Good morning, dear readers.  Your humble blogger offers you one totally undeniable fact, that I would challenge even the most argument-inclined applicant attorney to dispute: today is Wednesday.  And, as we all know, Wednesday is a very special day because it is named in honor of everyone’s most beloved Addams family member.

Now, to those of you who are thinking that your humble blogger has mentally checked out as the Thanksigving holiday approaches, you aren’t entirely wrong.  But, from the few brain cells that remain diligently on duty, not unlike brave Horatius, please allow me to submit this most humble of blog posts.

We all love the stories about workers’ compensation fraudsters being caught doing ridiculous things, typically an “injured” worker who lies about the causation or the nature and extent of injuries.  It’s always a big laugh to see an applicant claiming total paralysis accepting a first-place trophy for a triathlon.  After all, dear readers, we laugh to hide the pain.

But there is plenty of fraud, sadly, that occurs not from an injured worker, but on the part of medical practitioners.  Some physicians submit fraudulent bills, either overbilling for services rendered or submitting invoices for services never performed.  The first line of defense against such fraud is usually a diligent adjuster, but the California Department of Insurance recently charged and arrested a chiropractor for (allegedly) submitting fraudulent bills and the claims adjuster who (allegedly) intentionally paid these fake bills for a portion of the proceeds.

Your humble blogger is one of those old-school types that still subscribes to the antiquated notion that it is the government’s burden to prove guilt, and innocence must be presumed before a conviction is made, so I will again decline to name names.  But, if you are cat-like in your curiosity, you can follow this link to get the full scoop.

As alleged, this scam ran for 12 years and involved up to 459 liens for a total of $1,603,340 stolen from the insurer.  The adjuster (again, allegedly), settled all liens under the authority limit to avoid detection by a supervisor.  It was only a diligent co-worker who noticed a suspicious lien payment and started an investigation.  Quis custodiet Ipsos custodes?

A similar scam was noted on this most humble of blogs before: therein, an applicant submitted false invoices and medical bills and his co-conspirator, the adjuster, diligently paid them.

Your humble blogger wishes all parties in this case the best of luck in bringing the truth to light, and hopes justice is served, wherever the chips may fall.  But your humble blogger also wants this to be a reminder for all the claims adjusters and examiners out there to be diligent in helping identify and report the fraudsters sitting at the neighboring workstation that’s trying to sell the profession’s good name for a few dollars.