Summary of Fraudulent Operations and Charges
The Division of Workers’ Compensation continues the fight against fraud, adding eight medical providers to its suspension list - which now totals 49 for this year.
Ranging from overbilling, illegal kickbacks, defrauding Medicare, and money laundering, these medical provider schemes total more than $150 million.
Some providers were ordered to pay restitution, some were sentenced to federal prison, and others have surrendered their licenses.
While the state of California continues to pursue fraudulent Workers’ Compensation relationships, thorough program review becomes increasingly important for California employers. Full details of the suspension can be found at: http://dir.ca.gov/DIRNews/2017/2017-89.
Client Impact
Workers’ compensation medical treatment is often the most significant cost driver of a claim file. Reserves and medical spend influence the Experience Modification Rate and insurance premiums of all California employers. For some industries, the EMR impacts the ability to bid for and win business. For all employers, it brings unsolicited OSHA visits and fines.
Next Steps
Medical provider selection through advanced analytics can help employers eliminate providers that do not produce cost-effective outcomes.
By establishing service protocol with selected providers, employers can manage expectations. Ongoing oversight helps detect questionable activity early on in a claim and with that, an opportunity to end it.
For more information on medical provider selection and Workers’ Compensation program structure, visit www.globalriskcap.com.
Jennifer A. Lund is a Senior Vice President of Claims and Risk Control Services at Global Risk in Los Angeles. For more information regarding claims and risk control services, contact jlund@globalriskcap.com
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