Using Surveillance When Work Comp Fraud Suspected as Doctor Stages Accident Scene

A Case Study:

Physician Allegedly Makes False Work Injury Report with Intent to Defraud

A California medical doctor reportedly made false medical statements claiming to have suffered a hospital work-related injury stating an inability to sit, stand, or walk with the intention of committing insurance fraud according to the Orange County (California) District Attorney’s Office Investigators.

Here’s What Happened

1. The doctor (employed by a large California HMO) created an allegedly false “accident scene” in an examination room, calling a medical assistant who witnessed the doctor lying on the floor. The doctor said after slipping on an oily substance on the floor, injury occurred to the lower back and neck and the physician was unable to get up.

2. Over a six-month period, the claimant visited two physicians claiming suffering from severe pain as a result of the fall, citing an inability to sit, stand or walk for more than a 5 minute period and could only lie on one side in bed.

3. The defendant is accused of claiming all prescribed pain medication and physical therapy was ineffective; sleep was impossible; and body rotation was compromised due to the pain.

4. Authorities said the doctor arrived at appointments in a wheelchair because of constant pain and inability to walk or stand for more than 10 minutes. The defendant is accused of claiming having trouble finding rides to make it to the appointments.

5. After being placed on modified work restrictions recommended by doctors, the accused failed to return to work because the employer was unable to accommodate restricted modified duty terms.

6. Various examinations, X-rays, MRIs, and bone scans detected no abnormalities and offered no explanation as to the pain from which the defendant claimed to be suffering.

What the Employer Did

Because the defendant’s treating doctors could find no objective evidence to explain the employee’s pain and alleged disabilities, the employer hired an investigative service to conduct surveillance of the individual on three occasions over a three-month period. (workersxzcompxzkit)

Surveillance showed the defendant (by videotape) participating in physical activities such as sitting, standing, and walking – the very activities the doctor supposedly was unable to do as a result of the workplace injury.

As a result, the defendant was arrested and charged with 10 felony counts of making fraudulent statements and representations and, if convicted, faces a maximum sentence of 14 years in state prison.

Author: Robert Elliott, J.D.

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