Find Out About Quality Claims Handling Services

MSP/MIR Compliance

Onsite Wellness Clinics, Nurse Triage, Pre-employment Screening

Physical Therapy and Rehabilitation

Federal Workers Comp Consultants and Managed Care

Buy Workers Compensation Business Insurance

Workers Compensation and Occupational Medicine Conference


Buy through Advisen

Buy through RIMS (RIMS Members)



13 Arrested in New York Workers Comp Fraud Investigation


Thirteen people from eight New York counties have been arrested on charges that they cheated New York's workers compensation system, often by working side jobs while collecting benefits for injuries they pretended left them physically unable to work.
 
 
The series of arrests follow investigations by the New York State Insurance Departments Frauds Bureau, along with investigators from the Workers Compensation Board Office of the Fraud Inspector General, the New York Insurance Fund, insurance company special investigative units and local law enforcement agencies. (WCxKit)
 
 
The cases range from a Steuben County woman accused of fraudulently collecting $10,000 in benefits while running a ceramic supply store to a Schenectady man who claimed a job-related injury prevented him from working but was caught on videotape doing odd jobs.
 
 
Workers comp is designed to compensate people for lost wages after they suffer a job-related injury. It is also used to pay for medical care and rehabilitation for workers hurt on the job. Individuals must be legitimately unable to work to receive compensation.
 
 
Frauds Bureau investigators say people who illegally double-dip are often discovered in routine insurance company audits. In other cases, co-workers, and even relatives, have been known to turn them in.
 
 
The 13 recent arrests resulted in a range of charges which, in the event of convictions, could lead to sentences of up to seven years in prison. (WCxKit)
 
 
In some cases, individuals were charged with workers comp fraud, while in other cases, the charges included grand larceny and offering a false instrument for filing.
 
 
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
 
 
WC IQ TEST:  http://www.workerscompkit.com/intro/
WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:  http://www.LowerWC.com/transitional-duty-cost-calculator.php
WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: Workers Comp Resource Center Newsletter
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Posted in Fraud and Abuse, Legal Doctrines, NY Workers Comp Issues |


Comments Off

Ohio Man Receiving Workers Comp Nabbed Working in Arizona


Robert Harnage, formally of Middletown, Ohio, has been sentenced after an investigation by the Ohio Bureau of Workers Compensation (BWC) Special Investigations Department (SID) determined he owned and operated a business, Classic Home Restoration, in Sierra Vista, Arizona, while receiving temporary total disability benefits for a work related injury.
 
 
Harnage pleaded guilty to one count of workers compensation fraud, a felony of the fifth degree, and was ordered to pay BWC $67,000 in restitution. (WCxKit)
 
 
BWC opened the investigation into Harnage after receiving an anonymous tip and discovered the Arizona Registrar of Contractors had investigated his activities there and found him guilty of operating without a contractors license. This information conflicted with Harnages submission of signed documentation to BWC confirming his understanding that he was prohibited from working or operating a business while receiving temporary total disability benefits.
 
 
BWC agents conducted interviews of Harnages customers who confirmed that he actively participated in the day-to-day operations of the business including providing estimates for all jobs, assisting with physical labor and supervising his crew. Agents also identified 149 checks written from customers to Harnage for his work as a contractor and determined he received benefits for which he was ineligible over a three-year period.
 
 
Harnage was indicted in September, 2009, but failed to appear and a warrant was issued for his arrest. (WCxKit)
 
 
The BWC SID Fugitive Task Force coordinated with the Cochise Sheriff’s Department in Arizona and Harnage was arrested at work.
 
 
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
 
 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Posted in Fraud and Abuse |


Comments Off

New Zealand Woman Convicted in Compensation Scam


 
A New Zealand woman, Vanessa Kennedy was convicted and ordered to repay more than $65,000 for ACC fraud after pleading guilty to obtaining weekly compensation payments by deception under the Crimes Act in district court.
 
