In 2016, State Fund successfully resolved two Racketeering Influenced and Corrupt Organizations Act (RICO) suits. These suits were filed in 2013 to expose and prosecute a complex fraud scheme being perpetrated by a number of medical vendors in the California workers’ compensation system. We took on the monumental four-year legal battle that spanned both federal and civil courts as part of our commitment to ferret out fraud in the system and eliminate the losses associated with fraud to help keep prices down for our customers.
Through this work, many of the providers who defrauded State Fund are no longer able to treat our injured workers, and the suit brought greater awareness to the magnitude of medical fraud within the system so more can be done to protect injured workers and policyholders.
We’ve expanded our Special Investigations Unit in order to tackle more potential instances of fraud. This strategy is paying off, and in 2016, we doubled our annual fraud restitution collection rates to more than $2.1 million, which helps level the playing field for California businesses.
If you suspect fraud, call our Hotline at (888) 782-8338 / 7:30 AM – 5:30 PM, Monday – Friday.