CA - Comp Fraudsters Snared in Latest Medicare Bust
06/25/2026 | 0
A key figure in what California officials once called the largest workers' compensation fraud scheme in state history has pleaded guilty to orchestrating a new $270 million Medicaid scam, landing him squarely in the crosshairs of a record-setting $6.5 billion nationwide federal healthcare fraud takedown.
While Paul Richard Randall's latest scheme exclusively targeted Medi-Cal, the case helps illustrate the motivation behind anti-fraud measures enacted 10 years ago that bar convicted fraudsters from participating in the state's workers' compensation system and disallow their li
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The Missouri Court of Appeals ruled that a firefighter’s widow was not entitled to line-of-duty compensation for his death, even though his death was deemed compensable.
Case: Wynn v. City of Kansas City, No. WD88290, 05/26/2026, published.
Facts: Raymond Wynn served as a firefighter for the City of Kansas City for 31 years. Due to his exposure to multiple workplace carcinogens, he developed squamous cell lung cancer in 2018.
Wynn died as a result of his cancer in March 2021.
Procedural history: Wynn’s widow filed a workers’ compensation claim, asserting Wynns&rsqu
A New York appellate court ruled that a summary dismissal of a worker’s Labor Law claim for an alleged trip-and-fall accident should not have been granted.
Case: Woodward v. J.T. Magen & Co. Inc., No. 156960/17, 06/11/2026, published.
Facts: Robert Woodward suffered injuries while working on a construction project. According to Woodward, he fell just after coming out of the only available staircase leading to the mezzanine of a building when he tripped on a cutout/inlay in the floor.
Witness testimony described the area where he fell as a hallway or corridor connecting two larger
A New York appellate court ruled that a worker was entitled to summary judgment on his Labor Law claim for his fall from a ladder and that the third-party defendant should have been granted summary judgment dismissing the indemnification claims against it.
Case: Perez v. Parkside Terrace LP, No. 28976/18, 06/09/2026, published.
Facts: Wilborth Perez suffered injuries while working on a construction project when he fell from a ladder.
Perez worked for the drywall contractor on the project.
According to Perez, the accident happened while he was attempting to fix the framing in the ceiling ov
After decades of being wildly underpaid due to the Sunshine State’s abysmally low workers’ comp fee schedule, 2025 saw those worthies get a major jump in pay: 41%, to be precise.
That’s a key takeaway from the Workers Compensation Research Institute's recent report on nonfacility prices paid for workers’ comp medical services.
But — and it's a big but — Florida’s docs are still paid below the median in the 36 states evaluated by WCRI.
A key point is that WCRI’s report speaks to the prices paid, no
West Virginia’s Intermediate Court of Appeals upheld an award of additional temporary total disability benefits for a worker.
Case: Marshall County Coal Resources v. Kessler, No. 25-ICA-480, 06/02/2026, published.
Facts: Joshua Kessler worked for Marshall County Coal Resources. He suffered injuries in February 2024 when a concrete block wall that he was building fell, and a block struck him in the head and knocked him off a 4-foot ladder.
Kessler was taken to the hospital, where he denied loss of consciousness, denied neck or back pain and denied any other injury.
A computed tom
The Washington Department of Labor & Industries suspended a contractor's registration after dozens of customer complaints, a court decision and an investigation revealed more than $1 in fraud.
Construction Kings, based in Sumner, and owner Zakary Michael Nash received citations for repeated electrical code violations, L&I said. The agency also cited thousands in unpaid workers’ compensation.
Additionally, Construction Kings faces at least 11 lawsuits, L&I said.
“This is one of the most egregious cases I’ve seen involving a
The Missouri Court of Appeals ruled that a firefighter’s widow was not entitled to line-of-duty compensation even though his death was deemed compensable.
Patrick Williams served as a firefighter for the City of Kansas City for 38 years. Due to his exposure to multiple workplace carcinogens, he developed metastatic neuroendocrine carcinoma and multiple myeloma.
Williams died as a result of his cancer in February 2018.
Williams’ widow filed a workers’ compensation claim, asserting that his cancer was an occupational disease.
