Workers’ Comp, Auto Insurance Fraud Scams Busted in Washington, California

Washington Man Must Repay More Than $12,000 in Workers’ Comp Scam

A service technician who claimed he was too injured to work yet got a job driving a tow truck pleaded guilty Friday in a workers’ comp scam.
Kyle Valle, of Algona, Wash., pleaded guilty to felony, second-degree theft. King County Superior Court Judge Hollis R. Hill sentenced Valle to 20 days in jail, but allowed the jail time to be converted to 160 hours of community service. Hill also ordered Valle to repay the state $12,585, the amount of disability benefits he wrongfully received.

The Washington Attorney General prosecuted the case, based on an investigation by the Washington State Department of Labor & Industries (L&I).

“It’s shameful that people try to take advantage of the system that helps legitimately injured workers heal and get back to work,” said Elizabeth Smith, L&I’s assistant director of Fraud Prevention & Labor Standards. “Stealing workers’ comp money raises costs for the businesses and employees who support the system − and it’s just not fair.

“That’s why L&I is committed to finding workers’ comp scammers, and holding them accountable.”

Valle was working as a service technician for a waterproofing company when he hit his head on a support joist in Kirkland in May 2014. Valle filed a workers’ compensation claim, and medical providers verified his head and neck injuries prevented him from working full time.

An L&I check of Employment Security Department records, however, found that he was employed, even though he declared on official forms that he couldn’t work, and wasn’t working, due to his on-the-job injury.

Further investigation determined that Valle worked as a tow truck driver for a used-car dealership in Seattle from September 2014 through early June 2015.

California Chiropractor, Staff Busted for Insurance Fraud

Chiropractor William Guenther, of Granite Bay, Calif., and former owner of Fort Sutter Chiropractic, was arraigned in Sacramento Superior Court last week on eight felony counts of insurance fraud for his alleged role in a fraud scheme billing health and auto insurers for treatment services never provided.

Former in-house biller Pam Rivas and office managers Cristen Jones-Hassanali and Stacey Fellows face seven counts of felony insurance charges.

An investigation by department detectives revealed Guenther, owner and operator of Fort Sutter Chiropractic, and his staff billed several insurers for mechanical traction treatments for 50 to 70 patients per day between 2012 and 2015, when no mechanical traction units were in the office. Insurers paid $150,325 to Fort Sutter Chiropractic in fraudulent claims.

“Health insurance fraud is rampant in California, totaling billions of dollars annually and requiring consumers to pay higher premiums,” said Insurance Commissioner Dave Jones. “One of the top priorities of this department is to investigate fraud, including medical provider fraud, which is often complex and costly.”

Guenther was released on $150,000 bail. Rivas, Jones-Hassanali, and Fellows are scheduled to appear in court tomorrow. This case is being prosecuted by the Sacramento County District Attorney’s Office.