Workers Compensation Fraud

Workers compensation is insurance an employer pays for to cover any employee that is injured on the job. One of the benefits of workers comp insurance is that the employee can get immediate medical attention regardless of whether they can pay for it or not. Another benefit is that the employee can receive disability benefits if he or she cannot return to work.

As in most situations, some people take advantage of the system and commit fraud. According to the majority of worker’s compensation state boards, fraud occurs, “when someone knowingly and intentionally makes a false material statement in order to obtain or deny a benefit for themselves or another. “

Examples of acts of fraud involving employees are:

• Lying about the claim
• Claiming an injury is worse than it is
• Filing a false claim

Employers also commit acts of fraud such as:

• Lying about the ownership of the company
• Not reporting the correct number of employees the company has
• Purposely changing the classification of an employee’s status
• Lying about the nature of the work and the length of employment the employee has performed

Health providers commit fraudulent acts including:

• Miscoding medical services
• Submitting false bills to the insurance carrier
• Billing for services never rendered to the patient

Workers Comp Fraud in the News
A recent case in the Washington State Department of Labor and Industries involves an act of fraud committed by a Ritzville, WA, man. Ronald Newton collected worker’s compensation benefits from a 2004 truck injury while receiving income from a nursing home run by his wife. Newton had to repay the Department of Labor & Industries a whopping payment of almost $48,000.

Fraud is taken very seriously in any business, and worker’s compensation is no different. Although you can report fraud anonymously, in this economy, being known as a whistleblower may not be for you.

April 12, 2010 in Workers Compensation Tags: employers committing fraud, fraud involving employees, fraudulent health provider action, whistleblower, workers comp fraud

Michael Monheit is the managing lawyer at Monheit Law, outside Philadelphia, Pennsylvania. He has practiced law since 1989. Michael Monheit was the managing attorney of the law offices of Herbert Monheit — now Silverman and Fodera — a firm... Michael Monheit→