How To Report Workers' Compensation Fraud

Workers comp cheaters must be caught

It's a form of theft that some employers, employees or medical providers use to get money not due them. Workers' compensation is for legitimate on-the-job employee injuries; fraud hurts the small-business owner because it often results in higher premium fees. In most states, when you suspect workers' compensation fraud, you must follow specific steps to report it. Fraud Definition Workers' compensation fraud occurs when an employee, medical provider or an employer lies to get workers' compensation benefits he is not entitled to. Medical providers who bill for services not rendered and an employee who fakes an injury to get benefits are both defrauding the system by accepting money or medical benefits to which they are not entitled. Workers' compensation benefits involve a no-fault system for the sole purpose of covering the medical expenses and lost wages for an employee's on-the-job injury. Red Flags Because workers' compensation fraud is a serious charge, it's important to review the red flags that indicate a potential fraudulent claim. When you suspect fraud, these red flags can validate your suspicions.
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Management members of the workers comp council are proposing a fee schedule as a way to control costs, setting prices at 175 percent of what Medicare pays. They argue that cash payments cant decline forever and medical costs are expected to continue going up. But the nonvoting medical industry representatives on the council objected. A fee schedule, they argue, could lead to fewer doctors taking workers comp patients, resulting in reduced access, more time away from work and higher costs to the system. Labor members of the council havent supported the fee schedule, but for the first time agree that something needs to be done to control the medical costs, said Stephanie Bloomingdale, secretary-treasurer of the Wisconsin AFL-CIO. What we would like to see is more money going into workers pockets, Bloomingdale said.
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Workers' Comp Plan Sought for Gulfstream

Romans spends about $140,000 a year combined for workers' compensation coverage in Florida, Kentucky, and New York, Vaccarezza said. Trainer Milt Wolfson, now based at Gulfstream, has four employees and 10 horses. He is paying $14,000 this year for workers' compensation coverage even though he has a low claims rate. Vaccarezza and Wolfson are among the horsemen who expect that paying for group coverage would be less expensive than what trainers now pay for finding their own policies. Over the past two months Vaccarezza has evolved from being an outspoken critic of some Florida HBPA policies, especially those related to Gulfstream, to his current role of working with the organization on some projects.
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Md. physicians put high mark-up on workers comp pain-killers

They also taped her using a wheelchair for a visit to the doctor, then getting out of it after she left. She was convicted of fraud and sentenced to a year in prison. The two were ordered to pay $173,332 in restitution. Sometimes, the SID gets help from working Ohioans fed up with workers' compensation fraud by people they know. One man used his cell phone to videotape a coworker bragging about faking an injury so he could collect workers' compensation. Outrageous stories about workers' compensation fraud are more than just anecdotes.
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Rating bureau recommends 6.9 percent increase in California workers' comp rates

It found in many instances that average prices paid to physician-dispensers for prescription drugs are more than double the prices paid at pharmacies. Physician dispensing makes up about 40% of workers compensation prescriptions, but about 55% of the payments, according to the report. The report focused only on workers compensation payments, though physicians also dispense medication to patients whose bills are covered through other payors such as private insurance. Cost per pill: $0.37 compared to $1.46 One example in the report was that Vicodin cost $1.46 per pill when dispensed by a physician, compared to $0.37 at a pharmacy, according to a press release on the study. The report finds the trend even held true with over-the-counter medications for instance, Zantac costs $0.35 per pill at Walgreens, compared to $3.40 per pill dispensed by Maryland physicians, nearly 10 times as much. Data for the report came from payors in Maryland that represented 37% of the claims in the states workers compensation system. The system is paid for by employers through legally mandated insurance. Included were 16,860 claims where workers missed more than seven days of lost pay with injuries between Oct.
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Legislators consider workers' comp changes

Insurance Commissioner Dave Jones can accept, reject or modify the proposed rate increase after hearings this fall. Insurers often follow the commissioner's pure-premium rate recommendations, but aren't required to do so. The proposed rate "reflects insurer loss and loss adjustment experience" as of June 30, WCIRB said in a statement, but doesn't include "any provision" for the impact of medical fee schedule changes being considered by the state Division of Workers' Compensation. The advisory group's governing committee will meet Oct. 23 to consider how those changes might affect typical workers' compensation rates and "whether an amendment" to these proposed rate increases is justified. Pure premium rates are average base rates.
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