Workers' Compensation fraud can be committed by employers and employees. You may have an employee who exaggerates his injury in order to get more time off, or an employer who underreports its payroll so the Workers' Compensation insurance premiums are lower. Even some health care providers commit Workers' Compensation fraud by billing for services that were not performed. The sad truth is that Workers' Compensation fraud costs us billions of dollars every year. The good news is, there are stiff consequences for bringing fraudulent claims, as a nurse in Georgia recently found out.
What is Workers' Compensation fraud?
When a person willfully makes a false statement or conceals information in order to obtain Workers' Compensation benefits, or prevents someone from receiving Workers' Compensation benefits. Some common examples of fraud committed by employees include:
- Malingering or exaggeration of symptoms
- Working while allegedly disabled and not reporting income
- Claiming a job-related injury that never occurred
- Claiming a non-work related injury as a work-related injury
- Falsifying mileage reports
Georgia nurse criminally prosecuted for fraudulent claims
Loretta Smith worked as a nurse at the Carl Vinson VA Medical Center in Dublin, Georgia. According to the U.S. Attorney's Office, Smith filed fraudulent claims for Workers' Compensation benefits for nearly 4 years; between July 2009 and February 2013. She falsely claimed that she had been injured on the job, and that she traveled to receive medical treatment. This allowed her to also receive reimbursement for mileage.
Ultimately, she fraudulently obtained more than $450,000. She was charged with two counts of mail fraud, to which she pleaded guilty. As a result, she forfeited a total of $454,740.06 in cash, real estate and other property. She was looking at a maximum sentence of twenty (20) years in federal prison, and a $250,000 fine on each count, plus five (5) years of probation. By pleading guilty, she received a reduced sentence.
How is Workers' Compensation fraud investigated in Alabama?
The Workers' Compensation Division of the Alabama Department of Industrial Relations is responsible for ensuring proper payment of benefits to employees injured on the job, and to encourage safety in the workplace. The division has a fraud unit, which investigates and pursues anyone who attempts to abuse the Workers' Compensation Division.
Knowing the signs of Workers' Compensation fraud
Most often, tips regarding Workers' Compensation fraud come from fellow employees or employers. Workers' Compensation fraud affects more than just the insurance companies that provide the coverage. It also affects employers, when rates increase. Those cost increases may then be passed on to the employees. That's why it's important to know what to look for. Here are some of the warning signs of fraud committed by Workers' Compensation claimants.
- Poor attendance record
- Prior lost-time claims
- Accident occurs Monday morning, immediately after a vacation or holiday
- Accident happened in an area the employee is not expected to be in or while performing a task not ordinarily performed
- No witnesses or the only witness is a personal friend of the employee
- Claimant resists signing authorizations, delays treatments or refuses light-duty offers
- Alleged restrictions are out of line with the type or degree of injury
If you need to report a suspected fraudulent claimant, you can call the following toll-free Workers' Compensation Fraud Hotline at 1-800-923-2533.
If you feel you have questions or concerns regarding worker's compensation fraud, or if you have any questions regarding your employment rights, please contact Wrady & Michel, LLC, either online or by calling us at (205) 265-1880.