The Merced District Attorney's Office is committed to providing you with the necessary information to help identify potential scams and other forms of insurance fraud related crimes. We will continue to pursue an aggressive campaign to identify, investigate, and prosecute workers' compensation insurance fraud.
Fraudulent claims undermine the integrity of the system and cause unnecessary delays in treating real injuries, while casting a shadow over the thousands of legitimate claims that are filed each year. These crimes can be committed by employees or employers and can occur in both the private and public sector.
Workers' Compensation Fraud occurs when someone knowingly makes a false statement or conceals information in order to receive workers' compensation benefits or prevents someone from receiving benefits to which they might be entitled.
Some examples are:
- Exaggeration of symptoms.
- Working while allegedly disabled and not reporting income.
- Claiming a job-related injury that never occurred.
- Claiming a non-work related injury as a work-related injury.
- Falsifying mileage reports.
Medical or Health Care Provider Fraud
- Underreporting payroll for misclassifying employees for lower insurance premiums.
- Deducting premiums from employee wages.
- Employer knowingly fails to have necessary workers' compensation coverage. It is illegal for an employer to operate without workers' compensation insurance (CA Labor Code Section 3700.5).
- Providing unnecessary testing or treatment of injured workers for financial benefit.
- Billing for services never preformed.
- Billing the workers' compensation insurer and worker's health insurer for the same services.
Insurance Fraud is a FELONY
and any person, employee or employer who commits workers' compensation insurance is punishable by:
- Up to 5 years in prison,
- Fines up to $50,000 or double the value of the fraud (whichever is greater), and
- Restitution for benefits wrongly obtained.
If you feel you know someone who may be committing this type of fraud, report the fraud to your employer. You may also contact the District Attorney's Office at (209) 385-7383 or report it to the following agency:
CA Department of Insurance Fraud Hotline
(800) 927-HELP (4357)