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
- Searchable Database of Liens Dismissed per Labor Code §4903.05(c)(2)
- Suspended Provider List
- Criminally Charged Providers Whose Liens are Stayed pursuant to Labor Code § 4615
- Lien consolidation hearings’ Special Adjudication Unit Calendar
- Full List of Lien Claimants Whose Liens Have Been Flagged In EAMS As Potentially Subject To A Stay Under Labor Code Section 4615
- Public documents on which DWC relied in flagging lien claimants in EAMS as potentially subject to a stay under Labor Code section 4615.
- Report suspected medical care provider fraud
- Report fraud committed by a medical provider who is a Qualified Medical Evaluator (QME), by submitting the QME Complaint Form.
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
- California Department of Insurance Fraud Division
- Workers' Compensation Insurance Rating Bureau of California (WCIRB): Look up insurers who wrote a California workers’ compensation insurance policy for a specific employer on a specific date within the last five years.
Workers compensation fraudsters include employers who:
- Misreport claims history, or omit work injuries
- Encourage workers to submit fraudulent claims