According to a report from Safety + Health Magazine. California regulators have suspended several dozen medical providers from the state’s workers’ compensation system. The Department of Industrial Relations (DIR) confirms that 178 medical providers have been barred from workers’ compensation cases. Here, our Bakersfield workers’ compensation defense attorney explains why medical providers were suspended from California’s workers’ compensation system.

Most Medical Providers Suspended for Alleged Fraud

The DIR has an anti-fraud unit. Since 2017, the DIR’s anti-fraud unit has now suspended more than 600 medical providers in California from the state’s workers’ compensation system. For the most part, physicians and other medical providers are removed from the workers’ compensation system for fraud or other improper professional practices. Some possible reasons for suspension include the following:

  • Failure to meet the licensing requirements or standards of care for medical providers;
  • Failing to cooperate with investigations or audits of their medical practices;
  • Providing unnecessary or excessive treatment to workers’ compensation claimants;
  • Fraud or other criminal activity related to the provision of medical services; and
  • Failure to meet the licensing requirements or standards of care for medical providers.

What Happens When a Medical Provider is Suspended From Workers’ Compensation Claims?

When a medical provider is suspended from California’s workers’ compensation system, they can no longer provide medical services to workers’ compensation claimants in the state. It does not mean that they lose their medical license. However, it does mean that the provider cannot bill workers’ compensation for any services rendered.

Suspension of medical providers is case-specific and fact-specific. In some cases, a medical provider may be able to get themselves reinstated in the future—perhaps if they fall behind on licensing requirements. However, future reinstatement may not be possible in other cases—such as those with criminal workers’ compensation fraud allegations.

Workers’ Compensation Fraud: Misconduct By Medical Providers Remains a Challenge

Workers’ compensation fraud remains a very serious problem. The California Department of Insurance estimates that between $1 billion and $3 billion is lost annually to workers’ compensation fraud in the state. Bad-acting medical providers are often involved in workers’ compensation fraud schemes. As of November 2022, California state data shows that there are 86 medical providers who have been criminally charged for workers’ compensation fraud. They are barred from executing medical liens.

To combat workers’ compensation fraud, California has many different programs and initiatives in place, including a comprehensive fraud referral program, a fraud hotline, and a dedicated fraud investigation unit. These programs are designed to detect and investigate cases of suspected fraud and to hold those who commit fraud accountable for their actions.

Consult With Our Bakersfield, CA, Workers’ Compensation Defense Lawyer Today

At Yrulegui & Roberts, our Bakersfield workers’ compensation defense attorneys are standing by, ready to protect the best interests of our clients. Call us now to connect with us online to set up a completely confidential, no-obligation consultation. From our Bakersfield office, we provide workers’ compensation defense services in communities throughout the San Joaquin Valley.