The Department of Industrial Relations’ Division of Workers’ Compensation (DIR/DWC) and DIR’s Anti-Fraud Unit suspended 178 medical providers during the first eight months of 2022.
Providers are suspended from the workers’ compensation system 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.
Since 2017, a total of 649 providers have been suspended from participating in California’s workers’ compensation system.
DWC has also initiated new lien consolidation cases estimated at $75 million for those providers that were convicted of a fraud-related crime in 2022.
During lien hearings, medical providers have an opportunity to prove the billing is legitimate. If the providers are unable to produce such evidence, the liens are dismissed.
A total of 63,000 liens have been dismissed since 2017 with a value of nearly $775 million.
There are currently 86 criminally charged providers with 516,000 liens designated as stayed. The stays prevent criminally-charged providers from seeking payment for their liens while the criminal case is pending.
DIR’s Anti-Fraud Unit deals with suspending any physician, practitioner, or provider from participating in the worker’s compensation system per Labor Code § 139.21, and staying liens of criminally charged providers per Labor Code section § 4615. DIR has posted information on its fraud prevention efforts online, including information on suspended medical providers, lien consolidations and the Special Adjudication Unit.
DIR’s Division of Workers’ Compensation monitors the administration of workers’ compensation claims and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers’ compensation benefits.