Amador, Stanislaus, Tuolumne and Calaveras Workers' Comp Insurance Fraud

04/19/2017

PLANNING A REMODEL?

Protect your investment by knowing the facts and following these suggestions during your rebuild.

HIRE ONLY LICENSENCED CONTRACTORS: Check a contractor’s license number on the Contractor’s State License Board website at www.cslb.ca.gov or call (800) 321-CSLB (2752).

VERIFY WORKERS’ COMPENSATION INSURANCE COVERAGE: Employers are required to obtain a workers’ compensation insurance policy to protect employees who may be injured on the job. ALL ROOFING CONTRACTORS ARE REQUIRED TO HAVE WORKERS’ COMPENSATION INSURANCE. Check the status of a contractor’s workers’ compensation policy on the Contractor’s State License Board website.

GET A WRITTEN CONTRACT: Do not sign anything until you completely understand the terms. Avoid making cash payments and do not let payments get ahead of work. The down payment provided to contractors cannot exceed $1,000 or 10% of the contract amount, whichever is less.

The District Attorney’s Workers’ Compensation Fraud Unit investigates and prosecutes workers’ compensation fraud in Amador, Calaveras and Stanislaus Counties. The Fraud Unit also provides speakers to interested groups who want to learn more about Workers’ Compensation Fraud. You can contact the District Attorney’s Workers’ Compensation Fraud Unit by calling (209) 223-6444.

State of California

04/07/2017

Workers’ compensation protects employees who get hurt on the job. It may also protect employers from certain types of lawsuits brought by injured workers. Employers who don’t carry workers’ compensation insurance have an unfair economic advantage over businesses that obey the law. The Office of the Amador County District Attorney enforces these laws to protect workers and to assure fairness among businesses.

Failure to carry the required workers’ compensation insurance is a misdemeanor, pursuant to Labor Code section 3700.5(a). A person convicted of this crime can be sent to jail for up to one year or ordered to pay a fine of up to double the amount of the premium owed but not less than $10,000, or by both jail and a fine. Upon a first conviction a person may also be charged for the cost of the investigation.

04/04/2017

Medical Provider Fraud is described as the intentional act of deceiving, concealing, or misrepresenting information that results in health care benefits being paid to an individual or a group.

Examples of Medical Provider Fraud
Billing for services or treatment never performed;
Billing the workers’ compensation insurer and the workers’ health insurer for the same services;
Performing medically unnecessary treatment, examinations or diagnostic procedures in order to bill for them;
Miscoding or Up-coding treatment charges;
Billing for durable medical equipment that is never dispensed or selling used equipment as new.

If you know of a medical provider involved in fraudulent activity, contact the Insurance Fraud Unit of the District Attorney’s Office through our website at www.stopworkcompfraud.org or call
(209) 223-6444.

01/27/2017

STANISLAUS UNION SCHOOL DISTRICT EMPLOYEE CONVICTED OF WORKERS’ COMPENSATION FRAUD

Modesto, CA - The Stanislaus County District Attorney’s Office announced today the conviction of a Stanislaus Union School District employee for workers’ compensation insurance fraud. John Heaton was employed as a campus monitor for the district and reported an on the job injury in November 2015. Heaton filed a workers’ compensation claim and as a result, received medical treatment and workers’ compensation benefits. During a subsequent investigation, it was alleged Heaton presented false statements and material misrepresentations during a meeting with the school district’s Return to Work Specialist. Heaton misrepresented facts as it related to his physical abilities and limitations associated with his injury.

On January 23, 2017, Heaton pleaded no contest to Insurance Fraud, in violation of Insurance Code section 1871.4(a)(2), as a felony, in that he unlawfully and knowingly made a false and fraudulent material statement in support of obtaining workers’ compensation insurance benefits. He was sentenced to 30 days jail, three years formal probation and ordered to pay restitution in the amount of $8,341.66 for reimbursement of workers’ compensation benefits and investigation costs.

This case was a joint investigation by Probe Information Services, the California Department of Insurance, Fraud Division and the Amador County District Attorney’s Workers’ Compensation Fraud Unit. The Fraud Unit investigates insurance fraud cases in Amador, Stanislaus and Calaveras Counties through a grant provided by the California Department of Insurance. If you think someone is committing workers’ compensation fraud, report it to the California Department of Insurance Fraud Hotline at (916) 854-5700 or the Amador County District Attorney’s Office at (209) 223-6444.

