00:00:00.000 --> 00:00:01.600
Hey everybody, this is Tina.
00:00:01.679 --> 00:00:08.080
You're a very proud host of Fraudcraft, the podcast that promises you all things fraud significates, fraud schemes, fraud tech.
00:00:08.240 --> 00:00:12.400
We love diving in the world of California Workers Comp because it's so messy.
00:00:12.480 --> 00:00:13.679
There's so much fraud in there.
00:00:13.839 --> 00:00:16.719
We have a lot of really great experts who want to clean it up.
00:00:16.879 --> 00:00:18.000
I've got one of them on right now.
00:00:18.079 --> 00:00:18.559
Hi, Karen.
00:00:18.719 --> 00:00:19.039
How are you?
00:00:19.280 --> 00:00:20.079
Hey, good afternoon.
00:00:20.399 --> 00:00:28.239
So, as promised, this podcast brings you the best of the best subject matter experts, especially in California Workers Comp.
00:00:28.399 --> 00:00:32.479
And there's nobody better, and everybody will tell you this, than Karen Johnson.
00:00:32.719 --> 00:00:33.520
She is the best.
00:00:33.679 --> 00:00:44.479
And when we're talking the best, I'm talking about there's this very dark, obscure world called SJDB, voucher fraud, counseling and school frauds in California Workers' Comp.
00:00:44.719 --> 00:00:53.439
This is a system that is supposedly designed, and Karen will go into it, to help the injured workers get back to another career path if they choose.
00:00:53.600 --> 00:00:54.799
There's monies there for them.
00:00:54.880 --> 00:01:13.439
However, like everything else in California WorkersComp, the fraudulent fraudster, legal providers, medical providers, the bad applicant attorneys, there's a lot of good applicant attorneys, the bad applicant attorneys use benefits like this as the carrot on the stick to draw injured workers into very complex fraud schemes.
00:01:13.599 --> 00:01:17.680
And so I'm so proud to be good friends with this woman.
00:01:17.840 --> 00:01:25.200
She is not just an amazing investigator, but we're going to highlight how proud she is to be of service to the injured worker.
00:01:25.359 --> 00:01:35.359
And that's what I really love about you, Karen, is that there's really great people in the space who are investigators, attorneys, claims adjusters, who honestly really care about the injured worker.
00:01:35.439 --> 00:01:36.079
And that's you.
00:01:36.239 --> 00:01:39.200
That's that's who you have been since I have met you years ago.
00:01:39.359 --> 00:01:40.560
And I really love that about you.
00:01:40.640 --> 00:01:52.799
Now, what I want to talk about, I know I'm talking a lot before you even get started, but I want to tell our audience that we've done episode one, that we kind of glossed over the SJDB thing, the voucher counseling school thing.
00:01:52.959 --> 00:01:56.079
It's complex, it needs to be broken down, and that's what we're gonna do.
00:01:56.159 --> 00:02:03.760
So episode one was introduction of Karen Johnson, her greatness, this whole crazy weird world of voucher fraud.
00:02:03.920 --> 00:02:05.280
Now we're gonna break it all down.
00:02:05.439 --> 00:02:15.120
This is what it looks like, this is what the fraud is, this is how this is how people are harmed, this is how people are taken advantage of, these are the definitions, and we're gonna go into case scenarios.
00:02:15.360 --> 00:02:20.000
Lord, I'm all I'm so excited that I just pulled out my earplugs.
00:02:20.240 --> 00:02:23.680
I'm so excited to have you on because you're just an amazing person.
00:02:24.319 --> 00:02:26.560
We just don't have anybody like you in this space.
00:02:26.719 --> 00:02:31.599
There might be a few good investigators out there, but not at the level that that you're operating in.
00:02:31.759 --> 00:02:33.599
So it's such a privilege to have you on, Karen.
00:02:33.840 --> 00:02:34.400
Thank you very much.
00:02:34.560 --> 00:02:36.800
So if we could start from the beginning for our audience.
00:02:37.039 --> 00:02:37.840
Yeah, absolutely.
00:02:38.000 --> 00:02:45.199
So I think the one thing to remember about your 101 is that an injured worker gets hurt on the job and for whatever reason they can't go back to that job.
00:02:45.439 --> 00:02:54.000
And the benefit here is that it allows this injured worker to get a benefit of$6,000 to go back to school for retraining services.
00:02:54.159 --> 00:03:00.000
So, you know, maybe they were a mechanic before and now he's having back issues and he can't.
00:03:00.080 --> 00:03:04.319
So now he wants to take some computer classes or he wants to take an accounting class or whatever.
00:03:04.560 --> 00:03:06.719
So the benefit is to the injured workers.
00:03:06.800 --> 00:03:11.199
The insurance company is like the custodian of that trust fund.
00:03:11.360 --> 00:03:17.599
So the injured worker gets a stack of paperwork and it kind of explains to them what their retraining voucher is.
00:03:17.680 --> 00:03:20.960
And like I said, that has a$6,000 price tag on it.
00:03:21.039 --> 00:03:25.680
So it's basically like a training education grant for$6,000.
00:03:26.400 --> 00:03:30.000
So I think that's first and foremost is to understand what the voucher is.
00:03:30.159 --> 00:03:35.120
Then what happens is a lot of times these injured workers don't understand the voucher program.
00:03:35.199 --> 00:03:36.960
They don't understand their paperwork.
00:03:37.120 --> 00:03:42.719
I read talked to an injured worker just this last week who said, I've got so much paperwork, I just threw it all in the garbage.
00:03:42.800 --> 00:03:43.919
I didn't really read it.
00:03:44.080 --> 00:03:49.199
And so I took the time to explain to her what her voucher was, explained to her that she had options.
00:03:49.360 --> 00:03:55.759
Like in this particular case, what happened was she was contacted by a school who told her that she this was her only option.
00:03:56.000 --> 00:03:58.479
She was told that this was the only school that she could go to.
00:03:58.560 --> 00:04:01.039
And I, when I talked to her, I said, No, that's not the case.
00:04:01.199 --> 00:04:02.159
You can pick a school.
00:04:02.400 --> 00:04:06.319
She goes, Oh, thank you, because this school was going to be several several miles away from her.
00:04:06.400 --> 00:04:07.360
It was too far for her.
00:04:07.520 --> 00:04:10.159
And I said, Let me send you your paperwork again.
00:04:10.879 --> 00:04:19.920
And I put it in an envelope and I highlighted the sections for her so that she could look at it and she could make her educated decision on where she wanted to go to school.
00:04:20.079 --> 00:04:24.639
So what happens is the injured worker decides what schooling program they would like to go to.
00:04:24.800 --> 00:04:33.439
And then they send us their paperwork and the insurance company pays the bill for that education or reimburses the injured worker directly when appropriately.
00:04:33.600 --> 00:04:40.240
So again, the insurance company is writing the check for the$6,000, but it's technically the injured worker's benefit.
00:04:40.319 --> 00:04:42.959
It's part of his settlement, his or her settlement money.
00:04:43.680 --> 00:04:50.639
This is where it all gets complicated because it's not just the$6,000, because there is money that comes in from the state as well, right?
00:04:51.040 --> 00:04:52.639
It's like$5,000 from the state.
00:04:52.879 --> 00:04:55.519
Yeah, but we really don't have any bearing on that.
00:04:55.680 --> 00:04:57.120
That's a DIR thing.
00:04:57.279 --> 00:05:02.319
So I think that, you know, the insurance company pays the bill on behalf of the injured worker.
00:05:02.639 --> 00:05:04.000
There is that$5,000.
00:05:04.399 --> 00:05:14.240
It is bundled somehow into this whole scheme of how an injured worker is carrot dangled, enticed, and then may or may not get it.
00:05:14.319 --> 00:05:16.639
And it's it's used in the fraud scheme, right?
00:05:16.720 --> 00:05:18.800
So I just wanted to make sure I'm thinking out loud.
00:05:19.120 --> 00:05:21.600
Well, yeah, there's a case where they're actually blackmailed with it.
00:05:21.920 --> 00:05:22.560
Really?
