Putting a Price on Body Parts

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Architect is posing on construction site. She is happy. Two coworkers are in the back.

The title of this blog sounds a bit gruesome, but I assure you that it is only intended to get your attention about a workers’ compensation fraud scheme carried out in Southern California. (No body parts were bought or sold in today’s fraud case; however, injuries to various body parts were used to collect nearly $1.5 million in illegal workers’ compensation benefits.)

Scores of marketers, doctors, lawyers and medical service providers were in on the scam. Together, they conspired to steal as much money as possible from the California workers’ compensation system. At the time today’s fraud article was published, 32 people involved in the case have already pleaded guilty to workers’ compensation fraud and five were convicted by a jury.

Victims in this widespread fraud case include seasonal, migrant construction and farmworkers who regularly travel between California and Mexico. Conspirators recruited their “patients” in Central America and Mexico, then referred them to attorneys and physicians in California who filed fraudulent workers’ compensation claims on their behalf.

Attorneys, physicians and other medical services providers paid kickbacks to scam leaders for the referrals. These purported professionals were not in the business of providing legitimate medical care, they just wanted to bill as much as possible for unnecessary procedures and lab tests. (You could say that every body part had a price tag, so they billed for as many things as possible.) For example, a patient with a knee injury might be required to get a urine test, DNA test, sleep studies (because a knee injury could prevent you from sleeping, I suppose), unnecessary medical equipment and MRIs on other body parts, not just the knee.

So far, one of the defendants who recruited patients received a five-year prison term and must forfeit more than $1M in ill-gotten gains. An attorney was sentenced to 13 months behind bars and must forfeit $300,000. A San Diego chiropractor received a six-month sentence and must forfeit $150,000. (As for the victim patients? Let’s hope that no one lost a limb in the process.)

Congratulations to the Federal Bureau of Investigation and the U.S. Attorney’s Office for the Southern District of California for successfully prosecuting those involved in this heinous workers’ compensation fraud scam. (Their efforts were simply priceless.)

Today’s “Fraud of the Day” is based on an article, “Participants in Workers’ Comp Fraud Ring Sentenced,” published by EHS Daily Advisor on July 11, 2019.

Participants in a workers’ compensation fraud scheme were recently sentenced in federal court in San Diego, California. Dozens of marketers, doctors, lawyers, and medical service providers

conspired to bilk the workers’ compensation system in California, according to the Federal Bureau of Investigation (FBI) and the U.S. Attorney’s Office for the Southern District of California.

So far, 32 people and companies in the scheme have pleaded guilty, and 5 have been convicted by a jury, the FBI said in a July 2 statement.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.