Public Fraud Unit Favors Those Who Privately Fund It
D.A.'s workers' comp section is paid for with money from employers that is
doled out by insurers. Prosecutors tend to ignore both but go after
workers. Courts see no problem.
By TED ROHRLICH and EVELYN LARRUBIA, Times Staff Writers
The
Los Angeles County district attorney's office has for nearly a decade
operated with a built-in potential for a conflict of interest stemming
from its acceptance of private money to pay for public prosecutions of
workers' compensation insurance
fraud.
When defense lawyers challenged
this use of private funds, which was authorized by the state Legislature,
prosecutors said not to worry: Their judgments were independent. Appellate
courts agreed with prosecutors that there was no actual conflict of
interest.
However, a review of
prosecutors' performance shows that their decisions--on whom to
investigate and on whom to prosecute--have consistently favored those who
provide them with money.
The money
originates with the state's employers and is handed out by employers and
insurers. It is supposed to combat workers' compensation fraud in all its
forms--whether committed by employers, insurance companies or
workers.
But the district attorney's
office has downplayed employer fraud and repeatedly ignored evidence of
possible crimes by insurance companies. At the same time, it has cracked
down hard--and sometimes unjustly--on the workers whom insurance companies
and employers accuse of lying about on-the-job
injuries.
A case in point is that of
Indravadan Jayaswal.
The district
attorney's office had the middle-aged clerk handcuffed at work and taken
to jail after he filed a workers' compensation claim for his aching back,
arm and neck.
Jayaswal was experiencing
classic symptoms, one of his doctors said, of a "clerical workers'
sickness" caused by the repetitive stress of spending all workday, every
workday, typing on a computer. He was, therefore, his doctor said,
entitled to workers' compensation
benefits.
But Jayaswal had not at first
claimed that his ailments were
work-related.
He said he was afraid he
would be fired if he claimed to have been injured on the job. So, when
pressed, he said he told his doctors initially that he had experienced
pain lifting his garage door.
An
insurance adjuster seized on the garage door statement as evidence that
Jayaswal was lying when he later attributed his injuries to
work.
Without asking him to explain,
prosecutors charged him with the felony of lying to collect
benefits.
Compare that to the way
prosecutors handled what they regarded as lies under oath by some of their
benefactors.
District attorney officials
said they collected evidence that seven insurance company executives had
perjured themselves in reports to state
regulators.
The executives overstated the
extent to which their companies were financing their own legally required
efforts to ferret out fraud. The district attorney's office was almost
wholly dependent on these efforts as the source of its workers'
compensation fraud cases.
Although the
head of the D.A.'s anti-fraud effort routinely prosecuted workers for
lying under oath, he said it did not occur to him to apply the same
standard to the insurance executives.
He
did not see them as his targets. Nor did his
office.
The extent to which prosecutors
had abandoned even the possibility of going after insurers was made clear
in a 1998 job advertisement for the workers' compensation anti-fraud unit.
"The suspects we investigate," said the ad, issued by Chief Deputy Dist.
Atty. Robert P. Heflin, "include workers, employers, doctors and
lawyers."
The ad did not even mention the
possibility that insurance companies could be charged with
crimes.
The unit's priorities are evident
at a glance:
In eight years, it has spent
$38 million in private funds.
It has
prosecuted more than 250, mostly low-paid workers, fewer than 20 lawyers,
doctors or other medical personnel and about two dozen employers, all of
them small or medium-sized.
It has
prosecuted exactly zero insurance
companies.
Good
Intentions
The idea behind using
private funds to fight workers' compensation insurance fraud was to put
unscrupulous doctors and lawyers behind
bars.
These doctors and lawyers bilked a
system designed to speed benefits to injured workers. Workers could pick
any doctors they wanted. Employers, through their insurance carriers, were
stuck paying the bills.
Doctors were
making a mint because of unique California laws that gave them special
incentives to inflate their bills and required insurers and employers to
pay for initial evaluations whether workers turned out to be injured or
not. Doctors in California collected five to six times what they did in
other states for these evaluations.
