The cost of insurance fraud including workers compensation, automobile, and home owners insurance is estimated at 80 billion dollars a year. That is enough money to pay the salaries of every CEO of America’s 500 largest companies for the next 16 years!
Insurance fraud is often broken down into two types, intentional fraud and exaggeration fraud. Intentional fraud, also known as hard fraud, is where a person makes a deliberate attempt to fake an insurance claim for the purpose of defrauding the insurance company. For example, a hotel maid is in debt and decides to fake a back injury accident without any witnesses in a hotel room to receive a workers compensation settlement.
Exaggeration fraud, also known as soft fraud, occurs when there is a legitimate insurance claim, but the claimant decides to increase the size of the claim. For example, a construction worker falls off a scaffold and injuries his knee. The worker decides since he is going to be off work anyway to tell the doctor and adjuster he also injured his back. The worker has had back problems for years, but now has a chance to get it taken care of and paid for by the insurance company.
The people who commit workers compensation fraud often think they are just taking money from the “big insurance company”. They do not realize that the insurance company money is collected in the form of insurance premiums from the employers. For the insurance company to stay in business, the cost of insurance fraud is passed from the insurance company to the employers. The more employers have to pay for workers comp premiums, the higher the cost of the product or service the employer produces. The higher premiums force employers to reduce the number of jobs available and reduce the other benefits they provide to the employees.
Dishonest employees are not the only ones committing workers compensation insurance fraud. Employers who underreport the size of their payroll or the number of employees for the purpose of lowering their workers comp premiums are committing fraud. Employers who misclassify workers (for example high-rise window washers who are classified as janitors) are also committing fraud.
Workers compensation fraud is also committed by organized rings of lawyers, doctors, chiropractors, physical therapists and other medical providers. The workers compensation claims they are involved in can be either intentional fraud or exaggeration fraud. The medical treatment is either not provided or is inflated to increase the insurance billing. The amount of permanent partial disability from the injury is overstated for the sole purpose of defrauding the insurance company.
Recently in the insurance news there have been a lot of articles about the run-away cost in workers compensation of prescriptions drugs and narcotics in particular. Prescription fraud is a part of the problem. Employees fake injury claims, and have frequent visits to the doctor, (especially to pain management clinics) not only for the purpose of collecting the indemnity benefits, but also to obtain prescriptions for OxyContin, Vicodin and other narcotics they can sell on the black market. The diversion of narcotics, both for street resale and for recreational use is one of the fastest growing areas of insurance fraud.
Employers should be ever vigilant against the possibility of workers compensation claim fraud. The most common indicators of fraud include (WCxKit)
- Several prior claims
- Accidents without witnesses
- Accidents where the only witness is a friend
- Witness(es) heard but did not see the accident
- Poor attendance record prior to the injury
- Disciplinary action prior to the injury
- Problems with co-workers
- Performing a task that is normally not a part of the job
- In a work area that the employee does not work at
- Upcoming layoff
- Recent termination
- Missed promotion or transfer
- Passed over for a pay raise
- Monday morning accident
- New employee
- Resist light duty work
- Complaints of injury out of proportion to actual injury
- Nature and/or extent of injury is increased after it is originally reported
- It should be noted that none of these indicators is proof of fraud. However, with any of these indicators it is prudent to investigate the workers comp claim thoroughly.
There are steps the employer can take to reduce the cost of workers compensation fraud. The employer who has a strong safety program reduces the scenarios an employee can use to create a fraudulent workers comp claim. A strong and well known return to work program with a transition duty job for every injured employee reduces the financial incentive for workers comp fraud. Any suspected fraudulent claim should be discussed with the claims adjuster and special investigative unit. Any case of proven fraud should be prosecuted to the maximum to prevent copycat claims.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
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, contactInfo@ReduceYourWorkersComp.com.
When an employee commits workers compensation insurance fraud, they are stealing direct from the employer. While the insurance carrier or the self-insurance program may write the check, the cost of workers comp fraud comes right out of the employer’s pocket. The fraudulent workers comp claim is included in the calculation of the insurance premium, the same as legitimate workers comp injuries.