00:05:22.959 --> 00:05:29.759
Yeah, so there's a case where a school tells them that we won't get you your$5,000 unless you complete 70% of your training program.
00:05:30.000 --> 00:05:30.160
Okay.
00:05:30.399 --> 00:05:33.279
And that$5,000 that's not part of the$6,000.
00:05:33.519 --> 00:05:34.720
What's that$5,000?
00:05:35.199 --> 00:05:35.920
What's that called?
00:05:36.240 --> 00:05:38.480
So that is the return to work funds.
00:05:38.639 --> 00:05:42.720
That is directly administered by the Department of Industrial Relations.
00:05:42.879 --> 00:05:56.639
So once the insurance company processes the paperwork, which is the voucher paperwork as we call it, it's sent to the injured worker, the last page of that is the document that they need to file for their$5,000 from the state.
00:05:56.800 --> 00:06:04.959
So in essence, the injured worker is going to get$6,000 from the insurance company, and then they're going to get another$5,000 from the Department of Industrial Relations.
00:06:05.040 --> 00:06:09.680
So in total, they get a sum of$11,000 to use for training benefits.
00:06:09.920 --> 00:06:14.959
Okay, and if I understand correctly from what you said last time, you said it was that POS page.
00:06:15.439 --> 00:06:16.480
Proof of service document.
00:06:17.279 --> 00:06:18.560
The proof of service document.
00:06:18.720 --> 00:06:19.120
Gotcha.
00:06:19.439 --> 00:06:19.680
Okay.
00:06:19.920 --> 00:06:30.480
So if we were to wrap this up, play the scenario out, a California workers comp injured worker, right, is denied the ability to return back to work because of the restrictions, right?
00:06:30.800 --> 00:06:32.079
Like a permanent disability rating.
00:06:32.240 --> 00:06:32.480
Yep.
00:06:32.560 --> 00:06:32.800
Yes.
00:06:33.040 --> 00:06:33.279
Okay.
00:06:33.439 --> 00:06:33.759
Okay.
00:06:33.920 --> 00:06:39.199
And how many of these injured workers are they usually have their own attorney, have an applicant attorney?
00:06:39.439 --> 00:06:40.000
A lot.
00:06:40.480 --> 00:06:40.720
Okay.
00:06:41.040 --> 00:06:47.120
You know, I don't have the statistics on that, but you know, we see it a lot where we are mailing a copy of the voucher.
00:06:47.279 --> 00:06:49.199
We have to carbon copy their attorney.
00:06:49.360 --> 00:06:57.199
So whenever we send the voucher forms out, you know, obviously we have to send it to the injured worker and we send a carbon copy to the applicant attorney on file.
00:06:57.519 --> 00:07:07.040
That makes sense because I'm thinking this through because uh what most likely occurs is that the injured worker is represented by an applicant attorney for the process of the compromise and a release as well.
00:07:07.360 --> 00:07:18.240
And so the reason why I bring this up is because you're stuck a lot of the times, it's the applicant attorney's job to explain these benefits, but it seems like that falls on your shoulders a lot.
00:07:18.639 --> 00:07:20.959
You know, it depends on if the injured worker reaches out to us.
00:07:21.040 --> 00:07:28.800
And again, most of the time the injured workers don't contact us after the claim is settled and they've received their settlement checks, then they get a bunch of paperwork in the mail.
00:07:28.879 --> 00:07:30.240
This is their voucher forms.
00:07:30.399 --> 00:07:35.680
A lot of times they don't really always recognize what it is or, you know, reach out to us directly.
00:07:35.839 --> 00:07:37.920
They may use a counselor, which is a middle person.
00:07:38.240 --> 00:07:42.639
Counselor is again is somebody that is approved by the Department of Industrial Relations.
00:07:42.879 --> 00:07:52.319
Their role in this is to interview that injured worker and find out what's the best, you know, educational program or what's their best options, you know, to utilize those doctor funds.
00:07:52.560 --> 00:08:02.639
Let's talk about the counselor for a moment, because if I understand correctly, there's a whole lot of criminal charges that have been doled out the past few years against counselors, too, right?
00:08:02.879 --> 00:08:03.199
Correct.
00:08:03.360 --> 00:08:14.399
So, you know, thanks to the education of meeting with the industry, meeting with law enforcement, meeting with the prosecutors and stuff like that, there is a heightened awareness now of what voucher fraud is.
00:08:14.639 --> 00:08:16.959
And there have been several people that have been charged.
00:08:17.120 --> 00:08:26.879
So a lot of times with this case is if it's a criminal case with the school, there's a lot of times there'll be counselors involved in this also, you know, as a participant in the fraud.
00:08:27.120 --> 00:08:27.439
Okay.
00:08:27.839 --> 00:08:30.720
So what I think we should do is we should talk about the role of the counselor.
00:08:30.879 --> 00:08:36.720
And before we do that, what type of schools are these where we've got, let's say we've got an injured worker.
00:08:36.879 --> 00:08:42.960
The injured worker was a truck driver, or, you know, a lot of times in California, they're agricultural workers.
00:08:43.039 --> 00:08:45.679
They work on a farm or they work in a restaurant.
00:08:45.840 --> 00:08:49.919
So let's just say we have, you know, those types of claimants.
00:08:50.080 --> 00:08:55.200
What type of schools are out there that you normally see in your day-to-day work with this stuff?
00:08:55.440 --> 00:09:03.120
Unfortunately, the schools, there's there's been schools that are designed and have been created or built strictly to redeem voucher money.
00:09:03.360 --> 00:09:07.279
These are schools that are set up to do online training.
00:09:07.440 --> 00:09:09.840
They might be computer classes 101.
00:09:10.000 --> 00:09:13.919
A lot of times these schools will charge$6,000 to learn Microsoft Office.
00:09:14.080 --> 00:09:17.600
Another simple one is medical assistant programs, you know.
00:09:17.759 --> 00:09:26.960
So an 80-hour program for medical assistant is gonna cost you, you know,$4,500 for an example, automotive boot camps and online training.
00:09:27.120 --> 00:09:28.399
You know, things along that line.
00:09:28.480 --> 00:09:33.759
So these particular programs are geared 100% towards injured workers.
00:09:33.919 --> 00:09:38.879
If you walked into the school and and you were Joe Blow on the street, you would not be enrolled in the school.
00:09:38.960 --> 00:09:40.960
They're they're strictly geared towards injured workers.
00:09:41.200 --> 00:09:46.240
Okay, I'm gonna act as your interpreter for a moment, and I'm going to explain to our audience what you are really saying.
00:09:46.399 --> 00:09:49.759
You're really being kind and you're being very neutral on this.
00:09:49.840 --> 00:09:53.440
And I'm just gonna take it up a notch and say what you're really trying to say.
00:09:53.600 --> 00:10:04.000
What you're really trying to say is there are fraudsters out there who are solely focused on trying to gain as much money as they can from the workers' comp system.
00:10:04.080 --> 00:10:06.320
So they sit around and they think, what can we create?
00:10:06.399 --> 00:10:15.440
What type of school can we create that would normally cost a few hundred dollars and we can take all that money for ourselves and not care at all about the injured worker?
00:10:15.679 --> 00:10:18.639
You know, absolutely, and that is exactly what's happened.
00:10:18.799 --> 00:10:26.799
I mean, when I worked for the state doing this, is that I would get calls all the time from injured workers who didn't even know they were enrolled in schools.
00:10:27.039 --> 00:10:33.600
So the schools are enrolling these injured workers without their knowledge because that voucher form went to the applicant attorney.
00:10:33.759 --> 00:10:40.240
The applicant attorney gave it off to his preferred counselor or his preferred school of choice, his or hers.
00:10:40.320 --> 00:10:46.080
And then they would just simply, you know, use DocuSign to sign these documents and submit for payment.
00:10:46.320 --> 00:10:51.600
I mean, there was one school that was operating out of a mailbox, et cetera, when we started this in 2016.
00:10:51.759 --> 00:10:59.519
And this was, you know, millions of dollars a year in voucher money that was being sent to a mailbox, et cetera, and the industry didn't know it.