That
wasn't enough for some doctors and lawyers, who paid re cruiters to troll
unemployment insurance lines, telling laid-off workers that they would be
better off if they claimed that they had been injured on the
job.
Insurance companies rarely
challenged these fraudulent claims, electing instead to pay them and pass
the costs along to their
employer-customers.
These activities
caused a genuine fraud crisis in Southern California in the late 1980s and
early 1990s, resulting in steadily increasing insurance premiums for
businesses already struggling in a
recession.
Employers organized and got
the attention of state legislators by screaming that they couldn't afford
to pay these higher premiums and threatening to leave California if
something wasn't done.
Then-state Sen.
Robert Presley (D-Riverside) took the lead in writing legislation aimed at
putting the unscrupulous doctors and lawyers out of business and behind
bars.
Workers were never the target,
said James Morris, an aide to Presley. "Everyone realized that the workers
in this context were kind of the sheep in this whole thing," he
said.
Presley's legislation, which passed
in 1991, was unusual in that it required employers, rather than taxpayers
in general, to pay for investigations and prosecutions through a surcharge
collected on their insurance
premiums.
There were two reasons Presley
took the private money approach. The state was in the red and Presley said
any general fund appropriation would not pass. County prosecutors were
unwilling to use tax money already assigned to them. They had higher
priorities: violent crimes.
Morris, the
Presley aide, recalled speaking to several county prosecutors, including
representatives of the Los Angeles County district attorney's office who
told him: "Unless we see any money, we're not going to be prosecuting this
type of case."
Employers are now assessed
a statewide total of $30 million a year. In the Legislature's scheme, the
money is divided between the state Department of Insurance for
investigations and the various county district attorney's offices.
Prosecutors apply for the money annually to the insurance commissioner,
who doles it out with the consent of the state's Fraud Assessment
Commission, which consists of two insurers, two self-insured employers and
one otherwise insured employer. The Los Angeles County district attorney's
office has historically gotten the lion's share of the
funds.
The private dollars paid for a
slew of prosecutions, proving, said Stanley Zax, chief executive of Zenith
Insurance Co., that district attorneys are like anybody else: "When they
are incentivized to go after something, they go after it."
Medical
Mills
In the early days of the
program, Los Angeles County Dist. Atty. Gil Garcetti announced that he was
going to focus on the doctors and lawyers involved in the medical mills.
"Our goal has to be to put some of these people in prison," he said in
1993.
But the medical mill prosecutions
turned out to be quite difficult. (Garcetti, locked in a reelection battle
with one of his deputies, declined to discuss such cases or any aspect of
the workers' compensation anti-fraud fight for this
story.)
The district attorney's office
won only one of its big mill cases, against a psychiatrist named Mark
Kaplan, whose frauds were also documented by television news people
operating undercover.
The office lost the
other three such cases it pressed to conclusion. Part of this was because
prosecutors ineffectively presented evidence, jurors and defense lawyers
said. Part was because jurors had trouble distinguishing between
fraudulent actions and actions that were lawful--just
greedy.
The operators of a large chain of
clinics who were accused of systematically overcharging insurers and
performing unnecessary tests offered lawful greed as their
defense.
"They charged the absolute
maximum that was available under the law," said defense lawyer Michael
Chaney. "Charging too much isn't fraud. It's just excessive." Jurors
agreed.
The second in command of the
district attorney's workers' compensation unit also agreed. Deputy Dist.
Atty. Richard Rosenthal advocated abandoning his own prosecution of
another large string of clinics called Primedex. He concluded that its
alleged insurance company victims were not really victims; they were more
like accomplices in that they had willingly paid Primedex's bills and
passed the costs along to employers.
"It
is obvious that Primedex exploited the workers' compensation system,"
Rosenthal wrote to his superiors in a confidential memo. "It is obvious
that Primedex ordered medically unnecessary procedures. But it is also
obvious that the insurance companies and [state workers' compensation
judges] allowed the acts to occur."
