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September 16, 2018
Benjamin Gluck Gives Up Representation Of Frontline Medical In Criminal Organization Munir Uwaydah Case In Downtown LA. Sergeant McCrillis Continues On The Witness Stand, Claiming Stand-Alone Public Documents Are Not Privileged.

September 13, 2018
First Division of Workers' Compensation (DWC) Pharmacy and Therapeutics Committee Meeting Scheduled for September 26th 2018 in Oakland, California

September 12, 2018
Judge King Takes 995 Motion Under Submission From The Defense in Sim Hoffman, M.D. Billing Fraud Case in Orange County. If Prosecution Prevails, Case Will Be Set For Trial Within 30 Days Of September 28, 2018.

September 8, 2018
California’s Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) Post Progress Report on Department’s Independent Medical Review (IMR) Program.



California's Department of Workers' Compensation Posts RAND Report on Recommendations for Fraud Prevention in the Workers’ Compensation System
By Lonce LaMon and the California Department of Industrial Relations' Newsline - June 28, 2017

The Division of Workers’ Compensation (DWC) posted a report on recommendations to prevent fraud in the workers’ compensation system, issued by the RAND Corporation.

DIR last year requested that the RAND Corporation assess medical provider fraud in the California workers’ compensation system and propose a set of comprehensive and strategic policy recommendations. The report describes the challenges and issues related to provider fraud in the workers’ compensation system and recommends changes to existing practices to achieve specific anti-fraud goals. Three key recommended measures include:

  • The detection of fraudulent providers through the use of advanced analytics.
  • Keeping post-employment medical treatment claims under the employer’s control.
  • Suspending lien claims for suspected fraud providers.

Since the beginning of this year when anti-fraud bills SB 1160 and AB 1244 went into effect, more than 285,000 liens worth a combined claim value of more than $1 billion have been stayed. The liens are associated with 121 medical providers being prosecuted for fraud-related crimes. DIR has also started the process of consolidating and dismissing the liens of providers who have been suspended from the workers’ compensation system due to criminal convictions.   

DIR has posted information on its fraud prevention efforts online, including information on suspended medical providers. Providers are suspended when they have been convicted of fraud-related crimes, have been suspended from the Medicare or Medicaid programs due to fraud or abuse, or have lost their professional license.

###

 

Lonce LaMon, lonce@adjustercom.com, journalist, and the California Department of Industrial Relations Newsline, news release of June 28th 2017, www.dir.ca.gov

 
 

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