Per the Coalition against Insurance Fraud, bogus claims cost employers $6 billion a year. It is estimated that nearly 25% of the workers comp claims contain some element of fraud, whether it is the outright bogus claim or the employee who stays off work when he knows he could be working light duty. [WCx]
The employer should know the indicators of fraud, often referred to as the red flags. Something unusual about the claim does not indicate fraud, but unusual things can point to the possibility of fraud. When any of the following exist, consider a fraud investigation:
- Late reporting of the injury: real injuries get reported quickly.
- Accident details that do not fit: the accident details are sketchy or vague, the employee has difficulty describing what happened, and the employee gives more than one version of what happened.
- Witnesses: there are no witnesses, especially when the employee normally works around other employees, or the witnesses’ version differs from the employee’s version of the accident.
- Disgruntled employee: the employee has previous express dissatisfaction with supervision or management, the employee did not get a promotion she wanted, the employee is on "positive improvement needed" status, the union has announced an impending strike; the factory is closing, etc.
- Medical care: the injuries are subjective, i.e., low back pain, complaints of pain out of proportion to diagnostic findings, the employee changes doctors, the employee attempts to add additional body parts to the medical treatment.
- Monday morning claims: the injury, usually with no witnesses, occurs early Monday morning shortly after the employee gets to work (the injury occurred over the weekend while the employee was away from work). [WCx]
Unfortunately, when it comes to workers comp fraud, some employers take the defeated approach with “there is nothing we can do about it” line of thinking. There are many approaches the employer can follow to reduce and/or eliminate fraud including:
1. Having an established practice of investigating every workers comp claim. If the employees know it will not be easy to commit fraud, they are less likely to try it.
2. A required transitional duty program that all employees know about will prevent the employee who wants to “take a vacation on comp” or to work another job while collecting workers comp benefits.
3. Make sure all employees are aware that workers comp fraud is a crime and you strongly prosecute insurance fraud.
4. Make fraud beneficial to the employee who reports it. Have a published policy of paying a reward to the employee who provides information leading to the conviction of the criminal committing the fraud.
5. Report ALL questionable claims to the Special Investigative Unit of the insurer or third party administrator.
6. Have a strong safety program which will remove many of the scenarios the fraud prone employee can use to create a bogus claim.
7. Avoid hiring people of questionable ethics. Complete a thorough background check including criminal history and credit score (the lower the credit score, the higher the probability of a questionable workers comp claim). If you do not have the time to do an in-depth background check, consider a member of the National Association of Professional Background Screeners, www.napbs.com.
Fraud should never be tolerated and should be fought any time it occurs. As the employer, you should learn as much as possible about defeating workers comp insurance fraud. Our 2012 Manage Your Workers Compensation: Reduce Costs 20% to 50% has an entire chapter on Fighting Fraud and Abuse. It will show you many additional steps you can take as the employer to combat workers compensation fraud.
Author Rebecca Shafer, JD, President of Amaxx Risk 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. She is the author of the #1 selling book on cost containment, Manage Your Workers Compensation: Reduce Costs 20% to 50% www.WCManual.com.
Contact: RShafer@ReduceYourWorkersComp.com.
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.
© 2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Ohio Bureau of Workers Compensation (BWC) Administrator/CEO Steve Buehrer recently announced seven individuals were convicted of or pleaded guilty to charges related to defrauding Ohio's workers comp system during a 30-day period. The court actions are the result of investigations conducted by BWC's Special Investigations Department (SID), which works to deter, detect, investigate, and prosecute workers comp fraud.
The following is a sampling of cases that resulted in a guilty plea or a conviction.
Nancy Madewell, dba Bagel Cafe Inc. (Kettering, Montgomery County), pleaded guilty to three counts of failure to comply for operating her business without workers comp coverage. Numerous attempts were made by BWC's Employer Compliance Department to bring Madewell into compliance, but she continued to operate without proper workers comp coverage. Madewell failed to appear for trial and a warrant was issued. She then reported to Kettering Municipal Court in response to the warrant and entered a guilty plea. Madewell was sentenced to 60 days in jail suspended on the condition of not violating her three-year, unsupervised probation. [WCx]
Jose Ramirez (Cleveland, Cuyahoga County) was sentenced to one felony count of workers comp fraud for working while receiving benefits. SID opened an investigation after receiving an allegation that Ramirez was working on cars in his driveway. The investigation found that Ramirez was working for a transmission repair service while receiving temporary total disability benefits. Ramirez conducted various tasks, such as, sweeping the floors, cleaning the shop, delivering parts to customers, picking up parts from suppliers, supervising/assisting other mechanics with repairs, and driving business tow trucks to pick up vehicles. Ramirez worked up to four days per week and was paid in cash. Ramirez pleaded guilty in Franklin County Common Pleas Court and was convicted.