They
all participated in what amounted to "a giant quasi-legal Ponzi scheme
with citizens of this state on the losing end," he said. Rosenthal
declined to comment for this
story.
Although he repeatedly recommended
giving up on Primedex, his superiors would not allow it. The district
attorney's office had spent millions in private funds on the mammoth
prosecution and had repeatedly promised the Fraud Assessment Commission
that arrests were imminent.
Five years
after Rosenthal recommended dumping the case, former Primedex executives
are still awaiting trial. The prosecutor who inherited the case, Deputy
Dist. Atty. Robert Foltz, thinks it is going to be a tough
sell.
"The amount of provable fraud in
the case is really in question," he said in an interview, "because
basically the law allowed what they were
doing."
Primedex itself went out of
business long ago, as did many of the clinics specializing in workers'
compensation cases. They folded, in some cases, because they were spooked
when the district attorney's office obtained search warrants to seize
their files and, in other cases, because the Legislature clamped down on
the billing excesses that had made the clinics so profitable. The
Legislature imposed a schedule that limited fees for the first time in
1993.
The medical mill prosecutions saved
insurance companies millions of dollars. Primedex alone claimed that it
was owed $159 million for medical services when it shut down. Under
ordinary circumstances, the company's internal memos say, it could have
expected to collect $135 million. Once the district attorney's office
alleged fraud, however, insurance companies were able to settle for less
than $10
million.
See
No Evil
While prosecutors aligned
themselves with insurers in going after doctors, they elected not to
investigate complaints by doctors that dozens of insurers committed fraud
against them.
The doctors charged in
civil lawsuits that insurers illegally conspired to tar them as fraud mill
operators and drive them out of business without bothering to assemble any
evidence that they were in fact committing
fraud.
As proof of a conspiracy, the
doctors cited an account by a former executive for Golden Eagle Insurance
who said insurers decided to engage in a little vigilantism to control
costs.
In a letter to lawyers for some of
the doctors, the executive, Hy Bates, said he attended a secret meeting in
1991 with representatives from three dozen other insurers active in the
Los Angeles area.
"The gist of the
strategy," he said, "was to target the [medical] facilities with the
highest dollar volumes . . . and then utilize any technical or legal
argument available to them to deny or delay
payment."
Deputy Dist. Atty. Edward
Feldman, who headed the workers' compensation fraud unit from its
inception in 1992 until the end of 1996, said he was skeptical about the
lawsuits because he suspected that some of the doctors were crooks. He
said he had never heard about the secret meeting Bates
described.
The district attorney's office
also did not investigate the finding of a civil jury in Los Angeles
Superior Court, which concluded that the state's largest workers'
compensation insurer defrauded an employer of hundreds of thousands of
dollars.
The insurer, the quasi-public
State Compensation Insurance Fund, tricked its prospective customers,
jurors concluded. Its sales force told employers that their premiums would
be based on a realistic assessment of what claims by injured workers would
cost, jurors found, but instead the premiums were based on the highest
possible cost.
Court of Appeal justices
upheld the jury verdict of civil fraud and ordered the insurer to pay a
$5-million punitive damage award, asserting: "There was substantial
evidence that senior management personnel at SCIF . . . intentionally
misled prospective insureds."
For the
district attorney's office, prosecuting the State Compensation Insurance
Fund would have meant biting the hand that fed it--in more ways than one.
The fund's president is a permanent member of the Fraud Assessment
Commission, which decides how big a chunk of the anti-fraud funds the Los
Angeles County district attorney's office gets each year. The fund,
prosecutors say, is also the most cooperative insurance company in
providing information that leads to
cases.
Feldman said that had nothing to
do with the decision not to go ahead with a criminal probe. He said that
the fund's misconduct was called to his attention but that he had higher
priorities, particularly since his efforts would be duplicative: A civil
jury had already punished the insurer. That, Feldman suggested, seemed
punishment
enough.
