The Workers’ Compensation Fraud Unit identifies, investigates, and prosecutes workers’ compensation fraud. This crime – which is committed by doctors, lawyers, employers, insurance company employees and claimants – occurs in both the private and public sectors. The Workers’ Compensation Fraud Unit partners with investigators from the Department of Insurance to identify and combat workers’ compensation fraud.
The most common types of Worker’s Compensation Fraud include:
Provider Fraud
Regardless of the legitimacy of the original claim, many medical or other health practitioners fraudulently maximize the number of medical reports and referrals in each case to increase the number of billings. They may also over bill or render unnecessary treatment.
Premium Fraud
Premium fraud occurs when employers fraudulently misstate the number of employees or the nature of their work, such as reporting a roofer as an office worker. Other businesses are part of the "underground economy" and carry no workers’ compensation insurance. Under California law, the Workers’ Compensation Fraud Unit prosecutes the uninsured employer, and investigators in the Unit have a proactive compliance program where businesses are contacted and asked to provide proof of insurance.
Applicant Fraud
These cases involve workers who fake an injury, lie about the extent of their injury, lie by denying filing previous claims, fail to disclose a prior injury to the same body part, claim a non-work injury is work related, or illegally work while obtaining benefits. Sub rosa surveillance tapes regularly expose applicants who are fraudulent.