California Independent Providers vs Provider Networks

With uncertainty in everyday life, having an experienced  physicians, managers and surgery center operators like Medical Director Dr Alexander Zaks knowledge and expertise to navigate the complexities of California’s workers’ compensation system makes all the difference in medical treatment provided. The staff at Alex Zaks' surgery center facilities are conscious of the obligation to insure patients are treated with the proper care, respect and fairness. Alexander Zaks M.D. does not operate, manage or direct under the constraints of an provider networks to treat patients according to their medical needs and not the interests of an insurance carrier’s profitability that some medical providers, who are part of a Medical Provider Network, may have in reducing treatment costs.

Neither Dr. Zaks nor the physicians with whom he works over-treat patients Dr. Zaks is focused on ensuring that patient’s rights are protected under applicable workers’ compensation laws while balancing the interests of employers and insurance companies.

Employer Health Care Insurance in California

Health care fraud is commonly associated with claims fraud committed by workers’ compensation patients who exaggerate their injuries or medical providers of California who fraudulently bill insurers for expensive procedures that were never performed. However, fraud can also be committed by any of the many participants in the health care system, including employers, who have already developed an array of tactics to corrupt the workers’ compensation insurance system.

• Misclassification:

Employer’s workers’ compensation insurance rates are based on several factors, including the percentage of employees in high-risk jobs. As an example of misclassification, employers will fix their records to show heavy equipment operators as office clerks, a relatively safe job with substantially lower workers’ compensation premiums. According to a study from the University of California Berkeley, employers in high-risk industries in California may hide up to 75% of their payroll, or about 100 billion dollars, in the most dangerous jobs sectors. The study found that this misclassification fraud forces other employer’s workers’ compensation insurance premiums up to 800% more than if all workers were classified accurately. 

• Off-the-books payments:

Another form of employer insurance fraud involves companies that pay employees in cash or falsely categorize an employee as an independent contractor, keeping the employees off the books so that the company’s records show fewer employees to secure lower workers’ compensation premiums. According to research from Harvard University, these off-the-book payments cost the state of Massachusetts 100 million dollars a year in unpaid workers’ compensation premiums. The study showed that one in seven construction workers in Massachusetts is hired off the books or fraudulently classified as an independent contractor.

Another fraudulent scheme hatched by employers is failing to carry workers' compensation insurance altogether.  In this case, the employer thinks they are better off financially to eliminate the cost of insurance premiums, taking the risk that the state will investigate and discover the fraudulent and illegal lack of insurance coverage. If a worker is injured on the job in this scenario, the cost of care falls to the public insurance system, while the state must go through a lengthy legal process to recover costs from an employer.

Penalties for such fraud vary by state, ranging anywhere from a temporary order for the business to stop operations until it complies with the workers’ compensation insurance requirement, to a permanent closure of the business.