In August 2023, an administrative la
West Virginia’s Intermediate Court of Appeals upheld the denial of a worker’s claim for a knee injury.
Case: Jackson v. Monroe County Council on Aging, No. 25-ICA-484, 06/02/2026, published.
Facts: Sharon Jackson worked for the Monroe County Council on Aging. She allegedly injured her right knee at work on Oct. 4, 2024.
Jackson went to the WVU Medicine Princeton Community Hospital emergency department that day and reported right leg pain and stiffness. Jackson stated that she regularly experienced muscle cramps that were relieved with creams, but that morning, she did not e
May 20, 2026
A New York appellate court upheld a jury’s verdict and award for a worker on part of his Labor Law claim, and it ruled that one of the defendants should have been granted indemnification from a third-party defendant.
Case: Sinera v. Bedford-Webster LLC, No. 23902/15, 06/09/2026, published.
Facts: Bubacarr Sinera suffered injuries while operating a forklift during a construction project when the floor collapsed under him.
Procedural history: Sinera filed suit against 3170 Webster Avenue LLC and Bedford-Webster LLC, asserting claims for violations of the Labor Law.
Bedford-Webster file
A New York appellate court ruled that a worker was not entitled to summary judgment on his Labor Law claim for his injuries from allegedly being struck by a section of duct.
Case: Villanueva v. J.T. Magen & Co. Inc., No. 155823/20, 06/09/2026, published.
Facts: Carlos Villanueva suffered injuries while working on a construction project when a 350-pound section of duct struck him, knocking him to the ground.
According to Villanueva, the duct that fell on him was stacked on top of another duct being transported on two wooden dollies by him and his co-workers. The ducts were not strap
The California Senate Appropriations Committee forwarded to the full chamber a bill that would permanently allow employers to pay indemnity benefits with prepaid debit cards.
AB 1683 would make permanent the debit card pilot project launched in 2018.
The Senate Appropriations Committee on Monday sent it to the floor for a vote by the full Senate pursuant to Senate Rule 28.8, which allows the committee to forego hearing a bill if the chair determines that potential costs for the state are not significant.
An analysis performed by the Assembly Appropriations Committee in April determined that
Arizona Gov. Katie Hobbs signed a bill that explicitly identifies adenocarcinoma as a form of cancer that is presumed to be compensable for first responders, and it applies retroactively to June 30, 2021.
Hobbs on Monday signed SB 1215, which includes an itemized list of specific cancers that are part of the presumption, including bladder cancer, brain cancer, colon cancer, mesothelioma of the respiratory tract and adenocarcinoma.
The bill clearly identifies adenocarcinoma as a covered condition and applies retroactively to June 30, 2021, to reflect the fact that lawmakers intended for chang
The U.S. Department of Labor’s Office of Workers’ Compensation Programs seeks public comment on methods to test hearing and the best practices for evaluating occupational hearing loss.
In a request for information posted Tuesday, the OWCP asks for input from audiologists and other medical professionals, as well as employers, carriers and other interested parties, on the reliability and validity of audiograms compared with other tests, such as auditory brainstem response, auditory steady state response and otoacoustic emissions.
The agency is also soliciting comments on the c
New Hampshire Gov. Kelly Ayotte signed a bill allowing parties to a co-employment relationship to decide who will provide workers' compensation coverage for workers.
SB 655, which takes effect Aug. 11, repeals the law requiring employee leasing companies to pay for workers' compensation coverage for all leased workers.
The bill instead requires all leasing arrangements to explicitly detail whether the leasing company or client company will secure and maintain workers’ compensation insurance.
Client companies that elect to secure coverage themselves would be required to notify
The Wyoming Supreme Court upheld the summary dismissal of a worker’s civil suit against a co-employee for causing injuries to his hand.
Dusty Courtney and Kenneth Meyer worked for Wyoming Waste Systems. Meyer was a 28-year veteran, and he was training Courtney on the morning of Aug. 4, 2023.
The two men headed out on a garbage route, with Courtney driving the trash truck. The truck was equipped with arms that raise and lower dumpsters from the front to deposit trash into the truck’s container.
After collecting a dumpster, Courtney began to feel nauseous. He stopped the truck and
