FOX19 Investigates: Workers' compensation fraud

FOX19 Investigates: Workers' compensation fraud

CINCINNATI, OH (FOX19) - Workers compensation is intended to protect employees who get hurt on the job by paying their medical bills, lost wages and other expenses. However, workers compensation fraud costs $5 billion a year across the nation in bogus claims and unpaid premiums.

State officials are cracking down on worker compensation cheats who are costing us all money.

Investigators say the vast majority of claims filed with the bureau of workers compensation are legitimate, but there are a relatively few workers, employers and even health care providers that try to scam the system.

Shawn Fox, a Special Agent in Charge of Ohio Bureau of Workers' Compensation Special Investigations Department in Cincinnati, says that's where his team comes in.

"Here in the local area in Cincinnati we have six agents that go after claimant fraud," explains Fox. "These are injured workers that are working and receiving from false claims - working, physical activity cases where they're not supposed to be working or doing physical activity."

A Cincinnati man became the subject of an undercover investigation earlier this year. He can be seen on surveillance video working as a dump truck driver while he was supposed to be on temporary total disability.

Investigators also captured surveillance video of a Mercer county man who claimed he couldn't lift more than 10 pounds. However, the video clearly shows him bench pressing more than 500 pounds.

Both the truck driver and the weight lifter plead guilty to fraud charges and had to pay back the money they'd received in workers compensation.

Some fraudulent claims are actually filed by health care providers who inflate or exaggerate the seriousness of injuries. Billing for treatment of injuries that never happened is called phantom injuries.

Some shady medical clinics may actually team up with lawyers who threaten bogus lawsuits to get phony claims paid quickly.

Some clinics and lawyers hire recruiters, also known as runners, who will steer workers to certain doctors and lawyers in exchange for illegal kickbacks.

There are also fake clinics with no licensed doctors, little medical equipment and provide no helpful treatment to the worker.

Fox says his investigators stay busy looking into suspicious claims.

"Last year we processed about 3,000 allegations through the state of Ohio and identified about $55 million in savings. It's out there. We had locally about half of what we identified for criminal referrals were out of Cincinnati," says Fox.

Fox says Ohio investigators have a no nonsense reputation.

"Ohio has been recognized across the nation as being one of the most proactive state agencies in going after insurance fraud which is workers compensation fraud," says Fox. "We do a really good job of identifying it, prosecuting these people and collecting the money back which in turn goes back into the state fund and is given back to the employers."

So who pays for worker compensation fraud?

We all do in the form of higher insurance premiums which insurers pass onto policy holders and higher prices for goods and services when businesses pass on higher premium costs to their customers.

The Bureau of Workers Compensation tells FOX19 that for every dollar spent on investigating fraudulent claims, the state gets back up to five dollars in refunded payments and fines.

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