OhioBWC - Basics: Fraud, What Employers Need to Know
Fraud - What employers need to know
Workers compensation fraud occurs when:
Fraud is a hidden cost of workers compensation insurance, with an impact on both employers and injured workers.
National industry studies estimate 5 percent to 20 percent of all workers compensation benefits paid are fraudulent.
- Injured workers go back to work, but still collect benefits;
- Doctors bill for services they never provided;
- Employers underreport payroll to reduce their premiums.
If this is true in Ohio, BWC pays out $80 to $320 million in fraudulent medical and compensation payments each year.
What is workers’ compensation fraud?
Under ORC 2913.48 of the Ohio Revised Code,
a person commits workers compensation fraud if the person:
BWC is cracking down on workers compensation fraud
Receives workers compensation benefits to which he or she is not
Makes false or misleading statements with the purpose of securing
goods or services under the Workers Compensation Act;
Alters, falsifies, destroys, conceals or removes records or documents
necessary to establish the validity of a claim, or necessary to establish
the nature of goods and services for which reimbursement is requested
in a claim;
Enters into an agreement for conspiracy to defraud BWC or a
self-insuring employer by making false claims for disability benefits.
BWC is aggressively attacking fraud through its special investigations department. In 1993,
the Ohio House of Representatives passed House Bill (H.B.) 107 which gave BWC the legislative strength
to prosecute persons found to be defrauding the Ohio workers compensation system.
Between July 1993 and May 2002, from completed fraud investigations, BWC identified savings of nearly
$600 million in workers compensation fraud and obtained 570 convictions.
If you suspect workers compensation fraud, submit a
Fraud Allegation Form, or call
1-800-OHIOBWC, and follow the options.
Whether you submit the Fraud Allegation Form or call the fraud hotline, we will ask you to confidentially
provide all of the information you have pertaining to the suspected fraud, including the following:
- Name and address of the person you suspect is committing fraud;
- Details about the improper or fraudulent activity you suspect;
- Other general information pertaining to the suspected fraudulent activity.