February 18, 2010

City of Commerce, Calif., resident Richard Lewis Johnson has pled no contest to one count of grand theft of workers’ compensation payments and was placed on three years probation and ordered to pay $20,714 in restitution to Avizent Risk Management, the California Department of Insurance reported.

Detectives from the California Department of Insurance (CDI) were alerted to the alleged fraud by Avizent’s Special Investigations Unit in April 2009. Avizent reported that Johnson advised them that on May 28, 2008 he sustained an injury to his right shoulder while working at California United Terminals as a class B longshoreman. At the time of the reported injury Johnson was employed by Pacific Maritime Association.

The day after the reported injury, Johnson saw a chiropractor who then sent him to another doctor where Johnson allegedly lied about the severity of his injury. Avizent processed the claim in accordance with the Longshoreman and Harbor Workers’ Compensation Act.

During an internal Avizent investigation, it was alleged that Johnson lied to Avizent’s claims adjusters. Avizent set up surveillance on Johnson and witnessed him using his right shoulder with no apparent difficulty despite telling several doctors that his arm was to badly injured and was too painful to use.

Avizent turned its investigation over to CDI, which confirmed Avizent’s allegations. CDI turned over its criminal investigation to the Los Angeles County District Attorney’s Healthcare Fraud Division and on Nov. 12, 2009 the L.A. District Attorney’s Office issued a warrant for Johnson’s arrest on four counts of workers’ compensation insurance fraud.

In addition to the fine and probation, Johnson was ordered to pay court fees and perform 200 hours of community service.

Source: CDI

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