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Member, Beacon International Group, Ltd.
Workers compensation fraud is under attack in California, where recent laws and system overhauls have made it easier for regulators to find, prosecute and suspend those trying to manipulate the system.
In April, law enforcement working with regulators cracked open a $40 million scheme involving more than two dozen doctors, pharmacists and business owners in Orange County, California, involved in a fraudulent workers compensation medical billing and kickback operation. An article about the case was the most read Workers Compensation story on Business Insurance’s website in 2017.
Those who have previously been convicted of criminal acts that ranged from Medicare billing fraud to negligence are also on notice: as of mid-December, the California Division of Workers Compensation suspended 131 doctors treating injured workers. The division posted suspensions in chunks, with the bulk occurring toward the end of the year.
The suspensions were in line with A.B. 1244, which went into effect Jan. 1 and required the division’s administrative director to suspend any medical provider, physician or practitioner from participating in the workers comp system in cases that involve criminal activity or inability to perform duties safely, among other requirements.
A handful of suspended physicians had been deemed incapable of working due to health issues.
The state didn’t stop there. In September, Gov. Jerry Brown signed A.B. 1422, which he called “clean-up legislation to last year’s workers comp anti-fraud bills.” The new law requires the liens of doctors who had been charged with crimes involving the federal Medicare or Medicaid programs, the Medi-Cal program or the workers compensation system to be automatically stayed, along with any interest accruing, until disposition of the criminal proceedings.