Patricia 2

Case 2:08-cr-00427-MCE Document 438
Filed 07/06/11 Page 1 of 17
IN THE UNITED STATES DISTRICT COURT

FOR THE EASTERN DISTRICT OF CALIFORNIA.
---oOo--BEFORE THE HONORABLE MORRISON C. ENGLAND, JR., JUDGE
---oOo--UNITED STATES OF AMERICA,
Plaintiff,
vs.
No. 2:08-cr-00427
ALEXANDER POPOV,
RAMANATHAN PRAKASH, LANA
LE CHABRIER,
Defendants.
---oOo--REPORTER'S PARTIAL TRANSCRIPT

TESTIMONY OF
PATRICIA HOWARD-FOREMAN
WEDNESDAY, JUNE 22, 2011
---oOo---
Reported by:
DIANE J. SHEPARD, CSR #6331, RPR
DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

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APPEARANCES
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For the Government:

BENJAMIN B. WAGNER
UNITED STATES ATTORNEY
501 I Street, Suite 10-100
Sacramento, California 95814
BY: PHILIP A. FERRARI
JEAN M. HOBLER
Assistant U.S. Attorneys
For the Defendant, Lana Le Chabrier

JAN DAVID KAROWSKY
Attorney at Law
716 19th Street, Suite 100
Sacramento, California 95811
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For the Defendant, Alexander Popov:

RICHARD ALAN MOSS
Attorney at Law
255 South Marengo Avenue
Pasadena, California 91101
For the Defendant, Ramanathan Prakash:

RONALD NEIL RICHARDS
Attorney at Law
P.O. Box 11480
Beverly Hills, California 90213
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SACRAMENTO, CALIFORNIA
WEDNESDAY, JUNE 22, 2011
PARTIAL TRANSCRIPT
---oOo---
PATRICIA HOWARD-FOREMAN,
a witness called by the Government, having been previously
sworn by the Clerk to tell the truth, the whole truth, and
nothing but the truth, testified as follows:
REDIRECT EXAMINATION
10
BY MS. HOBLER:
11
Q.
12
done at the Sacramento clinic?
13
A.
Not that I know of.
14
Q.
Were nerve conduction studies performed there?
15
A.
Not that I know of.
16
Q.
How about transcranial dopplers?
17
A.
No.
18
Q.
How about carotid dopplers?
19
A.
No.
20
Q.
When did you first talk with federal agents about
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this case?
22
A.
23
something like that.
24
Q.
May 2011 sound about right?
25
A.
Yeah.
Ms. Foreman, you stated that no sleep studies were
Not that -- I don't think so.
When they showed up at my house about a month ago,
Q.
You told them that when you started working for
Dr. Prakash, you were an experienced physician assistant,
correct?
A.
Yes.
Q.
Had been a PA since January 2001?
A.
Yes.
Q.
And so you had been working as a PA for a little over
five years when you started working with Samvel and Drs. Popov
and Prakash?
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A.
Yes.
11
Q.
You could run a clinic by yourself?
12
A.
Yes, I can.
13
Q.
You told them that Samvel was your boss, but you were
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supervised by Dr. Prakash?
15
A.
Yes.
16
Q.
You told them that Dr. Prakash actually provided no
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supervision?
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MR. RICHARDS:
Your Honor, these are all leading
questions.
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THE COURT:
Sustained.
21
Q.
BY MS. HOBLER:
Did you tell them that Dr. Prakash
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provided you no supervision?
23
A.
Yes.
24
Q.
Did you tell them that you saw a pattern in the
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patient tests that were being ordered at that clinic?
A.
Yes.
Q.
Told them that you saw tests you hadn't ordered?
A.
Yes.
Q.
Did you tell them that Samvel and another man told
you to order unnecessary tests?
A.
Yes.
Q.
Did you tell them you were frustrated because the
patients never came back for follow-up?
A.
Yes.
10
Q.
Did you tell them that someone asked you to sign
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blank forms?
12
A.
Yes.
13
Q.
And did you tell them that you did that?
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A.
Yes.
15
Q.
And you told them that you saw an increasing number
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of PR-49 patients?
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A.
Yes.
18
Q.
What are PR-49 patients?
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A.
When I asked about what that was, because at first I
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didn't know what that was --
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MR. RICHARDS:
22
THE COURT:
23
Q.
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patients?
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Objection.
Hearsay.
Sustained.
BY MS. HOBLER:
MR. RICHARDS:
What is your understanding of PR-49
Hearsay.
No foundation.

