Some of us have heard variations of this story: an employee feigns injury in order to obtain workers’ compensation benefits. However, in the vast majority of cases, this simply is not true.
The image of fraud within the workers’ compensation is inaccurate. Studies disclosed that fraud has only been found in 1 to 2 percent of workers’ compensation claims. Further studies note that employer, insurer and health provider fraud is a far greater problem than fraud perpetrated by claimants.
Providers billed for surgeries that did not occur
Take, for instance, a federal case in Ohio that came to a conclusion in February. The case involved three health care providers who agreed to pay $3.2 million for charging the Ohio Bureau of Workers’ Compensation (BWC) and Medicare for surgeries that did not take place. The BWC’s share of that amount is nearly $1.16 million.
In this situation, a physician and part-owner of a central Ohio orthopedic practice regularly billed for complex shoulder surgeries that either did not take place or did not happen within the standard of care. The surgeries happened at a number of different medical centers.
Employers, too, have done their share of fraud. Some employers fail to buy the required workers’ compensation insurance. Others cheat the system by underreporting or misclassifying its payroll, falsely claiming that employees are independent contractors.
And the likelihood of fraud committed by insurance companies at the expense of workers is substantial, too.
Emphasis should be on employer safety violations
Overall public perception regarding workers’ compensation fraud remains exaggerated. Too much emphasis on fraud and its related costs distracts the public from the real issue: hazardous workplaces and the rampant safety violations of an employer.