Assembly Bill (AB) 1244 introduced new changes to the workers’ compensation system that take effect January 1, 2017.
As a major step to combat fraud in the workers’ compensation system, AB 1244 added Section 139.21 to the Labor Code, which requires the Division of Workers’ Compensation to suspend certain medical providers from participating in the workers’ compensation system, including those who are convicted of a felony or misdemeanor involving fraud or abuse of any patient, the Medi-Cal or Medicare programs, or the workers’ compensation system itself. Labor Code section 139.21 provides for a hearing process regarding the suspension and a special lien adjudication procedure to address pending liens of those providers who are suspended based upon a criminal conviction.
AB 1244 also made changes to Labor Code section 4906 related to the Attorney Fee Disclosure Statement, including requirements to ensure that the injured worker is informed of the specific district office location at which the injured worker’s case will be filed.
Orange County DA Press Release
Case # 17CF1361-17CF1369,
Date: June 5, 2017
PHASE I CHARGES FILED ON 10 ATTORNEYS AND SIX CAPPERS IN MASSIVE MULTI-MILLION DOLLAR WORKERS COMPENSATION INSURANCE REFERRAL SCHEME
*Largest number of attorneys charged in one case in Orange County history
SANTA ANA, Calif. – Ten attorneys and six cappers were charged today for participating in a massive multi-million dollar workers’ compensation insurance referral scheme that exploited persons in predominantly Spanish-speaking communities. This is the first phase of filing resulting from a 3-year insurance fraud investigation by the Orange County District Attorney’s Office (OCDA) Bureau of Investigation, Insurance Fraud Unit with assistance from the California Department of Insurance (CDI).
Charged on June 5, 2017, with multiple felony counts of:
Maximum sentences range from seven years to 25 years and eight months in state prison
*Individual complaints specifying charges for each defendant are available upon request.
Circumstances of the Case
Business & Professions Code § 6152 prohibits individuals or businesses from procuring clients (aka “capping”) for attorneys or law offices. Likewise, Insurance Code § 750 and Labor Code § 3215 also prohibit attorneys from paying cappers for referred clients. Insurance Code § 750 and Labor Code § 3215 also prohibit copy service companies from offering any type of consideration to attorneys in exchange for the referral of business. Moreover, conspiring to illegally refer or pay for clients and hiding the capping from the insurance company in order to obtain benefits is further prohibited by Penal Code §§ 549, 550(a)(1), and 550(b)(3).
The Orange County District Attorney’s Office Bureau of Investigation investigated this case with the assistance of the California Department of Insurance.
Prosecutor: Deputy District Attorney Noor Hasan, Insurance Fraud Unit
Hefley Law, APC