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Friday, June 14, 2024 | Back issues
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Medi-Cal Office Described as Nest of Vipers

VENTURA, Calif. (CN) - Ventura County Medi-Cal administrators can't account for nearly $1 million in public money in their discriminatory and nepotistic program, and fired the women who blew the whistle on it, two former employees claim in court.

Aimee Sziklai, Candice Limousin and John Limousin sued the Ventura County Medi-Cal Managed Care Commission dba Gold Coast Health Plan (GCHP), Regional Government Services (RGS), and four individuals, alleging 11 causes of action, including fraud, defamation, conversion, wrongful termination, retaliation, discrimination and violations of the Labor Code and Constitution, in Ventura County Court.

The individual defendants are Jennifer Bower, then-head of human resources for RGS; Earl Greenia, CEO of GCHP; Andre Galvan, manager and then director of member services for GCHP; and Pamela Kapustay, director of health services for GCHP.

Candice Limousin claims GCHP and RGS hired her in 2010, to work under defendant Bower. Limousin says she began as an independent contractor but became a regular employee in December 2010.

After defendant Greenia took over as CEO of Gold Coast, Limousin says, she warned him against hiring his handpicked CFO because of her criminal record. She claims she also provided "advice and guidance to Greenia regarding human resource issues," including about his "open and public disparagement" of plaintiff Sziklai, whom he hired as interim COO.

Limousin says she regularly advised Greenia to convert Sziklai to regular status, and that keeping her as an interim violated labor codes. She says that twice, in August and September 2011, she warned Bower of Greenia's disparate treatment - and of her own fear of losing her own job for speaking out against Greenia.

Meanwhile, Greenia brought another friend aboard, defendant Andre Galvan. According to Limousin, she objected to the hiring and told Greenia that Galvan had been convicted of a felony.

"Nevertheless, Greenia insisted upon Galvan being hired. Once hired, Galvan wanted to be promoted to a director position. Greenia repeatedly asked Sziklai about promoting Galvan to director, stating 'Andre really wants to be a director.' Sziklai and Limousin repeatedly advised Greenia that Galvan was not competent in his role, and that such a promotion would be negatively viewed by staff and unwarranted. Greenia then removed Galvan from under Sziklai's direct report and promoted him to director. The promotion was made despite the objection of three directors who asserted that Galvan was not qualified to be Director of Member Services. Limousin informed Greenia of the impropriety of giving Galvan raises and promoting him to a director position, and advised that such an action would result in turmoil, since many in the organization did not view Galvan as qualified and did not support the promotion. Greenia's response was 'I'm tired of all this and they can kiss my ass ... there's not enough people around here that are doing that,'" the complaint states.

Things didn't go well from the outset of Galvan's promotion, Limousin says. She says she investigated sexual harassment complaints against him from two female employees he supervised.


"Limousin informed Bower that she was fearful of retaliation by Greenia and feared that she would be terminated by Greenia for performing her job duties with respect to the complaints regarding Galvan. Limousin's fear was a direct result of Greenia voicing his threats to terminate employees who disagreed with him or with his chosen favorite employees, which included Galvan. Limousin further feared for her job having witnessed Greenia's threats to terminate Sziklai for performing her job," the complaint states.

According to the complaint, Limousin also counseled Greenia after several employees complained about his purported affair with his administrative assistant. But things got really nasty in early 2012, when the California Department of Health Care Services ordered an independent audit of GCHP's books after hospital complaints of slow payments and accounting irregularities, the complaint states.

The state hired Berkeley Research Group to investigate the agency and ordered all officers, directors and employees to cooperate. Greenia responded by ordering certain directors to stay away from the GCHP offices during the probe, according to the complaint.

But Limousin says she met with investigators and "truthfully disclosed information pertaining to violations of California and federal law."