Hear
No Evil
The district attorney's
office has never prosecuted an insurance company for defrauding injured
workers by not paying them benefits.
It's
not that the unpaid benefits involve insignificant sums, said Casey Young,
the former head of the state Division of Workers'
Compensation.
Year after year, insurers
on average shortchange one of six injured workers by $900 apiece,
according to random audits performed by the
division.
Young told a legislative panel
in 1998 that this rate of shortchanging translates statewide to $84
million per year. "This is not money that's disputed, I want to
underline," he said. It's money that insurers acknowledged that they owed
but were caught keeping for
themselves.
Young's estimate did not
include additional sums that insurers saved by not notifying workers when
they were eligible for vocational rehabilitation benefits, as required by
law.
The same audits showed that, year
after year, insurers failed to inform nearly half of all injured workers
who had been out of work for 90 days that they were eligible for job
retraining.
Cora Lee, who is in charge of
the audits for Southern California, once testified in a deposition that up
to 80% of the files checked at some insurance companies have showed money
owed. "We've had some really nasty companies," she
said.
Officials in the Los Angeles County
district attorney's office, including Feldman and the current head of the
workers' compensation fraud unit, Deputy Dist. Atty. Philip Wynn,
acknowledged that a criminal investigation might be appropriate to
determine whether these patterns of shortchanging workers were
intentional.
But these same officials and
their supervisor, Director of Special Operations Allen Field, said they
had never launched one because they had never heard of the audits, which
were mandated by the Legislature in 1989 and have been the subject of
legislative hearings, news releases and trade press reports. Summaries of
the 150 audits conducted to date are available on the Internet at http://www.dir.ca.gov/dwc/audit.html.
Not everyone in the office was in the
dark. Kristie Hutchinson, then and now the unit's special assistant, said
she knew about the state auditors, though not about the audit results.
David Guthman, who headed the unit for one year in 1997, said he learned
about the audits when the Division of Workers' Compensation approached him
for help during one particular audit, of the Fremont Compensation
Insurance Group of Glendale. Fremont marketed itself as a company that
could save employers money by rooting out worker and doctor fraud. It
advertised on more than 600 billboards around the state that showed
cheating workers behind bars. Its slogan was "Fraud Doesn't Work
Here."
It was wrong about
that.
Auditors alleged that Fremont
employees, spread among all three of its California claims-adjusting
locations--Glendale, Fresno and San Francisco--backdated about 10,000
documents between 1990 and 1996. Auditors alleged that the backdating,
which sometimes saved Fremont late-payment fees to workers and doctors,
was sufficiently widespread as to constitute a general business
practice.
To settle an administrative
case that could have cost it its license, Fremont agreed to pay $525,000
without admitting wrongdoing and promised to spend an additional $200,000
to train employees to play by the rules. It also agreed to change its
computer system to make backdating impossible. Fremont said settling the
case was cheaper than fighting
it.
Fremont reported six of its employees
to prosecutors. Two from its Fresno office were convicted of fraud-related
charges. Four from its San Francisco office were never charged. Jacqueline
Schauer, the lawyer for the auditors, ridiculed the extent of Fremont's
housecleaning, saying that apparently more than 150 Fremont employees in
the San Francisco office alone were involved. Fremont did not refer any of
its Glendale headquarters employees to the Los Angeles County district
attorney's office.
While investigating
the backdating allegations in Glendale, however, auditors had approached
the district attorney's office for help. The auditors said through a
spokesman that they wanted the district attorney's office to grant
immunity to some Glendale employees so they could question them. But they
said the district attorney's office
declined.
Deputy Dist. Atty. Adalbert
Botello, the supervisor who was the primary person dealing with the
auditors, said he thought they merely wanted legal advice on immunity
procedures, which he gave. He said he did not see their inquiry as a
reason to assign his unit's investigators to probe for possible criminal
acts by Fremont or its
employees.
Employer
Fraud
The district attorney's office
has prosecuted few employers, explaining that cases of employer fraud are
rarely called to its attention.
