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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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Supplemental Job Fraud Case Filed

Three defendants will be in court to face arraignment next week on three felony counts alleging they conspired to defraud workers’ comp carriers through the Supplemental Job Displacement Benefit program. The defendants operated the iLearn Institute in San Francisco. Allegedly they pocketed more than $6 million from workers’ comp carriers for training services never provided … Read More »

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CIGA Launches In-House Fraud Fighting Unit

The California Insurance Guarantee Association is taking a more direct role in fighting insurance fraud by creating an in-house special investigations unit (SIU) to investigate suspicious claims activity. Just over a year old, the unit is actively working cases, and leaders say one investigation is getting close to an indictment. “Most of our investigation time … Read More »

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Commission Updates Goals For Fraud Prosecutions

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