Fruits of the Poisonous Trees Apr10

Fruits of the Poisonous Trees

The recent enactment of AB 1244 and SB 1160 have identified individual(s) and providers that have been indicted or convicted.  The problem many claims personnel face is identifying how many of these convicted and indicted individuals have affected their claims.  Most are lacking in information to further identify the poisonous frui...

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Two Judges Define “Conviction” for Purpose of Suspending Providers Pursuant to AB 1244 Apr11

Two Judges Define “Conviction” for Purpose of Suspending Providers Pursuant to AB 1244

In a recent article on workcompcentral.com, it was reported that two workers’ compensation judges, Paul DeWeese and Alan Skelly, summed up the definition of “conviction.”  The question at hand is if a defendant has pleaded guilty to a crime but has not yet been sentenced, is that a conviction? The judges ruled that a guilty pl...

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California Department of Insurance Announce 26 Providers Charged in 40 Million Kickback Scheme May01

California Department of Insurance Announce 26 Providers Charged in 40 Million Kickback Scheme

On April 20, 2017 Insurance commissioner Dave Jones and Orange County DA Tony Rackauckas announced a shut down on a $40 million workers’ compensation fraudulent medical billing and kickback operation. The charges are against 26 providers that involve around three key scams: a “snake oil” scam, a medication kickback scam and uri...

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WCAB Case: Jessica Senquiz vs. City of Fremont

Date: 11/14/17 No: 2016-1770 WCAB Case: ADJ5829433 Significance CostFirst, using its knowledge of the law and Labor Code, prevails against lien claimant's attempt to collect on paid dates of service without following the SBR/IBR process. Case Facts One lien was referred to CostFirst through OptiMix™. The...

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AB 1422 – What you should know

On September 26, 2017 Governor Brown passed AB 1422, which became effective on January 1, 2018. AB 1422 bridges the gaps in SB 1160 and AB 1244 by including entities that have controlling interests by a Director, Officer or 10% shareholder that has been indict...

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WCAB Case: Jessica Senquiz vs. City Of Fremont

Case Facts Lien claimant filed a Petition for Reconsideration of Opinion and Decision After Reconsideration arguing that non-payment of services had deemed the procedures as neither reasonable nor necessary, and warranted resolution prior to the matter proceeding to independent bill review (IBR). CostFirst Corp...

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