Reporting Workers’ Compensation Fraud

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Workers’ compensation fraud occurs when an employee, employer, or medical provider gives false information or misrepresents facts to collect or deny benefits unjustly. Workers’ comp fraud is anything but a victimless crime. The law in Cincinnati covering work incidents considers it a felony.

Workers’ comp fraud hurts everyone. Overpayment to claimants who are not entitled to benefits means employers have little money to pay out to deserving workers. Companies also pay higher premiums and become increasingly suspicious of workers who make legitimate claims.

Injured employees are not the only people who engage in this illegal behavior. Employers and healthcare providers can be perpetrators as well. Workers’ comp fraud can look different depending on who commits it. Here are some red flags that might tip off illegal activity:

Employee Fraud

Workers commit fraud when they present false information or hide facts to collect benefits. More specific types of employee fraud include

  • Collecting worker’s comp benefits while working
  • Being self-employed or working from home
  • Collecting cash payments “under the table”
  • Performing seasonal work that soon concludes as they file a claim
  • Being unavailable for phone calls or medical and other appointments outside the home
  • Engaging in physical activities inconsistent with claims of disability or injury
  • Suspiciously exaggerating the extent of their injuries
  • Falsely reporting being injured on the job or while performing work
  • Deceiving medical providers to get multiple narcotics prescriptions or giving extra medications to others

Employer Fraud

Employers are guilty of fraud when they misreport their payroll or misclassify employees to save on tax or insurance payments. More specifically, they commit fraud when they

  • Operate a business with no workers’ compensation coverage
  • Pay employees cash “under the table”
  • Do not display an updated BWC coverage certificate or have documentation with erroneous names or dates
  • Misclassify employees as independent contractors or subcontractors
  • Misreport payroll amounts

Provider Fraud

When physicians or other medical providers engage in fraud, they typically do so to receive payments they are not entitled to. Red flags include

  • Overcharging for a treatment or procedure
  • Maintaining incorrect information about a patient’s treatment
  • Misrepresenting who provided care for a patient
  • Keeping patient notes that do not change over several visits
  • Prescribing controlled substances for no legitimate medical reason
  • Consistently billing for the same procedure across multiple patients

How Do I Report Workers’ Comp Fraud?

Anyone can report workers’ comp fraud by a worker, medical provider, or employer. You do not need irrefutable proof or evidence that fraud has occurred. Instead, you only have to have reasonable suspicion. The BWC provides an online form you can complete. You can also talk to an experienced worker’s comp attorney if you are unsure about your suspicions or have questions.

When making your report, try to provide as much detail as you can. If possible, have the following information on hand:

  • Name of the worker, employer, or medical provider
  • Details about the suspected fraudulent activity
  • Other information relevant to the alleged fraud

Any information you provide will assist the BWC in investigating the suspected activity fairly and objectively. Once you submit your report, the BWC special investigations department will review your information. During the investigation, someone might contact you for more information. Be assured that your information will be kept confidential until the matter is closed.

If you need to file a workers’ compensation claim, it is always beneficial to talk to a lawyer. Not only will they ensure that you file all paperwork, but they will also make sure you understand the law and do not unintentionally engage in fraudulent actions.