• Menu
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

  • About
  • Search
  • Resources
  • Privacy
  • Contact
 

Amaxx Workers Comp Blog

Reduce Workers Compensation Costs By 20-50%

Header Right

  • Home
  • Books
    • Big Book
    • Mini Book
  • Training
    • WC Mastery Membership
    • Course Curriculum
    • Certified Master of Workers’ Compensation
    • Certified Master of WC – Best in Class
  • Coaching
    • CompElite Strategic Coaching for Employers
    • BrokerElite Coaching for WC Business Growth
  • Software
  • Blog
  • Advertising

Mobile Menu

  • Home
  • Books
    • Big Book
    • Mini Book
  • Training
    • WC Mastery Membership
    • Course Curriculum
    • Certified Master of Workers’ Compensation
    • Certified Master of WC – Best in Class
  • Coaching
    • CompElite Strategic Coaching for Employers
    • BrokerElite Coaching for WC Business Growth
  • Software
  • Blog
  • Advertising
  • About
  • Search
  • Resources
  • Privacy
  • Contact
You are here: Home / Claim Management / Fight Workers Comp Fraud & Abuse / 11 Ways to Manage Employer, Provider, and Employee Fraud in Workers’ Compensation

11 Ways to Manage Employer, Provider, and Employee Fraud in Workers’ Compensation

March 6, 2024 By //  by Michael B. Stack

11 Ways to Manage Employer, Provider, and Employee Fraud in Workers’ Compensation

Workers’ compensation fraud by workers gets the most publicity. But additional fraud is committed by staffing companies, professional employer organizations, medical and ancillary service providers, and brokers.

Sometimes multiple parties are involved, as in the case in California involving an alleged $40 million medical billing and kickback operation that involved more than two dozen physicians, pharmacists, and business owners.

Here are also some simple preventive measures that could potentially save companies mega dollars.

Click Link to Access Free PDF Download

“The 5Cs to Taking a Bulletproof Injured Worker Recorded Statement”

11 Ways to Manage Employer, Provider, and Employee Fraud

  1. Educate the workforce. Explain to employees that workers’ compensation fraud hurts the whole company, and the loss of revenue may threaten upcoming pay raises or even their jobs. They must also be informed that fraud is a serious crime with penalties. They should have a way to report suspected fraud anonymously.
  2. Teach the higher-ups. Managers and supervisors should understand that every reported injury should be treated as legitimate; however, they should also be taught to recognize some of the red flags that may indicate a fraudulent claim and have a procedure for reporting them. They also need to know how to take statements about an injury — from the worker and any witnesses.
  3. Work with the insurer. Report all suspicious claims immediately.
  4. Investigate ASAP. Make sure all reported injuries and illnesses are immediately and thoroughly investigated.
  5. Pay careful attention throughout the claims process to see if any information about the injury changes or doesn’t make sense. Also, note whether the injured employee was disgruntled before the injury.
  6. Drug tests. Require drug testing as a condition of employment. Drug users are statistically more likely to file fraudulent workers’ compensation claims than non-users.
  7. Implement a zero-tolerance policy for fraud and take every action possible to expose and prosecute it
  8. Make examples of cheaters. Whether it is a worker, provider, or someone else involved in the process, all participants should see that you will take all steps necessary to fight fraud.
  9. Evidence-Based Medicine (EBM). Ensure all treatment follows evidence-based treatment guidelines and do not allow claims handlers to authorize treatment unless trained in EBM.
  10. Clean the provider network. Vet providers before allowing them into the medical network. Verify their physical location and try to determine if they own the clinic. Where possible, remove from your network any provider who has been accused of fraud.
  11. Involve workers. Regularly send out notices to injured workers with the dates and types of treatment that has been billed and ask them to report discrepancies.
  12. Conclusion

    FREE DOWNLOAD: “The 5Cs to Taking a Bulletproof Injured Worker Recorded Statement “

Fraud costs companies billions of dollars. The money lost is passed on — in the form of higher premiums, increased prices for services, or lower money available to pay employees or expand the business.

Instead of turning a blind eye to the situation, organizations should adopt a zero-tolerance policy for fraud, educate all involved and enforce rules and regulations to expose the guilty parties and deter it from happening again.