 
In 2009, Mrs. Kennedy acting on behalf of her husband, Grant Kennedy, advised ACC he was unable to work due to a back injury sustained doing landscaping. She indicated Mr. Kennedy’s annual income was around $75,000 and requested weekly compensation. (WCxKit)
 
 
However, ACC’s investigation unit discovered Mr. Kennedy was not earning anything and Mrs. Kennedy had provided false documents to support her claim.
 
 
Mrs. Kennedy was ordered to repay ACC $65,931.80, given 150 hours community service, and put on a six month community detention curfew between 8 p.m. and 6 a.m. (WCxKit)
 
 
ACC General Manager Claims Management Denise Cosgrove welcomed the successful prosecution saying, "This case is a reminder that ACC takes fraud seriously. People who defraud ACC are stealing money from all New Zealanders and diverting funds that would otherwise be used to help injured people who really need ACC’s support .


Author Robert Elliott
, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information.  Contact:  Info@ReduceYourWorkersComp.com or 860-553-6604.

 
WC IQ TEST:  http://www.workerscompkit.com/intro/
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
Posted in Fraud and Abuse, WC in Other Countries (International) |


Comments Off

26 Red Flags of Medical Provider Fraud in Workers Compensation


The large majority of the doctors, clinics, hospitals, chiropractors, pharmacists, and other medical providers are honest providers of medical service. Unfortunately, a small minority of medical providers knowingly try to profit off the workers compensation system in ways that are unethical and fraudulent. The unethical medical provider realizes that most people will not recognize their efforts to deceive and to commit fraud. The unethical medical providers are further embolden by work comp adjusters who do not have a basic medical understanding or who are so overloaded with claim files, they do not have time to question unusual or out of the ordinary billing and/or medical treatment.
 
 
While a few medical provider frauds start with a fictitious injury, most medical provider frauds start with a legitimate injury. The fraud begins when the medical provider knowingly begins or knowingly continues to provide medical treatment to the employee that is unnecessary. When the medical providers intent is to maximize the number of medical treatments, medical reports and referrals to other medical providers, the fraud has begun. Another way of looking at it – if the medical treatment is being provided is primarily for the medical providers benefits, not the employees benefit, it is medical provider fraud. (WCxKit)
 
 
There are two primary types of unethical medical providers that commit workers compensation fraud – the claim mills with doctors working with attorneys to maximize each others income, and the lone medical provider who is not operating in concert with anyone else. 
 
 
Claim mills vary from the totally bogus where the doctors and the plaintiff lawyers conspire to create inflated work comp claims to the quid pro quo “business relationship”. In the quid pro quo, the plaintiff lawyer directs the employee to treat at the medical provider who will keep the employee off work as long as possible and write the employee a highly favorable disability rating. The medical provider provides these “services” knowing that their biased medical reports will earn them additional clients from the plaintiff attorney in the future.
 
 
The injured employee who is treating at a claim mill may or may not know they are a part of the fraud being committed by the medical provider. If the doctor keeps telling the employee they need follow-up treatment and it is not safe to work, the employee is not likely to question it, especially if their attorney is telling them that going back to work will diminish their potential settlement of the workers' compensation claim.
 
 
The lone medical provider who is committing work comp fraud know what he/she is doing is wrong, but wants to minimize the chance of getting caught by limiting the number of people who are aware of their unethical actions.
 
 
The work comp adjusters, claim supervisors and nurse case managers of insurers, self-insured employers and third party administrators need to be cognizant of the ways medical providers can commit work comp fraud.   Some of the “red flag” indicators of possible fraud include:
 
