Recent Releases
DWC Reminds Claims Administrators of Their Responsibility to Report Fraud
April 10, 2006
The California Division of Workers' Compensation on Wednesday reminded claims administrators they have duty to report suspected fraud by medical providers, and released a simple form to help them do it. The DWC posted an informational bulletin on its Web site explaining the law that mandates fraud reporting, with a link to an electronic copy of a document that can be used to report suspicions to the DWC's Medical Unit. The memo also has a link to forms that can be used to submit fraud reports to the California Department of Insurance Fraud Division. "The majority of medical-care providers are honest and ethical professionals," the DWC said in the memo. "Unfortunately, a small number of providers choose to try to cheat the system by committing fraud." Labor Code section 3823 requires any insurer, self-insured employer, third-party administrator, workers' compensation administrative law judge, audit unit, attorney, or other person who believes that a fraudulent claim has been made by any person or entity providing medical care to report the apparent fraudulent claim in the manner prescribed by the reporting protocols adopted by the DWC's administrative director. Division spokeswoman Susan Gard said nothing in particular prompted the DWC to issue the memorandum on Wednesday. "It's just something we've been working on for awhile with the Department of Insurance and the Department of Justice," she said. "CDI has a fraud-reporting form. We wanted to do something a little bit simpler than they had." To view the memorandum, with links to fraud reporting forms, go HERE