On March 3rd, 2020, the Special Investigative Unit of RJN Investigations, Inc. was notified that the Orange County District Attorney’s Office had filed criminal charges pertaining to at 20 million dollar healthcare insurance fraud and kickback scheme. In this case, the co-conspirators allegedly ordered screening and prescriptions for patients in order to enrich themselves as part of a kickback referral scheme, doing business as DSJ MGT out of Fountain Valley, California. There are five workers’ compensation clinics in Southern California which control treatment, referrals and medical and financial records at the clinics even though the co-conspirators were not licensed to practice medicine. Other firms involved in the alleged scheme include LFPS, Inc. and Resource Pharmacy, Inc.
In the course of the criminal investigation performed by the Orange County District Attorney’s Office, the RJN SIU provided pertinent medical and financial billing information to help build a stronger case in order to document the true scope of the alleged fraud.
“These fraudulent workers’ compensation claims funnel resources away from the injured workers and make it more difficult to provide the treatment to those workers who truly need it,” says District Attorney Todd Spitzer. “The Orange County District Attorney’s Office is corroborating with the California Department of Insurance to crack down on workers’ compensation fraud and preserve resources for the truly injured.”
ABOUT R.J.N. SIU:
Formed in 1996, the SIU Division was created to assist California employers, small size insurance carriers and TPA firms in securing professional assistance so as to detect, investigate and prosecute insurance fraud. To date, the unit has trained well over 3,500 examiners and the documented referrals by this unit have resulted in over 195 convictions for workers’ compensation insurance fraud in California.