Aggressive Approach Puts Workers’ Compensation Fraud Perpetrators on Notice
Workers’ compensation fraud has received special attention in the media recently. Just a few months ago, you may have read about the high-profile criminal prosecutions of medical providers involved in kickback schemes that were designed to generate billings for unnecessary or nonexistent medical evaluations and treatment. Also, in 2016 the Department of Industrial Relations established various reforms that have now resulted in the suspension of 21 providers, as well as put in place $2.3 billion in lien stays, which prevents payments to those providers. The financial impact of fraud has a broad impact that is far reaching to everyone in the workers’ compensation industry.
Keenan takes an aggressive approach to combatting fraud and was awarded “Fraud Fighter of the Year” in 2016 by the Employer Fraud Task Force for our implementation of the Register of Benefits (ROB); the first third party administrator to implement this type of approach. The Register of Benefits is a statement of medical services paid,including provider names and dates of service. The ROB is provided to the injured worker – much like an Explanation of Benefits for health plan participants – and allows the injured worker to see an itemization of services rendered and encourages them to report services not actually provided to them. This has brought awareness to medical providers that Keenan is serious about fighting fraud in the system:
“Keenan is in the forefront fighting workers’ compensation fraud thanks to the concerted efforts of their Assistant Vice President, Stacey Golden. As an Advisor to the Employers’ Fraud Task Force, Stacey has been a leading force in supporting the idea of bringing the Injured Worker into the loop by sending them a copy of their medical bills in the form of a “Register of Benefits (ROB)”. If there are any billing mistakes, mischief or fraud, the Injured Worker, upon review of their ROB, can respond directly to Keenan regarding any questions or discrepancies. The ROB can serve as a valuable tool to identify and stop fraud and even prosecute someone trying to game the system.”
– Laura Clifford, Founder and President of the Employer Fraud Task Force
As member of the National Insurance Crime Bureau (NICB), an Advisor of the Employers’ Fraud Task Force and member of WeTip, Keenan is an industry leader in the fight against fraud. We have established relationships with local District Attorneys, Commissioners from the California Department of Insurance (CDI) and local law enforcement, and it is through these relationships that we are able to gain arrests and convictions on injured worker fraud. In 2016/2017 Keenan had 21 suspected fraudulent claims pending with District Attorney’s offices. All 21 claims are for injured workers who are suspected of filing fraudulent claims. In this same year we received two convictions and restitution totalling $54,000. Within the preceding ten years, Keenan had successfully participated in another 11 convictions, with restitution totaling more than $240,000 for our clients.
We have frequently been invited to present at industry fraud conferences on topics highlighting “Packaging a Perfect Fraudulent Claim” and “ The Role of the Special Investigation Unit (SIU) investigator.” Our fraud training program has been recognized as “top notch” in the industry.
Keenan continues to work closely with law enforcement, the district attorneys’ offices and the Department of Insurance to raise awareness about fraud detection and prevention to fraudulent providers, lien claimants and injured workers.
About Stacey Golden
Stacey Golden, Assistant Vice President, is responsible for leading Keenan’s SIU/Fraud Unit, training and development, and vendor management. She has more than 20 years of experience and is certified by the Insurance Educational Association, Workers’ Compensation Claims Professionals Association and California Office of Self Insurance Plans.