Yet fraud
committed by employers is probably more costly than that committed by
workers, according to assessments by prosecutors in Los Angeles and
elsewhere.
Some employers save money by
lying to their insurers about the nature of work their employees perform.
Insurance premiums for dangerous jobs such as roofing can run one-third of
payroll or more. If a roofing contractor falsely claims that his work
force is clerical, identical coverage runs only about 1% of
payroll.
But the district attorney's
office says that, with a few exceptions, insurers don't want the
reputation of nailing their own
customers.
Deputy Dist. Atty. Barry
Gale--the only one of the unit's 16 prosecutors who handles employer
fraud--said he has been frustrated because he has been unable to get
insurance companies or others to refer him cases. Only eight of the
state's approximately 300 workers' compensation insurers have done so, he
said.
Gale said he tried to open an
investigation into employers who illegally operate without insurance.
Taxpayers pay more than $20 million a year in benefits to injured workers
whose employers don't have insurance.
But
the state Insurance Department blocked him with a legal opinion. Its
conclusion: Private industry pays his salary to prosecute insurance fraud,
and people who do not have insurance, by definition, cannot commit that
crime.
Some of the state's large
employers qualify to insure themselves. They have the same responsibility
to handle claims fairly as insurance companies, and the same auditors who
check insurance companies also review their practices and sometimes find
them wanting.
Ralphs Grocery Co. of Los
Angeles set a new record in 1998 for "amount in penalties in one audit."
The total: $217,530. Ralphs had shortchanged about half of 154 injured
workers whose claim files were checked--by a total of $106,000. Auditors
also found that Ralphs failed to investigate some claims and denied
benefits in others without saying why. Ralphs did not respond to an
invitation to comment.
District attorney
officials never looked into these allegations to determine whether the
short-changing was intentional. They said they learned of the Ralphs audit
for the first time while being interviewed for this article.
'Low-Hanging
Fruit'
Workers are the defendants in
four out of five of the cases handled by the district attorney's special
unit. This mirrors statewide and national
trends.
Cases against workers are easy.
The overwhelming majority of workers who are charged plead guilty, are
placed on probation and are ordered to pay restitution. Prosecuting them
is known in the trade as picking the "low-hanging
fruit."
In its most recent grant
application, the Los Angeles County district attorney's office said the
workers it goes after commit outrageous fraud: "supposedly bed-ridden
claimants [who are] playing tackle
football."
It produced records of two
cases it said were typical. One involved a $5-an-hour temporary laborer
who hurt his heel but exaggerated his injury and was caught on videotape
rehearsing a limp with a cane in a doctor's parking lot. The other
involved a bartender who said he hurt his back on the job; he was
collecting disability while secretly working as a bartender
elsewhere.
Those records did not provide
a full picture.
The district attorney's
office also picks off people such as:
*
George Solis
At age 56, Solis was
run over by a hit-and-run driver as he crossed a street carrying a crate
of jalapeno peppers for the family restaurant he
managed.
He suffered brain damage, said
he couldn't work and was paid $126 per week in workers' compensation
benefits.
But after several years, the
Fremont insurance firm, which was looking at paying a potentially much
larger settlement for permanent disability, decided to see for itself just
how well Solis' brain worked. The insurer hired a private detective who
videotaped Solis playing flag football, race-walking and driving a car.
Solis had told an insurance company doctor that he could not live
independently and could not drive. The doctor looked at the videotape and
said it proved that Solis was a
malingerer.
The district attorney's
office had Solis arrested. Agents carted him off during an early morning
raid on his Huntington Park house as his 80-year-old mother screamed: "You
can't take my son. My son is no
thief!"
Deputy Dist. Atty. Eleanor
Daniels did not dispute that Solis had been injured. She told Los Angeles
Municipal Judge Elva Soper that he was arrested for exaggerating: "The
impairment is not as extensive as 100%
disabled."
