Sacramento Area Neurosurgeon Charged With Workers' Compensation Fraud and Insurance Fraud For Alleged Upcoding and Ghost Billing For Services Not Provided

On April 9, 2019, Dr. Laura Anderson, a neurosurgeon from Carmichael, California, was charged with multiple counts of medical insurance fraud, workers’ compensation fraud, and grand theft. A felony complaint is not evidence and Dr. Anderson is presumed innocent.

The prosecution alleges that from 2013 to 2018 Dr. Carmichael changed the coding of bills ("upcoding") for X-rays and telephone consultations in order to obtain higher reimbursement. It is also alleged that there was billing for medical services not provided to patients whose workers' compensation was covered by the State Compensation Insurance Fund (SCIF). 

Attorney Commentary: One issue with physicians and other health care providers billing workers' compensation is that when it is on a lien basis, the billing is often charged and handled differently than regular insurance billing. Due to the length of time getting paid and the negotiated, litigated amounts, medical billers have been more aggressive and this can cause problems for physicians when improper coding is used. Often physicians leave it to office staff and medical billers and have problems years' later. There are many laws and regulations that govern the disclosure of medical billing and reports in workers' compensation in California. 

Physicians and health care providers should have a compliance plan for workers' compensation billing and collection since insurance carriers can be very aggressive and report claims to the local District Attorney's Office who have designated prosecutors paid out of state fund for workers' compensation.

Posted by Tracy Green, Esq.
Green and Associates, Attorneys at Law