A California court of appeal is reinstating a “qui tam” complaint against a chiropractor and his associates who were convicted of defrauding the California workers’ comp system. The Superior Court dismissed the Qui Tam case filed by a whistleblower as untimely. But an appeals court says that the nearly three years the complaint was kept …
Three defendants will be in court to face arraignment next week on three felony counts alleging they conspired to defraud workers’ comp carriers through the Supplemental Job Displacement Benefit program. The defendants operated the iLearn Institute in San Francisco. Allegedly they pocketed more than $6 million from workers’ comp carriers for training services never provided …
The California Insurance Guarantee Association is taking a more direct role in fighting insurance fraud by creating an in-house special investigations unit (SIU) to investigate suspicious claims activity. Just over a year old, the unit is actively working cases, and leaders say one investigation is getting close to an indictment. “Most of our investigation time …
Insurance company investigators, prosecutors, and defense attorneys warn that organized crime is alive and well in California’s workers’ comp system. They say networks of cappers are driving schemes that often work in collusion with applicant’s attorneys, doctors, and marketers. “Organized crime is happening every single day. There are cappers out there, marketers, solicitors. They’re waking …
Commissioners at the California Fraud Assessment Commission voted 3-2 to hold the employer assessment steady next year at $85,700,386. Motions for increases of up to 10% failed. Commissioners voting against the measure voted on an earlier motion for a 3% increase, while the District Attorneys sought an 8% increase in the assessment. The pushback against …
Insurance Commissioner Ricardo Lara made a handful of changes to the recommendations of an anti-fraud funding review panel for distributing $50,545,239. The money goes to California’s District Attorneys to fight workers’ comp fraud. In the end, the three most expensive programs in California had to take less than they requested so that two other counties …
Orange County Superior Court Judge Sheila Hansen dismissed all charges against the defendants in the Landmark Medical Management workers’ comp fraud case, including a manslaughter charge. An earlier finding of prosecutorial misconduct tainted much of the evidence. The failed prosecution is the second major loss in a workers’ comp provider fraud case for the Orange …