States offer public tools to curb premium fraud
Massachusetts has recently announced an online tool to verify that an employer has workers’ compensation coverage. The tool can be accessed from the Department of Industrial Accidents site.
In addition to helping employees to verify that they will be covered should they be injured on the job, businesses may also want to verify that their competitors are not gaining unfair advantage by avoiding their workers compensation obligations. Officials say the stated goals of the program are to:
- Permit homeowners to ensure that hired contractors have workers’ comp insurance
- Allow general contractors to ensure that all subcontractors are properly insured
- Assist medical providers with coverage questions when treating an injured worker
- Aid state and municipal officials with ensuring workers’ comp compliance with licensing, permitting, and awarding public contracts
- Help protect employers from agent and broker fraud allowing them to verify their own coverage
State officials have noted that 36 other states have similar public services online – we’ve seen such services on the NY, CA, FL, IL and TX workers’ comp sites, although on some sites, it can be a devil of a time to find the services. See All 50 States’ and D.C.’s Home Pages and Workers’ Compensation Agencies
While most states have some type of anonymous fraud reporting system on their websites, some states are getting more aggressive than others in promoting their services to the public. Florida has been touting the results of their workers comp whistle blower site, which allows citizens to submit referrals of alleged violations of workers compensation rules. As of August, after only two months of operation, the site had already produced hundreds of new complaints and over $500,000 in penalties. Fraud reporting systems aren’t just for reporting noncompliant employers. They can also be used to report suspected employee, physician, or attorney fraud related to workers comp.
Fraud is on the rise
According to the National Insurance Crime Bureau, workers comp fraud referrals were up by 2% in the first half of 2009. Premium fraud was down by 21%, but other types of fraud such as medical provider fraud and claimant fraud have risen.
Steve Tuckey is currently writing an in-depth series on fraud for Risk and Insurance. The first installment, Transparency of Evidence, deals with fraud by doctors, hospitals and other healthcare professionals. He notes that “grayer areas of so-called abuse or overutilization continue to vex payers, insurance companies and lawmakers eager to maintain the financial stability and integrity of the system that has protected workers for nearly a century.” Evidence-based medicine standards are helping to curtail both the egregious fraud as well as “softer” abuses. Part 2, Vanishing Premiums, deals with the issue of premium fraud and the myriad schemes employers use to avoid paying their fair share.
Social networks provide clues
Some employers and insurers are finding that social networking sites are a useful new tool in com batting employee fraud. In fact, in many cases, fraudulent employees are outing themselves as cheats by bragging about false claims or posting photos or videos of themselves engaging in activities that are incompatible with the injuries they are claiming.
“Some claimants supposedly too disabled to work post locations and dates for their upcoming sports competitions or rock band performances, boast of new businesses launched, and include date-stamped photographs of their physical activity, investigators say.
Others have openly bragged about fooling their employers with “Monday morning” workers comp claims for injuries that occurred the weekend prior and away from the workplace.”
However, employers need to ensure that they stay within the law when using online information about employees. New Jersey attorney Jonathan Bick suggests some best practice policies for employers when mining social networks. The issue of employee privacy can be a murky one. A good rule of thumb is that an employer should avoid duplicitous methods to spy on private, nonpublic pages – a New Jersey jury recently upheld a group of employees’ rights to privacy in just such a case. Information that employees post to public pages may be another matter. As Bick notes, “In order for a person’s privacy to be invaded, that person must have a reasonable expectation of privacy.”
Tags: privacy, Social media, uninsured
