Healthcare Fraud Lawyer Blog
In January 2018, the California Division of Workers’ Compensation (DWC) suspended 18 medical providers. These providers, many of whom are physicians, can no longer work in the state’s workers’ compensation system due to the loss of their medical license, criminal conduct, or fraud.
DWC Require to Suspend Certain Providers
AB 1244 went into effect January 1, 2017. This law requires the DWC to suspend any doctor or other medical provider from participating in the workers’ compensation system if:
- The provider was convicted of any crime involving fraud or abuse related to Medicare, Medi-Cal, workers’ comp, or fraud, abuse, or other misconduct toward a patient.
- The provider was suspended from the Medicare or Medi-Cal programs because of fraud or abuse.
- The provider lost his or her license or certificate enabling them to provide medical care.
Health Care Fraud a Common Reason for Suspension
Many physicians and other medical providers are suspended because they participated in some type of health care fraud scheme. A common fraud scheme is to pay or obtain illegal kickbacks. In order to gain referrals for certain services or products, which a physician or facility can bill for, a provider pays individuals capable of making referrals to ensure they send patients their way. Many physicians or other professionals working within medical offices knowingly receive compensation or some other benefits for referring clients to a particular facility or doctor.
Another common scheme is to fraudulently bill a government health care program, such as Medicare, Medi-Cal, or TRICARE. Fraudulent claims may include those for services not actually provided, services unnecessary provided, unbundled services, services provided at a different date or time claimed, and services performed by a professional other than the one claimed. All of these false claims may unlawfully increase the medical providers’ reimbursements.
Individuals Suspended by the DWC
The individuals suspended by the DWC in the beginning of January for fraud or other illegal conduct relating to medical care include:
- David Wayne Fish
- Perry Tan Nguyen
- David James Garrison
- Matthew Cho
- Boyao Huang
- Eleanor Mela Santiago
- Alvin Mingczech Yee
Another DWC announcement on January 25 stated that more providers had been suspended for fraud or other criminal conduct, including:
- Edward Aslanyan
- Armen Shagoyen
- Carolyn Vasquez
- Van Nuys
- Sharon Patrow
- Priscilla Villabroza
- Erwin Castillo
- Nancy Briones
- Elza Budagova
- Ji Hae Kim
Do You Have Information About Health Care Fraud?
If you are a medical provider or work in a health care facility and you believe you have evidence of health care fraud, or an attempted scheme, contact an experienced San Francisco health care fraud lawyer at Brod Law Firm right away. You may have information that is important to state or federal authorities. You may also have enough information to file a lawsuit yourself on behalf of the state or federal government. If this qui tam suit is successful, you may receive part of the settlement amount, compensating you for your time and effort on behalf of the government.
To learn more about qui tam suits, call Brod Law Firm at (800) 427-7020.
(image courtesy of Hush Naidoo)
