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Finger Pointing Amid the Fight Against Workers’ Comp Fraud

District Attorneys around the state are decrying a sharp drop in the number of suspected fraud referrals over the past few years and complain that pandemic-induced changes to carrier operations are sabotaging the prosecution of cases. But employers and insurance carriers say that many DAs are unresponsive when fraud cases are brought to their attention, … Read More »

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Fraud Assessment Commission Losing Decades of Experience

The Fraud Assessment Commission is heading into 2024 with two of its seven commissioner positions vacant, and now the two longest-serving members on the commission have announced that the January meeting will be their last. FAC chairman Don Marshall of Zenith Insurance and self-insured representative John Riggs of Disney are stepping down after each has … Read More »

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Employers To Pay More To Fight Workers’ Comp Fraud

The California Department of Insurance Fraud Assessment Commission members will reconvene this morning to decide how much employers will pay next year to fight workers’ comp fraud. It is a foregone conclusion it will be more than this year. A majority of the members already expressed support for an increase at a meeting of the … Read More »

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Court Reinstates Qui Tam Case Alleging Fraud

The Second District Court of Appeal says Allstate Insurance Company can proceed with its lawsuits alleging that a group of radiologists and other affiliates have been defrauding workers’ comp and auto insurance carriers by overbilling for radiology services. The carrier alleges the medical corporations are controlled by an unlicensed individual and operated as a referral … Read More »

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DA’s Anti-Fraud Funds Approved

Insurance Commissioner Ricardo Lara changed the funding allocations for two counties as he signed off on workers’ comp anti-fraud funding recommendations. The commissioners at the Fraud Assessment Commission consented to the changes without any objections. The money comes from all California employers. It is in addition to the regular funding District Attorney’s get from their … Read More »

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DAs’ Fraud Funding Requests Get Mixed Reactions

Representatives from 34 district attorneys’ offices pitched on behalf of 44 counties for a share of the $50,545,239 California employers are required to provide next year to fight fraud in the workers’ comp system. The five-member review panel queried the applicants about their program’s successes, problems, and plans for funding before making their allocation recommendations … Read More »

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Pandemic Era Changes Hampering Workers’ Comp Fraud Prosecutions

Prosecutors and investigators are making steady gains against medical providers and vendors intent on cheating the workers’ comp system. Officials say they’re suspending some 40 providers a week on average and should rid the system of another $500 million in suspect liens this year to go with the $701 million in liens already dismissed. However, … Read More »

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Qui Tam Complaint Can Move Forward

A California court of appeal is reinstating a “qui tam” complaint against a chiropractor and his associates who were convicted of defrauding the California workers’ comp system. The Superior Court dismissed the Qui Tam case filed by a whistleblower as untimely. But an appeals court says that the nearly three years the complaint was kept … Read More »

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