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Study of Impact of Medical Fraud Enforcement Released

In a new study, WCIRB researchers examine the impact that increased efforts to identify and prosecute provider fraud may be having on the California workers’ compensation system. The Impact of Medical Fraud Enforcement on California Workers’ Compensation Study uses data from the WCIRB’s medical transaction database to analyze the volume and type of medical services that were performed by providers who were subsequently indicted or suspended for fraud (“Indicted Providers”). 

Notable findings of the Study include:

  • Within the California workers’ compensation system, over 7% of total medical payments were made to Indicted Providers, who rendered more than 4% of the medical services in the second half of 2012. By the second half of 2017, the shares of both medical payments and transactions to these Indicted Providers had fallen by over two thirds.
  • The total medical payments to Indicted Providers peaked in 2013, when 23% of medical lien payments, 14% of pharmaceutical payments and 4% of payments for other medical services were made to these Providers. 
  • Since 2013, the share of total payments to Indicted Providers declined across all types, but the proportion of medical lien payments to these providers increased by 130% from 2013 to 2017.
  • Except for medical liens, the time between when a service was provided and when the payment was made was considerably longer for Indicted Providers than for other, non-indicted providers.

The complete Study is accessible at the link below and in the Research section of the WCIRB website.

Impact of Medical Fraud Enforcement on California Workers’ Compensation Study

WCIRB Research Forum

The WCIRB will hold a WCIRB Research Forum webinar to discuss the findings of this Study as well as the WCIRB's Cumulative Trauma Study. Register to attend the free webinar at the link below:

Cumulative Trauma Study and Impact of Medical Fraud Enforcement Study
Thursday, October 18, 2018, 10:00 AM – 11:00 AM PT

Cumulative Trauma Study - Dave Bellusci, EVP and Chief Actuary; Tony Milano, VP, Actuary
Impact of Medical Fraud Enforcement Study - Tim Basuino, Medical Analytics Specialist
Register now>
For those unable to attend the live webinar, a recording will be posted in the Research section of the WCIRB website following the event.

October 16, 2018