Rand Report Recommends Analytics for Fraud Prevention in Workers’ Comp

The California Division of Workers’ Compensation has posted a report from the Rand Corp. with recommendations to prevent fraud in the workers’ compensation system.

The Department of Industrial Relations last year requested that the Rand assess medical provider fraud in the California workers’ comp system and propose policy recommendations.

The report describes the challenges and issues related to provider fraud in the workers’ comp system and recommends changes to existing practices to achieve specific anti-fraud goals.

Three key recommended measures include:

• The detection of fraudulent providers through the use of advanced analytics.
• Keeping post-employment medical treatment claims under the employer’s control.
• Suspending lien claims for suspected fraud providers.

DIR has posted information on its fraud prevention efforts online, including information on suspended medical providers. Providers are suspended when they have been convicted of fraud-related crimes, have been suspended from the Medicare or Medicaid programs due to fraud or abuse, or have lost their professional license.