OhioBWC - Basics:  Fraud Red Flags

Fraud red flags

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 assigned to the BWC special investigations department will carefully collect and analyze the facts to determine whether or not fraud was committed.

If you suspect workers’ compensation fraud, submit a Fraud Allegation Form or call 1-800-644-6292, and follow the options.

Spotting claimant fraud
Red flag indicators that may signal claimant fraudulent activity include:

  • Individuals are 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
Red flag indicators that may signal employer fraudulent activity include:

  • Suspect that a competitor can underbid contracts due to not paying for workers' compensation coverage.
  • Certificate of BWC coverage is not visible or contains an outdated coverage period and/or incorrect name of the BWC Administrator.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
Red flag indicators that may signal health-care provider fraudulent activity include:

  • 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 provide limited or no medical treatment while heavily furnishing prescriptions for narcotics.