Workers’ Compensation Insurance Fraud

Workers’ compensation fraud costs California billions each year. Workers’ compensation fraud can take the form of health care providers billing for services never performed, employers under-reporting payroll, and attorneys or claims adjusters facilitating fraud.

Workers compensation fraudsters include medical providers who:

  • Bill for inappropriate or unnecessary treatment
  • Submit bills with improper medical codes
  • Pay bribes or kickbacks

Workers compensation fraudsters includeinsurers, claims administrators and third-party administrators who:

  • Make payments to nonexistent claimants or medical providers
  • Refer patients or clients to medical providers or attorneys for compensation
  • Issue excessive payments to an attorney or medical provider in return for kickbacks
  • Backdate documents to avoid penalties, or alter documents to support unjustified denials of claims



Workers compensation fraudsters include employers who:

  • Misreport claims history, or omit work injuries
  • Encourage workers to submit fraudulent claims



May 2018