This is also known as claimant fraud. Do you suspect someone who is out of work and receiving BWC disability benefits is committing fraud? Some red flags that may signal injured worker fraud include individuals who:
- Collect BWC total disability compensation benefits while working.
- Work for cash under the table.
- Are self-employed or work from home.
- Are never available to answer calls at home or have limited availability for medical exams and/or appointments.
- Perform seasonal work that is about to end when they file a claim.
- Are on disability compensation, but engage in physical activities inconsistent with the limitations they claim to have due to their injury.
- Divert their prescribed narcotics to others or deceive medical providers to obtain multiple prescriptions.
- Claim to be injured at work, but were actually injured elsewhere.
- Grossly exaggerate the extent of his or her injury.
Employers who defraud the Ohio workers' compensation system get an unfair advantage over businesses that follow the law, ultimately harming the honest employers' ability to compete. This can result in innocent, hard-working employees losing their jobs and business owners losing their business. Some red flags that may signal employer fraud include:
- Someone who operates a business without workers' compensation coverage.
- A competitor who frequently underbids contracts (due to not paying for workers' compensation coverage).
- If a certificate of BWC coverage is not visible, or contains an outdated coverage period and/or incorrect name of the BWC administrator.
- An employer who misreports the amount of payroll or shifts payroll to lower cost jobs to avoid paying its fair share.
- An employer who misrepresents/reports employees as independent contractors/subcontractors.
- An employer who pays employees cash under the table.
Nefarious health-care providers pose a risk to the well-being of their patients by misrepresenting treatments and conditions to get money to which they're not entitled. Some red flags that can signal health-care provider fraud include if the:
- Provider bills for a more costly service than what was actually performed.
- Provider misrepresents who provided the care.
- Provider dispenses controlled substances with no legitimate medical purpose.
- Provider consistently bills the same procedure codes across their entire patient base.
- Provider bills a high number of units related to time-based codes.
- Injured worker's treatment notes do not change from visit to visit.
- Information contained in injured worker's treatment notes is incorrect.
Workplace safety violations pose a risk to the well-being of Ohio workers by potentially causing serious injury or fatalities. To address these situations, BWC's safety violations investigation unit (SVIU) team members are located throughout the state and investigate potential safety code violations in the workplace.
To report a safety violation, fatality or serious injury email the safety violations investigations team.