1
THE COURT:
MS. HOBLER:
THE COURT:
Overruled.
It's for her state of mind.
I overruled.
Q.
BY MS. HOBLER:
Thank you.
question.
A.
Okay.
Q.
And did you understand that to be a code associated
with Medicare?
A.
Yes.
10
Q.
All right.
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results in the charts looked similar?
12
A.
Yes.
13
Q.
And did you tell them that Samvel told you the office
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staff filled out the forms that you had signed and left blank?
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A.
Yes.
16
Q.
And you say you didn't know there was anything wrong
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at the clinic?
18
A.
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wrong until I started to look through the charts, and I'm,
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like, there's something wrong here.
21
Q.
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directors?
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A.
Yes.
24
Q.
And they didn't show up very frequently?
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A.
No.
P is patient.
I didn't.
You can answer the
R is responsibility.
Code 49.
Did you tell the agents that all the test
No, I didn't.
I didn't know anything was
You say you've worked in other clinics with medical
Q.
working with you, correct?
A.
Yes.
Q.
When a PA or a doctor signs the bottom of a medical
form, what does that indicate?
A.
A medical --
Q.
We have seen multiple medical forms here.
order forms.
at the bottom of that form, what does that indicate?
But in those clinics there were doctors onsite
We have seen adult histories.
We've seen
If somebody signs
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A.
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procedure was done.
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Q.
By that individual?
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A.
Supposedly, yes.
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means that he recognizes that it was done.
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Q.
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what does that indicate?
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A.
That the supervising doctor didn't see it or hasn't.
18
Q.
Assuming it's a doctor or a PA?
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A.
And there's only one signature?
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Q.
And there's only one signature.
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A.
Then that person was responsible for it.
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Q.
I'm going to put on the screen what has been marked
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for identification as Exhibit 127.
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that is Exhibit 105.
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Indicates that either something was performed or a
Okay.
And the countersign by the doctor
And if it's signed by only one individual,
MR. RICHARDS:
It is a file from the box
Is this a new exhibit?
Because if it

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is, it's outside the scope.
MS. HOBLER:
It's in Exhibit 105.
It has been
separately marked for identification as Exhibit 127, and it has
been on our exhibit list since it was originally filed.
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MR. RICHARDS:
Outside the scope of the cross.
That's my objection.
MR. MOSS:
THE COURT:
MS. HOBLER:
10
No.
signed.
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I would join in that objection.

It does appear to be outside the scope.
She's testified to a number of forms she
I'm just going to show one to her.

MR. RICHARDS:
That would still be outside the scope.
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They can show her the form that was shown.
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not get into files with the witness.
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THE COURT:
Sustained.
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Q.
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can I get Defense Exhibit 814.
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I intentionally did
BY MS. HOBLER:
All right.
So Ms. Howard -- actually
That is your signature at the bottom of that form,
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correct?
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A.
Yes.
20
Q.
And it is dated 8-8-2006?
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A.
Yes.
22
Q.
And at that point you were working full time at La
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Vita, correct?
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A.
Yes.
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Q.
So you did not see the patient that this physician

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order form relates to, correct?
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MR. RICHARDS:
Object.
Is she asking the witness
to --
THE COURT:
THE WITNESS:
Overruled.
There is no name at the top of this
one.
Q.
correct?
A.
Yes.
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Q.
So whoever this relates to, you did not see them, did
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you?
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BY MS. HOBLER:
MR. RICHARDS:
And yet it is a form that you signed,
Objection.
Assumes a fact not in
evidence.
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THE COURT:
Overruled.
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Q.
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this form relates to, you signed it but you did not see this
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patient?
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BY MS. HOBLER:
MR. RICHARDS:
You can answer the question.
Objection.
Whoever
evidence.
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THE COURT:
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THE WITNESS:
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THE COURT:
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THE WITNESS:
Overruled.
Am I supposed to answer?
Yes.
You're supposed to answer.
There is no name, yes, I guess.
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There's no name there, so I don't know who this belonged to.
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Q.
BY MS. HOBLER:
And yet there's an order form for a

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patient, correct?
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MR. RICHARDS:
THE COURT:
The fact is there is no name on the form,
so that means there was no patient.
THE WITNESS:
THE COURT:
Objection overruled.
No patient?
That's not what I'm saying to you.
saying that to counsel.
attorney.
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Objection.
evidence.
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5
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Filed 07/06/11 Page 10 of 17
I'm
You answer the question from the
Was there a patient that you saw that related to
this form?
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THE WITNESS:
No.
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Q.
BY MS. HOBLER:
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August of 2006 ordering tests for whoever somebody decided?
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MR. RICHARDS:
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THE COURT:
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THE WITNESS:
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So did you just sign a blank form in
Assumes --
Overruled.
Sit down.
Can you go with this question?
This is
confusing.
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Are you saying did I see a patient?
No.
There is no
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name on there, so it's just my name is at the bottom, but
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there's no patient there.
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Q.
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somebody else could order tests for a patient that you had
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never seen?
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A.
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you're taking it as being.
BY MS. HOBLER:
And so did you sign this form so that
That was not my intention, but apparently that's what

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MR. RICHARDS:
THE WITNESS:
THE COURT:
Filed 07/06/11 Page 11 of 17
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Move to strike as non-responsive.