1.      The medical billing is much higher than normal for the type of injury incurred
2.      The medical equipment used and billed for appears unnecessary
3.      The injured employee does not recall having received the medical service billed
4.      The medical billing does not have diagnosis codes
5.      The use of a billing code that does not apply to the service performed
6.      The resubmission of bills with diagnosis codes changed
7.      The “padding” of billing codes by adding billing codes for related services not performed
8.      The use of “upcoding” – the charging for a more complex service than what was performed
9.      The medical billings normally or always exceed the state-approved medical fee schedule
10.  The billing on consecutive dates for a minor injury
11.  The billing for medical services on dates the employee was on vacation, out of state, etc.
12.  The billing is for a date of service after the employee changed to a different medical provider
13.  The medical provider bills for services previously billed and paid
14.  The medical provider billing for non-emergency medical services on weekends or holidays when they would normally be closed
15.  An unexplained increase in the frequency of medical visits, especially on older claims
16.  The medical provider continues the same treatment program for an extended period of time without any improvement in the employee's condition
17.  A medical specialist billing for medical services not related to the specialty practiced
18.  The same doctor-lawyer combinations are repeatedly involved with the same type of questionable injury
19.  The medical reports are the same for various dates of service
20.  The medical reports are nearly identical for different employees with different types of injuries
21.  The medical reports are inconsistent with the medical services billed
22.  The frequent submission of billing without the submission of any medical reports
23.  The prescription drugs significantly exceed what is normal for the type of injury incurred
24.  The dispensing of generic drugs while billing for brand name drugs
25.  The dispensing of used durable medical equipment while billing for new equipment
26.  The billing for durable medical equipment that is never provided (wcxkit)
 
 
It is medical provider fraud any time the medical provider knowingly provides false or fraudulent medical reports or medical billing for the purpose of their own enrichment. It is also medical provider fraud any time the medical provider provides services beyond the point where they are medically justifiable.   All insurers, employers and third party administrators should be vigilant to be sure the employee is receiving all necessary medical services while at the same time protecting themselves from the small minority of medical providers who would use the work comp system for their own unjustified self enrichment.
 
Peter Rousmaniere commented, after reading this article, that the good thing is almost all of these issues can be researched automatically by medical billing review software. Peter is a featured writer about workers compensation for LRP's Risk and Insurance Magazine and writes Working Immigrants webblog at http://www.workingimmigrants.com/
 
 
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com or 860-553-6604.
 
 
 
WC IQ TEST:  http://www.workerscompkit.com/intro/
WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:  http://www.LowerWC.com/transitional-duty-cost-calculator.php
WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: Workers Comp Resource Center Newsletter
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Posted in Fraud and Abuse, Medical Issues, WC 101 |


Comments Off

Three Ways Indemnity Payments Are Delivered, or Not


The employee has presented the workers compensation claim and the medical provider has confirmed the employee cannot work. The work comp adjuster has properly investigated the claim and there is no known reason the employee is not entitled to temporary total disability benefits while he remains unable to return to work. In most states this means a weekly payment of indemnity benefits (a few states allow biweekly payment of benefits).
 
There are basically three ways for indemnity payments to be delivered from the work comp claims office to the employee. The most prevalent way is the computer issuance of a check each week that is sent by the U.S. Mail to the employee. With the advent of direct deposit for payroll and the electronic transfer of money from one account to another, direct deposit of the indemnity benefit has become common. The third method is the issuance of the check and the employee comes by either the employer's location or the claim office where the check is handed to the employee. (WCxKit)
 
 
While there is a lot of debate about which of the three methods of delivering the indemnity payment is best, each of the three methods have their pros and cons. Let's look further at each method.
 
 
The first and most prevalent method involves the computer generating a check each week that is stuffed into an envelope and mailed to the employee. The pros and cons are:
 
 
1.     In some computer systems, the adjuster has to approve the release of the indemnity check before the computer will generate it. This is a good thing as it makes the adjuster consider the status of the claim and why the employee is still off work.
2.     In other computer systems, the computer generates the check each week without any adjuster approval. This is not a good thing as the adjuster can easily lose track of the indemnity status of the claim when the adjuster has no weekly input or control over the issuance of the indemnity payment.
3.     A negative of mailing the check is the uncertainty of the delivery date, with postal holidays, inclement weather and human error causing delays in the employee receiving the indemnity payment.
4.  A positive to paying by U.S. Postal Service is that receiving checks that one is not entitled to is sometimes considered mail fraud and prosecutable. Employees who play this game regularly know that fact and are weery.
 
 
The second method, direct deposit of the indemnity payment each week into the employee's checking account has:
 
1.     A major advantage in the reduction in the amount of money spent on printing, envelopes and postage.
2.     When there is no human involvement, the claims office saves time.
3.     A major disadvantage of no human involvement – it is a good way to lose connection with the employee.
4.     The employee receives the weekly check like clockwork, on the same day every week.
 
