Workers' Comp Fraud
Red flags to spot fraud
A red flag is a warning or a sense that something isn't right and leads one to take a closer look. The lists below will help you to identify likely fraudulent behaviors. Identification of any one of the following red flags does not mean that fraud exists. However, to submit a fraud allegation to BWC, you need only have a suspicion that fraud may have been committed. Experienced investigative experts at BWC will carefully collect and analyze the facts to determine whether fraud was committed.
Spotting claimant fraud
Individuals never available to answer calls at home or have limited availability for exams and/or appointments
Individuals who perform seasonal work that is about to end when they file a claim
Individuals who are on disability compensation engage in physical activities inconsistent with the limitations they claim to have due to their injury
Individuals who collect BWC total disability compensation benefits while working
Individuals who divert their prescribed narcotics to others or deceive medical providers to obtain multiple prescriptions
Spotting employer fraud
Suspicion that a competitor can underbid contracts due to not paying for workers' compensation coverage
Certificate of BWC coverage not visible or contains an outdated coverage period and/or incorrect name of the BWC Administrator
Employer misreports the amount of payroll or shifts payroll to lower cost jobs to avoid paying its fair share
Employer misclassifies employees as independent contractors/subcontractors
Spotting health-care provider fraud
Medical providers perform medically unnecessary treatments or diagnostics tests.
Medical providers bill for services not provided or bill for more expensive procedures than were actually performed.
An unlicensed medical provider bills for services.
Medical providers give limited or no medical treatment while heavily furnishing prescriptions for narcotics.
Information courtesy of Ohio.gov