Mitchell Oakley (Harrod, Allen County) pleaded guilty to one count of workers comp fraud for filing a false claim. Oakley filed a claim indicating he was injured on his first day of work for an employer. However, SID found that Oakley was actually injured moving boxes at home prior to his employment. He was sentenced in Lima Municipal Court to 30 days suspended and must repay $150 in court costs.
Victoria Hall (Toledo, Lucas County) was sentenced to a felony count of workers comp fraud for working while receiving benefits. SID investigators obtained undercover surveillance video showing her working at a convenience store while receiving temporary total disability benefits. Hall was previously injured at the same gas station and returned to work there after the gas station was under a different name and owner. Hall admitted to wrongdoing during an interview and pleaded guilty. Hall was sentenced to three years of community control and ordered to pay restitution in the amount of $7,754.97 and investigative costs of $1,000. The conditions of her community control are to pay the restitution and maintain employment. If Hall violates her probation, the judge stated that he will send her to jail for a term of 12 months.
Nancy Palmer (Cleveland, Cuyahoga County) was sentenced on a felony count of workers comp fraud for working while receiving benefits. SID received an allegation that Palmer had been working at a local veterinary hospital. Investigators found she had returned to work as a veterinary assistant while receiving temporary total disability benefits. She was performing duties such as office work, assisting during surgeries, cleaning and taking care of animals. It was also found that Palmer was working as a telephone solicitor for a local charity. Palmer entered a guilty plea and the judge ordered her to pay $7,457.72 in restitution and $1,000 for investigative costs. She was also sentenced to seven months in prison suspended, for 18 months of community control. [WCx]
Randall Schornack (Austintown, Mahoning County) was sentenced on a felony count of workers comp fraud for working while receiving benefits. SID received an anonymous tip on the fraud hotline that Schornack was working as a disc jockey at area bars under the name "DJ Randy Stevens." SID's investigation determined that Schornack was working as a DJ for several bars in Mayfield and also for a professional DJ service in Girard while receiving temporary total disability benefits. The SID obtained video of Schornack unloading and carrying speakers and other equipment from his vehicle into different establishments on a weekly basis and performing work services as a DJ. Schornack was ordered to pay $27,202.62 in restitution He was also sentenced to 18 months in prison suspended, for five years of community control.
Information from Ohio BWC
Author Robert Elliott, executive vice president, Amaxx Risk 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. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
VIEW SAMPLES PAGES
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
From time to time employers are confronted with the dilemma of how to deal with a small, but fraudulent, workers compensation claim. The employer knows the claim is fraudulent. However the cost of contesting the claim, and the extra time that will be required of the risk manager or workers comp coordinator, makes it seem like a good idea to let the employee ‘get away with it’. Why spend $5,000 in legal fees on the workers comp claim, complete the investigation needed to defeat the claim, and risk a wrongful discharge claim, when the employee will be back at work in a couple of weeks?
If the ‘little fraud” is not contested, there will undoubtedly be more little frauds. And as the word spreads that the employer is an easy mark, employees will push the envelope with larger fraudulent claims. When the employer lets the minor, clearly fraudulent claim run its course, the other employees notice what is occurring. [WCx]
The workplace grapevine quickly shares the news that ‘good ole Joe’ is going to claim he hurt his back, so he can take his family on that extended vacation that he has promised them for years. When everyone in the shop knows that he is going to make a fraudulent workers comp claim, they all watch to see what develops. ‘Good ole Joe’s’ bogus workers comp claim is often the subject of discussion at lunch, or during breaks. The employees will wait and see if he gets away with it. When Joe stays off work for a month then returns to the job like nothing has happened, the dishonest employees may also plan “vacation on comp.”
