A California psychologist and doctor have been charged for allegedly submitting fraudulent insurance claims for workers’ compensation medical legal evaluations in an attempt to steal tens of thousands of dollars from multiple insurers.
Psychologist Danita Stewart, 51, of Chatsworth, a licensed psychologist, allegedly submitted 36 fraudulent insurance claims between April 2015 and June 2015 to five different insurers for medical legal evaluations for a total of $90,714.
A medical legal evaluation is conducted to evaluate an employee’s work-related injury. Even though Stewart was a licensed psychologist she has never been certified as a Qualified Medical Examiner as required by law to conduct and bill for the evaluations. Stewart allegedly conducted these fraudulent evaluations at clinics in Fresno, Tulare and Kern Counties.
Dr. Catalino Dureza, 54, of La Quinta, a licensed medical doctor, had obtained the proper certification to conduct and bill for medical legal evaluations, but his certification lapsed.
Dureza allegedly continued to conduct and bill for Medical Legal Evaluations, and once he was recertified he conducted and billed for unauthorized medical legal evaluations. Between January 2014 and May 2015, Dureza allegedly submitted 17 fraudulent insurance claims for medical legal evaluations conducted in Fresno County to five different insurers for a total of $16,292.
“Workers’ compensation insurance fraud is a multi-billion dollar drain on our state’s economy,” Insurance Commissioner Ricardo Lara said in a statement. “It is crucial that we work with our partners in law enforcement to catch fraudsters like these who are contributing to higher insurance premiums for all Californians.”
The cases were investigated by the Central Valley Workers’ Compensation Task Force, an anti-fraud partnership which includes the California Department of Insurance, the Fresno County District Attorney’s Office, the Tulare County District Attorney’s Office, the Kern County District Attorney’s Office, the Kings County District Attorney’s Office, the Madera County District Attorney’s Office, the Merced County District Attorney’s Office, the Employment Development Department, and the Franchise Tax Board.
Stewart and Dureza posted bond on Monday. Stewart will be arraigned on May 10. Dureza will be arraigned on May 20. The Fresno County District Attorney’s Office is prosecuting the cases.
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