Worker’s Compensation is a service that provides reimbursement for lost wages to employees who have sustained injuries from work or work-related tasks. It is also one of the services that is most often the victim of fraud. Each of the three types of fraud, claimant, employer, and provider, is defined by the same characteristics, outlined by the Ohio Board of Workers Compensation: Receiving workers’ compensation benefits that are not entitled to the claimant; Making false or misleading statements with the purpose of securing goods or services under the Workers’ Compensation Act; Altering, falsifying, destroying, concealing, or removing records needed to assess claim validity or establish the nature of goods and services for which reimbursement is requested; Entering into an agreement for conspiracy to defraud the BWC or a self-insuring employer by making false claims for disability benefits.The public and many enforcement agencies tend to dwell on claimant fraud, as it is the most widely publicized (Beck). The fixation on claimant fraud has distracted the public and these enforcement agencies and policy-makers from growing evidence of the real problem: millions of dollars in employer and provider fraud.Claimant fraud is very serious, but has more than its share of attention in the media, completely blowing the problem out of proportion. The Press Democrat found that, “While some insurance companies claim one out of three workers lie about their injuries, or 33%, the actual number of fraud cases sent to prosecutors is less than one out of one hundred, or less than 1%.” In New York, for example, over $6 million in insurance fraud was documented, less than 2% of which resulted from claimant fraud cases (Dao par. 2). The state of Kansas, however, reports that the most common form of fraud involves workers being untruthful about the extent of injuries that occur on the job (...
