Calif. fraud report chronicles provider suspensions, illegitimate liens

Since reforms took effect last year, the California Department of Industrial Relations has suspended 227 medical providers from treating injured workers and has dismissed 292,000 illegitimate liens filed by or on behalf of criminally charged providers, with claims valued at over $2.5 billion, the department announced Monday.

The state’s progress report on anti-fraud efforts since the state enacted workers compensation reforms put the focus on two pieces of legislation that aimed to stop fraud at the provider level.

The new laws that went into effect in 2017 were S.B. 1160, which requires the department to automatically stay liens belonging to providers who have been indicted or charged with crimes until the disposition of criminal proceedings, and A.B. 1244, which requires the workers compensation division’s director to suspend any medical provider, physician or practitioner from participating in the workers compensation system when convicted of fraud.

“(The department’s) anti-fraud efforts have allowed us to remove fraudulent providers and their claims for payment from the system, with the aim to improve services and reduce premium costs,” Director Christine Baker said in a press statement. “Our fraud prevention work also involves identifying fraudulent activity through data analytics and defending anti-fraud laws in court.”