A MAJOR drawback of direct depost is the employee does not sign the Fraud Statement on the check endorsement line on the back of the check. In some states, there is a statement the employee must sign indicating they are aware that working while collecting workers compensation is fraud and is a criminal act. If you knew this, you are in the minority, as few people even know the fraud endorsement exists, yet is some states it is mandatory, others permitted. Last time I looked, RI was mandatory and NY was optional, and I haven't reasearched others, but YOU should! If you don't research this, you are missing a big opportunity to state your position and communicate that to the employees.
 
 
A third method of indemnity payment delivery that was common several decades ago and then went out of style is beginning to make a comeback. That is having the employees that are physically able to do so to come to either the claims office or the employer's location and pick up the check. The pros and cons of this method are:
 
 
1.     The employer or adjuster gets to see the employee movement and physical appearance.
2.     The employer or adjuster has the opportunity on a weekly basis to converse with the employee, and discuss with the employee the progress the employee is making toward recovery. Druing this meeting, they can SHOW the employee potential transitional duty positions.
3.     If the employer has an aggressive return to work program with light duty or modified duty, it is often easier to get the employee back to work when they have to come to the employer's location to pick up their indemnity check.
4.     For the employees who are physically unable to come in and pick up their check, the checks either have to be hand delivered or mailed. (WCxKit)
5.     This approach to delivering the indemnity check each month to each employee can be very time consuming when the claims office or employer has numerous employees out of work at the same time.
 
 
Employers often think the best approach to delivery of the indemnity disability check is to have the employee come in and pick it up, as it gives them the opportunity to gauge the ability of the employee to return to work.   Third party administrators and insurance claim offices tend to prefer either mailing the check or having the money direct deposited to the employee's checking account as these two approaches saves them time. Employers, especially self-insured employers, should discuss the feasibility of hand delivery of the disability check with their claims office and make a determination as the method of disability check delivery that works best for them.


Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.  See www.LowerWC.com for more information. Contact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

WC IQ TEST:  http://www.workerscompkit.com/intro/
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com
Posted in Fraud and Abuse, Settling WC Claims, TPA and Claims Administration |


Comments Off

Ohio Chiropractor Pleads Guilty to Workers Comp Fraud


A Fairfield (Butler County), Ohio chiropractor has pleaded guilty to workers compensation fraud, a third-degree felony, in a case that already resulted in charges against four additional employees of the Back and Spine Center, located at 2336 Mack Rd.
 
 
Dr. Gary Berner accepted the plea to avoid an impending trial stemming from an investigation by the Ohio Bureau of Workers Compensation (BWC) Special Investigations Department (SID) and Attorney General Mike DeWine’s office. (WCxKit)
 
 
Berner was indicted in July 2010 for his role in a scheme that allowed his colleague, Dr. Bruce Holaday, to continue billing BWC after being banned from treating injured workers.
 
 
Ohio Attorney General Mike DeWines office assisted in the investigation into Holaday, Berner and three other clinic employees.
 
 
Holaday was indicted on one count each of workers comp fraud and theft, felonies of the third degree; 32 counts of forgery, each fifth-degree felonies; and engaging in a pattern of corrupt activity (racketeering), a first-degree felony. His trial is set for March 29. The three other clinic employees have been convicted of fraud as part of the investigation. (WCxKit)
 
 
As part of his plea, Berner agreed to pay $104,000 in restitution and $5,000 investigative costs. His sentencing is scheduled for April 21, 2011.
 
 
 
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.
 