The honest employees will continue to be honest, regardless of whether or not some co-workers get away with fraud. But, the favorable impression of the employer is diminished, as the employer should have done more to prevent the fraud. Plus, when the fraudulent employee gets light duty or a cushy job, while the honest employees have to pick up the fraudulent employee’s heavier tasks, resentment builds. This is not just towards bogus ‘good ole Joe’, but also at the employer for giving the honest employees an unfair share of the work. Morale declines among all the honest and good employees.
While management may be frustrated by a bogus workers comp claim, when nothing is done about it, the employees do not perceive it that way. The impression the employees will get is that management does not care about a little time off on comp. And, most employees think that workers' compensation is paid for by the insurance company, not their employer. Besides it is the big, rich insurance company that is paying for it, not the employer (in the mind of the dishonest employee). Hence, since management will turn a blind eye to the fraud, the discontents, the gripers, the poor performers and the troublemakers all see this as a turn to get something for nothing. The number of bogus claims then increases.
Many of the bogus claims will run a course in a month or two. However, for some employees the bogus claim is the solution to a long-term ailment. The pre-existing slip disc in the neck, or the torn knee ligament, can now be paid for by workers compensation. The employees saw that management took no action on ‘good ole Joe’s” claim; therefore, management does not care if the employees “fudge” a little bit, and claim the medical problem is related to work, when it is not.
The employee who turns in the bogus claim for a major medical problem does not think about the cost differential between his workers comp claim and ‘good ole Joe’ who just took some paid time off. Also, the bogus employee may be a little concerned that he will get caught in the fraud. The employee committing fraud is much more likely than the honest employee with a legitimate injury to hide behind the curtain of protection of a personal injury lawyer (who does not care if the workers compensation claim is bogus, as long as he gets his fee).
The culture of fraud will grow from the minor claims to major claims, plus the number of bogus workers compensation claims will increase significantly, all because management allowed “a little fraud” to save the cost of fighting it. [WCx]
The employer can prevent the bogus / fraudulent claims from spiraling out of control. The employees should know that every workers compensation claim is investigated thoroughly, and all questionable claims are vigorously defended. In addition, any proven case of fraud should be turned over to local law enforcement for prosecution. Every employee should know that the employer pays for all workers comp claims through the insurance premium, and that bogus claims are theft from the company. A culture where every legitimate claim gets prompt medical care and every questionable claim is contested will go a long ways toward preventing the ‘it is only a little fraud’ mentality.
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and 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. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com
MODIFIED DUTY CALCULATOR: www.LowerWC.com/transitional-duty-cost-calculator.php
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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
A former MBTA driver (Massachusetts) is looking at a fall trial on charges that she staged an armed robbery, lied about it to police, and then claimed more than $7,000 in workers compensation funds, Suffolk County District Attorney Daniel Conley reported.
Nancy Parker, 53, of Burlington was arraigned recently in Suffolk Superior Court on charges of workers comp fraud, making a false police report, and misleading an investigator, a subsection of the state’s witness intimidation statute. (WCxKit)
Assistant District Attorney David McGowan told the court that Parker was driving an MBTA bus on Route 111 in the area of Garfield Avenue and Exeter Street in Chelsea on the afternoon of Oct. 2, 2007, when she made the initial false report.
When MBTA Transit Police along with Chelsea Police and other law enforcement officials responded to a call for shots fired, Parker allegedly told them that she was heading inbound when she stopped to pick up a passenger. The man, that Parker allegedly told Transit Police detectives about, pulled a gun, demanded her money, and shot at her. He shot her once as she sat in her seat and three more times after she tried to rush past him and he pushed her to the ground, where he took her wallet and fled.
Though she claimed ignorance as to his identity or motive beyond the robbery, Parker allegedly gave a detailed description of the assailant. This description led Transit Police to conduct an extensive investigation into who he might have been. After posting a composite sketch to the Massachusetts Most Wanted web site and circulating it among local businesses, Transit Police received a tip that led to particular scrutiny of a suspect in past offenses. He was eventually cleared of wrongdoing in the bus incident.
Parker also allegedly showed investigators her uniform jacket, which had three holes in it. Though she described them as bullet holes, she suffered no injuries from the shooting she described. She did, however, leave work and file a workers comp claim which amounted to $7,750.87, plus an additional $2,063.07 in payments to medical providers.
