California bill would prevent banned providers from billing workers' comp

Months after a report that the absence of fraud prevention measures in California’s workers' compensation program allowed providers to bilk the system, legislators are moving forward with a bill that would stop providers banned from Medicare and Medicaid from billing the program, according to Reveal News.

Introduced by Assemblyman Adam Gray, the proposed law would require the administrative director of the Division of Workers’ Compensation to “promptly suspend” any physician convicted of a felony or a fraud-related misdemeanor from filing workers’ compensation claims. The bill would also require the director of healthcare services to notify the administrative director of the workers’ compensation program if a physician is suspended from the Medi-Cal program.

State senators have called for the state to investigate fraud vulnderabilities within the workers’ compensation program. A representative with the California Society of Industrial Medicine and Surgery and the California Neurology Society told Reveal that physician groups oppose the bill unless it includes a clause that limits the ban to felonies involving “moral turpitude.”

Weak fraud-prevention measures have been linked to the fraud scheme dubbed “Operation Spinal Tap,” which fraudulently billed as much as $600 million to the state workers’ compensation program and implicated dozens of physicians, surgeons and hospital executives. Last year, Texas officials arrested 28 individuals linked to a “sprawling” fraud scheme that targeted the state’s workers’ compensation program.

- read the Reveal News article
- here’s the California bill