 
WC IQ TEST:  http://www.workerscompkit.com/intro/
WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:  http://www.LowerWC.com/transitional-duty-cost-calculator.php
WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: Workers Comp Resource Center Newsletter
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
Posted in Fraud and Abuse |


Comments Off

Chiropractor Indicted on Work Comp Fraud Charges


Fairfield, Ohio chiropractor has been indicted on charges of workers compensation fraud and theft, following an investigation by the Ohio Bureau of Workers' Compensation Special Investigations Department (BWC SID). According to Fox19.com, Bruce Holaday, owner of Back and Spine Center on Mack Road, was indicted by a Franklin County grand jury.
BWC SID initiated an investigation after receiving an allegation saying Holaday was concealing from BWC his direct involvement in the treatment of injured workers.  Holaday was unlawfully using the names and provider identification numbers of the chiropractors with whom he practiced after being permanently decertified as a BWC health care provider, preventing him from seeking and obtaining reimbursement from BWC. (WCxKit)
Holaday also pleaded guilty to a charge of workers comp fraud in December of 1996, when he was proprietor of Advantage Care Chiropractic, Inc. He billed BWC for $13,006 in services he did not provide.


Author Robert Elliott
, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information.  Contact:  Info@ReduceYourWorkersComp.com or 860-553-6604.

  

WC IQ TEST:  http://www.workerscompkit.com/intro/
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com
Posted in Fraud and Abuse, Medical Cost Containment & Managed Care |


Comments Off

New York Workers Comp Board Fraud Investigator Terminated after Investigation


An investigator for New Yorks Office of the Workers Compensation Board Fraud Inspector General knowingly fabricated entries in reports he filed with OFIG regarding investigations he had conducted, according to a report issued by the state Inspector Generals office.
 
 
According to the North County Gazette, Brian Codys employment with OFIG was terminated as of Nov. 7, 2008, based upon similar findings by OFIG. The Inspector General has referred these findings for prosecutorial review. (WCxKit)
 
 
On Oct. 27, 2008, Workers Compensation Board Fraud Inspector General William Gurin informed the Inspector General that, in September 2008, OFIG investigator Cody had admitted fabricating information in his investigative reports regarding allegations of fraud by employees, health care providers, and others.
 
 
Specifically, Cody had told colleagues that in order to close cases, they should do what he does and “make up” information. Based upon that remark, OFIG reviewed a sample of 41 of Codys closed cases from the prior year, and memorialized its findings in a report dated Sept. 29, 2008. The review determined that in eight cases Cody had manufactured details regarding his investigations in official reports.
 
 
Not long after informing the Inspector General of Codys fabrications, OFIG provided its Sept. 29, 2008 report of Codys false and inaccurate statements to the Inspector General, as well as an Oct. 29, 2008 memorandum memorializing an Oct. 24, 2008 conversation among OFIG employees Cody, Deputy Inspector General Robert Gabrielli, and Assistant Inspector General Scott Jaffer.
 
 
According to that memorandum, the conversation occurred not long after Cody was told that he would be fired from employment.
 
 
OFIG also determined that, in seven of the 41 cases, Cody had provided incorrect or misleading, though not materially false, information.
 
 
Cody acknowledged that he had “embellished” and fabricated interviews and personal visits but was adamant that none of his embellishments had result in to the effect [sic], “nobody innocent went to jail and nobody guilty got a free ride.” Cody stated that he “just wanted to make myself look smart” and that this practice had been long going [sic], including back to his service in the NYPD.
 
 
At one point, he allegedly turned to Jaffer, a former NYPD detective, and commented, “You know, it was just like we always used to do on the [NYPD form] DD5s.”
 
 
Gabrielli also noted that Cody “seemed not to grasp the seriousness of these ‘embellishments’” and stated that, “if he had to do all the things he had represented on [sic] his reports, he would not have the time to close any cases.” According to Gabriellis memorandum, Cody insisted several times that he had acted alone.
 
 
On or around December 2008, OFIG provided the Inspector General with 137 of Cody’s reports, a sample from his caseload encompassing the period January 2006 to August 2008. (WCxKit)
 

The Inspector General
reviewed the documents in each case and, where appropriate, contacted the person or persons whom Cody alleged had provided material information which was used as a basis for ending the investigation.

