Sunday, June 24, 2018


 

Celebrating Over 30 Years (1987 - 2018)

of Superior Service to our Valued Clients

 
   
Press Release

In Home Care Provider Convicted of Insurance Fraud

1/8/2018

 On January 8th, 2018, the Special Investigative Unit of RJN Investigations, Inc. was formally notified by the Los Angeles County District Attorney’s Office regarding the successful prosecution in the case of People of California vs. E. Pace.  In this particular case, the examiner noted that on the invoices submitted by the in home care provider, that she billed exactly 4 hours every day from 8:00 a.m. – 12:00 p.m., seven days a week.  She was never late and never missed a day of work according to the billing.  An initial surveillance investigation performed by the RJN SIU found no evidence of the in home care provider providing care to the claimant during the timeframe billed.  An unmanned surveillance van was then utilized on a 24/7 basis and substantial additional video evidence was secured, reflecting the in home care provider was not with the claimant taking of her during the timeframe she was billing the claim file.  Further investigation discovered that the in home care provider was actually a relative of the claimant with a different last name.  In accordance with the regulations set forth by the California Department of Insurance, the case was then filed by the RJN SIU to their Fraud Division as well as to the Los Angeles County District Attorney’s Office.  Upon completion of a detailed criminal investigation by the Los Angeles County District Attorney’s Office, the in home care provider was formally charged with 2 felony counts in violation of Insurance Code Section 1871.4 and Penal Code Section 118(a).  After attending several hearings, the in home care provider subsequently pled nolo contendere to Count One and Count Two was dismissed.  She was then sentenced to 5 years formal probation, 180 hours of community service and ordered to pay restitution back to the employer in the amount of $ 17,400.00.

 

 

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 2,750 examiners and the documented referrals by this unit have resulted in over 170 convictions for workers’ compensation insurance fraud in California.

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