00:10:59.759 --> 00:11:01.279
Okay, I'm gonna interpret for you again.
00:11:01.440 --> 00:11:04.080
Um, I'm gonna interpret two different things that you're saying here.
00:11:04.240 --> 00:11:17.039
The first thing that you're saying is that when you're saying that the injured workers didn't even know that they were enrolled in schools, what you're saying is that those schools billed the insurance carrier for attendance, got the money, students didn't even know they were enrolled.
00:11:17.200 --> 00:11:22.559
Now the school is rolling down the road with all that money, usually about$4,500 or something like that, right?
00:11:22.799 --> 00:11:23.600
Per student.
00:11:23.840 --> 00:11:24.080
Okay.
00:11:24.799 --> 00:11:25.200
Yep.
00:11:25.519 --> 00:11:31.440
Didn't bother to tell the insurance carrier that they never contacted the student or the the student is not even going to the school, right?
00:11:32.240 --> 00:11:41.759
And the second thing I want to interpret for you is the fact that you said that schools operating out of a mailbox express or a postal annex or something that like that, right?
00:11:41.840 --> 00:11:52.399
So what you're actually saying is that those schools are willing for students to be enrolled in a school and going to classes operate out of a postal annex.
00:11:52.639 --> 00:11:54.080
So you don't exist.
00:11:54.399 --> 00:12:00.399
I saw it quite a bit when I worked for the state, and I would go out and do site inspections, or I'd go out and inspect the schools.
00:12:00.559 --> 00:12:11.200
Uh there was one I did, um, she was enrolling students in an automotive program, and it was on the 14th floor of a professional high-rise building that was a um professional suite.
00:12:11.360 --> 00:12:18.960
And when I went into the room, there was no screwdrivers, there was no computers, there was no car engines, there was nothing automotive in that suite.
00:12:19.120 --> 00:12:22.559
And yet, you know, again, she was rolling injured workers in that program.
00:12:22.720 --> 00:12:31.440
And it's like, you know, we saw it all the time, or I'd walk into a class or a school and it would be dusty computers, and there would be no, they had a hard time even finding the the students' files.
00:12:31.600 --> 00:12:32.960
Like, where's the records?
00:12:33.039 --> 00:12:34.720
You know, where's the attendance records?
00:12:34.879 --> 00:12:38.960
So, you know, I saw it over and over and over again, unfortunately, when I work for the state.
00:12:40.559 --> 00:12:46.480
Aren't counselors care so much about their client that they're making sure the school exists?
00:12:46.720 --> 00:12:48.240
You know, that's a mixed bag.
00:12:48.399 --> 00:12:59.279
I mean, I I do work with some counselors that absolutely care a lot about the injured workers, and they they give a great service to these injured workers and they help them out quite a bit in what's their best interest for them.
00:12:59.440 --> 00:13:02.480
So, but then on the second hand, there's ones that don't.
00:13:02.639 --> 00:13:12.559
And, you know, there's there's a couple of them that have been caught and they've been charged with foraging the signatures of the injured workers, foraging documents, you know, enrolling them in multiple schools.
00:13:12.799 --> 00:13:15.360
So it's it's a mixed bag, just like with everything else.
00:13:15.440 --> 00:13:23.200
Like you said, there's good cops, there's bad cops, but unfortunately, it's been not recognized, you know, and it's a very difficult crime.
00:13:23.360 --> 00:13:33.200
It's a very difficult investigation to do these voucher cases because a lot of times these injured workers they don't come forward and they don't communicate with us and say, Hey, look, I think there's a problem.
00:13:33.360 --> 00:13:37.519
And that makes it difficult when you you don't have a victim who's willing to cooperate.
00:13:37.600 --> 00:13:38.559
It it makes it challenging.
00:13:48.000 --> 00:13:48.799
In High Tell.
00:13:49.279 --> 00:13:49.519
Yes.
00:13:49.600 --> 00:13:50.799
So that would be the state.
00:13:50.960 --> 00:13:55.200
The Bureau for Private Post Secondary Education is the agency that approves that.
00:13:55.440 --> 00:14:04.480
So if I wanted to open a school, I would write my curriculum, I would define it and explain it, and then I would submit it to the state for approval.
00:14:04.559 --> 00:14:15.039
And I could either have a fully in-person program, I could have an online program, or I can have a hybrid program where I'm gonna do both online and in-person.
00:14:15.279 --> 00:14:17.679
So that would be approved by the state.
00:14:17.840 --> 00:14:22.320
So that does become very important if you're gonna do these doctor investigations to find out.
00:14:22.480 --> 00:14:30.000
I have an example of one where the injured worker lives in Mount Shasta and the cosmetology school was in LA.
00:14:30.159 --> 00:14:33.039
And you can't take cosmetology 100% online.
00:14:33.200 --> 00:14:42.000
You can take it hybrid, but you know, obviously, a worker in Shasta in Northern California is not flying down to LA to take some colismatology programs.
00:14:42.159 --> 00:14:45.039
So that was uh a big red flag for me on that case.
00:14:45.840 --> 00:15:01.759
For the SIU special investigator to be taking a look at this if they're supposedly enrolled in tractor trailer driving school or makeup or haircutting or anything like that, it would be difficult to learn all that just online.
00:15:02.320 --> 00:15:03.120
You would hope.
00:15:03.279 --> 00:15:20.960
Unfortunately, there are um programs offered by the California State University systems, those are all 100% online, you know, and those are HVAC programs, those are veterinary tech programs, programs that you would expect an electrical technician to know the difference between a Phillips and a standard screwdriver.
00:15:21.120 --> 00:15:25.200
But when they're taking these classes online, uh you don't know what they're learning.
00:15:25.600 --> 00:15:27.279
It gets very difficult.
00:15:27.360 --> 00:15:33.919
I think I'd want a plumber electrician at my house learned gone in their cation just online and have never touched anything.
00:15:34.000 --> 00:15:39.519
I mean, that's or or driving a big rig down the highway at 65 miles an hour.
00:15:40.720 --> 00:15:47.039
That you know, it's a lot of these truck driving schools are hybrids in that, you know, they're online and they're in person.
00:15:47.200 --> 00:15:48.399
So, yes, it's very concerning.
00:15:48.720 --> 00:15:57.039
One of the things I'd like to talk to you about um before we move into any case scenarios is that we talk about there's a counselor involved, and I think that's a pivotal part of this.
00:15:57.120 --> 00:16:03.679
So I'd like to talk about private versus public institutions involved in this type of work.
00:16:04.240 --> 00:16:06.799
Said scheme, I say scheme as well.
00:16:07.279 --> 00:16:12.720
The aspect of whether it leads to a certification or not, a state certification.
00:16:12.879 --> 00:16:14.080
Can you talk about all that?
00:16:14.799 --> 00:16:18.480
So there's there's several different programs that these injured workers get enrolled in.
00:16:18.639 --> 00:16:23.440
Private post-secondary is that it's private schools, it's private classes.
00:16:23.600 --> 00:16:31.039
It's put on by any person that wants to apply to have a school who wants to charge over$2,500.
00:16:31.519 --> 00:16:42.720
They they, like I said, they create a school, they get curriculum, they get teachers, they get, you know, materials, they present it to the state of California for approval and they get approval.
00:16:42.879 --> 00:16:46.159
Now, one of the big programs is contractors licensing.
00:16:46.399 --> 00:16:51.039
So, you know, a lot of times these injured workers, and it's very common, and and I'm not against it.
00:16:51.120 --> 00:16:56.320
I I fully support it, you know, is that they want to get their contractor's license, and I think that's a great thing.
00:16:56.480 --> 00:17:07.359
So, again, in a situation like that, that's a private post-secondary situation where, you know, they're gonna go back to school, they're gonna take some classes, they're gonna get their contractor's license, and that's what those schools are geared towards.
00:17:07.519 --> 00:17:12.400
Now, the public institutions is a is another situation, as I'm gonna call it.
00:17:12.640 --> 00:17:27.359
And the frustrating part with the public schools is that, you know, these public schools, these universities are utilizing third-party vendors that are not regulated by the state, that the programs are not vetted by their accrediting agencies.