Non-responsive.
Overruled.
BY MS. HOBLER:
Yes.
That's what she responded.
Q.
Is signing blank forms consistent
with the standard of care in medicine?
A.
No.
Q.
Did you know that in 2006?
A.
Yes.
Q.
Now there were at least three months that you were
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signing charts for the Sacramento clinic for which you did not
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set foot in that clinic, is that correct?
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A.
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again?
14
Q.
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doing what you characterized as cleaning charts from L.A. for
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the clinic in Sacramento, correct?
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A.
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everything that was supposed to be done in those charts was
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done.
20
Q.
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what you had done and what somebody in the clinic had done?
22
A.
They could not have known.
23
Q.
And was that consistent with the standard of care in
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medicine?
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No.
We went over this.
Do I need to explain this
Well, let me ask you this, for three months you were
I was -- I was checking charts to make sure that
And so how did anybody looking at those charts know
MR. RICHARDS:
Objection as to what standard of care.

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THE COURT:
THE WITNESS:
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Filed 07/06/11 Page 12 of 17
Overruled.
No.
Q.
BY MS. HOBLER:
A.
I didn't think about that at the time.
Q.
Now for those three months that you were signing
charts for the Sacramento clinic from L.A., did Dr. Prakash
notice that you were not in the clinic in Sacramento?
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MR. RICHARDS:
And you knew that at the time?
Objection.
Vague.
I'm sorry.
Foundation.
Calls
for speculation.
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THE COURT:
Vague as far as in Sacramento.
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Q.
12
Dr. Prakash in the clinic in Sacramento, correct?
13
A.
Yes.
14
Q.
And he was still paying you through September of
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2006, correct?
16
A.
Yes.
17
Q.
Did he ever call you and ask you why you weren't
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showing up at the clinic?
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BY MS. HOBLER:
MR. RICHARDS:
Okay.
You were working for
Assumes a fact not in evidence.
No
foundation.
21
THE COURT:
Overruled.
22
Q.
BY MS. HOBLER:
Did he ever call you and ask you why
23
you were not showing up to work in the clinic in Sacramento?
24
A.
No.
25
Q.
To your knowledge, did Dr. Prakash have any idea that
Filed 07/06/11 Page 13 of 17
the PA he was supervising wasn't in the clinic for three
months?
A.
No.
Q.
Did Dr. Popov ever call you to ask you why you
weren't showing up to see patients in Sacramento?
A.
No.
Q.
To your knowledge, did Dr. Popov have any idea that
the PA he was supervising wasn't in the clinic for three
months?
10
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MR. MOSS:
Objection.
13
evidence.
12
THE COURT:
13
THE WITNESS:
Overruled.
No.
14
Q.
BY MS. HOBLER:
Do you remember meeting with agents
15
Heather Sowa and Marla McCarthy last week in Los Angeles?
16
A.
Yes.
17
Q.
Do you remember at one point during that meeting
18
realizing we had charts with your signatures in them dating to
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September 2006?
20
A.
Yes.
21
Q.
And realizing that you had worked at La Vita since
22
June of 2006?
23
A.
Yes.
24
Q.
Do you remember getting upset about that?
25
A.
Yes.
Filed 07/06/11 Page 14 of 17
Q.
hurt as a result of your practices at the Sacramento clinic?
A.
14
Do you remember asking whether any patients had been
Yes.
MS. HOBLER:
MR. RICHARDS:
THE COURT:
I have no further questions.

Redirect, please?
Or recross?
Recross.
RECROSS-EXAMINATION
BY MR. RICHARDS:
Q.
10
If we can just leave this on.

If you could just take a look at this, Exhibit 814.
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There is no patient name on there, is there?
12
A.
No.
13
Q.
That doesn't mean that you could -- or you can't tell
14
from this form whether any test was ordered for a blank form,
15
can you?
16
A.
No.
17
Q.
Right.
18
A.
No, it is not.
19
Q.
And counsel asked you if you order -- if signing a
20
blank form is consistent with the standard of medicine -- or
21
standard of care, and you said no.
22
answer?
23
A.
Yes.
24
Q.
But people in a medical office sign blank forms all
25
the time, don't they?
Those are just symptoms.

