Report on California Workers’ Comp Shows 227 Medical Providers Suspended

March 26, 2018

The California Department of Industrial Relations on Monday issued a progress report on its anti-fraud efforts, including updates on the suspension of 227 medical providers from treating California’s injured workers and the dismissal of 292,000 illegitimate liens with claims valued at more than $2.5 billion.

DIR’s efforts to eliminate medical provider fraud and illegitimate liens were bolstered by two new laws effective Jan. 1, 2017: SB 1160 requires the DIR to automatically stay liens belonging to providers who have been indicted or charged with crimes until the disposition of criminal; AB 1244 requires the Division of Workers’ Compensation administrative director to suspend any medical provider, physician or practitioner from participating in the workers’ comp system when convicted of fraud.

According to the report, the anti-fraud efforts have resulted in:

  • Dismissals of 292,000 liens with claim values of $2.5 billion for failure to file the required declarations.
  • 465,000 liens filed by or on behalf of criminally charged providers have been automatically stayed pending criminal prosecution.
  • 23,000 active and pending liens filed by or on behalf of 28 suspended providers have been consolidated for adjudication in special lien proceedings.
  • 10,000 active and pending liens are being processed for consolidation.
  • 30,000 liens filed by or on behalf of suspended providers have been voluntarily dismissed.
  • A total of 227 medical providers have been excluded from participating in the workers’ comp system after being issued a suspension order.

“DIR’s anti-fraud efforts have allowed us to remove fraudulent providers and their claims for payment from the system, with the aim to improve services and reduce premium costs,” DIR Director Christine Baker said in a statement. “Our fraud prevention work also involves identifying fraudulent activity through data analytics and defending anti-fraud laws in court.”

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