00:17:27.519 --> 00:17:34.960
So, you know, again, in that situation, these injured workers are being steered to an HVAC program that's online.
00:17:35.200 --> 00:17:38.319
And again, I've spoken to the injured workers, I've spoken to the schools.
00:17:38.480 --> 00:17:44.559
It's very concerning when I got an injured worker who is gonna enroll in an online HVAC program.
00:17:44.720 --> 00:17:53.200
And when he graduates, if he graduates, because my experience is that roughly 75% of these injured workers don't complete the programs.
00:17:53.519 --> 00:18:01.200
So if he's one of the 25% that pre-completes the program, he's gonna get a certificate that makes it look like he graduated that university.
00:18:01.359 --> 00:18:02.480
And that's just not the case.
00:18:02.720 --> 00:18:10.559
The university faculty did not teach that program, the university accrediting agency did not review the curriculum of that program.
00:18:10.880 --> 00:18:16.480
So basically, it's kind of like a little diploma mill or certificate mill for these programs.
00:18:16.720 --> 00:18:18.799
That's the difference between the private and public.
00:18:18.960 --> 00:18:23.680
It's very common in our industry and our society now to allow electronic signatures.
00:18:23.920 --> 00:18:35.279
So it's very hard for us as an insurance company to, you know, try to validate when we're getting all these documents in the mail on a regular basis and the claims adjusters are, you know, they're handling their claims.
00:18:35.440 --> 00:18:38.400
We can't sit and verify electronic signatures.
00:18:38.480 --> 00:18:46.640
So we have to kind of take it at face value that these injured workers are are familiar with what these forms are and they know what they've signed.
00:18:46.720 --> 00:18:50.480
And, you know, they have knowledge of it, but that's not something we can verify.
00:18:50.960 --> 00:19:00.160
A lot of those the signatures that are on the enrollment agreement for the schools really mysteriously match the signatures on the some release settlement documents.
00:19:00.559 --> 00:19:02.400
We used to see that quite a bit.
00:19:02.480 --> 00:19:17.039
Um, there was actually one case scenario that we had that actually somebody was visiting the school and it sitting in plain sight were these documents where the the little strips of signatures were literally being taped on the enrollment agreements.
00:19:17.279 --> 00:19:21.599
In today's world, we see just more docusigns than anything.
00:19:21.839 --> 00:19:24.400
And it you can clearly see that it's not a legitimate.
00:19:24.640 --> 00:19:31.519
I mean, it's legitimate in a docu-signed world, but it's not somebody scribbling on a on a you know, on the paper or stuff like that.
00:19:32.000 --> 00:19:37.519
Encourage everybody to come watch you speak because you do a lot of public presentations.
00:19:37.759 --> 00:19:40.720
I think that's really great because that's the only way to get this out.
00:19:40.799 --> 00:19:42.319
And I I want to thank you for doing that.
00:19:42.400 --> 00:19:49.680
And I think you get to reach enough people, which will is why you're on the podcast so that we can reach more people and that we can really get the word out there.
00:19:49.759 --> 00:19:59.279
And the now, when it comes to the private post-secondary schools, you know, they have to be on the ETPL, which is the eligible training provider list, which is is handled by EDD.
00:19:59.519 --> 00:20:05.440
And and again, this is why vouchers get so complicated, is because you've got so many different agencies involved in this.
00:20:05.680 --> 00:20:11.440
But, you know, clearly on the on the voucher forms, it says that the school must be ETPL approved.
00:20:11.599 --> 00:20:23.039
So as a as a carrier, you know, you would hope that the claims adjuster would take the time to make sure that before she processes that payment that the school is is approved for vouchers.
00:20:23.119 --> 00:20:32.079
And, you know, in cases where they're not, maybe send that off to their claims or to their SIU units to take a look at that and find out, you know, who is this school?
00:20:32.240 --> 00:20:33.599
Are they BPP approved?
00:20:33.680 --> 00:20:36.880
Is it some Joe Blow that's just trying to collect these funds?
00:20:37.039 --> 00:20:38.480
And, you know, things along that lines.
00:20:38.640 --> 00:20:40.559
Make sure that it's a legitimate location.
00:20:40.640 --> 00:20:49.519
I'll do things like check their addresses, I'll check their catalogs for their programs, things along that lines to make sure that they're that they're legitimate.
00:20:49.920 --> 00:20:56.480
We would see for a while there was one school that was notorious for calling up the injured worker and saying, Hey, what kind of class do you want?
00:20:56.640 --> 00:20:58.000
Oh, you want dog grooming?
00:20:58.160 --> 00:20:59.839
Okay, well, let's put you in dog grooming.
00:20:59.920 --> 00:21:02.319
And the school's not approved for dog grooming, you know?
00:21:02.400 --> 00:21:04.000
So crazy stuff like that.
00:21:04.160 --> 00:21:08.640
And then, you know, like I said, the paperwork comes across the desk and the claims adjuster is like, I gotta go.
00:21:08.720 --> 00:21:10.799
And she, you know, stamps it and pays it.
00:21:10.960 --> 00:21:16.559
So, but from an SIU standpoint, when you're kind of break it down a little bit, there are some tools that we can do.
00:21:16.799 --> 00:21:21.519
Here's where it gets kind of cloudy that I'd like to clear up for people trying to learn this, right?
00:21:21.839 --> 00:21:27.680
For the private schools, the schools have to be P BPPP approved, PL approved.
00:21:27.839 --> 00:21:30.720
So, what's the difference and what does that all mean?
00:21:31.039 --> 00:21:39.920
Okay, so BPP approval, which is the Bureau for Private Post-secondary Educate, is the state agency that basically gives these schools their approvals to operate.
00:21:40.079 --> 00:21:51.359
They're the ones that bet the teachers, they're the ones that bet the curriculum, they're the ones that look at the online platforms to make sure they're all legitimate, they make sure all the business records that the financial responsibility is all there.
00:21:51.519 --> 00:21:57.039
I mean, it is a hugely in depth program that these schools have to go through to get state approval.
00:21:57.279 --> 00:22:01.279
So that is handled by again Consumer Affairs, the Bureau of For private post-secondary.
00:22:01.440 --> 00:22:18.079
Once the school has that approval, then that school can take that approval over to EDD, which is employment development, and get on their program to get people back to work, you know, things along that line, and get approved on the ETPL, which is the eligible training provider list.
00:22:18.160 --> 00:22:26.960
So that is like a second platform of approval that can, you know, give them a different audience for students, for an example.
00:22:27.119 --> 00:22:37.359
And you have somebody who's been laid off from their job and they want to go back to school, EDD might contact them and say, hey, look, we we see that you you made widgets and now you want to be a cosmetologist.
00:22:37.440 --> 00:22:38.079
We'll pay for that.
00:22:38.160 --> 00:22:40.160
That's all part of EDD's program.
00:22:40.400 --> 00:22:44.240
And it kind of ties into this work comp arena that we're in.
00:22:44.400 --> 00:22:46.640
So the school basically has to have two approvals.
00:22:46.720 --> 00:22:50.000
They have to have the state approval and then they have to have ETPL approval.
00:22:50.160 --> 00:23:04.400
And that's for private post-secondary private schools, for example, truck driving schools, cosmetology schools, computer technology schools, medical assistance, um, anything that's that's more that vocational training would have to have those two approvals.
00:23:05.200 --> 00:23:10.799
A lot of the fraud that's involved in this world, um, the E just trust that they're operating.
00:23:11.200 --> 00:23:14.319
Yeah, no, BBPE does have a compliance and enforcement section.
00:23:14.400 --> 00:23:22.480
And that's what I did when I worked for them is I would go out to these schools and I would verify were their instructors, was their equipment there, how old was the equipment?
00:23:22.559 --> 00:23:27.440
You know, so that was a role that we did do to go out and and verify these types of things.
00:23:27.599 --> 00:23:34.720
So students who had complaints or had issues or had concerns would file complaints with the Bureau, and that was our investigative.
00:23:34.799 --> 00:23:46.240
But then also the to that is that schools were required to have, you know, inspections every so many years, every two or three years or five years, whatever it is, that the Bureau has to go out and do those types of inspections.
