The Fourth District Court of Appeal says it was proper to dismiss a case alleging a workers’ comp carrier, its claims administrator, and the claims adjuster violated Insurance Code section 1871.7 – the Insurance Frauds Prevention Act (IFPA). The Court maintains that the act’s purpose is to prevent and punish fraudulent claims made to insurance …
A Southern California jury last week acquitted Dr. Sim Carlisle Hoffman of the sole remaining workers’ comp fraud claim he was facing after the multi-week trial. The verdict came a week after the judge gutted the prosecution’s case and dismissed 120 charged felonies leaving only a charge for a fraudulent claim for health benefits. The …
Nearly four years and two trials later, the Los Angeles District Attorney’s Office secured only a single felony conviction against the owner of a Southern California staffing company. It is for transacting insurance without a certificate of authority. The charge was one of 78 alleged in both trials, but the jury acquitted on all the …
District Attorneys in three counties are pressing fraud charges against employers accused of hiding millions of dollars in payroll from their insurance carriers in a bid to lower their workers’ comp premiums. In one case the employer claimed to have only one full time employee, but prosecutors say they’ve found at least $1.7 million in …
President Donald J. Trump granted a full pardon to Dr. Faustino Bernadett, who was facing a 15-month prison sentence for failing to expose the illegal kickback scheme at Pacific Hospital of Long Beach. Bernadett owned the hospital for five years, during the time Michael Drobot ran the scam that generated nearly $1 billion in fraudulent …
Workers’ comp claim activity has decreased significantly during the COVID-19 pandemic as Californians sheltered in place and many businesses curtailed operations. Telemedicine quickly became an option for injured workers needing to continue their treatment, but investigators say that while the service is useful some unscrupulous providers and cheats may be preparing to use it to …
The California Department of Insurance’s continuing effort to update the rules for insurance carriers’ special investigative units (SIU) has produced a third set of amended draft regulations with changes to streamline some provisions while expanding on others. The updates also reflect the reality of the lengthy rulemaking process, which started over a year ago with …
Orange County prosecutors filed felony charges against two people in an alleged kickback and workers’ comp insurance fraud scheme. Prosecutors say that Bradley Dan Groscost and Felix Koltsov concocted a plan that ultimately billed workers’ comp carriers over $20 million for urine drug screenings and prescriptions for compounded creams. The scheme was driven by $2 …