Nine California Providers Convicted of Workers Compensation Fraud–
The California Workers Compensation system provides millions of dollars in much needed medical and living expense benefits to deserving injured workers. But when health care providers – and/or injured workers – try to “cheat” the worker comp system there are very serious consequences.
Both health care providers, employers and employees who try to defraud the workers compensation system can end up facing felony convictions, prison time, and huge fines. Health care providers, including physicians and nurses who try to cheat the workers comp system can also loose there medical licenses.
In 2017 the California Division of Workers’ Compensation (DWC) has suspended ninety-four health care providers for fraud or other criminal actions. This includes nine new suspensions this month.
What is Workers’ Compensation Fraud?
Workers’ compensation insurance fraud can takes many forms, and can be committed by employers, healthcare personnel, insurers, and workers who are recipients of workers comp benefits.
1. Workers Compensation Fraud by Medical Providers
When medical providers are found guilty of workers comp fraud, greed is usually the motivation. Physicians may bill for inappropriate or unnecessary treatment in order to receive payments. Medical facilities may submit bills with improper medical codes in order to receive payment for non-covered services.
In extreme cases medical providers have even bribed or paid indigent individuals to pose as “injured worker” patients in order to submit fraudulent workers compensation claims.
2. Workers Compensation Fraud by Insurers
Workers Comp Fraud can also be committed by Insurers, their claims administrators, as well as third-party administrators for self-insured employers.
Examples of Workers Comp Fraud committed by Insurers include making payments to fake, nonexistent claimants or medical providers – and then keeping the cash. Referring patients to medical providers who pay them “kick-backs” is also a form of fraud.
In other cases insurers have altered documents to support an unjustified denial of a workers comp claim.
3. Workers Compensation by Fraud Employers
Unscrupulous employers may also engage in dishonesty to try and lower their workers comp insurance premiums. Examples of Workers Comp Fraud committed by employers include classifying high-risk jobs as low-risk jobs to lower premium rates, as well as misreporting claims history and omitting work injuries in order to lower premium rates.
4. Workers Compensation Fraud by Employees
Workers, too, sometimes try to cheat the system by submitting fraudulent workers comp claims. Fabricating or exaggerating work-related injuries or illnesses is the most common example of this.
November 2017 California Workers Compensation Fraud Suspensions
Suspension orders were issued against the following healthcare providers, this month (November 2017) by the Division of Workers’ Compensation (DWC):
- Sathish Narayanappa Babu, physician.
- Uche Chukwudi, physician
- Charles Ikechukwu Okoye, physician
- Adeline Ekwebelem, DME provider
- Victoria Kim, physician
- Daria Renee Million of Corona, registered nurse
- Victoria Onyeabor, owner Fendih Medical Supplies Inc.
- Godwin Onyeabor, corporate officer of Fendih Medical Supplies Inc.
- Sri Jayantha Wijegunaratne, physician
What to Do if You Suspect Workers Compensation Fraud
Workers’ compensation fraud is not a victimless crime. It hurts everyone in the long run. Fraud costs the insurance industry millions of dollars per year – which raises your employer’s premiums – which can lead to layoffs, downsizing and even closing! This impacts not only your job, but California’s overall economy.
Further, fraudulent workers compensation claims take money and resources away from individuals who are truly disabled and need these benefits to obtain medical treatment and meet living expenses.
The Fraud Division of the California Insurance Bureau has established a method to report suspected insurance fraud- which may be made anonymously. CLICK HERE for the Department’s information on reporting Workers Compensation Fraud.