"Limousin further informed investigators of gross waste of funds, including but not limited to:

"a. Greenia's comment about the furniture in his office, that 'a woman must have picked out the furniture' and then instructed Limousin to purchase new furniture at a cost of $6,000 - $8,000;

"b. Greenia extending $17,000 in relocation expenses to the CFO after several months of working as an 'interim' employee with all housing and travel expenses paid for by GCHP. Other 'interim' directors were encouraged to promptly convert to 'regular employee' status so as to eliminate the housing and travel expenses;

"c. In addition to the $20,000 severance payment made to the claims director upon her voluntary resignation, Greenia also paid the same claims director $9,000 as relocation expenses even though she was not to be relocating;

"d. Greenia, against the advice of Sziklai, the CMO, the CFO and other plan directors approved approximately $280,000 for needless advertising even though GCHP was the only Medi-Cal program for Ventura County, thus approving his friend [communications director Steven] Lalich's expenditures without question or inquiry;

"e. Greenia used his friend's executive search firm for the director of QI and the CFO positions, despite less costly available methods for searching, as presented by Limousin;

"g. Greenia directed salary increases for his friend Galvan from $90,000 to $110,000 to $140,000 over a three-month period over Limousin's and the other directors' objections;

"h. Greenia needlessly increased the budget by refusing to follow the approved performance appraisal process which dictated prorating raises based upon length of service and performance rating," the complaint states.

Limousin says Greenia's waste of public money was just the beginning. She says she and Sziklai told investigators that Greenia's gross mismanagement resulted in a disruption of vendor and employee relations because he ignored "aggressive and hostile behavior" on the part of defendant Kapustay, who falsely accused a Xerox account executive of sexual harassment.

Greenia also withheld information and made misleading statements about contract negotiations with Clínicas del Camino Real, Inc. to take care of treatment, hospitalization, billing and other services for some of the 100,000 Medi-Cal patients covered by GCHP, according to the complaint. State officials blocked the deal last week, according to the Ventura County Star.

"Greenia and Galvan were adjusting the auto-assignment of members to unfairly benefit Clínicas del Camino Real, Inc. and making those assignments retroactive to July 1, 2011. [Greenia withheld] information about contract negotiations with Clínicas from the director of provider relations and contracting and the director of health services. Greenia further falsely asserted that credentialing had been fully delegated to Clínicas unlike other provider processes," the complaint states.


Limousin says she also reported Greenia's "abuse of authority and violation of law" to the independent auditors.

"Greenia's selection of candidates was based upon prior personal relationships rather than qualifications. Despite the lack of requirement or need for a project specialist, Greenia insisted upon hiring his friend Galvan who was not qualified for any specific business need. In January 2011, Greenia decided that a communications director was necessary, over objection of other directors. Two highly qualified female candidates were interviewed and recommended by the panel. Greenia directed that his friend Lalich be hired for the position over the recommendation of the panel against his hire due to lack of qualifications in the business," according to the complaint.

Greenia, Galvan and Lalich openly derided gays and lesbians - at one time asking Sziklai if she "ate steak," which apparently was a code word for lesbians. They also made derogatory race-based comments and pejorative statements about handicapped people, according to the complaint.

Sziklai says she told auditors that Greenia ordered her to alter the results of Medi-Cal's auto-assignment rules, the process which assigns beneficiaries to clinics and physicians. When she refused, she says, Greenia threatened to fire her.

"PCP auto-assignment rules were not openly and accurately communicated to the commission or providers. After assignments were made, Greenia instructed Sziklai to alter the assignment results in violation of Medi-Cal laws. Sziklai refused to alter the results. Thereafter, Greenia threatened to fire her and instructed that she was not to provide the outcome of selection and assignment results to providers," Sziklai says in the complaint.

Greenia's harassment of Sziklai escalated the more she questioned, according to the complaint.

"Commencing in the beginning of August 2011, whenever Sziklai raised operations questions to Greenia, Galvan or Lalich, she would be told 'You need to talk less and smile more.' Such statements were not made to any male employees. Sziklai was also repeatedly informed by Greenia, Galvan and Lalich that 'loyalty is more important than competency.' Sziklai is informed and believes that those statements were not made to male employees. These refrains were further directed at Sziklai by Bower. Simultaneously, she was frequently told that she was doing a superior job as COO and that there were no performance issues," Sziklai says in the complaint.

