According to Business Insurance, 261 medical providers were suspended for the California workers’ compensation system in 2022—a dramatic increase when compared to the previous two years. As the COVID-19 pandemic recedes, the California Division of Workers’ Compensation (DWC) is cracking down on fraud. Below, our Fresno workers’ compensation defense lawyers provide an overview of the enforcement action taken by California state regulators.

A Big Spike in the Number of Medical Providers Barred from the Workers’ Compensation System

The number of medical providers that have been suspended from California’s state workers’ compensation system jumped substantially in 2022. The DWC confirms that 261 medical providers were barred from workers’ compensation in 2022. It is the highest number of providers that have been suspended in more than five years and a sharp increase from 2020 and 2021. Over the first two years of the COVID-19 pandemic, just 47 providers were suspended from the workers’ compensation system.

Bad-Acting Medical Providers May Facilitate Workers’ Compensation Fraud

In California’s continued effort to crack down on workers’ compensation fraud, it is clear that many of these cases involve medical providers who act unethically. These providers may submit false or exaggerated bills to insurance companies, leading to overpayment for services that were never performed or were unnecessary. This type of fraud not only costs insurance companies and employers but also undermines the credibility of the workers’ compensation system and takes away from the legitimate benefits of injured workers. By holding medical providers accountable for their actions, California can create a more efficient and fair workers’ compensation system.

A 2016 Law (AB 1244) Granted Regulators Enhanced Authority to Crack Down on Fraud

In October 2016, the then-California Governor Jerry Brown signed Assembly Bill 1244 (AB 1244) into law. Among other things, the legislation granted state regulators additional power to crack down on billing fraud by medical providers. Notably, the law gave the DWC the ability to exclude medical providers from the workers’ compensation system if they were convicted of fraud. This measure effectively gives regulators a powerful tool to rid the system of unscrupulous providers who engage in fraudulent activities, such as submitting false bills or overcharging for services.

Further, AB 1244 also allows the DWC to ban medical providers who have been barred from participating in Medicare or Medicaid programs in California. The provision is significant because it acknowledges that fraudulent activities in one government program often indicate similar behavior in others. It is a proactive tool, by leveraging this information the DWC can more effectively root out fraudulent providers and protect the workers’ compensation system from abuse.

Get Help From a Workers’ Compensation Defense Attorney in Fresno

At Yrulegui & Roberts, our Fresno workers’ compensation attorney provides solutions-driven legal guidance and support to employers, insurers, and claims administrators. If you have any specific questions or concerns about a workers’ compensation fraud-related matter, we can help. Call us now or connect with us online to set up a fully confidential consultation. We provide workers’ compensation defense representation in Fresno and all around the wider region in Central California.