Hello, dear readers!  Your humble blogger brings you the story of a recent fraud case today.  As the defendants in this case are merely accused, and not convicted, I will decline to name names.  That being said, the information is just a click away to the California Department of Insurance website.

This story is a common one – worker gets injured at work and the injury is accepted.  As part of future medical care, home-care is provided, and the injured workers’ (now ex-) wife provides the “home care” billing the insurer for the services.

So, what’s the problem, dear readers?  Sub rosa video apparently showed that the “injured” worker didn’t need the home health care, and this raised significant doubts that any such care was necessary or provided.

We’ve seen similar issues on this little blog before – where an insurer was forced to hire an illegal alien to provide in-home care services to an injured worker, on the sole basis of the marital relationship between the injured worker and the in-home care services provider.  In other words, even though the injured worker would not be able to obtain legal employment otherwise, through the magic of comp, this became possible!

The in-home care “treatment” provides an exceptionally effective opportunity for fraud because of the degree of trust and cooperation between the two conspirators – they can both profit and share the proceeds of fraud, the benefit being in the form of liquid cash rather than opioids that have to be sold or durable medical equipment with low re-sale value.

Obviously, your humble blogger wishes the prosecutorial forces all the luck in the world, and I’m certain justice will be sought and done.  At the same time, perhaps this can serve as an opportunity for us to remember that when in-home care services are being provided, especially by a family member rather than a professional agency, we should regularly check to make sure the services are both necessary AND being provided.  Typically, sub rosa will do the trick, although social media monitoring should be explored as well.

What’s your worse home-care story?