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Coalition Against Insurance Fraud

Ohio saves $60.1M by combatting workers-comp cons

October 09, 2018, Lima, OH — During the 2018 fiscal year, the Ohio Bureau of Workers’ Compensation Special Investigations Department received 3,150 workers’ compensation fraud allegations, 166 criminal referrals, and 101 convictions which resulted in $60.1 million in identified state savings.

The BWC work diligently every year to ensure that Ohioans are not committing workers’ compensation fraud, said Shawn Fox, Ohio BWC special investigations department special agent in charge, during a West Central Ohio Safety Council event Tuesday at Howard Johnson Lima.

Workers’ compensation fraud is when an employee, healthcare provider, and/or employer is deceitful about information provided to the Ohio Bureau of Workers’ Compensation.

“With workers’ compensation, you have to have an intent to falsify information,” said Fox.

Someone who injures themselves on the job, receives workers’ compensation benefits and goes back to work (full-time, part-time, or commission) while receiving benefits or is no longer injured but is still receiving benefits is committing worker’s compensation fraud.

Workers’ compensation fraud also includes when healthcare providers bill patients for services they did not receive or when employers do not maintain workers’ compensation coverage.

The special investigation department has several teams that uncover workers’ compensation fraud: claimant investigation, healthcare provider investigation, premium enforcement investigation, the SID intelligence unit and digital forensics unit.

In fiscal year 2018, there were 298 closed employer fraud cases with a savings of $8.7 million, there were 54 healthcare closed cases and $3.4 million of savings and 1,270 closed claimant fraud cases with $47.8 million in savings.

Sixty-two percent of the cases were claimant fraud cases, which is when a claimant receives benefits from the BWC while working, is no longer injured and/or did not get injured on the job.

Those who are convicted of this crime may be subject to paying fines or incarceration. Penalties can be found on the BWC forms.

The most common red flags of someone committing workers’ compensation fraud include no witness to the accident, tips from coworkers, the claimant being unable to recall the details of the incident and an answering machine message that indicates the claimant is self-employed, said Fox.

“The special investigation department’s mission is to educate the employers in the state of Ohio who pay into the system about how to identify fraud, what is workers’ compensation fraud to let them know that we are out there protecting the state fund and will help prosecute those that are not entitled to those benefits,” said Fox.

More information regarding BWC special investigations department and workers’ compensation fraud can be found at bwc.ohio.gov or on facebook.com/ohiobwcfraud.

Source: Lima Ohio

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