See also: Be Aware of Employer, Provider, and Employee Fraud in Workers’ Compensation.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

©2024 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

FREE DOWNLOAD: “The 5Cs to Taking a Bulletproof Injured Worker Recorded Statement “

 

 

Filed Under: Fight Workers Comp Fraud & Abuse

Related Articles

Important Times to Use Surveillance in Workers’ Comp Claims

Important Times to Use Surveillance in Workers’ Comp Claims

Avoid Ethical and Legal Pitfalls In Workers’ Comp Surveillance

Avoid Ethical and Legal Pitfalls In Workers’ Comp Surveillance

Use Social Media When Investigating Workers’ Comp Claims

Use Social Media When Investigating Workers’ Comp Claims

11 Tips for Taking an Effective Recorded Statement in Workers’ Compensation Claims

11 Tips for Taking an Effective Recorded Statement in Workers’ Compensation Claims
11 Ways to Manage Employer, Provider, and Employee Fraud in Workers’ Compensation

10 Ways To Prevent Workers’ Comp Fraud

10 Ways To Prevent Workers’ Comp Fraud
workers' comp Investigation

Special Investigation Unit: Stop Fraud with Proper Training

Special Investigation Unit: Stop Fraud with Proper Training
11 Ways to Manage Employer, Provider, and Employee Fraud in Workers’ Compensation

Snuff Out Fraud to Reduce Work Comp Costs

Snuff Out Fraud to Reduce Work Comp Costs

3 Things To Watch For In Workers Comp Surveillance Footage

3 Things To Watch For In Workers Comp Surveillance Footage

Overcoming Fraud in Workers’ Compensation

Overcoming Fraud in Workers’ Compensation

The Importance Of Employer’s Injury Investigation

The Importance Of Employer’s Injury Investigation

Fight Workers Compensation Fraud With A Special Investigation Unit

Fight Workers Compensation Fraud With A Special Investigation Unit

The First Step In a Bulletproof Workers’ Comp Claim Investigation

The First Step In a Bulletproof Workers’ Comp Claim Investigation

Free Download

The 5 Cs For Taking A Bulletproof Injured Worker Recorded Statement - FREE Download Click Here Now!

Train to Succeed

BECOME CERTIFIED IN WORKERS’ COMPENSATION

Proven Course Catalog & WC Toolbox Give You The Power To Achieve Lower Costs and Better Injured Worker Outcomes

VISIT WORKERS' COMP TRAINING CENTER

Previous Post: « Part 4 of 5: Work Comp and the Grand Bargain – Tips for Stakeholders to Reduce Premiums & Costs
Next Post: Maximize Your Third Party Administrator (TPA) Relationship With A Vendor Day Maximize Your Third Party Administrator (TPA) Relationship With A Vendor Day »

Primary Sidebar

FREE DOWNLOAD

The 5 Cs For Taking A Bulletproof Injured Worker Recorded Statement - FREE Download Click Here Now!

Our Sponsors

Catastrophic and Risk Solutions, Case Management Solutions, and Specialty Networks
 

Injury Management Solution for Employers

Blog Categories

Search Our Archive

Subscribe to Our FREE Newsletter

Return-to-Work Essentials

Footer

Search Our Archive

Search our continually growing archive of over 5,000 articles about Workers' Comp issues.

Quiclinks

  • Calculators
  • Terms & Abbreviations
  • Glossary of WC Premium Terms
  • WC Resources
  • Best Practices
  • Industries
  • Return-to-Work Essentials

RSS Recent Blog Posts

  • Job Descriptions: The Secret Weapon for Safer Hiring and Lower Workers’ Comp Costs
  • Resume Lies, Fake References, and Hidden Risks: How to Spot Red Flags Before You Hire
  • How to Stop Duplicating Efforts: Coordinating OSHA and Workers’ Comp Data
SUBSCRIBE TO OUR FEE NEWSLETTER
Let Us Help You Stomp Down the High Cost of Workers' Comp!
Top of Page ↑
  • Home
  • Training Center
  • Search
  • Membership
  • Products
  • Blog
  • About
  • Contact
  • Subscribe
  • Login
Copyright © 2025 Amaxx, LLC. All Rights Reserved. · Privacy Policy / Legal Notice