What Is Workers’ Compensation Fraud?
Workers’ compensation fraud occurs when someone receives these benefits when they are not entitled to them. This may sound like a small deal, but the numbers really add up.
Recently, the Ohio Bureau of Workers’ Compensation (BWC) identified several incidents of fraud, taking money from a system intended to provide help to injured workers. The following fraudsters were described:
- A woman from North Canton was sentenced to five years’ probation upon conviction of a fifth-degree felony for collecting $22,000 in workers’ comp during two years while she was working as a home health aide. During this time, the woman had claimed injuries kept her from working.
- A business owner in Columbus pled guilty to a second-degree misdemeanor for failing to accurately report his payroll. His objective was to pay less to the BWC for workers’ comp benefits for the employees of his security company.
- After an injured worker filed an application for benefits, the operator of a Quizno’s restaurant pled guilty to failing to provide workers’ compensation coverage. The offender was ordered to pay $10,487 to BWC, remain compliant, and carry out two years of probation.
- A Cincinnati man was placed on probation and ordered to pay reimbursement to the BWC for using the BWC debit card of his wife after her death.
Each of these examples illustrates a different form of workers’ compensation fraud. While the monetary damages were larger in some cases than in others, all these types of fraud drain the BWC system of resources intended to pay the legitimate claims of injured workers. Common categories of workers’ comp fraud include the following:
- Failing to arrange for workers’ compensation — Employers must either self-insure or purchase workers’ comp through BWC. This type of fraud often comes to light only when an employee files a claim and is denied benefits.
- Misclassification — By under-reporting their number of employees or by designating their employees as “independent contractors,” employers pay less in BWC premiums — until they are caught.
- Fraudulent claims — Too often, employees who obtain workers’ comp benefits continue to claim those benefits after they recover from their injuries. Other workers file claims even though they did not suffer an injury.
- Healthcare fraud — Healthcare providers also engage in workers’ comp fraud by billing for exams or services they did not provide, giving out prescriptions without responsible medical care, or performing unneeded and expensive tests and procedures.
If you know someone taking advantage of workers’ comp, you may laugh and turn away, but the fraud is costing you money. The cost of healthcare fraud of any kind is passed along in higher premiums, reduced services, and potentially less money for employers to offer in raises and benefits due to the rising costs of workers’ compensation premiums.
Because of fraudulent claims, legitimate workers’ comp claims can take longer to process and may be denied if fraud is suspected. Workers’ comp fraud hurts everyone. If you know someone cheating the system, think about reporting it and improving the system for everyone.
Keeping workers’ comp claims legitimate means the system will be there when you need it. If you are injured on the job in Ohio and have questions about your application for benefits, an attorney can guide you.