Sziklai claims she also told investigators that Greenia kept a $250,000 slush fund and regularly altered organization charts, changed employee titles and unilaterally reallocated budgets.

"Financial accounting problems result[ed] in inability to reconcile accounts with between $500,000 and more than $1,000,000 remaining unaccounted for," Sziklai says in the complaint.

After the investigation by independent auditors, Greenia announced plans to bring in an investigator of his own from defendant - and county-run - Regional Government Services. According to the complaint, he said he wanted to explore rumors that Sziklai had "coached employees to tell the auditors everything that was wrong with GCHP."

Five days later - before any investigator interviewed them - Limousin and Sziklai, Bower fired them via telephone and email, providing with no reason for the termination. Neither received the company-standard progressive discipline or coaching before being fired, they say.

One week after firing Limousin and Sziklai, Greenia resigned, telling his bosses at the Ventura County Medi-Cal Managed Care Commission that "he made the decision with sadness but though it was best for him," according to the Ventura County Star.

Both women claim that after Greenia resigned, Bower begged them not to initiate wrongful termination proceedings, promising them that they would be rehired. They say that county and commission officials told them the same thing.

But that's not what happened, they say.

"Subsequent to Sziklai's and Limousin's termination of employment, Kapustay, health services director, made a false statement to the Ventura County Star newspaper, under color of authority as a director and as an employee of RGS and GCHP that Sziklai's and Limousin's terminations were 'justified.' Bower was requested to obtain a retraction and to address the apparently authorized false statements being made to the media by an RGS and GCHP employee. Bower refused to do so.

"Subsequent to the termination of Limousin and Sziklai, and on the eve of the commission meeting that Bower had represented she would recommend reinstatement, but instead recommended against reinstatement, Bower informed Sziklai and Limousin that an 'independent' investigation was being conducted into purported racial slurs allegedly made by Limousin and Sziklai. Bower expressly stated that if they did not voluntarily participate in the investigation that the findings would be publicly reported and they could read the results in the commission's minutes or in the newspaper.

"The purported claim[s] of racial slurs were made by Galvan and were completely without merit. Galvan himself engaged in repeated racial slurs against persons of his own ethnicity, made sexually inappropriate comments to Sziklai and about gays and lesbians, and was investigated for harassing two of his direct reports. Galvan, after making his purported claim of racial discrimination, was heard by several people stating that he has 'whistleblower' protection for making these claims. Limousin and Sziklai are informed and believe that the racial slur claims were trumped up by Galvan with the tacit approval of Bower and Greenia, at precisely the same time that Bower advised Limousin and Sziklai that she would recommend their reinstatement, but immediately thereafter informed the commission in closed session that she was against reinstatement," the women say in their complaint.

Closed-door discussions of employment status without giving Sziklai and Limousin notice violated California's Brown Act, the women say. After a four-month independent investigation, they say, both were cleared of Galvan's charges.

According to the complaint, Galvan claimed that Sziklai referred to Latinos as "Mixtecas," and "your people," and called Galvan "boy." He accused Limousin of stating that "Mexicans are nothing more than toilet bowl cleaners" and referring to him in staff meetings as "whatever his name is over there."

Limousin's husband, John Limousin, claims he lost a lucrative real estate deal because of his wife's wrongful termination. He says he entered into an agreement to sell the home of one of his wife's coworkers - nonparty Melanie Frampton - when his wife was fired.

"Plaintiffs are informed and believe that Melanie Frampton and [fiancé] James Alba were instructed by Bower to have no further contact with plaintiffs under threat of loss of Frampton's job with GCHP and RGS. This resulted in Frampton and Alba informing J. Limousin that they could not list their property for sale with him. The property listing with J. Limousin was then canceled and subsequently listed for sale with another real estate broker and recently sold," according to the complaint.

The plaintiffs seek compensatory, special, punitive and statutory damages. They are represented by Fern Nisen of Los Angeles.

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