OhioBWC - Basics:  Fraud, What Employers Need to Know

Fraud - What employers need to know

Workers’ compensation fraud occurs when:
  • Injured workers go back to work, but still collect benefits;
  • Doctors bill for services they never provided;
  • Employers underreport payroll to reduce their premiums.
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.

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:
  • Receives workers’ compensation benefits to which he or she is not entitled;
  • 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 cracking down on workers’ compensation fraud
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.

Reporting fraud
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.