The vast majority of workers’ compensation claims are legitimate. Most injured workers want nothing more than appropriate medical treatment and compensation for lost wages until they can return to work. Fraudulent workers’ compensation claims, though not a large percentage, erode the integrity of the workers’ compensation system and results in significant costs to employers. Such fraud undermines the perceived legitimacy of appropriately filed workers’ compensation claims and drains scarce tax dollar.
Workers’ compensation fraud may fall under the following categories:
Medical Provider Fraud:
A medical provider bills for services never provided, over states the services provided to maximize payments, performs unnecessary treatment, or enters into a referral agreements with other providers resulting in kickbacks and additional charges to employer.
A claimant reports an injury that never occurred, magnifies the severity of an injury by indicating limitations that do not exist, or fails to report earnings received during the period he/she is receiving workers’ compensation time-off benefits.
Well orchestrated billing schemes that do not rely on patients, but on the acquisition of billing information that can be turned into medical bills and submitted to workers’ compensation payers Such schemes may result in millions of dollars in workers’ compensation system costs. It is a felony to make a false or fraudulent statement, file a false report, or submit any other false documentation for the purpose of obtaining or denying workers’ compensation benefits. Injured workers are required to report to their employer or claims administrator any money they earn for work performed during periods they received temporary disability benefits (including salary continuation or Labor Code 4850 benefits). Failure to follow this requirement may be a violation of the law. Workers’ compensation fraud is a serious offense and, if convicted, a person can face up to five years in prison and/or a fine of up to $150,000 or double the amount of fraud committed. It is vital for the County of Los Angeles to aggressively detect, prosecute, and deter fraud in order to protect resources. You can report suspected workers’ compensation fraud by contacting one of the offices listed below