If you suspect someone of committing workers’ compensation insurance fraud, report them to the ACDAO at (510) 383-8600 or DA-InsuranceFraud@acgov.com.
Workers’ Compensation Fraud
In California, workers’ compensation insurance is a no-fault system. Injured employees need not prove an injury was someone else’s fault to receive workers’ compensation benefits for an on-the-job injury. In addition to medical expenses being covered for injured employees, some injured workers are entitled to recover a portion of lost wages resulting from injury. Fraudulent workers’ compensation claims can be an enticing target for criminals.
Workers’ compensation insurance fraud occurs in simple and complex schemes that often require difficult and lengthy investigations. Employees may exaggerate or even fabricate injuries. At the other end of the spectrum, white-collar criminals, including doctors and lawyers, entice, pay, and conspire with others to defraud the system by creating false or exaggerated claims, over-treating, and overprescribing harmful and addictive drugs. Insurance companies pick up the tab, passing the cost onto policyholders, taxpayers, and the public. Insurance fraud totals over $15 billion yearly, an average of $500 per year per California resident.
The Alameda County District Attorney’s Office (ACDAO) identifies, investigates, and prosecutes workers’ compensation insurance fraud. If you suspect someone of committing workers’ compensation insurance fraud, report them to the ACDAO at (510) 383-8600 or DA-InsuranceFraud@acgov.com.
Fraud
CLAIMANT FRAUD
Any person who knowingly makes a false statement or representation, deliberately fails to disclose material facts, or knowingly withholds information to obtain benefits.
EMPLOYER FRAUD
Employer conceals or fails to disclose a workplace injury, misrepresents the facts, or discourages an injured worker from filing a claim
INSIDER FRAUD
Fraud committed by employees or agents of an insurance company, self-insured employer, or third-party administrator as defined in California Insurance Code Section 1877.
LEGAL OFFICE FRAUD
Legal provider inflates billing or materially misrepresents the facts.
MEDICAL PROVIDER FRAUD
Medical provider inflates billing, knowingly submits bills with improper medical codes, or misrepresents the facts.
PREMIUM FRAUD
Acts of fraud, including but not limited to under-reporting payroll, misclassification of employees’ duties, and experience modification evasion committed by or at the direction of an employer, for the purpose and with the effect of reducing premium liability.
UNINSURED EMPLOYERS
Employers that willfully fail to obtain workers’ compensation insurance.