D. A. Reports Anti-Fraud Program Has Met Its Goals : Crime: A special unit to investigate workers’ compensation cases has never prosecuted anyone, but officials say it is deterring false claims.

A year after the Ventura County district attorney’s office created a special unit to investigate suspicious claims for workers’ compensation, prosecutors call the program a success--although no one has been prosecuted under it.

Local prosecutors said they have achieved their goals for the program so far.

Mainly, they said, they have deterred workers from filing fraudulent claims.

Employees now think twice before filing false claims for compensation, prosecutors said. The result: a 20% to 40% reduction in claims, they said.

“The purpose is not only to prosecute,” said Assistant Dist. Atty. Colleen Toy White. “It’s the deterrence.”

Actual data on the number of claims filed were not available. The figures are kept by insurance companies, which are prohibited by antitrust laws from sharing information with each other, prosecutors said.

But individual employers throughout the county report that claims have been filed less frequently in the past year, they said.

Claims are also down statewide, thanks to a program established by the Legislature in 1992, state workers’ compensation officials said.

“There has been a large reduction in claims,” said John Duncan, a deputy director in the Industrial Relations Department, which oversees workers’ compensation.

But Ventura County officials said they believe their local campaign has played the largest role in reducing claims in the county.

The county’s Workers’ Compensation Fraud Prosecution Unit was created last January when the district attorney’s office began to raise money from private businesses to investigate the crime.

Businesses contributed more than $150,000 to help fund the unit, which consists of two full-time members: a deputy district attorney and an investigator. Cases began coming in last summer.

Although no cases have been prosecuted, the unit has received 45 cases for investigation.

“I do believe the deterrent impact is there, and it is having an effect,” said Robert P. Roy, president of and general counsel for the Camarillo-based Ventura County Agriculture Assn. The organization represents 35 companies that employ 8,000 workers.

“I’m not dismayed at the fact that there have not been significant prosecutions,” Roy said. “I think it only takes one. I think it would be symbolic, and it would send a message to the community and let people know the D. A. will prosecute fraud.”

Cracking down on false claims of workers’ compensation is important for several reasons, authorities said.

The crime has been identified as the No. 1 problem facing business in California, said White. She also said that insurance premiums for workers’ compensation are the third-highest personnel cost for employers.

“This is an issue that hits them right in the gut, and I think that is a reason we have had support,” she said.

When the unit was formed, some defense attorneys and legal scholars criticized the public-private partnership. They questioned whether the district attorney’s office would become beholden to the contributors and prosecute cases more diligently for the biggest sponsors.

Also, although Public Defender Kenneth I. Clayman did not oppose the plan, he predicted it would create more work for his office and wondered whether funding would also be provided for any extra defense cost.

“When I raised the question, the D. A. said they would be going after people I would never defend,” said Clayman, who took that to mean doctors, lawyers and others who reportedly operate “workers’ comp mills.”

Clayman applauded prosecutors for “investigating carefully” and “not rushing to file cases.”

One of the reasons no one has been prosecuted, authorities said, is that investigations into workers’ compensation fraud are more complex than most other criminal probes.

“They are not like burglary cases,” White said.

To get a conviction, prosecutors must prove that a defendant intended to defraud by filing a false claim. That can be difficult, prosecutors said, because doctors often do not agree on the extent of an injury.

For example, is it a crime for a doctor to write a report that says a worker has an injured back, even though X-rays don’t show any injuries?

“That’s one of the hardest ones--your back,” said Robert A. Guillen, executive secretary for the Ventura County Building and Construction Trades Council. “It’s hard to diagnose.”

Employer representatives agree.

“I can assure you that successful prosecution is difficult,” said Roy of the agriculture association. “It’s difficult to find the smoking gun. You have to rely on indirect circumstances to prove the intent.”

Roy’s organization covers 8,000 agriculture workers in a group insurance plan. He said those workers are filing fewer and fewer claims--and credits that in part to the crackdown against false claims by the district attorney’s office and the state.

“They are well aware of the program, simply because we have advertised it through the media, through our clients and through posters,” Roy said. “We have passed out leaflets along with their paychecks.”

In all, Roy estimated that 25% of the claims filed by agricultural employees are bogus.

On the labor side, some union leaders also agree that word of the district attorney’s new unit has stopped some workers from filing false claims.

Guillen said the unit was long overdue.

“Fraud really makes the (insurance) rates go up,” Guillen said. “If you can control fraud, the rates come down.”

Guillen said he is not concerned about workers being harassed by investigators trying to make a case against them. In fact, if authorities can curtail the false claims, it might keep more jobs in the area, he said.

“That’s why some of the companies are leaving California, because workers’ compensation is so high,” Guillen said. “I think the district attorney’s fraud unit is a good deal. I think it was long overdue.”