An investigation into what’s being called one of the largest cases of workers’ compensation health care insurance fraud in California Department of Insurance history led to 13 indictments announced today against seven Southern California-based medical professionals.
This is the second wave of indictments against attorneys, doctors and medical providers who ripped off nearly 20 insurance companies by taking kickbacks totaling nearly $500,000 for treatments, including chiropractic, pain management, echo cardiograms and sleep studies resulting in millions of dollars of fraudulent workers’ comp claims, according to CDI.
These indictments are the result of a joint investigation by the Department of Insurance, FBI, U.S. Attorney’s Office and the San Diego District Attorney’s Office.
The operation was first announced in November, when federal indictments were handed down to eight defendants including doctors and their associates.
In addition to today’s state charges, the U.S. Attorney’s Office announced federal indictments against three additional defendants who allegedly recruited individuals to file workers’ comp claims resulting from on-the-job injuries. The defendants then directed these patients to specific chiropractors who met a pre-determined quota of referring new patients for goods and services such as MRIs and medical equipment, according to CDI.
“These providers built an elaborate and illegal kickback and bribery scheme that bought and sold patients – putting profits ahead of patient medical needs,” Insurance Commissioner Dave Jones said in a statement. “Workers’ compensation is designed to protect injured workers and legitimate businesses, not create a fraudulent profit center for providers bent on taking advantage of the system. Fraudulent enterprises like this create a multi-billion-dollar drain on California’s economy.
*ˆThis story ran previously in our sister publication Insurance Journal.