1. Department of Industrial Relations

Anti-Fraud Unit

The Anti-Fraud Unit deals with suspending any physician, practitioner, or provider from participating in the Worker’s Compensation system, per Labor Code § 139.21 and staying liens of criminally charged providers, per Labor Code § 4615.

Suspensions

Suspension of any physician, practitioner, or provider from participating in the workers’ compensation system can occur if the individual or entity meets any of the criteria, per Labor Code § 139.21(a)(1):

1. The individual or entity has been convicted of felony or misdemeanor, per outlined criteria. The individual or entity has been suspended, due to fraud or abuse, from the federal Medicare or Medicaid programs or the Medi-Cal program. The individual’s license, certificate, or approval to provide health care has been surrendered or revoked. The entity is controlled by an individual who has been convicted of a felony or misdemeanor described in subparagraph (A). Suspension Activities
2. Suspension notices, hearing requests, and suspension orders for physicians, practitioners, and providers.
3. Lien Consolidation Hearings for Suspended Physicians, Practitioners, or Providers Pursuant to Labor Code § 139.21
4. Hearing details for addressing pending liens for physicians, practitioners, and providers who are suspended based upon a criminal conviction, per Labor Code § 139.21(a)(1)(A).
   • Suspension Activities
     Suspension notices, hearing requests, and suspension orders for physicians, practitioners, and providers.
   • Lien Consolidation Hearings for Suspended Physicians, Practitioners, or Providers Pursuant to Labor Code § 139.21
     Hearing details for addressing pending liens for physicians, practitioners, and providers who are suspended based upon a criminal conviction, per Labor Code § 139.21(a)(1)(A).

Criminally Charged Providers

When criminal charges are filed against a physician, practitioner, or provider for a crime described in Labor Code § 139.21(a)(1)(A), liens that meet the criteria per Labor Code § 4615(a)(1), are subject to an automatic stay. Liens are stayed in Electronic Adjudication Management System (EAMS) which is used for the Division of Workers' Compensation’s (DWC) case management process.

• 4615 Public Documents
  Documents DWC relied on for criminally charged physician, practitioner, or providers whose liens are stayed in EAMS under Labor Code section § 4615(a)(1).
  
• Criminally Charged Providers Whose Liens are Stayed Pursuant to Labor Code § 4615(a)(1)
  Names of criminally charged physician, practitioner, or providers along with case information for criminal charges whose liens are stayed in EAMS under Labor Code section § 4615(a)(1).
  
• Lien Claimants with 4615 Designation in EAMS
  EAMS reference number, entity name, and entity address associated with criminally charged physician, practitioner, or providers for whose liens are stayed in EAMS under Labor Code section § 4615(a)(1).

To refer a physician, practitioner, or provider for suspension and/or automatic lien stay, please contact the Anti-Fraud Unit

August 2021