 

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact:  Info@ReduceYourWorkersComp.com or www.LowerWC.com

 
WC IQ TEST:  http://www.workerscompkit.com/intro/
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
Posted in Fraud and Abuse, NY Workers Comp Issues, WC 101 |


Comments Off

Florida Man Arrested in Workers Comp Scheme


A Jacksonville, Florida man was taken into custody recently for his alleged role in a workers comp scheme. According to a statement from the office of Chief Financial Officer Jeff Atwater, 49-year-old David Rodriguez-Socarras cashed nearly $3 million in payroll checks through a "shell " company in order to avoid paying payroll taxes and workers comp premiums. (WCxKit)
The bureau of Worker's Compensation Compliance served a stop work order on his business, HMV Construction Incorporated, and discovered 57 certificates of insurance had been issued to companies statewide.
Atwater's office said shell companies are frequently created for money service businesses, such as check cashing stores, to cash payroll checks without paying the taxes and premiums. "Unlawful acts, such as these, hurt honest business owners, our state's economy and Floridians who bear the cost of these crimes," said Atwater. (WCxKit)
Socarras faces felony charges including application fraud, workers comp fraud, criminal use of personal identification information, fraudulent application for a Florida driver's license or ID card and possession of a fraudulent Florida driver's license or ID card. If found guilty, Socarras could be looking at 20 years in prison.


Author Robert Elliott
, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information.  Contact:  Info@ReduceYourWorkersComp.com or 860-553-6604.

 

WC IQ TEST:  http://www.workerscompkit.com/intro/
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 © 2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.  
Reformating or rewriting  articles and using them as your own is a violation of copyright law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
Posted in Buying Workmans Comp, Fraud and Abuse, Insurance Issues, Rates, Premiums |


Comments Off

Investigation of Cumulative Trauma Claims from Locking Prison Cells


The head of Illinois workers compensation commission is seeking an investigation of close to $10 million paid out in claims to more than half the staff of a southwestern Illinois prison over the past three years.
 
 
According to the Belleville News-Democrat, the figures involve claims paid by state taxpayers to 389 guards and other workers at the maximum-security Menard Correctional Center in Chester, approximately 60 miles southeast of St. Louis. (WCxKit)
 
 
More than 500 claims filed in the last three years include one involving a $75,678 payment in June to the prisons warden, Dave Rednour. Some 290 cases are pending.
 
 
Mitch Weisz, chairman of Illinois WCC, said he has requested a meeting with Illinois Department of Insurance Director Michael McRaith to discuss a potential fraud probe.
 
 
"I'm surprised that with all the different agencies that are involved, that it's taken you guys to bring this to my attention. My eyes are wide open," Weisz told the newspaper. "Its hard for me to imagine its all kosher."
 
 
More than 230 prison workers claim that their injuries were caused by repetitive actions such as manually locking and unlocking cells. The prison, which opened in 1878, doesnt have electric locks, meaning workers are required to use keys and crank a heavy wheel to open a row of cells. The Department of Corrections said installing electronic locks would be too expensive.
 
 
Illinois Attorney General Lisa Madigans office is re-evaluating all such repetitive-trauma cases to review their validity and appropriateness for compensation, especially those from Menard and other prison sites, according to Madigan spokeswoman Cara Smith, a deputy attorney general.
 
 
Smith also said reviews of work conditions at Menard and other prisons were planned to determine if such injuries could be avoided. She said fighting the repetitive-trauma cases could be an "uphill battle."
 
 
Claims settlement records from the commission indicate that 86 of 98 claims for repetitive trauma filed in 2009 for Menard workers were brought by Illinois attorney Thomas Richs office and were handled by the same lawyer from Madigans office, as well as the same state arbitrator or judge.
 
 
Data going back to January 2008 indicates $5.9 million was awarded in settled claims in which a prison employee, typically a guard, reported injury due to repetitive trauma due to working manual locking systems and keys, among other things. (WCxKit)
 
 
An additional $2.2 million was dispensed due to accidents and overextension-related injuries, while $1.6 million was paid to workers recuperating from injury, according to the newspaper.
 

Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information.  Contact:  Info@ReduceYourWorkersComp.com or 860-553-6604.

 
WC IQ TEST:  http://www.workerscompkit.com/intro/
WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php
MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php
 
WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/
SUBSCRIBE: 
Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.
Posted in Fraud and Abuse, Safety and Loss Control |


Comments Off