Soper made her own
observations and took an unusual step early in the case. She appointed a
specialist on the mental effects of brain injuries to examine Solis for
the defense at public expense.
Dr. Robert
Brook looked at the secretly recorded videotapes and concluded that they
proved Solis was gravely disabled.
An
average adult takes far less than a minute to tie his shoelaces, he said.
A videotape showed that Solis took three
minutes.
Another tape showed that when
Solis was playing flag football, he seemed to be playing by himself, Brook
said. Neither his teammates nor his opponents paid him any
mind.
Still another tape showed that in a
race-walk, he couldn't master the fundamental stride, the doctor said. He
was disqualified.
"It was a rather sad
vignette," Dr. Brook testified.
He said
the only kind of work Solis could do would involve "simple, concrete,
repetitive activities under constant
supervision."
Over the D.A.'s objections,
Soper dismissed the case. She also dismissed a companion case against
Solis' brother Austin, who had been accused of fraud for allegedly lying
to doctors about his brother's
limitations.
* Edgar
Huaz
Huaz, a 35-year-old father of
four from Guatemala, was working the graveyard shift as a chicken deboner
at a food plant in Vernon when an industrial-size soap dispenser fell on
his head in the men's room while he was washing up, he
said.
Huaz wound up in a hospital
complaining of headaches. Within a month, a neurosurgeon, Dr. Harley
Deere, operated to relieve pressure from a bruise on his
brain.
But the food plant's insurer,
Fremont again, fought Huaz's claim about the work injury. It uncovered
evidence that Huaz had been in a fistfight with a co-worker off the job
site shortly before he had had brain
surgery.
Fremont inferred that the
fight--not the incident with the soap dispenser--was the real cause of the
injury and that therefore the insurer and Huaz's employer should be let
off the hook.
The D.A.'s office agreed
and charged Huaz with insurance
fraud.
But its case fell apart when Dr.
Deere testified that it would have been a physical impossibility for the
fight to cause the injury he saw when he opened Huaz's
head.
The district attorney's office
dismissed the case.
* Indravadan
Jayaswal
Jayaswal, a data entry clerk
for Blue Cross, had first visited a doctor for what he said was
work-related neck, back and shoulder pain in
1991.
He said in an interview that he did
not file a claim at that time because a co-worker warned him that people
who filed such claims were fired.
His
pain remained manageable until early 1995, he said, when production quotas
were increased and he had to spend more time at the computer. He visited
his own doctor, who referred him to two specialists. He told the
specialists, according to their notes, that he had experienced a pulling
sensation lifting a garage door. He did not mention that he thought his
pains were work-related, although one of the doctors told him he should
take a break from working. This doctor and Jayaswal signed a state
disability form, checking off a box that said explicitly that the ailment
was not work-related.
When Jayaswal
returned to work with restrictions on using a computer, records show, a
supervisor referred him to Blue Cross' health and safety department. He
then filled out a workers' compensation claim, stating that his pains were
work-related.
A claims examiner for Blue
Cross' workers' compensation insurance carrier, a Kemper company, became
suspicious.
When an insurance
company-hired doctor told the claims examiner that she was on to
something, Kemper referred the case for investigation and prosecution to
the state Department of Insurance and to the district attorney's
office.
In doing so, Kemper officials
said Jayaswal was known to file false claims--an assertion they later
admitted they could not support, according to court records. They also
suggested that he fraudulently filed for workers' compensation benefits to
pay for his medical care because he had no group health insurance. In
fact, he had used his group health plan to pay for his
treatments.
The Department of Insurance
investigation into whether Jayaswal's injuries were related to his job was
woefully incomplete.
"What is his job?"
the case investigator was asked at a preliminary
hearing.
"I really don't know," he
said.
He told a judge, however, that he
had spoken to the specialists who had treated Jayaswal initially and that
both had told him that Jayaswal's ailments could have been caused by his
job.
At Jayaswal's trial one of the same
doctors went further. He testified that, not only could Jayaswal's
problems have been work-related, they probably
were.