12/28/2016

The Workers' Compensation Insurance Fraud Unit announced today the conviction of a local shop worker for workers’ compensation insurance fraud. Thomas James Staten reported an on the job injury in March of 2014 while employed as a shop worker and truck driver for a small trucking company. Staten filed a workers’ compensation claim and as a result, received medical treatment and workers’ compensation benefits. During a subsequent investigation, it was alleged Staten presented false statements and material misrepresentations to his treating medical physician. Staten misrepresented facts as it related to his physical abilities and limitations associated with his injury.

On September 13, 2016, Staten pleaded no contest to Insurance Fraud, in violation of Insurance Code section 1871.4(a)(1), as a felony, in that he unlawfully and knowingly made a false and fraudulent material statement for the purpose of obtaining workers’ compensation insurance benefits. He was sentenced to 60 days in jail, three years formal probation and ordered to pay restitution, which is estimated over $26,000.00.

This case was a joint investigation by the California Department of Insurance, Fraud Division and the Amador County Workers’ Compensation Fraud Unit, which investigates and prosecutes insurance fraud cases in Amador, Stanislaus, and Calaveras Counties through a grant provided by the California Department of Insurance. If you think someone is committing workers’ compensation fraud, report it to the California Department of Insurance Fraud Hotline at (916) 854-5700 or the Amador County District Attorney’s Office at (209) 223-6444.

12/02/2016

WORKERS’ COMPENSATION FRAUD
stopworkcompfraud.org

Under reporting employee payroll to an insurance company to receive a reduced workers' compensation insurance premium is a crime. Report all workers’ compensation fraud to the Amador County District Attorney's Office at (209) 223-6444 or stopworkcompfraud.org.

04/22/2016

INSURANCE BROKER CONVICTED OF INSURANCE FRAUD

Valley Springs, CA - The Calaveras County District Attorney’s Office announced today the conviction of an insurance broker who received payments from clients for insurance policies but failed to forward the premium to the insurance company. Kannai Scantlen, acting on behalf of Kan I Save Insurance Services, collected over $19,000 in insurance premiums from clients in order to purchase Workers’ Compensation and general liability insurance. Scantlen would give his clients certificates of insurance reflecting valid coverage; however, no policies were ever actually issued by any insurance company. Scantlen’s actions caused his clients to be at risk of uncovered losses. A joint investigation by the Department of Insurance, Investigation Division and the Amador County Workers’ Compensation Fraud Unit, found six victims of Scantlen’s fraud in California.

On April 4, 2016, Scantlen pleaded no contest to Insurance Fraud, in violation of Penal Code section 550(b)(2), as a felony, in that he prepared a written statement intended to be presented to any insurer or insurance claimant in connection with payment pursuant to an insurance policy, knowing that the statement contained false or misleading information. He was sentenced to 60 days in custody, three years probation, and ordered to pay restitution to his victims. At the time of sentencing, Scantlen had already reimbursed over $11,000 to victims.

The Department of Insurance, Investigation Division and the Amador County Workers’ Compensation Fraud Unit, investigates and prosecutes insurance fraud cases in Amador, Calaveras, and Stanislaus Counties through a grant provided by the California Department of Insurance. If you think someone is committing workers’ compensation fraud, report it to the California Department of Insurance Fraud Hotline at (916) 854-5700 or the Amador County District Attorney’s Office at (209) 223-6444.

09/22/2014

Our Education and Outreach Program offers free training on the most common types of fraud associated with workers’ compensation, how to distinguish between fraud and abuse, and employee rights and employer responsibilities. Representatives from the Amador County District Attorney’s Office will travel off-site to host trainings, as well as, question and answer sessions within Amador and Calaveras Counties.

09/22/2014

Under reporting employee payroll to an insurance company to receive a reduced workers' compensation insurance premium is a crime. Report all workers’ compensation fraud to the Amador County District Attorney's Office at(209) 223-6444 or stopworkcompfraud.org.

09/17/2014

WHAT IS FRAUD?
*Faking an accident or injury
*Exaggerating symptoms of an injury
*Obtaining other employment while allegedly disabled and not
reporting income
*Employers failing to have required workers’ compensation
insurance
*Dissuading employees from claiming job-related injuries or
seeking medical attention

09/17/2014

If you or someone you know suspects any fraudulent activities, or if you are suspicious of certain activity and merely need to ask whether it is fraud, please contact us at (209) 223-6444.