Kern County Cracks Down on Comp Fraud

When most people think about fraud, they probably think “it could never happen to me.” Whether or not you’re involved first-hand in a case is irrelevant though, because you usually end up paying for it either way.

Many states now have laws in place to help deter fraudulent claims. Most of those laws also have numerous penalties, including being ordered to pay back three times the amount of money that was stolen, and jail time that can range from two to five years.

“We’re talking about billions of dollars statewide in insurance fraud,” Kern County deputy district attorney Kate Zimmermann told Eyewitness News.

According to KBFX Eyewitness News, their local DA’s office just got some help towards combating this fraud, a $760,000 state grant. Zimmermann is set to command the special unit that investigates and prosecutes this crime.

Workers’ comp insurance is there to provide medical care for employees who are injured on the job. Behind that comp insurance though, there is a lot of money that is paid to medical providers,  and the unscrupulous are known for running up unwarranted treatment.

“On the side that everybody’s familiar with, it’s the person who’s injured, but is either working in secondary employment or maybe is not as injured as they claim to be,” Zimmermann said. But, she said that’s really the smallest part of the problem.

“We have the medical providers’ end where a doctor views the injured worker as a billing opportunity,” Zimmermann said. The prosecutor said a doctor on the take could pad an injured patient’s bill with hundreds of dollars of costs, or order care that’s not necessary, just to cheat the system.

On top of all that, Zimmerman also noted that dishonest medical clinics can also really rip off funds, along with lawyers who try to play the system and insurance providers.

Fraud hurts the honest businesses, by driving up their costs, which means consumers end up paying for those added costs that are passed on to them in the end.

Zimmerman has real disdain for businesses that cheat by not paying for the workers’ compensation insurance that they are required to have.

“Basically, what they do is, if someone’s uninsured or under-insured, they’re shifting the costs to the people (businesses) that are trying to do it right.” She said the honest business owner bears costs for insurance that the cheaters don’t have, and that’s unfair competition.

She also states that when individual workers file bogus worker’s comp claims, that hurts the companies that are following the law.

For example, if someone tries to fake an injury, that goes against the employer when they get rated for their workers’ comp insurance policy. Zimmermann said. “That employer’s rates are going to go up because somebody had a claim that reflects on the business practices of that business owner.”

After Zimmermann estimated that the special unit in the Kern County DA’s office gets two to five new cases every week, she also noted that they get all different types and sizes of cases; and they go after all of them.

In a recent case against the Dodd family for example, Zimmerman pointed out that Shawn Rene Dodd was convicted of fraud and conspiracy, and he got a six-year prison sentence for it. Other members of the family also got prison time, as the result of claims that they were running a medical clinic and filing false claims.

Through her time in the unit, Zimmermann stated the suspects can sometimes surprise you. And the suspects get surprised sometimes, too, because they may not see themselves as “real” criminals. Some may be businessmen who think they’re just competing; others are seen as upstanding in the community.

“You go to prison for five years,” Zimmermann said. “You can be out millions and millions of dollars that you’re going to repay somebody, and that tends to get people’s attention.”