Workers' Compensation & Disability Solutions
   

Report Fraud

Workers' compensation fraud increases the cost of the workers' compensation by providing undeserved benefits to employees committing fraud as well as medical providers who submit fraudulent bills for treatment.

Employee Fraud

An employee is engaging in fraud when she misrepresents important facts about an injury in order to obtain workers' compensation benefits. This includes filing a claim for an injury that did not occur at work; misrespresenting employment status while collecting workers' compensation benefits; or falsely reporting the severity of an injury.

Some indications that an employee may be involved with workers' compensation fraud include:

  • Unwitnessed accident
  • Employee's description of accident is vague or inconsistent
  • Fellow employees are describing the accident as staged or occuring off the job
  • Employee exhibits an unusual familiarity with the workers' compensation system
  • Employee working another job while collecting workers' comepnsation benefits
  • Change of physician when treating physician clears employee to return to work
  • Employee can not be reached at her home phone number 

Medical Provider Fraud

A healthcare provider is engaging in fraud when he misrepresents the treatment provided to a worker' compensation claimant and presents a bill for payment. It can be committed by medical doctors, chiropractors, pharmicists, and other healthcare providers.

Some examples of medical provider fraud include:

  • Billing for exams and other treatments that are not provided
  • Miscoding for the treament provided
  • Billing multiple insurance companies for the same treatment
  • Inflating bills by bundling covered services with uncovered services

REPORT SUSPECTED FRAUD TO FCS

If you suspect or have knowledge of workers' compensation fraud, please contact FCS's Operations Manager Kathy Hamilton by phone (716) 650-2739 or e-mail KHamilton@fcsadministrators.com to report your concern.

Please click here for a link to the State of New York Workers' Compensation Board's Office of the Workers' Compensation Fraud Inspector General