So this not an order form of a test, correct?
Do you remember that
Filed 07/06/11 Page 15 of 17
15
A.
Yes, we do.
Q.
So it's not the holy grail of violations if somebody
that you trust, you sign a blank form for, correct?
A.
Yes.
Q.
And did anybody on this prosecution team threaten you
in any way with charging you with something in this case?
A.
No.
Q.
Okay.
there, are you?
So you're not intimidated by anybody over
10
A.
No.
11
Q.
All right.
12
A.
Let me take that back.
13
to wonder.
14
Q.
You mean -- not me?
15
A.
No.
16
Q.
The woman sitting over there for the Government?
17
A.
You need to wonder what's happening next.
18
Q.
Well, that's not going to affect your testimony as
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far as --
20
A.
No, it's not.
21
Q.
-- being truthful, is it?
22
A.
No, it's not.
23
Q.
I just wanted to also just politely just clarify with
24
you that when you were signing -- when you were making sure
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that charts were in order, isn't it fair to say you were doing
And -After that one, I'm beginning
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Filed 07/06/11 Page 16 of 17
that as a courtesy to the clinic to assist them?
A.
Yes.
Q.
You weren't trying to do anything malicious at that
time?
A.
No, I wasn't.
Q.
And sometimes when you leave a job, you still help
out with the former employer, correct?
A.
Yes.
Q.
And you heard counsel's questions to you about
10
whether Dr. Prakash knew that you were not actually going to
11
the clinic, and you said, no, I don't think he knew.
12
remember that answer?
13
A.
Yes.
14
Q.
I just wanted to just establish -- I'm asking an
15
obvious question.
16
said, hey, I don't like what's going on with these charts, I
17
want to have a meeting, that's fair to say, right?
18
A.
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meeting -- asking for a meeting, no.
20
Q.
21
what Dr. Prakash's response would have been if you would have
22
called him and said, hey, I don't like what's going on with
23
these charts?
24
told, correct?
25
Do you
You never called Dr. Prakash at any time and
I did have them call him, but as far as having a
And so is it fair or unfair to say that we don't know
We just will never know because he was never
MS. HOBLER:
Objection.
Calls for speculation.

1
THE COURT:
Filed 07/06/11 Page 17 of 17
17
Sustained.
Q.
BY MR. RICHARDS:
When you were signing these charts
at the clinic when they would be presented to you, they looked
like normal medical charts, didn't they?
A.
Yes.
Q.
And I asked you this yesterday, but I just want to
establish.
chart would maybe go to Dr. Prakash to look at, there was no
notation in the chart that you would put, saying, hey, I'm
By the time you would sign the chart, and then the
10
concerned about these items, or I have a question, would you?
11
A.
Not a notation like that, no.
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MR. RICHARDS:
Thank you very much.
13
(End of partial transcript.)
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CERTIFICATION
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I, Diane J. Shepard, certify that the foregoing is a
18
correct transcript from the record of proceedings in the
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above-entitled matter.
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/s/ DIANE J. SHEPARD

DIANE J. SHEPARD, CSR #6331, RPR
Official Court Reporter
United States District Court
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Case 2:08-cr-00427-MCE Document 438

Filed 07/06/11 Page 1 of 17

IN THE UNITED STATES DISTRICT COURT

---oOo--REPORTER'S PARTIAL TRANSCRIPT

DIANE J. SHEPARD, CSR #6331, RPR

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 438

Filed 07/06/11 Page 2 of 17

For the Government:

For the Defendant, Lana Le Chabrier

For the Defendant, Alexander Popov:

For the Defendant, Ramanathan Prakash:

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 438

Filed 07/06/11 Page 3 of 17

WEDNESDAY, JUNE 22, 2011

a witness called by the Government, having been previously

nothing but the truth, testified as follows:

done at the Sacramento clinic?

Not that I know of.

Were nerve conduction studies performed there?

Not that I know of.

How about transcranial dopplers?

How about carotid dopplers?

When did you first talk with federal agents about

something like that.

May 2011 sound about right?

Ms. Foreman, you stated that no sleep studies were

Not that -- I don't think so.

When they showed up at my house about a month ago,

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 438

Filed 07/06/11 Page 4 of 17

You told them that when you started working for

Dr. Prakash, you were an experienced physician assistant,

Had been a PA since January 2001?

And so you had been working as a PA for a little over

You could run a clinic by yourself?

supervised by Dr. Prakash?

You told them that Dr. Prakash actually provided no

Your Honor, these are all leading

Did you tell them that Dr. Prakash

provided you no supervision?

Did you tell them that you saw a pattern in the

patient tests that were being ordered at that clinic?

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 438

Filed 07/06/11 Page 5 of 17

Told them that you saw tests you hadn't ordered?

you to order unnecessary tests?

Did you tell them you were frustrated because the

patients never came back for follow-up?

Did you tell them that someone asked you to sign

And did you tell them that you did that?

And you told them that you saw an increasing number

What are PR-49 patients?

When I asked about what that was, because at first I

didn't know what that was --

What is your understanding of PR-49

DIANE J. SHEPARD, OFFICIAL COURT REPORTER, USDC -- (916) 554-7460

Case 2:08-cr-00427-MCE Document 438

Filed 07/06/11 Page 6 of 17

And did you understand that to be a code associated

results in the charts looked similar?