In a second interview with Transit Police, Parker allegedly stated that she had lied in her initial statement. This time she allegedly indicated that a former intimate partner had sent the gunman to collect a $5,000 debt Parker had incurred about 14 years earlier.
After interviewing that former partner, conducting further investigation, and attempting to contact Parker only to be met with evasiveness or, on one occasion, shouted profanities, Transit Police determined that her story was a fabricated.
Parker was first charged in Chelsea District Court on April 30, 2009. A judge dismissed the case of prosecutor objections in 2010. Conley’s office put the matter to a grand jury last year, leading to her Dec. 20 indictment. (WCxKit)
Her trial is now scheduled for Oct. 15, and she is due back in court soon.
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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
Oklahoma Attorney General Scott Pruitt recently charged two men with workers compensation fraud. Charlie Jones, 45, of Norman faces one count of workers comp fraud.
According to charges filed in Oklahoma County District Court, Jones had filed a claim for injuries to his right arm and hand allegedly sustained while working. He was awarded permanent total disability (PTD) benefits. In a medical re-evaluation two years later, Jones claimed constant pain with limited mobility.
During the investigation, Jones was observed feeding animals and cleaning his pool with no clear signs of pain or lessened mobility. The fraud resulted in Jones receiving $11,385 in benefits to which he was not entitled.
Meantime, Johnny Lee Crowder, 42, of Lawton also was charged with one count of workers comp fraud. According to charges filed in Oklahoma County District Court, Crowder filed a claim for injuries to his left hand when he tripped and fell while working. Crowder sought medical treatment for an injury to his hand sustained while at home. (WCxKit)
During the investigation, investigators found discrepancies in Jones’ claim and medical records. On the day in question, the business was closed for holiday and the ambulance picked him up at home not at work as he originally stated.
Ohio Man Not Liking the Tune of Workers Comp Fraud
An Austintown (Mahoning County), Ohio man was sentenced recently for workers comp fraud after Ohio Bureau of Workers Compensation (BWC) investigators caught him on video entertaining partygoers and bar patrons as a disc jockey.
According to the BWC, Randall Schornack pleaded guilty and must repay more than $27,000 he collected illegally while receiving benefits for a workplace injury. (WCxKit)
BWC's Special Investigation Department (SID) received an anonymous tip on the fraud hotline that Schornack was working as a disc jockey at area bars under the name "DJ Randy Stevens."
SID's investigation determined that Schornack was working as a DJ for several bars in Mayfield and also for a professional DJ service in Girard while receiving temporary total disability benefits. The SID obtained video of Schornack unloading and carrying speakers and other equipment from his vehicle into different establishments on a weekly basis and performing work services as a DJ. (WCxKit)
Schornack was sentenced in a Franklin County courtroom and the judge ordered him to pay $27,202.62 in restitution He was also sentenced to 18 months in prison, suspended for five years of community control.
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.
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.
A Brunswick (Medina County), Ohio business owner is sentenced following a fraud investigation. He operated his business in violation of the law which forbids injured workers from working while also receiving benefits from the Ohio Bureau of Workers Compensation (BWC).
George Seiber is ordered by a Franklin County judge to repay more than $24,000 he received while working and simultaneously receiving Temporary Total Disability benefits. (WCxKit)
“The law is very clear in forbidding employment or running a business while receiving workers comp benefits,” said BWC Administrator/CEO Stephen Buehrer. “Unfortunately for many of the perpetrators, BWC’s fraud staff sees these cases over and over again and is much attuned to the red flags that often signal fraudulent activity.”
BWC’s Special Investigations Department (SID) received a fraud allegation from a BWC employee who suspected Seiber of working while receiving Temporary Total Disability benefits. When the employee called Seiber, she received a voice mail message for a business called Roofer Inc. Suspecting that Seiber may be working at Roofer Inc., SID opened a fraud investigation.
The investigation found Seiber owned and operated the company and performed work activities including contacting customers, appraising roofs, preparing proposals, supervising staff, and handling money transactions. (WCxKit)
Seiber pleaded guilty in the Franklin County Common Pleas Court. Seiber was sentenced to 12 months incarceration, suspended, and five years of community control. He was also ordered to pay restitution in the amount of $24,883.88, including $1,000 for investigative costs.
