California Provider Suspension Actions Put Workers Compensation Provider Fraud Under Scrutiny

September 28, 2026 | JacobiJournal.com — Workers compensation provider fraud remains a significant enforcement concern in California as the Division of Workers’ Compensation continues maintaining a public suspension system for physicians, practitioners, business owners and healthcare entities that meet specified statutory criteria. In September 2026, the DWC suspension-activity record listed a series of September 4 suspension notices involving individuals and entities across California and other states. The listed grounds include categories associated with Labor Code section 139.21, including qualifying criminal convictions, federal Medicare or Medicaid fraud or abuse, healthcare license actions and entities controlled by individuals who meet specified conviction criteria. The enforcement system is designed to restrict qualifying providers from participating in the workers’ compensation system rather than treating every provider listed in the notice records as having been independently found guilty of workers’ compensation fraud by DWC.

The September activity is particularly relevant to workers compensation provider fraud because California’s statutory framework reaches beyond conduct involving workers’ compensation claims alone. Labor Code section 139.21(a)(1) identifies several categories that can trigger suspension, including a qualifying conviction involving fraud or abuse of the workers’ compensation system, Medicare, Medi-Cal or a patient; certain financial crimes; conduct concerning a provider’s medical practice; and the qualifications, functions or duties of a provider. The law also covers certain providers who have been suspended from federal Medicare or Medicaid programs because of fraud or abuse, providers whose licenses or certifications have been surrendered or revoked, and entities controlled by individuals with qualifying convictions.

September 2026 Notices Expand California’s Provider Enforcement Record

The September 2026 workers compensation provider fraud enforcement record includes notices issued on September 4 to Ghaemi, Michael Mohammad, identified as an attorney in Irvine; Grigoryan, Haykush, identified as a phlebotomist in Los Angeles; Letko, James, identified as an owner or CEO of pharmacies in Pittstown, New Jersey; Karimi, Parto, identified as a physician in Alamo; Sheibani, Malek Iraj, identified as a physician in Los Angeles; Statewide Law PC, identified as an entity in Tustin; Tieu, Huu Sai, identified as an owner or CEO of pharmacies in Porterville; Rivas, Carlos A., identified as a physician in Redwood City; Bentley, Keri M., identified as a physician in Knoxville, Tennessee; and Favakehi, Bijan Mohamad, identified as an attorney in Tustin. The DWC table identifies the applicable statutory grounds for each entry, including categories marked A, B, C or D.

These entries should be understood as administrative suspension notices rather than as a single criminal case or a finding that every listed individual or entity committed workers compensation provider fraud. The DWC’s published table states that providers are issued suspension notices or suspension orders under Labor Code section 139.21(a), and that a suspension generally takes effect 30 calendar days after the notice is issued unless it is appealed. The September 4 notices therefore represent the beginning of an administrative enforcement process for those entries, with the statutory hearing and appeal framework remaining relevant. That distinction is important for accurate reporting because the existence of a suspension notice does not by itself establish that a provider committed every form of fraud or abuse referenced in the statute.

Labor Code Section 139.21 Creates a Broad Enforcement Framework

California’s approach to workers compensation provider fraud enforcement is built around Labor Code section 139.21 and related administrative procedures. The DWC explains that providers can be suspended when statutory criteria are satisfied, including qualifying criminal convictions, federal program fraud or abuse suspensions, license surrender or revocation, or certain ownership and control relationships. The statutory structure consequently connects workers’ compensation claims integrity with broader healthcare-program enforcement. A provider’s participation in the workers’ compensation system can be affected by conduct involving Medicare, Medi-Cal, licensing authorities or other qualifying criminal proceedings, even where the public suspension record does not describe a new workers’ compensation fraud prosecution.

The connection is important because workers compensation provider fraud can involve more than fraudulent billing for a particular medical service. California’s DIR identifies healthcare providers billing for services never performed as one example of workers’ compensation fraud, while the suspension statute establishes separate grounds involving qualifying convictions, federal program fraud or abuse, licensing actions and provider qualifications. Once a provider is suspended from participation, the restriction affects the provider’s ability to provide or obtain payment for treatment, evaluation or other services related to a workers’ compensation claim. The regulatory framework therefore functions as both an enforcement mechanism and a participation restriction within the claims system.

