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 …
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 …
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 …
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 …
Orange County Superior Court judge Israel Claustro agreed to plead guilty to federal charges that he defrauded the California workers’ comp system, in particular the Subsequent Injuries Benefits Trust Fund, …
The California Department of Insurance will hold a public meeting to discuss potential changes to regulations governing insurance fraud grant programs. The agency has developed draft regulations to standardize oversight of programs that grant California’s district attorneys funding to pursue insurance fraud. “The proposed regulations aim to standardize the management of grant programs administered by …
Federal officials filed an eight-count federal indictment naming seven staffing industry executives as defendants. The case alleges a scheme to pocket payroll taxes from client employers and workers, and to cheat workers’ comp carriers out of premium. Proceeds from the $90 million scheme allegedly went toward buying real estate, luxury cars, expensive vacations, and other …
The California Department of Insurance Fraud Assessment Commission (FAC) voted to hold the anti-fraud assessment steady next year. That marks the third year the Commission has voted not to increase the employer assessment for fraud fighting. The Commission may review a potential one-time shift in the funding split between District Attorneys and CDI’s Fraud division …