September 20, 2017

CA DWC Posts RAND Report on Provider Fraud Prevention in Workers’ Comp System

Oakland, CA – The Division of Workers’ Compensation (DWC) recently posted a report on recommendations to prevent fraud in the workers’ compensation system, issued by the RAND Corporation.

DIR last year requested that the RAND Corporation assess medical provider fraud in the California workers’ compensation system and propose a set of comprehensive and strategic policy recommendations. The report describes the challenges and issues related to provider fraud in the workers’ compensation system and recommends changes to existing practices to achieve specific anti-fraud goals.

Three key recommended measures include:

  • The detection of fraudulent providers through the use of advanced analytics.
  • Keeping post-employment medical treatment claims under the employer’s control.
  • Suspending lien claims for suspected fraud providers.

Since the beginning of this year when anti-fraud bills SB 1160 and AB 1244 went into effect, more than 285,000 liens worth a combined claim value of more than $1 billion have been stayed. The liens are associated with 121 medical providers being prosecuted for fraud-related crimes. DIR has also started the process of consolidating and dismissing the liens of providers who have been suspended from the workers’ compensation system due to criminal convictions.

DIR has posted information on its fraud prevention efforts online, including information on suspended medical providers. Providers are suspended when they have been convicted of fraud-related crimes, have been suspended from the Medicare or Medicaid programs due to fraud or abuse, or have lost their professional license.

Click here for the report: RAND: Provider Fraud in California Workers’ Compensation (PDF)

Source: CA DWC

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