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The fraud fight continues

The fight against fraud to the Division of Workers' Compensation system continues. Earlier this year, an orthopedic specialist from Oakland was one of 20 medical providers suspended from providing care for injured employees covered by workers' compensation. According to reports, these providers were suspended for fraud and other criminal actitives. 

The Oakland doctor mentioned above also surrendered his medical license after being accused of sexually harassing two of his patients. In addition, he has been charged with a federal crime, the alleged transport of child pornography.

Criteria for Suspension

California's labor code, in Chapter 5, section 139.21, outlines the criteria for suspension from participation in the workers' compensation system. Here are reasons for a medical provider suspension from the workers' compensation program.

  • A misdemeanor or felony conviction regarding fraud or abuse of patients, Medicare, Medicaid, or workers' compensation
  • Medical board findings of bad conduct in patient care, lack of qualifications or failure to carry out duties
  • Suspension or withdrawal of license to practice medicine
  • Criminal financial activity with workers' compensation or any other publicly-funded medical program

A Work in Progress

This latest round of suspensions is part of workers' compensation anti-fraud reform that began back in 2016. A March 2018 report on the progress made in all areas of workers' compensation fraud reform reveals that the law is still a work in progress, with Governor Edmund G. Brown Jr. signing Assembly Bill (AB) 1422 into law. This law will further close gaps in the system, as it will crack down on billing fraud, especially with suspended providers.

Not limited to just medical providers, fraud can happen in every component of the system. A continued commitment to reform will be necessary to stem the large volume of fraud of all kinds in the California workers' compensation system.

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