The Division of Workers’ Compensation agreed to drop nearly $200,000 in administrative penalties against Keenan and Associates, a Third-Party Administrator that failed a DIR claims audit. For its part, Keenan agreed to fix the problems identified in the audit and drop its appeal. The settlement leaves the failing grade intact. The deal was revealed as …
The California Department of Insurance Fraud Assessment Commission (FAC) approved another one-year adjustment to the anti-fraud funding formula. This one will redirect approximately $4 million away from county district attorneys and give it to the Department. Insurance Commissioner Ricardo Lara requested the change after DAs again failed to use the entirety of the grants provided …
The number of suspected workers’ comp fraud cases (SFCs) referred to California Department of Insurance investigators is returning to normal. Referrals plummeted during the pandemic. The Department’s Fraud Division received nearly 3,000 referrals last year involving cases with more than $149 million in potential losses. California Insurance Code section 1872.4 requires carriers to report suspected …
The Orange County District Attorney’s Office announced a 13-count felony complaint against a twice-convicted felon that accuses him of running a kickback scheme that generated $100 million in fraudulent bills on workers’ comp claims. Charged along with three others, the ringleader allegedly created a medical management company that ran clinics and steered workers’ comp claimants …
The State Bar of California will hold a disciplinary hearing next month to determine if attorney Matthew Rifat’s conviction for soliciting business with reckless disregard for an entity’s intent to commit insurance fraud constitutes moral turpitude. The attorney was connected to an alleged medical mill in Riverside County that prosecutors said bilked the system out …
In yet another case involving fraudulent staffing companies, the head of the BaronHR staffing empire – Luis E. Perez – agreed to a plea agreement that has him pleading guilty to cheating the federal government out of nearly $60 million in taxes. Perez was accused of personally evading nearly $30 million in taxes, penalties, and …
The Los Angeles County District Attorney filed charges against six individuals alleging insurance fraud and labor code violations related to the Supplemental Job Displacement Benefit program. Prosecutors allege executives at the Caledonian Vocational School paid kickbacks to vocational counselors for referring injured workers and then cheated the workers out of their SJDB benefits. Guillermo Frias, …
Some $52,479,138 was awarded to 33 district attorneys around the state to fight workers’ compensation fraud. The funding includes nearly $5.4 million that was awarded to the DAs last year but was not spent. California employers pay $90 million per year to fight workers’ comp fraud through assessments on workers’ comp premiums or directly to …