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Organized Crime: Continuing Problem For Workers’ Comp

Insurance company investigators, prosecutors, and defense attorneys warn that organized crime is alive and well in California’s workers’ comp system. They say networks of cappers are driving schemes that often work in collusion with applicant’s attorneys, doctors, and marketers. “Organized crime is happening every single day. There are cappers out there, marketers, solicitors. They’re waking … Read More »

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Declining Stats Beget Zero Increase In Fraud Assessment

Commissioners at the California Fraud Assessment Commission voted 3-2 to hold the employer assessment steady next year at $85,700,386. Motions for increases of up to 10% failed. Commissioners voting against the measure voted on an earlier motion for a 3% increase, while the District Attorneys sought an 8% increase in the assessment. The pushback against … Read More »

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$50.5 Million In Anti-Fraud Funds

Insurance Commissioner Ricardo Lara made a handful of changes to the recommendations of an anti-fraud funding review panel for distributing $50,545,239. The money goes to California’s District Attorneys to fight workers’ comp fraud. In the end, the three most expensive programs in California had to take less than they requested so that two other counties … Read More »

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Court Tosses Landmark Medical Fraud Case

Orange County Superior Court Judge Sheila Hansen dismissed all charges against the defendants in the Landmark Medical Management workers’ comp fraud case, including a manslaughter charge. An earlier finding of prosecutorial misconduct tainted much of the evidence. The failed prosecution is the second major loss in a workers’ comp provider fraud case for the Orange … Read More »

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Does the Fraud Law Apply To Insurers & Adjusters?

The Fourth District Court of Appeal says it was proper to dismiss a case alleging a workers’ comp carrier, its claims administrator, and the claims adjuster violated Insurance Code section 1871.7 – the Insurance Frauds Prevention Act (IFPA). The Court maintains that the act’s purpose is to prevent and punish fraudulent claims made to insurance … Read More »

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Radiologist Acquitted In Decade Old Fraud Case

A Southern California jury last week acquitted Dr. Sim Carlisle Hoffman of the sole remaining workers’ comp fraud claim he was facing after the multi-week trial. The verdict came a week after the judge gutted the prosecution’s case and dismissed 120 charged felonies leaving only a charge for a fraudulent claim for health benefits. The … Read More »

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One Conviction Out of 78 Charges In Temp Agency Fraud Case

Nearly four years and two trials later, the Los Angeles District Attorney’s Office secured only a single felony conviction against the owner of a Southern California staffing company. It is for transacting insurance without a certificate of authority. The charge was one of 78 alleged in both trials, but the jury acquitted on all the … Read More »

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Three Separate Employers Indicted For Hiding Payroll

District Attorneys in three counties are pressing fraud charges against employers accused of hiding millions of dollars in payroll from their insurance carriers in a bid to lower their workers’ comp premiums. In one case the employer claimed to have only one full time employee, but prosecutors say they’ve found at least $1.7 million in … Read More »

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