Provider Suspensions Can Affect Claims, Liens and Payments

The practical impact of workers compensation provider fraud enforcement extends beyond the provider’s ability to participate in future claims. DWC states that providers suspended under the qualifying conviction category are also subject to consolidation and dismissal of pending lien claims, with lien-consolidation hearings posted through the agency’s Special Adjudication Unit. The SAU was established following statutory changes associated with Senate Bill 1160 and Assembly Bill 1244 and handles disputes and adjudication responsibilities arising from provider suspensions and certain stayed liens. This gives the enforcement process a direct connection to outstanding financial claims within the workers’ compensation adjudication system.

September’s calendar illustrates that these matters can continue through administrative proceedings after a suspension action appears on the public record. DWC’s September and October calendars list lien-consolidation proceedings involving suspended providers and entities, including hearings scheduled for September 28, September 29 and September 30 and additional proceedings in October. These proceedings are distinct from the underlying criminal or licensing events that may have triggered a suspension, but they can determine how pending liens associated with suspended providers are handled. For claims administrators and other participants, that distinction makes the public suspension record an important component of broader workers compensation provider fraud monitoring.

Why This Matters for JacobiJournal Readers

The September activity shows how workers compensation provider fraud enforcement operates across several layers of California’s claims system. A provider may come under DWC scrutiny because of a qualifying criminal conviction, federal healthcare-program action, license revocation or another statutory condition. The resulting suspension process can then affect the provider’s participation in workers’ compensation treatment and payment activities, while separate administrative proceedings can address pending liens. This structure allows the state to use information generated by criminal, federal and licensing systems as part of its workers’ compensation provider oversight.

For investigators, insurers, claims administrators and attorneys following workers compensation provider fraud, the September 2026 records also demonstrate why the status of an individual entry must be checked carefully. A suspension notice, a request for hearing, a final suspension order and a lien-consolidation proceeding are different stages with different legal consequences. DWC’s regulations provide that a provider may request a hearing within 10 days after a suspension notice is served to contest whether section 139.21 applies and the basis for suspension. If no timely hearing request is made, the suspension order generally becomes effective 30 days after the notice was mailed. The administrative record therefore requires attention to both the underlying statutory ground and the procedural status of the particular provider.

For the official enforcement record, readers can review the California DWC Suspension Activities page, which provides the current provider notices, statutory grounds and suspension-status information. JacobiJournal.com will continue monitoring workers compensation provider fraud, provider suspensions, lien enforcement and broader California claims-integrity developments.

FAQs: Workers Compensation Provider Fraud

What is workers compensation provider fraud?

Workers compensation provider fraud generally refers to fraudulent conduct involving a healthcare provider and the workers’ compensation system, such as billing for services that were never performed. California’s provider-suspension framework under Labor Code section 139.21 is broader than that definition and can encompass certain qualifying convictions, federal Medicare or Medicaid fraud or abuse, licensing actions and other statutory circumstances.

What happened with California provider suspension notices in September 2026?

The DWC’s public suspension record includes 10 providers and entities with suspension notices dated September 4, 2026. The listed entries include physicians, attorneys, a phlebotomist, pharmacy owners, a business entity and other provider-related parties. The record identifies different statutory grounds for the individual entries.

Does a suspension notice automatically mean a provider committed workers compensation provider fraud?

No. A suspension notice reflects that DWC identified a statutory basis for initiating the suspension process. The grounds can include matters beyond direct workers’ compensation fraud, such as qualifying Medicare or Medi-Cal fraud, license revocation or certain convictions. Providers can request a hearing to contest whether Labor Code section 139.21 applies and the basis for suspension.

What happens after a provider is suspended?

A suspension means the provider is unable to provide or obtain payment for treatment, evaluation or other services related to a workers’ compensation claim. Providers suspended under certain statutory grounds can also face consolidation and dismissal of pending lien claims, with proceedings handled through DWC’s Special Adjudication Unit.

Visit JacobiJournal.com for continued coverage of California insurance fraud cases, enforcement actions and emerging claims-integrity developments.