Crutches
used as props and wages deposited into an
undisclosed bank account are evidence in
real-life workers' compensation fraud cases...
The stories
of workers' compensation fraud can be brazen,
appalling or just plain stupid. Some schemes
are concocted by hardened criminals, others by
generally honest people who commit serious
errors in judgment. But all are illegal,
contributing to what appears to be a
multi-billion dollar a year problem.
The American
Insurance Association estimates workers'
compensation fraud losses at $3 billion a
year, while industry watchdog the National
Insurance Crime Bureau puts it at $5 billion.
Experts believe the difficulty with measuring
fraud is that much of it goes undetected.
Crimes can
range from "hard" fraud such as
collecting benefits for faked injuries to
"soft," which can mean exaggerating
an injury or staying on benefits longer than
necessary.
We estimate
that 3 percent to 5 percent of our wage
replacement claims have some element of fraud.
Without an effort to recover them, the
associated benefits would have totaled more
than $2 million a year.
If you're an
employer who is ready to turn a suspicious eye
toward every workers' compensation claim that
crosses your desk, don't. Most injury claims
are legitimate. Instead, ramp up your
fraud-prevention program.
- Promote a
fraud-free workplace. Convey your tough
stance on fraud and let employees know how
they can report fraud anonymously. Run
background checks on employees before
hiring. Install video equipment.
- Consider
drug testing. Drug users make unsafe
workers and are more likely to file false
claims.
- Start a
safety program. Safe workplaces make fake
injuries harder to legitimize.
- Have a
plan. Put someone in charge of workplace
injuries, recommend your medical provider
right away, get an accident and injury
description, preserve evidence and get
names of witnesses.
- Know the
red flags of fraud: sketchy work history
or "job jumper," child-support
lien, extensive criminal record,
exaggerated details about incident or
symptoms.
- Work with
your insurer's investigative unit when
you're suspicious.
- Listen for
rumors and scuttlebutt. Co-workers often
know about after-work activities that may
be inconsistent with injuries.
- Prepare a
return-to-work plan that includes
temporary or alternative duties.
Claimants
aren't the only drain on the workers'
compensation system - employers and medical
providers cheat, too. Premium fraud can be as
simple as under-reporting payroll or
misclassifying workers to a less risky
category.
Medical
provider double-dealings range from kickbacks
from referrals to dozens of creative billing
techniques like charging for services not
rendered or billing for a more expensive one.
The truth is
we all pay for insurance fraud. But it doesn't
need to flourish. Every one of us, whether
employer or employee, can do our part to stop
it. Not only does every ill-begotten benefit
dollar add cost to our system, it also serves
to undermine the plight of legitimately
injured workers who deserve every payment.
Perhaps that is the worst crime of all.