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County Targets Fraud in Workers’ Compensation Claims

May 20, 2016 by  
Filed under Blog

County Targets Fraud in Workers’ Compensation Claims

(Santa Ana, CA) — A 10-year County employee pleaded guilty today to four misdemeanor counts of insurance fraud and paid restitution of $30,271.80 in full today. He has been placed on three years of informal probation; required to complete 100 hours of community service and pay $100 to the Worker’s Compensation Fraud Assessment Fund as well as the statutory fees.

Maluelue Tafua, formerly employed at the Social Services Agency, was arrested in October 2015 as part of a multi-level County effort to target those suspected of collecting benefits they did not earn. He was charged with insurance fraud and making fraudulent statements.

“The resolution of this case reimburses the County for our losses and sends a message that fraud will not be tolerated,” Board of Supervisors Chairwoman Lisa Bartlett, Fifth District, said.

“When people claim benefits they didn’t earn, it abuses the system and drains County resources,” said Supervisor Shawn Nelson, Fourth District, who encouraged heightened fraud-detection efforts. “This is about promoting government accountability and integrity.”

“This plea agreement represents a sad chapter for the County and particularly this employee,” said County Executive Officer Frank Kim. “We intend to do all that we can to support the legitimate efforts of our hard-working employees.”

Tafua was on paid workers’ compensation leave in 2014 when he reportedly was observed weightlifting at a gym and engaging in other physical activities. During questioning more than a month later, he claimed that he was still injured.

In August 2015, the County successfully prosecuted a similar case against another employee who claimed that an on-the-job back injury left him unable to work when he had suffered injuries earlier in non-work vehicle collisions.

The County provides intensive periodic training to human resources professionals and attorneys on workers’ compensation abuse and fraud, what to look for and the importance of open communication among all parties in workers’ compensation cases. The County also routinely seeks restitution from those found guilty of obtaining fraudulent benefits.

Workers’ compensation fraud drains public treasuries by contributing to the high cost of insurance and self-insurance. It harms employees by undermining the perception of those legitimately claiming on-the-job injuries to receive the benefits to which they’re entitled. The California Department of Insurance estimates that worker’s compensation fraud costs the state between $1 billion to $3 billion each year.

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