Author Robert Elliott, executive vice president, Amaxx Risk 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.
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
A longtime Tulsa, Oklahoma criminal defense attorney has pleaded guilty in Tulsa County District Court for his role in helping embezzle more than $1 million from clients, Attorney General Scott Pruitt’s office reported.
Fred Schraeder entered a guilty plea to one count of conspiracy to commit workers compensation fraud. He received a 5-year deferred sentence and will pay more than $36,000 in restitution, $500 in fines and a $100 victim’s compensation assessment. (WCxKit)
The Oklahoma Bar Association's Clients Security Fund is also assisting in reimbursing victims. Schraeder must surrender his law license and is not eligible to re-apply while on probation.
Schraeder’s accomplice, William Anton, received four consecutive sentences totaling 35 years, with 25 years suspended. He was ordered to pay $702,813 in restitution and surrender his law license. (WCxKit)
The Attorney General’s office filed charges against Schraeder and Anton, alleging they embezzled money from clients personal injury benefits, insurance settlements and workers comp benefits. The defendants purportedly embezzled more than $1 million from 49 identified victims.
Author Robert Elliott, executive vice president, Amaxx Risk 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.
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
Recently addressing a group of 40 fraud directors from around the country, Massachusetts Attorney General Martha Coakley highlighted the importance of collaboration among law enforcement, employers, employees, and local fraud bureaus to prevent and prosecute cases of fraud across a variety of industries, according to a report from her office.
“The cost of corruption on businesses and taxpayers is significant,” AG Coakley said. “It undermines the level playing field for businesses, distorts the competitive marketplace, and costs taxpayers at a time when every dollar is crucial. It is in everyone’s interest – in both the public and private sector – to deter and prosecute cases of fraud, and we must all work together to do that effectively.” (WCxKit)
The Fraud Directors Conference, held in Chatham, was sponsored by the Insurance Fraud Bureau of Massachusetts. The Attorney General discussed the types of cases prosecuted by her office ranging from public corruption and Medicaid fraud matters to workers compensation and auto insurance schemes.
She highlighted examples in which public and private cooperation proved key factors in deterring cases of fraud. For instance, when the state was confronted with an uptick of cases of auto insurance fraud schemes, a collaborative effort between the Massachusetts Insurance Fraud Bureau, District Attorneys, federal and state law enforcement, and private insurance companies worked to combat these crimes and build strong criminal cases.
Coakley’s office has made the investigation and prosecution of cases of fraud and corruption a priority. For instance, in the last fiscal year, the Attorney General’s Office recovered $69 million in Medicaid fraud. (WCxKit)
Recently, she reported the indictments against 10 people in connection with four Medicaid Fraud cases.
Author Robert Elliott, executive vice president, Amaxx Risk 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
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
A judge sentenced a Rancho Palos Verdes, Calif., woman to three years in state prison for refusing to pay $75,000 in restitution on a 2007 insurance fraud and grand theft conviction stemming from a phony accident claim.
According to the Los Angeles County District Attorney’s office, Sheila Burke was remanded to prison by Superior Court Judge Judith Champagne after roughly 20 probation violation hearings dating back to Aug. 26, 2007, when she was sentenced to one year in county jail and 5 years of probation and ordered to pay restitution to APM Terminals.(WCxKit)
But Burke refused to comply with the restitution order, despite owning several properties and still being employed. A Rancho Palos Verdes property she owns was valued at $218,000, according to Deputy District Attorney Anthony Colannino who prosecuted the case.
At a recent hearing, Judge Champagne provided Burke with a final opportunity to show progress toward paying the restitution, said Colannino of the District Attorney’s Healthcare Fraud Division.
But during another hearing, Judge Champagne found Burke had refused to make any meaningful attempt to pay restitution and did not comply with orders to produce documentation about her assets.
In 2007, a jury found Burke guilty on two counts of insurance fraud and one count of grand theft stemming from insurance claims she filed. Burke claimed that in November 2006, while a long shore worker, she was injured in a collision involving her pickup truck and a tractor-trailer.(WCxKit)
Since her conviction the only meaningful income obtained toward paying the restitution was roughly $17,000 in California income tax refunds that were impounded by the state.
Author Robert Elliott, executive vice president, Amaxx Risk 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.
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.
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