The prosecutor said this did not
matter. Deputy Dist. Atty. Robert Wallace argued that fraud hinges on a
state of mind. He contended in court that whether Jayaswal was entitled to
benefits or not was irrelevant. If he merely tried to collect benefits
while believing that he was not entitled to them, that would be enough for
a conviction.
Superior Court Judge
Michael Tynan did not need to hear any more. He acquitted Jayaswal before
the defense put on any
witnesses.
Jayaswal sued the insurance
company for malicious prosecution and settled with Kemper for an
undisclosed sum.
But he could not get his
old job back. He said he could not even get a job in the same
industry.
"They destroyed all my life,"
said Jayaswal, now 61. "I was just interested in why I had pain. I had a
good job. My company was paying a lot of overtime. . . . Why should I go
to workers' compensation? I wasn't going to get [much money]. I only
wanted the pain to go
away."
System
Defended
District attorney's
officials assert that the insurance industry is not their boss, nor even
their partner. The insurance industry merely directs their attention to
possible cases, they say, and the district attorney's office alone
determines whether these cases are worthy of
prosecutions.
"No deputy who has ever
worked in this program heard us ever, ever say we were doing anything to
serve the insurance companies," said Feldman, the former head of the
unit.
Insurance companies don't pay the
bills, the district attorney's office points out. They merely have a say
in how the funds are handed out. The district attorney's office says it is
insulated from influence by individual employers since all employers are
obligated to pay a surcharge on their insurance premiums--whether they
like it or not.
Trial and appellate
courts have reviewed these funding arrangements and have agreed with the
district attorney's office that no conflict of interest
exists.
District attorney's officials
added that they would gladly look into allegations that insurers were
ripping off workers if someone would just bring them the
evidence.
The officials said they have
repeatedly asked, in vain, that lawyers who represent injured workers
seeking benefits bring them cases of suspected criminal wrongdoing by
insurers or employers. Prosecutors said their appeals for cooperation have
been made at functions put by on by these workers' lawyers, who are known
as applicants' attorneys.
There are three
applicants' attorney groups in Los Angeles County. A member of one said he
had a client who contacted the district attorney's office and found
officials receptive to looking into a complaint about possible insurer
fraud. No action has been taken in that
case.
But presidents of the other two
applicants' attorneys associations said they were dumbfounded by the
district attorney's office assertion that it had tried to get them to
refer cases.
"I must live on a different
planet," said Larry Stern, president of the Southern California Applicant
Attorneys Assn. "Applicant attorneys have given up writing to the D.A.'s
office, because they don't respond. . . . It's a waste of 33 cents."
Conflict of Interest
The actual conflict of
interest between the district attorney's office as public prosecutor and
the office as an institution dependent on private industry can be seen in
the way it passed prosecuting some of the insurance companies that fed it
with cases.
Few insurance companies
bothered to meet their legal responsibility to refer suspicious
claims.
In fact, only one in 10 insurers
sent over any, said Feldman. And the industry's lack of cooperation made
"a mockery of fraud enforcement" and took "the heart out of the
system."
As Feldman struggled to keep the
district attorney's workers' compensation unit going with "two hands . . .
tied behind our back," his special assistant called to his attention
evidence that executives of some of the precious few firms that were
cooperating had committed perjury.
The
special assistant, Hutchinson, said the executives had made "material
misrepresentations" under oath, overstating the extent of their anti-fraud
efforts in reports to state
regulators.
Feldman acknowledged that
filing perjury charges against them would have been possible--even that it
would have had "nice symmetry" given his unit's custom of charging alleged
worker cheats with perjury. But he said that arresting the executives
never crossed his mind.
Pressed to
explain, he said that even if it had occurred to him to prosecute, it
would have been counterproductive.
The
insurance carriers involved were among the few that were bringing any
cases to the unit.
If he had filed
charges, Feldman said, they would have
stopped.
And if that happened, he added:
"We'd have to close down our shop."