Given the financial ramifications to states and taxpayers when someone abuses workers compensation claims, it’s only natural that fighting back against such incidents is important.
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“The 5Cs to Taking a Bulletproof Injured Worker Recorded Statement”
Obtained Prescription Narcotics From Numerous Hospitals
In a recent case in Washington State, Jose Ramon Amaya-Hernandez thought he developed a sound means to obtain prescription narcotics — go to a hospital claiming to be in pain due to a work related injury. However, an investigation by the Department of Labor & Industries (L&I) uncovered the scam.
Amaya-Hernandez recently pleaded guilty to three counts of obtaining a controlled substance by fraud and was sentenced to 45 days in jail on each count to run concurrently. He must also pay fines as well as a yet to be determined amount of restitution to the hospitals he defrauded.
More Than 50 Fraudulent Claims Filed
The investigation found that Amaya-Hernandez filed a total of 53 claims for injuries over a three year period.
The claims were filed at a dozen different Seattle area hospitals and were subsequently denied by L&I because there were no records showing that the man ever worked for any of the employers he listed on the claims.
However, the hospitals provided him with narcotic pain medications for the treatment of his claimed injuries.
Although Amaya-Hernandez was using several aliases, L&I investigators became suspicious and used a cross match through the Department of Licensing to determine his actual identity and build their case.
L&I’s Fraud Prevention and Labor Standards program assessed $24.6 million in unpaid employer premiums plus penalties in fiscal year 2012. The program brings in close to $9.30 for every dollar spent to combat fraud.
Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: [email protected].
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