The Workers’ Comp Fraud Blotter
Employee or employer fraud – which is the greater problem? Double dippers, false claims, misclassification of workers, and payroll underreporting, are just some of the more common types of fraud we read about in the media and government press releases. But complex insurance fraud schemes, such as premium fraud, can cost up to hundreds of millions of dollars. Healthcare provider fraud also generates losses in the millions of dollars. Each week we will survey what the media, state agencies, insurance companies, and others report in terms of workers’ compensation fraud.
The Richmond Police Department (RPD) seeks to fire its fourth highest ranked officer citing workers compensation fraud.
RPD said the police captain claimed workers’ compensation after he tore a tendon while watching television at home last year. One of the officer’s attorney said the claimant reported he felt something go “pop” when he jumped off the sofa to celebrate a play while watching a sporting event in April 2008.
The city accuses the police captain of fraud, as his injury undeniably happened away from work. But the 29-year veteran, embroiled in a racism lawsuit against the department since 2006, views the action against him as further evidence of discrimination and retaliation.
“After Captain “Ross” (name changed) returned to work, the city of Richmond placed him on administrative leave, and he has remained on administrative leave for close to a year,” said an attorney for the officer, who also represents six other city police managers in the racism complaint. “They do not want him to return.”
City officials declined to elaborate, citing privacy laws for police and public employees limiting disclosure of information in disciplinary cases. Captain “Ross” has appealed a notice of termination he received this month and will argue his case during a closed hearing in the near future.
“It’s an ongoing personnel matter, and can’t be discussed publicly.” city’s Human Resources Director said. He expressed confidence the process will run its course and there will be an appropriate finding.
The police captain tried to return to work in August. His attorney, who represents him in his civil suits, said his client submitted the workers’ compensation claim because his injury could have been cumulative and therefore work-related as Captain “Ross” has had previous, similar injuries during his career.
“This is perhaps the weakest termination allegation I have ever seen. There’s no question that these charges were levied because of Captain Brown’s lawsuit,” an attorney representing the police office in his labor grievance.
His attorney claims the city’s argument focuses on a negligible “inconsistent statement” in Captain “Ross'” paperwork, trumped up to railroad his client out of his job. The dispute will live on well after any appeal hearing, he added, as an item of evidence in a federal lawsuit filed in 2007, claiming the department retaliated against “Ross” and others for suing in state Superior Court over perceived racism in 2006.
“Ross” pleaded no contest in 1985 to a misdemeanor charge of selling cars without a license, fallout from claims of fellow officers that he defrauded them by failing to deliver after they paid him to find and import expensive German vehicles.
The city’s Human Resources Department handled the investigation in the workers’ compensation case, not the Police Department’s Professional Standards Unit, sources inside and outside the department confirmed, and also hired a private investigator for the case.
City officials have denied all assertions in the past racism suits, even hiring the former head of the State Bar to investigate, but he found little evidence supporting the plaintiffs’ claims.
The suit against the city will continue in Contra Costa County Superior Court, however, with the claimant and six other plaintiffs. A jury trial is set tentatively for December.
Source: An article by Karl Fischer, West County Times with contributions by staff writer, Malaika Fraley. This blog originally appeared on the LexisNexis Workers’ Compensation Law Center.
Reposted with Permission Visit LexisNexis for more information and full reports.
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