00:23:46.400 --> 00:23:48.720
So, yeah, that is a regular process there.
00:23:48.960 --> 00:23:49.920
Let's talk about the counselor.
00:23:50.319 --> 00:24:05.759
Counselor's job is to help that injured worker navigate this training program, to talk to them about what are their limitations, what are their work restrictions, what would be a good career path for them, what would be a good school opportunity, do they want to take in person?
00:24:05.839 --> 00:24:06.960
Do they want to take online?
00:24:07.119 --> 00:24:10.160
So that counselor is, like I said, it's a counseling service.
00:24:10.319 --> 00:24:13.519
Um, that is what is it is in the perfect world.
00:24:13.680 --> 00:24:15.839
So there's good counselors and bad counselors.
00:24:16.000 --> 00:24:24.400
As a carrier, if you're gonna look at something, you should be asking for detailed invoices, like what are the dates and services that you provided services to this injured worker?
00:24:24.640 --> 00:24:35.920
If the counselor just sends you a bill for$6,000 and that's it, it's like, is that really what you're gonna pay when you don't have any documentation that services were provided to the injured worker?
00:24:36.000 --> 00:24:41.920
So that's kind of between an insurance company to kind of validate that the counseling is doing some services.
00:24:42.079 --> 00:24:44.720
The$600 is what the counselor can collect.
00:24:44.880 --> 00:24:49.279
So the counselor can be paid$600 out of the$6,000.
00:24:49.680 --> 00:24:52.240
Asking those questions like, did they provide any services?
00:24:52.400 --> 00:24:56.000
I don't like it when the counselor sends me a bill for$600 and I'm like, what did you do?
00:24:56.160 --> 00:25:11.279
Now with the new regulations coming out, there will be stricter guidelines on what counselors are required to do, and that will be to provide detailed invoices, and that the person providing the counseling services must actually be a DIR-approved person.
00:25:11.519 --> 00:25:15.519
And what fraud have you seen on the counselors?
00:25:15.920 --> 00:25:28.240
Enrolling the school, the injured workers in schools without their knowledge is so they get their hands on the voucher from the attorney and they just they fill out their forms to say, hey, look, Joe Blow, you know, injured worker.
00:25:28.400 --> 00:25:31.440
I helped him with this counseling and I enrolled him in this school.
00:25:31.599 --> 00:25:36.400
So, and then later you find out that the injured worker didn't even know that they were enrolled in a school.
00:25:36.480 --> 00:25:41.039
So they'll enroll the injured workers without their knowledge, they'll forge the injured workers' signatures.
00:25:41.200 --> 00:25:46.240
Um they'll I've even seen them direct injured workers to go to unapproved schools, which cracks me up.
00:25:46.400 --> 00:25:48.720
Be like, what kind of a counselor are you?
00:25:48.799 --> 00:25:52.880
You're supposed to be helping them and you just enrolled them in a school that's not even state approved.
00:25:53.119 --> 00:25:54.880
Um, you know, things along that line.
00:25:54.960 --> 00:25:59.279
So giving the injured workers bad advice, that can be an issue.
00:25:59.440 --> 00:26:00.880
We see that on occasions.
00:26:01.279 --> 00:26:05.119
From the injured workers' perspective, how they see the fraud if there's something wrong.
00:26:05.200 --> 00:26:10.400
Like we've got an injured worker and they they sign the enrollment agreements, they talk to a counselor.
00:26:10.799 --> 00:26:12.000
What do you see on their end?
00:26:12.400 --> 00:26:20.880
You know, I think that when they start to take the program, they find out that the program is not what they thought it was, that the program is not there at all.
00:26:21.039 --> 00:26:27.119
Like they some of these schools, what they'll do is they'll say, Oh, we're gonna start next month, or oh, we're gonna start next month, or oh, we're gonna start next month.
00:26:27.279 --> 00:26:36.640
And eventually they the injured workers are like, We've never started the program, or there's no teacher, there's no materials, it's a bad program, um, things along that line.
00:26:36.720 --> 00:26:41.200
So the injured worker will start to realize that something's not, you know, adding up here.
00:26:41.359 --> 00:26:46.319
And again, a lot of times it's very challenging though, because the injured workers might just go, forget it.
00:26:46.400 --> 00:26:47.119
I'm not gonna do this.
00:26:47.200 --> 00:26:49.359
I got to go back to work, I gotta feed my family.
00:26:49.519 --> 00:26:50.559
And they just drop it.
00:26:50.720 --> 00:26:54.799
They don't pursue, you know, the fact that they really wanted an education.
00:26:55.119 --> 00:27:05.279
So I had another situation recently where the injured worker was told, if you go to school, you're gonna get 60, I believe it's$6,500 or something like that.
00:27:05.440 --> 00:27:11.599
You know, you're gonna get the$5,000 from the state, and you're gonna get$1,000 for the computer, and you'll get a$500.
00:27:12.079 --> 00:27:17.920
So they they actually lied to the injured worker and said, Hey, look, if you go to school, we're gonna get you$6,000, you know.
00:27:18.799 --> 00:27:25.440
The injured workers don't know when you read their depot transcripts or you talk to these injured workers, it's like, what's your highest level of education?
00:27:25.599 --> 00:27:41.279
You know, a lot of times these are blue-collar, they've been working all their lives, um, probably don't have a high school diploma, and they're being enrolled in these programs where they they have to read and write English or take online classes and they don't know how to turn the computer on, or they don't even have internet service.
00:27:41.359 --> 00:27:43.279
So or they don't speak English.
00:27:43.759 --> 00:27:44.000
Right.
00:27:44.079 --> 00:27:44.640
They don't speak.
00:27:45.039 --> 00:27:46.640
Oh, we see that all the time.
00:27:46.799 --> 00:27:52.720
So I think from the injured worker, it depends on how invested they are in wanting to get that program.
00:27:52.880 --> 00:28:00.400
You know, if they call me up and say, hey, look, I I I had one where she called me up and said, I was told to take YouTube channel videos.
00:28:00.559 --> 00:28:02.880
That was my training, was to watch YouTube videos.
00:28:03.039 --> 00:28:03.519
That was it.
00:28:03.599 --> 00:28:05.599
And I'm like, yeah, that doesn't fly here.
00:28:05.759 --> 00:28:08.720
So, you know, I fought with getting their money back for them.
00:28:08.799 --> 00:28:10.640
We got the refunds from the school.
00:28:10.799 --> 00:28:15.279
I encourage that injured worker to file a complaint with the state, let the state do their job.
00:28:15.440 --> 00:28:18.559
So a lot of times if I talk to the injured workers, I educate them.
00:28:18.640 --> 00:28:25.119
It's like, hey, look, if you feel like you've got a bad program, you need to contact the state because they're the ones that need to fix it.
00:28:28.480 --> 00:28:37.200
Is that if you're an injured worker, those benefits uh and don't, you better report them because that is an indication that you're wrapped up in a fraud syndicate scheme.
00:28:37.599 --> 00:28:38.960
They're they prey on these people.
00:28:39.119 --> 00:28:42.640
They're, you know, the the injured workers in most of the cases are victims in this.
00:28:42.720 --> 00:28:48.400
Now we we have seen situations where the injured workers will sell their vouchers to a school.
00:28:48.559 --> 00:29:04.799
Um, I saw that when I worked for the state of California, is that I would go in, it was a truck driving school, and I would go ask for the student's file, and I knew that it was voucher money that they were getting because I'd received the complaint from the insurance company to say, hey, look, there's a problem here with this truck driving school.
00:29:04.960 --> 00:29:16.559
I'd go out to the school, I'd ask to see the student files, and the school had billed the$6,000, but then cut a check to the injured worker for$3,000 or$2,500 or whatever.
00:29:16.799 --> 00:29:23.920
So in that situation, you know, you kind of got the school and the injured worker kind of working hand in hand to collect that money, you know.
00:29:24.319 --> 00:29:24.640
Right.
00:29:24.960 --> 00:29:30.720
You'd have to go out and do the research or talk to the these injured workers aren't going to tell you what really happened.
