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CDI Wants Changes to Anti-Fraud Funding

The California Department of Insurance is proposing updates to the regulations governing grant funding programs that fight fraud in workers’ compensation, automobile, disability, and healthcare insurance. The regulations haven’t been updated in decades. Tens of millions of dollars are awarded annually to county district attorneys (see related story on page 6). The Department will hold … Read More »

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Commissioner, FAC Approve Funding Split Among District Attorneys

The Fraud Assessment Commission and Insurance Commissioner Ricardo Lara approved a review panel’s recommendations for splitting $55.6 million in anti-fraud funds among 30 District Attorneys. The number of DAs getting funding this year to fight workers’ comp fraud is down by two after Merced and Tulare counties did not apply this year. In 2025, Tehama … Read More »

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Prosecutors & Carriers Are Failing in Anti-Fraud Results

District attorneys from around the state made their case for a share of the anti-fraud funds to a panel of experts in the field. Many DAs faced pushback for the meager results they have produced to date, but their partners in the fight against workers’ comp fraud – the workers’ comp carriers – also took … Read More »

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Stalled Workers’ Comp Fraud Bill Amended Before Hearing

A proposal to help insurers fight workers’ comp premium fraud was amended by Members ahead of a hearing before the Assembly Insurance Committee scheduled for later this morning. The legislation, designed to provide insurers with greater access to the payroll records employers submit to the Employment Development Department, was narrowed in a bid to advance … Read More »

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Plaintiff Faces Workers’ Comp Exclusivity

The Fourth District Court of Appeal ruled that a lower court was correct to dismiss an injured employee’s lawsuit alleging fraud and violations of California’s unfair competition law and the federal RICO Act. The court says the actions of the third-party administrators, claims adjuster, and provider were all covered under the Workers’ Compensation Act’s exclusive … Read More »

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Workers’ Comp Fraudster Linked To $270M Medi-Cal Fraud

Federal prosecutors secured a guilty plea in a $270 million Medi-Cal fraud scheme that submitted fraudulent bills for high-cost compounded medications made from generic ingredients that were not medically necessary or, in many cases, not even provided. It was a page straight out of the workers’ compensation fraud handbook – literally. Pleading guilty was Paul … Read More »

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Former Judge Banned Over SIBTF Fraud

The California Commission on Judicial Performance imposed public censure and barred former Judge Israel Claustro from ever taking the bench again. The action follows Claustro’s admission of guilt to a scheme that defrauded the state’s Subsequent Injuries Benefits Trust Fund and the California employers who fund it. “The parties request that the Commission resolve this … Read More »

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And a Fight Breaks Out

Insurance Commissioner Ricardo Lara and the California Department of Insurance asked, for the third time in three years, that the Fraud Assessment Commission approve a one-time realignment of how anti-fraud funds are divided between CDI and county District Attorneys. CDI argued for a bigger piece of the pie given that the DAs were again leaving … Read More »

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