Jump to Navigation

Workers’ compensation fraud and patient protection

Despite California’s strict penalties for workers’ compensation fraud, there are still plenty of attempts to beat the system in many industries, including medical services. This is evident in a recent legal case that is returning to court this month and that involves not only workers’ compensation but also serious threats to patients’ health.

According to US News and World Report, prosecutors in Los Angeles County took steps this month to reorganize an ongoing workers’ compensation insurance fraud case involving funds up to $150 million. There were 12 defendants in total who were originally indicted in 2015. Those charges have been dismissed, allowing prosecutors to refile allegations with the aim to revisit previously dismissed counts and simplify the litigation process. Defendants include a physician’s assistant who performed surgeries without attending medical school and two fugitives—an orthopedic surgeon and an office manager—who remain subject to the original indictment.

The defendants were accused of capping, a practice that involves offering money for patient or client referrals. In this case, marketers and lawyers received monthly payments of up to $10,000 for patient referrals.

Capping is considered unlawful under California’s labor code, which explicitly forbids any party from seeking or accepting payment for referring or soliciting clients. In a medical setting, this means that payments for patient referrals are also forbidden. Likewise, knowing participation in any service that makes recommendations to patients in regard to seeking “medical or medical-legal services or benefits” for profit is also considered abuse of the workers’ compensation system.

The code specifies that anyone who takes or offers unlawful payments for patient referrals (or anyone who violates any other provisions of this labor code section) may be subject to an assessment of up to three times the patient’s medical expenses as well as a civil penalty of at least $4,000 but not more than $10,000. 

No Comments

Leave a comment
Comment Information
Subscribe To This Blog's Feed
Main Office Los Angeles County 800-461-0268 Inland Empire Orange County Office 800-461-0268
Contact Sacks & Zolonz

Bold labels are required.

Contact Information
disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

close
Office Locations

Main Office
LOS ANGELES COUNTY

400 Corporate Pointe
Suite 800
Culver City, CA 90230
Phone: 800-461-0268
Fax: 310-216-9552
E-mail Us | Map & Directions

Inland Empire &
ORANGE COUNTY OFFICES

638 North Eckhoff Street
St. Orange, CA 92868
Phone: 800-461-0268
Fax: 909-476-2131
E-mail Us | Map & Directions

Rancho Cucamonga &
Workers Compensation Office

9513 Business Center Drive, Suite H
Rancho Cucamonga, CA 91730
Phone: 800-461-0268
Fax: 909-476-1333
E-mail Us | Map & Directions