00:29:30.880 --> 00:29:33.920
You know, and like I said, the vast majority I've talked to, they don't care.
00:29:34.000 --> 00:29:35.839
They just they wanted to move on with their life.
00:29:35.920 --> 00:29:36.720
They're they're over it.
00:29:37.119 --> 00:29:37.519
I get that.
00:29:37.680 --> 00:29:44.559
I guess my message to the injured worker would be you really don't understand what's happening on the side or on the back end on your head.
00:29:44.720 --> 00:30:04.160
You know, you think you're getting away with that that$3,000, but you actually shortchange yourself from all these other benefits that you actually could have had if you did it correctly, um, and weren't involved with these fraudsters, and you can get wrapped up in this criminal scheme where at some point you might find yourself on the stand or arrested.
00:30:04.319 --> 00:30:06.880
Um, you know, consider an accomplice.
00:30:07.200 --> 00:30:07.519
Exactly.
00:30:07.599 --> 00:30:15.599
And that's what makes these cases so hard to prosecute is to get these injured workers to kind of step forward and not be scared and say, hey, look, we're here to help you.
00:30:15.839 --> 00:30:27.359
Um, you know, when you talk about injured workers having their money stolen, I had a great case the other day where the injured worker was going to enroll in that phlebotomy program and they were taking her whole the whole$4,900.
00:30:27.759 --> 00:30:29.119
They were gonna take all of her money.
00:30:29.279 --> 00:30:32.799
And I looked at the catalog and I'm like, this program's only$1,600.
00:30:33.119 --> 00:30:38.960
Why are you charging her$45 or$4,900 when you in your catalog says it's only$1,600?
00:30:39.279 --> 00:30:41.759
So, you know, I contacted the school.
00:30:41.920 --> 00:30:43.119
I said, we're not gonna pay this.
00:30:43.200 --> 00:30:44.000
This isn't right.
00:30:44.160 --> 00:30:45.839
And I contacted the injured worker.
00:30:45.920 --> 00:30:47.519
She confirmed that's the program she wanted.
00:30:47.680 --> 00:30:49.519
I said, Great, that's what we're gonna do.
00:30:49.759 --> 00:30:52.160
But then we got her her the paid the difference.
00:30:52.240 --> 00:31:08.319
So she still had money left over that she wanted to take a certified nursing assistant program, which, you know, again, as a single mom who's trying to go back to school, this was actually gonna allow her to get her phlebotomy program and get a medical assistant program, which was even gonna extend her a little further than she'd even thought.
00:31:08.400 --> 00:31:10.640
And she's like, she was so excited, you know.
00:31:10.799 --> 00:31:14.319
And she just called me a couple of weeks ago and said she'd completed her program.
00:31:14.400 --> 00:31:18.559
And I was like in tears of like a proud mom of like, you got it, yes.
00:31:18.799 --> 00:31:23.440
You know, I was so happy for her that she goes, I'm a single mom and now I've got this certificate.
00:31:23.519 --> 00:31:25.039
I get to be a phlebotomist.
00:31:25.119 --> 00:31:28.240
I did my externship, and I was like, I was glowing.
00:31:28.319 --> 00:31:30.559
I mean, that was just I was celebrating that night.
00:31:30.720 --> 00:31:38.799
And you know, it's it's very challenging when I watch these schools rip off these injured workers and just not take, you know, just not give them their services.
00:31:39.119 --> 00:31:41.359
So it's just frustrating.
00:31:41.599 --> 00:31:56.000
You have identified something that uh falls short with a lot of people that resonates with me because back in the day when I saw all these capping schemes happen in California Workers Comp, the messaging out, everybody was like, Well, you know, what's the big deal?
00:31:56.160 --> 00:31:58.480
Who's who's really losing here in this scenario?
00:31:58.640 --> 00:32:01.839
Yeah, we have bad attorneys, we have bad doctors, you know, whatever.
00:32:02.240 --> 00:32:03.759
You know, where's the actual victim?
00:32:03.920 --> 00:32:09.359
Well, at the end of the day, like you have recognized the victim is the injured worker.
00:32:10.400 --> 00:32:14.960
Even injured workers don't get it that they're being used by these fraudsterists.
00:32:15.119 --> 00:32:20.640
This is a big machine hanging in the background that you have identified that you really can't see.
00:32:20.720 --> 00:32:21.759
It's very obscure.
00:32:22.079 --> 00:32:26.880
You really have to drive down into the fraud and see what is all happening.
00:32:27.119 --> 00:32:30.799
And that's what makes you a really great subject matter expert in this space.
00:32:30.960 --> 00:32:44.400
Um, let's talk about some other scenarios that you have seen where injured workers have been harmed because at the end of the day, what we're trying to do with this podcast is people not fall prey to these schemes, what to look, you know, what to look for.
00:32:44.559 --> 00:32:46.000
Here's real case scenarios.
00:32:46.160 --> 00:32:47.599
Can you hit us with some more?
00:32:48.000 --> 00:32:48.319
Sure.
00:32:48.480 --> 00:32:52.160
So I had a young man uh enroll in one of the public institutions.
00:32:52.240 --> 00:33:02.240
It was a California State University, and he was so excited, he was ecstatic to think that he was enrolling in a public school, public university for him was a big deal.
00:33:02.400 --> 00:33:07.680
And then when he got there and he needed help, he went to the instructor and said, Hey, I I'm having trouble with this program.
00:33:07.759 --> 00:33:08.319
I need some help.
00:33:08.480 --> 00:33:14.880
And the instructor said, Well, you either watch some YouTube videos or you hire your own tutor, but we we can't help you.
00:33:15.119 --> 00:33:20.720
And then he started doing some research, and that's when he found out that he was enrolled in a third-party program.
00:33:20.960 --> 00:33:28.640
But even worse than that, he was actually sub-sub-enrolled in another program that was uh an online program out of Iowa somewhere.
00:33:28.720 --> 00:33:31.200
It wasn't even a California-based school.
00:33:31.359 --> 00:33:34.880
So he was just so disappointed and so frustrated with the situation.
00:33:35.039 --> 00:33:43.119
His enrollment agreement said he his whole mindset was he was so proud that he was enrolled in a California State University and he was not.
00:33:43.279 --> 00:33:48.160
That one just kind of broke my heart because I felt like I was dealing with my own son, you know, in that situation.
00:33:48.319 --> 00:33:52.400
I've had situations like I've mentioned the gal in Mount Mount Shasta.
00:33:52.799 --> 00:33:57.519
She's 73 years old and she was ripped off and she wanted to go back to school for cosmetology.
00:33:57.599 --> 00:33:59.599
Like I talked to her, I still talk to her.
00:33:59.759 --> 00:34:01.039
She calls me all the time.
00:34:01.200 --> 00:34:11.199
I'm still working with her, but you know, she's 73 years old and she really wanted to go back to school for cosmetology because that's what she had done previously, and the school took her money, you know.
00:34:11.360 --> 00:34:13.760
So I had to fight the counselor and the school.
00:34:13.840 --> 00:34:15.599
I in that case, I fought the counselor.
00:34:15.840 --> 00:34:19.519
I'm like, how dare you enroll her in an unapproved program?
00:34:19.679 --> 00:34:20.800
You know, that's not good.
00:34:20.960 --> 00:34:25.039
So I I asked for the counseling money back, I asked for the money back from the school.
00:34:25.119 --> 00:34:29.519
Um, and she's now got those funds available to get the education she wants.
00:34:29.679 --> 00:34:32.239
So that was another one that stands out to me.
00:34:32.480 --> 00:34:39.360
Um again, the one before you go any further, I want to remind people that the people who you're talking about has already got their money.
00:34:39.599 --> 00:34:40.159
Well, they were paid.
00:34:40.559 --> 00:34:42.559
The hard part is we have to pay them up front.
00:34:42.719 --> 00:34:48.159
So, you know, unlike a medical bill, for an example, you know, a medical bill is paid after the fact.
00:34:48.320 --> 00:34:53.119
You pay for the medical bill after the MRI or after the x-ray or after the doctor's appointment.
