From April 2015 to June 2015, 51-year old Danita Stewart, a licensed psychologist, is alleged to have submitted 36 insurance claims for Medical Legal Evaluations, which assess employees’ work-related injuries.
Stewart is not certified as a Qualified Medical Examiner, a legal requirement to conduct Medical Legal Evaluations. She conducted these evaluations in clinics in Fresno, Tulare, and Kern County, and billed five different insurers a total of $90,714 for work she is not certified to do.
Catalino Dureza is a 54- year old licensed medical doctor who is certified to conduct and bill for Medical Legal Evaluations however, he continued to conduct and bill for these evaluation when his certification lapsed. Between January 2014 and May 2015, Dureza billed for 17 claims he performed in Fresno County while his certification was expired, totaling $16,292.
The fraudulent claims were investigated by the Central Valley Workers’ Compensation Task Force, which is made of members of the California Department of Insurance, the Employment Development Department, the Franchise Tax Board, and the District Attorney’s Offices of Fresno, Kern, Kings, Madera Merced, and Tulare Counties.
“Workers’ compensation insurance fraud is a multi-billion dollar drain on our state’s economy,” said Insurance Commissioner Ricardo Lara. “It is crucial that we work with our partners in law enforcement to catch fraudsters like these who are contributing to higher insurance premiums for all Californians.”
Stewart and Dureza were arrested earlier this May and will be prosecuted by the Fresno County District Attorney’s office.