Insurance Fraud

About Insurance Fraud

The Office of the District Attorney has a vertical unit to prosecute Insurance Fraud cases to combat the underground economy that is costing the State and Orange County residents millions of dollars of taxes and higher premiums.

Specially trained prosecutors and investigators work closely with the California Department of Insurance to detect, investigate and prosecute Workers’ Compensation Insurance Fraud, Healthcare and Disability Insurance Fraud, Auto Insurance, Prevailing Wage Fraud and fraud in connection with Sober Living Homes and Addiction Treatment or Recovery Centers.  OCDA trains its prosecutors and investigators to become experts in the field of insurance.

Workers' Compensation Fraud

The Worker’s Compensation Insurance Fraud Division prosecutes a large variety of cases in our fight against workers’ compensation insurance fraud which costs Californians between an estimated $1 billion to $3 billion every year.  Our team works together to investigate and prosecute a large variety of cases in criminal court in Orange County.  Common types of workers’ compensation insurance fraud that the team prosecutes are listed below.

Fraud by Medical and Legal Professionals/Providers (Provider Fraud)

Fraud by doctors, chiropractors, lawyers and other professionals further harm workers that were legitimately injured on the job and need care to get better.  These professionals either bill insurance companies for services that they did not give to the injured worker or give patients procedures, medical supplies, or prescriptions that they do not need.  The team also prosecutes lawyers, doctors, chiropractors, and other professionals who pay (in money or services) another person to recruit or refer patients.

Fraud by Employers
  • The Workers’ Compensation Insurance Fraud Division prosecutes a variety of fraud by employers including employers who do not accurately report their employees’ payroll, employment status (unfairly calling employees independent contractors) or job duties to their insurance companies in order to illegally reduce their workers’ compensation insurance premiums/payments (Premium Fraud).  Premium Fraud is unfair to other businesses who are competing fairly.
  • The team also prosecutes employers who do not have or do not maintain a workers’ compensation insurance policy for their employees in violation of Labor Code section 3700 and employers who deny benefits to their employees by discouraging injured workers from filing a workers’ compensation claim in violation of Insurance Code section 1871.4.
Fraud by Employees

Our team also prosecutes employees, including government employees, for Claimant Fraud.  Examples of these prosecutions include:

  • Employees who say an injury happened at work when it did not;
  • Employees who do not report other income they have while they are receiving benefits;
  • Employees who lie about their recovery while receiving workers’ compensation benefits so that they can receive benefits longer (e.g., an employee who says that he still cannot perform certain movements like lifting heavy objects when he can perform these movements in his private life such as at the gym).
Fraud by Contractors in Public Works

The Worker’s Compensation Insurance Fraud Division works to hold contractors in the public works system accountable.  Public Works contractors violate the law when they bid for public works projects and later fail to pay a proper prevailing wage or fringe benefits to their employees (violation of Labor Code section 1778) or they dissuade their workers from filing a workers’ compensation claim if injured on the job (violation of Insurance Code section 1871.4).

Fraud by Insiders

The Worker’s Compensation Insurance Fraud Division also prosecutes insiders like insurance brokers who commit fraud in the worker’s compensation system by pocketing their client’s premium payments and falsifying insurance policy documents.

 

Disability and Healthcare Insurance Fraud

The Disability and Healthcare Insurance Fraud Division investigates and prosecutes schemes that defraud disability and healthcare insurance companies and often hurt vulnerable individuals.  Some examples are below:

Fraud by Medical and Legal Professionals/Providers (Provider Fraud)

Fraud by doctors, psychologists, laboratory companies, pharmacists and other professionals further harm individuals who seek medical treatment.  These professionals either bill insurance companies for services that they did not give to the patient or give patients procedures, medical supplies, or prescriptions that they do not really need.  The Disability and Healthcare Insurance Fraud Division also prosecutes doctors, chiropractors, laboratory companies and other professionals who pay (in money or services) another person to recruit or refer patients.

