took care of my mom and was great with her !!!

  17. Why we’re all of these paitents not notified..I had reds and all installed as well. If one is done then all is questioned….I wish to be added to this law suit…how do I do that. No to help do that

  18. Wao!!!!!!! i had most of my hardware removed after 2 years of pain and suffering , after 2 back surgeries , i hope he used medical grade hardware on me . i still have a few staples inside of me I’m wondering if they can get infected in the near future .I can’t believe i trusted him with my life …….

  19. My friend had the spinal surgery and the hardware broke 4 times, now he’s worse than when he started. D. Akmajian never cared about his patients, his waiting room and patient rooms looks like a museum for athletes. He was all show, no heart. I hope they all get what you hey deserve.

  20. I was referred to Dr. Akmajian in 2013. I’ll admit my first initial interactions with him were hit and miss at first. But once my MRI hit his desk everything was set in high gear. With my diagnosis, I would not be walking today had it not been for him. I was not privately insured either, yet he took me in. Far as I am concerned, this man is the absolute best in my book. Do I have pain? Yes. And I probably always will. Being diagnosed with cervical myelopohy, is a very serious condition. It’s painless, mostly. And by the time it’s detected, why most ppl haven’t even seen a dr, before it’s too late and damage is done, and screaming pain is the aftermath of an irreversible diagnosis. I love this man. He saved what’s left of my life.

  21. Dr Akmakjian did two spinal fusions on my lumbar spine. One was done at Tri-City Medical Center Hawaiian Gardens, CA and the second was done at Riverside Community Hospital. Both times he used fake hardware in my spine. At the time of the second surgery he removed the hardware but after the second surgery was done he implanted the second fake hardware which is still in my spne. I have been suffering persistant pain daily ever sonce the second surgery. I attempted to have the fake hardware removed several times but couldnt find a surgeon willing to remove the hardware. No one wanted to get “involved” in the complicated situation reguarding the pending civil suit against Dr Akmakjian and Riverside Community Hospital. I finally got a surgeon willing to remove it. I will be having it removed in a couple of months. I have been on opiod pain killers for many years but could never be out of pain. How could any doctor who takes an oath to care for his patients do this for money? My current Pain Management Doctor says Dr Akmakjian is in jail. I am glad. I hope he never get his license to practice medicine again

    1. I am truly sorry for what this doctor did to you! So sad! I will pray for you and pray for your healing! This doctor should have his practicing license revoked!!!

  22. The doctor is not in jail in fact he is paying people cash to say they did a great job on their backs and their necks. I randomly ran into a woman and we start talking about back surgeries and she told me she’s all for the doctor that she’s getting paid by him to say that he’s a great surgeon when his day in court does come. Too bad for me I can’t get an attorney that wants to help me or wants to touch the case

  23. I had my surgery done in 2004 and 2008 by Dr. J. Akmanjian. How would I know what type of screws were used on my neck surgery. Wo do I contact?

    1. I watched a program called Whistleblowers and this doctor was featured in the story of knowingly using fake screws in spinal fusion patients in return for kickbacks! The program said the only way to know if you are one of these patients, is to have your back opened up again and looking at the hardware to determine this!!!!

      1. Good luck with your case! I hope you find peace and healing and are NOT one is these unfortunate patients!!!

  24. Dr Jack Akmanjian did my surgery in March of 2011. How do I find information??? I have screws in my back and have been having issues.

  25. I had surgery at Pacific Hospital of long Beach in 2011 Doctor Serge Obukhoff did my surgery and he’s been indicted with the fraud case he used fake hardware on me to this day I’ve had 5 more surgeries to help me with pain I need to tell someone my story what happened to 3 at Pacific Hospital of Long Beach I don’t know who to tell, It was horrible. Help

  26. I had back surgery by Dr Akmakjian in 2006 and still had chronic pain, in 2007 he had to go back in and remove the hardware cause the screws were coming loose !! I asked for my hardware but it couldn’t be found when I was discharged from Riverside Community Hospital, at my post op appointment I asked the doctor where my hardware was and he didn’t know he said he would check with the hospital!! Never got it, probably because it was counterfeit!! Hopefully they didn’t reuse it😬

    1. That’s ridiculous that they couldn’t find it!! Anything going into your back and/or out of your back, has to literally be counted twice so to be sure nothing was left in your back! They know where that hardware is!! I’m sure some screws were counterfeit but they couldn’t hand you evidence to sue!!!!
      Good luck and I wish you peace and good health!!

  27. I wanted to sue Jack Akmajian in 1995, he messed me up very bad but he was long gone even before my first follow up after botched surgery. Was told malpractice to hard to prove. Now his office is closed and he’s in a class action suit.
    How do I get justice now?

  28. I just found out that my second neck fusion has failed just like the first one, but instead of only 2 screws coming out I have 4 screws almost out and 1 screw has cracked almost completely in my spine. The pain I go through every day and non stop is unreal and unbearable, that I wouldn’t want anyone to ever feel this pain I’m living with. I had these 2 neck surgeries within 1 month of each other back in 2013. They say this is not common and really doesn’t happen. I asked why would something like this happen? Poor machining the screws or maybe it’s not federally approved screws and hardware? Dr Jack h. Akmakjian did both fusions that both ended up as Hardware failure. My fusions were done 2/28/2013 & 3/28/2013. I thought he was a nice Dr. Now I think he’s a piece of shit and he should have fake hardware embedded into his spine. What an asshole

  29. After my first surgery at Hospital of Long Beach
    Survey performed by Dr.Jack Akamajian
    I was confined to my bed for 4 years unable to walk .
    A second surgery was needed to remove all none approved FDA hardware . Implanted by Dr.Jack Akamajian . I’m currently still in pain and I will need a third surgery .

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