00:34:53.280 --> 00:35:00.559
When it comes to these vouchers, the insurance company, we have to pay the money up front so that that injured worker can actually start the program.
00:35:00.800 --> 00:35:04.639
So that makes it very hard because then you got to try to fight to get that money back.
00:35:04.800 --> 00:35:09.119
Uh, I've had injured workers that were told that these are the only programs that we offer.
00:35:09.199 --> 00:35:10.960
This this is your only choice.
00:35:11.119 --> 00:35:13.519
Um, I've had situations like that.
00:35:13.679 --> 00:35:20.559
Um my PowerPoint presentation for the last two years has been dead injured workers don't enroll in school.
00:35:20.719 --> 00:35:21.679
It's my slogan.
00:35:22.079 --> 00:35:25.199
And and I I it it sounds corny, but it's true.
00:35:25.360 --> 00:35:27.760
I had a cosmetology school and I was on the phone with them.
00:35:27.840 --> 00:35:29.280
I'm like, are you sure?
00:35:29.519 --> 00:35:31.039
You're sure she wants to go to school?
00:35:31.199 --> 00:35:32.079
Oh, yeah, yeah, yeah.
00:35:32.239 --> 00:35:33.119
I said, Well, let's do this.
00:35:33.199 --> 00:35:36.719
Why don't you call her and I want you to verify it again, please?
00:35:36.960 --> 00:35:40.639
And they called me back and said, Oh, no, no, we've confirmed she wants to go to school.
00:35:40.719 --> 00:35:41.440
And I said, Really?
00:35:41.519 --> 00:35:42.079
Because she's dead.
00:35:42.239 --> 00:35:45.119
Dead injured workers don't enroll in school, you know.
00:35:45.280 --> 00:35:53.280
Um, and we've seen this in the criminal complaints, you know, where the bureau's gone out and done inspections and found out that the injured workers were dead and they were enrolled in school.
00:35:53.519 --> 00:35:54.960
It's a sad situation.
00:35:55.039 --> 00:36:00.639
Uh some other ones are again these online programs where they tell them to watch YouTube videos.
00:36:00.960 --> 00:36:14.400
Um when they when they kind of do these backdoor programs, you know, where they're they're kind of offering their own curriculum that's away from state approval, then at that point it's scary because we don't know what they were taught.
00:36:14.559 --> 00:36:22.559
We don't know what their their protocols are, we don't know who the the teachers were, what was the curriculum, did they were they even qualified to teach the class?
00:36:22.719 --> 00:36:34.079
So there's a lot of stuff that happens in this education world that, you know, at the end of the day, somebody's gonna get a diploma or certificate saying that they've attended this program, and when in reality, we don't know what the heck they did.
00:36:34.239 --> 00:36:37.280
It's very concerning because they're gonna end up in the workforce.
00:36:37.599 --> 00:36:49.840
If you have an injured worker, uh thieve that they were enrolling in type of school, HVAC or truck driving or or anything, real estate, you name it, uh those are the documents as they signed.
00:36:49.920 --> 00:36:52.400
That's that's the class they believe they were about to take.
00:36:52.480 --> 00:36:54.480
And then this is not offered to them.
00:36:54.559 --> 00:36:58.000
They don't get to take that any classes or they get a different class.
00:36:58.239 --> 00:36:58.960
What can they do?
00:36:59.039 --> 00:37:03.599
What they should contact the insurance company because the insurance company was the one that paid for the program.
00:37:03.760 --> 00:37:09.199
If there's a good SIU unit there, they the SIU should do an investigation on that situation.
00:37:09.440 --> 00:37:15.920
But also, most and foremost, is contacting the Bureau for Private Postsecondary Education, filing a complaint with them.
00:37:16.079 --> 00:37:18.960
You can also file the complaint with the Department of Industrial Relations.
00:37:19.039 --> 00:37:24.000
So it's the Department of Industrial Relations that regulates and says, hey, these vouchers have to be handed out.
00:37:24.159 --> 00:37:26.719
And they do have an anti-fraud unit with DIR.
00:37:26.960 --> 00:37:31.760
You'll get an investigator there who's like at least has some experience, or like, hey, I know something about this.
00:37:31.920 --> 00:37:34.320
I don't know exactly all of it, but I know who to talk to.
00:37:34.559 --> 00:37:40.000
You know, and so there's a lot of lieutenants and sergeants at the Department of Insurance that are familiar with voucher fraud now.
00:37:40.159 --> 00:37:55.280
I think that's why you're also so valuable to us, Karen, is the fact that we, the rest of the world, is just waking up to this fraud that you have been working for years and you've met injured workers to see this and hear you and start coming forward.
00:37:55.519 --> 00:38:01.039
Um just like the complex capping schemes that I work, the organized fraud schemes, this is part of it.
00:38:01.199 --> 00:38:12.159
This is like a piece of the pie of these major schemes is the edit counselors, the bad counseling schools, uh, the voucher fraud, uh and such great work in what you've done.
00:38:12.320 --> 00:38:18.000
Um weren't for you, the so many more fraudulent schools operating out there.
00:38:18.239 --> 00:38:27.440
Um any current criminal charges happening within the past couple of years that we can talk about from coming out of the horizon?
00:38:27.840 --> 00:38:30.400
You know, there's a couple of charges that happened last year.
00:38:30.480 --> 00:38:34.320
Um there's a counselor out of the LA area that was charged.
00:38:34.400 --> 00:38:36.639
Um she was her and a school were charged.
00:38:36.719 --> 00:38:42.639
So there's actually two counselors and a school that were charged at the end of last year.
00:38:42.800 --> 00:38:45.199
I think it was a total of 31 felonies.
00:38:45.360 --> 00:38:49.440
And in that case, you know, they were enrolling the injured workers without their knowledge.
00:38:49.599 --> 00:38:51.440
They were foraging their signatures.
00:38:51.599 --> 00:38:53.119
That's a public record document.
00:38:53.199 --> 00:38:55.119
There's a press release out on that.
00:38:55.360 --> 00:39:00.320
There were a couple other schools, probably about two or three years ago, there were a couple schools charged.
00:39:00.480 --> 00:39:02.159
So those were big cases as well.
00:39:02.400 --> 00:39:07.280
And then again, that same counselor, that same counselor's been charged in actually three cases.
00:39:07.440 --> 00:39:16.079
Um her first case, the charges were dropped due to statute of limitations, but her other two cases are are very significant of like 29 and 31 felonies.
00:39:16.320 --> 00:39:25.440
So I just Googled Hazel Insurance, just released um, it's a 2026 press release, February 23rd, 2026.
00:39:26.000 --> 00:39:33.840
CEO of largest vocational school and alleged co-spirators charged in a scheme that drain injured workers' education benefits.
00:39:34.159 --> 00:39:34.400
Yes.
00:39:34.559 --> 00:39:39.360
The price releases are fantastic because they really tell the story of how the injured workers are being frauded.
00:39:39.679 --> 00:39:40.000
Absolutely.
00:39:40.079 --> 00:39:41.440
So it's out of Los Angeles.
00:39:41.519 --> 00:39:57.199
It says the CEO of one of California's largest vocational return to work counseling centers, Hazel are drained on 31 felony counts for allegedly operating a kickback in forgery scheme that drain injured workers' educational benefits for personal profit.
00:39:57.599 --> 00:40:15.519
Outside of California, you might not know is if you're a pro billing provider in the California workers' compensation system and you've been criminally charged, is that you get put on the labor code 4615 list, which that you cannot collect on your bills or liens a disposition of your case.
00:40:15.599 --> 00:40:21.519
And then if you've been convicted, then it goes to labor code 139-3 uh 21.
00:40:21.679 --> 00:40:25.920
Um you get um funded from the California workers' comp system.
00:40:26.159 --> 00:40:35.519
So so right now she cannot give compensation from insurance carriers for her schools, and neither can anyone else charge in the scheme.
00:40:35.599 --> 00:40:38.800
So was uh the Department of Insurance did that case.
00:40:38.880 --> 00:40:40.079
It's been a it's a great case.
