DWC and RAND Institute Weigh In On Work Comp Fraud

DWC and RAND Institute Weigh In On Work Comp Fraud

It’s no secret: Workers’ comp fraud is officially on notice throughout California. Recent months have seen a wide range of anti-fraud measures embraced and implemented by the state legislature and the Division of Workers’ Compensation (DWC). Last week, the DWC posted a 96-page report from the RAND Institute for Civil Justice recommending further actions to reduce provider fraud throughout the state.

A DWC Newsline announcing the report’s publication paints a rosy picture of the state’s efforts to reduce provider fraud, singling out liens in particular as an area where the government has been able to flex its muscles:

“[M]ore 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.”[1] 

The newly released RAND report takes these steps even further, recommending an intensive data-driven approach to sussing out fraud.

“…[T]o truly exploit the power of analytics, even more information is needed: reports of injuries, lien filings, WCAB calendars, employer insurance coverage, employer payrolls, criminal court dockets, health care provider licensing, and corporate ownership records for providers.”[2]

That’s not the only recommendation in the report. The RAND Institute suggests that the state should suspend lien claims whenever the holder is suspected of fraud, never mind whether they’ve been tried and found guilty.

We’re still unpacking the magnitude of this report. Stay tuned – we’ll have more on the RAND report and the recommendations therein in the weeks to come.

To learn more about the recent fraud-focused reforms to the California workers’ comp system, watch our webinar on Senate Bill 1160 below.


[1] See DIR Newsline 2017-51.

[2] Full text of the RAND Institute’s report is available here.

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