Fraud in the Addiction Treatment Industry

The Disability and Healthcare Insurance Fraud Division has a specialized team to investigate and prosecute fraud related to addiction treatment centers and sober-living homes called the Sober Living-Home Investigation and Prosecution (SLIP) Team.  Patients addicted to opioids are particularly vulnerable to fraud within the addiction treatment industry and the addiction treatment industry is largely unregulated.  Some schemes include marketers, doctors, and laboratory companies that operate within a scheme to pay addicts to receive medical or mental health treatment, procedures, prescriptions or laboratory tests (some of these procedures are experimental and could even seriously harm the patients).

OCDA Sober Living telephone tip line: (714) 664-3950

OCDA Sober Living referral email: soberlivingreport@da.ocgov.com

Disability Fraud

The Disability and Healthcare Insurance Fraud Division also prosecutes individual claimants who attempt to cheat the system by continuing to collect disability payments after they have returned to work or after they have recovered from their injuries. 

Other Prosecutions

The Disability and Healthcare Fraud Division also prosecutes other types of fraud including fraud by pharmacists or embezzlement by insiders in the disability and healthcare insurance industry.

You can report suspected disability and healthcare insurance fraud to the Orange County District Attorney's Office Insurance Fraud Unit by emailing hffraudfd1@da.ocgov.com.

OCDA Healthcare fraud referral email: hffraudfd1@da.ocgov.com

OCDA Sober Living telephone tip line: (714) 664-3950

OCDA Sober Living referral email: soberlivingreport@da.ocgov.com

Automobile Insurance Fraud

The Automobile Insurance Fraud Division is a concentrated team that investigates both fraud by policyholders of vehicles as well as fraud by individuals who are involved in the treatment of personal injuries that resulted from an automobile collision.

Fraud by Policyholders & Arson

The Automobile Insurance Fraud Division prosecutes insurance policyholders who file false claims based on staged collisions or traffic accidents.  The team also prosecutes those who falsely report a vehicle as stolen to their insurance companies.  Some of the automobile insurance fraud cases that the team prosecutes involve arson, which creates a major public safety risk.

Fraud by Medical and Legal Professionals/Providers (Provider Fraud)

The Automobile Insurance Fraud Division prosecutes fraud by doctors, chiropractors, lawyers and other professionals that further harm individuals that already suffered personal injuries from auto accidents.  These professionals either bill insurance companies for services that they did not give to the patient or give patients procedures, medical supplies, or prescriptions that they do not really need.  The team also prosecutes lawyers, doctors, chiropractors, and other professionals who pay (in money or services) another person to recruit or refer patients.

Insider Fraud

The Automobile Insurance Fraud Division prosecutes insiders like insurance brokers who commit fraud in the automobile insurance system by pocketing their client’s premium payments for auto insurance and falsifying insurance policy documents.

How Do I Report Workers’ Compensation Insurance Fraud?

Workers’ compensation insurance fraud costs Californians between an estimated $1 billion to $3 billion every year.  Help the Orange County District Attorney's Office fight workers’ compensation insurance fraud.

You can report suspected insurance fraud to the Orange County District Attorney's Office Insurance Fraud Hotline by calling 714-648-3650 (anonymous calls accepted) or via email at wcfraudfd1@da.ocgov.com.

Orange County District Attorney’s Office works closely with the California Department of Insurance (CDI).  You can contact Orange County’s CDI office via phone or fax.

California Department of Insurance Regional Office

Orange, CA 92868

Phone: (714) 712-7600

Fax: (714) 456-1838

The public can report suspected fraud to California Department of Insurance here:  https://cdiapps.insurance.ca.gov/CRIMS/publicform/

Insurance carriers, TPAs, and self-insured employers can report suspected fraud to California Department of Insurance via an electronic FD-1 here:  https://cdiapps.insurance.ca.gov/crims

OCDA Healthcare fraud referral email: hffraudfd1@da.ocgov.com

OCDA Sober Living telephone tip line: (714) 664-3950

OCDA Sober Living referral email: soberlivingreport@da.ocgov.com

Trainings and Outreach

Orange County District Attorney’s Office is available to conduct trainings and outreach to the public, private companies, labor unions and other workers’ organizations, and to the insurance industry.

If you are interested in receiving a training or other outreach for your group, contact us here:  Speakers Request Form