00:40:40.159 --> 00:40:45.599
And then Department of Insurance, I believe the same investigator did her prior case from the prior year.
00:40:45.679 --> 00:40:48.639
So let's see, that was the 2025 case.
00:40:48.800 --> 00:40:52.800
She was charged in 20, I think she was charged in December of 2025.
00:40:53.039 --> 00:40:56.719
She had another case in 23 or 24.
00:40:56.880 --> 00:40:59.679
There was another case also filed on her.
00:40:59.760 --> 00:41:02.079
Um, and the same investigator handled both of those.
00:41:02.320 --> 00:41:06.559
Again, just asking that people get involved and to bring awareness to this.
00:41:06.719 --> 00:41:13.440
Um, you know, I've been doing this for 10 years, and I think that the the society is hot right now when this whole fraud thing.
00:41:13.519 --> 00:41:15.760
Um, I think they're starting to be tired of it.
00:41:15.840 --> 00:41:22.320
I think we're worn out of fraud and we're tired of being victims of it, regardless of who you are or what industry you're in.
00:41:22.480 --> 00:41:26.960
There's just so much fraud in our country, and it's been so acceptable for so long.
00:41:27.119 --> 00:41:30.400
But you know, voucher fraud is sixty-four million dollars a year.
00:41:30.639 --> 00:41:36.880
$64 million is fraud in workers and just the vouchers and just the vouchers alone.
00:41:37.119 --> 00:41:39.119
So, you know, it's very frustrating.
00:41:39.199 --> 00:41:41.360
It's not just a it drop in the bucket.
00:41:43.039 --> 00:41:46.559
You said voucher fraud in the California workers' compensation system.
00:41:47.119 --> 00:41:48.800
$54 million a year, right?
00:41:49.199 --> 00:41:49.519
Correct.
00:41:50.400 --> 00:41:55.760
Talking about a fraud that is very obscure that few people are focusing on right now.
00:41:55.920 --> 00:41:58.400
It's still like a new type of fraud in our system, right?
00:41:58.960 --> 00:42:06.079
What happens is the Department of Industrial Relations publishes their um information as far as how much money is paid out to vouchers.
00:42:06.320 --> 00:42:08.400
It's a statistical information.
00:42:08.800 --> 00:42:16.960
Um, based on my experience of doing this for 10 years, I estimate that roughly 75% of the money paid out is paid out to some sort of fraud when it comes to the voucher.
00:42:17.199 --> 00:42:18.880
So that's just my rough estimate.
00:42:19.039 --> 00:42:22.639
But like I said, that's a conservative number when I throw that out there.
00:42:22.880 --> 00:42:40.159
The astounding information is data that I saw when I worked for the state was that you would find a school that was doing$15,000 a year in voucher money, and then the next year they're doing$250,000, and then the next year that same school is doing, you know,$750,000 in voucher funds.
00:42:40.239 --> 00:42:49.920
And I could see that in the bookkeeping and the finances as I was looking at the accounting for these schools, because we have to make sure that schools are viable financially to continue to operate.
00:42:50.079 --> 00:42:54.239
They have to, they have to be a profitable entity to continue.
00:42:54.480 --> 00:43:06.880
And so I got to see the financials and I got to see where these schools were barely scraping by or they weren't enrolling voucher people at all to being$10 million a year 100% voucher funded.
00:43:07.119 --> 00:43:15.760
I want to thank you so much for coming on and educating everybody about the SJDB voucher fraud issue happening out there.
00:43:15.920 --> 00:43:21.199
I'm gonna try to have you on as much as possible because this warrants continues.
00:43:21.280 --> 00:43:23.360
There's criminal cases that are coming down.
00:43:23.440 --> 00:43:27.360
I want to messaging, can we share with injured workers out there that are going to be a good one?
00:43:27.519 --> 00:43:33.199
I think first and foremost is to read the paperwork that they're given by their insurance company, is to pay attention to those documents.
00:43:33.360 --> 00:43:34.239
They're very important.
00:43:34.320 --> 00:43:40.239
You know, that that's a$6,000 voucher right there that they need to understand what it is and read those papers.
00:43:40.400 --> 00:43:46.480
There's contact information in those documents for the injured worker that tells them how they can call GIR if they have questions.
00:43:46.639 --> 00:43:53.119
They can reach out to, you know, the Bureau or ETPL if they have questions, contact the Bureau for Private Postsecondary.
00:43:53.360 --> 00:44:00.719
I think doing their research and as far as their training programs or the school that they want to go to is important, that they know that they have choices.
00:44:00.880 --> 00:44:13.440
A lot of times these uh bad players will call these injured workers and say, hey, look, we've enrolled you in this computer class or your your insurance company enrolled you in this program or authorized you to take this class from us.
00:44:13.599 --> 00:44:15.360
And they don't even know they have choices.
00:44:15.440 --> 00:44:23.679
I I've had injured workers that were enrolled in a nursing program that really wanted to be a truck driver, wanted to do cosmetology, and they were never told that that was their options.
00:44:24.159 --> 00:44:32.000
So again, I think letting them know they have choices and that they should pay attention to that paperwork and and utilize it to the best of their benefits.
00:44:32.239 --> 00:44:33.679
Karen, thank you for all your work.
00:44:33.760 --> 00:44:36.559
And uh I want everybody to watch you on our next episode.
00:44:36.719 --> 00:44:37.440
Appreciate you.
00:44:37.679 --> 00:44:38.159
Absolutely.
00:44:38.239 --> 00:44:39.280
It's my pleasure to be here.
00:44:39.360 --> 00:44:39.679
Thank you.
00:44:39.840 --> 00:44:40.880
What a great guest.
00:44:41.039 --> 00:44:43.519
What great information that was just imparted.
00:44:43.679 --> 00:44:45.920
This is why I love doing this podcast.
00:44:46.079 --> 00:44:47.039
We have great people.
00:44:47.199 --> 00:44:54.559
This is this is why I created this podcast is to highlight the great subject matter experts that we have in the space.
00:44:54.719 --> 00:45:10.960
This podcast is for you, for the consumer, for the special investigator in the insurance industry, for the criminal investigator and the prosecutor in law enforcement, trying to figure out the weird language and what to do with insurance fraud crimes.
00:45:11.039 --> 00:45:12.000
It's complicated.
00:45:12.159 --> 00:45:16.000
I want to thank you so much for watching us, for supporting us.
00:45:16.159 --> 00:45:18.159
I can tell you this we need your support.
00:45:18.320 --> 00:45:20.320
If you don't mind subscribing, it's free.
00:45:20.480 --> 00:45:23.280
By subscribing, you'll see all the new videos coming on.
00:45:23.599 --> 00:45:26.400
I have a lot of subject matter experts coming on.
00:45:26.559 --> 00:45:29.280
We have really great stuff happening.
00:45:29.519 --> 00:45:32.159
This podcast is growing like crazy.
00:45:32.320 --> 00:45:36.960
I love it, and we're getting the word out there, and we're helping people, and that's what's really important.
00:45:37.119 --> 00:45:43.840
So please support us by subscribing, by hitting like on the videos, by watching the videos in their entirety.
00:45:44.000 --> 00:45:46.239
The algorithms don't like it if you don't do that.
00:45:46.320 --> 00:45:47.199
I'm learning that.
00:45:47.360 --> 00:45:51.280
Also, what's really important is that this is to build a community, right?
00:45:51.440 --> 00:45:54.320
So I want to know what you're thinking when you're watching the video.
00:45:54.400 --> 00:45:58.800
What questions that you have, what thoughts are prompted by the content?
00:45:58.960 --> 00:46:04.800
If I can't answer your question, as you can see, uh, we have a lot of subject matter experts at hand.
00:46:04.960 --> 00:46:08.079
Stay on for the next video because I have another great guest for you.
00:46:08.159 --> 00:46:10.880
And most importantly, remember that it's cool to be kind.
00:46:11.039 --> 00:46:12.480
Money's earned from this podcast.
00:46:12.639 --> 00:46:16.960
Go to really great charities related to animals who don't have living homes right now.
00:46:17.119 --> 00:46:18.639
So we'll see you on the next video.