The Insurance Coverage Law Information Center
|
|
- Brett Melvin Edwards
- 8 years ago
- Views:
Transcription
1 The following article is from National Underwriter s latest online resource, FC&S Legal: The Insurance Coverage Law Information Center. The Insurance Coverage Law Information Center EXPERIENCE, EXPERTISE, AND PREPARATION: KEYS TO A SUCCESSFUL WORKERS COMPENSATION FRAUD INVESTIGATION Stacey Golden October 7, 2014 Unfortunately, workers compensation fraud has been on the rise. The poor state of the U.S. economy is certainly a factor with the associated mortgage meltdown and government cutbacks. Even rising student debt in this environment is placing pressure on young people. Equally unfortunate for those who see fraud as a solution to their challenges, many consider it easy money and are simply clueless to the potential consequences. There are also plenty of examples of sophisticated cases that require careful and persistent digging. Workers Compensation Fraud Statistics Here are some statistics from the National Insurance Crime Bureau: - The cost to the insurance industry is roughly $5 billion annually; - Calls to the fraud hotline doubled from 2008 and to 2009; - Questionable claims are up 16 percent in 2012 over 2011; and - Referrals exceeded 100,000 in 2011 for first time. With cases of workers compensation fraud, there are three primary points of contact the worker, the employer, and the medical provider. And there are many associated reasons why such fraud may be committed, including: Claimants - Financial problems - Lack of medical insurance - Sense of entitlement - Layoffs looming - Adverse employment action Employers - Reduce premiums - Underbid competitors - Reduce costs - Bonus tied to safety programs
2 Providers - Organized crime - Exploitation of loopholes - The competition is doing it - Greed Special Investigations Units In California, insurers are required to maintain a special investigations unit ( SIU ). SIUs can help ensure that all packaged submissions to the Department of Insurance ( DOI ) are in order and considered by the authorities for further investigation, and, if warranted, arrest are made and convictions obtained. Additionally, SIUs can act as the liaison between claims and the DOI and attend hearings as needed on suspected fraudulent claims. SIUs also can ensure compliance standards with the Department of Industrial Relations. Goals of the SIU are to have a positive impact on a successful investigation, the recovery of the injured worker, reducing the risk of litigation, and ensuring the provider s satisfaction. Many compensability issues can be resolved by an informal inquiry by an examiner. In other cases, with high cost potential or complex subrogation issues, a referral to a licensed investigator may be appropriate. What Is Insurance Fraud? At its most basic, workers compensation fraud occurs when an individual purposely lies to obtain some benefit or advantage, or to cause some benefit that is due to be denied. It is a felony and can result in prison time and/or payment of restitution. Employee fraud can involve a claim for an injury that did not occur or did not occur in relation to the job, or receipt of total temporary disability benefits as a result of lying about outside employment, re-employment or ability to work. In billing fraud, a provider submits a bill for services never provided, for a patient who was never examined, or for more services or time than was actually provided. Abuse, as opposed to outright fraud, can include sending claimants to specific attorneys, doctors or facilities; kickbacks for insurance reps of employees; and rewards or gifts for quick or favorable settlement of claims. Here are some specific examples: - Knowingly presenting, or causing to be presented, any false claim for the payment of a loss, including a loss under a contract of insurance; - Knowingly presenting multiple claims for the same incident; - Knowingly causing or participating in a vehicular collision for the purpose of presenting a false or fraudulent claim; and - Knowingly preparing, making or subscribing any writing with the intent to present or use it in support of a false or fraudulent claim. A few caveats are in order here. Each case must be considered on its own merits. Do not designate people for special attention simply based on their origins, ethnicity, profession, area of practice, or because they do a large volume of business. Avoid generalized and accusatory statements. Beware of withholding payments or making accusatory statements based on the serving of search warrants or the filing of criminal charges. Evaluating a Potential Case Although the process of pursuing workers compensation cases is fairly straightforward, attention to detail and the proper resources are essential for success. Solid experience and training on the part of the examiner are essential in identifying
3 things that simply do not feel right in the early stages. The first step is to look for red flags. Here are some possible indicators of fraud: - Claimant is exceedingly eager for a quick or discounted settlement; - Claimant lists P.O. Box or hotel as their residence; - Claimant threatens to see a doctor or attorney if the claim is not settled quickly; - Claimed injuries are disproportionate to the impact of the accident; - Claimant has financial or marital problems; - Claimant wants a relative or friend to pick up settlement check; - Claimant will not provide a sworn statement or documentation to confirm loss or value; - Claimant has multiple prior claims or lawsuits; - Claimant over documents losses; - No independent witnesses or versions differ significantly; - Claimant recently purchased private disability insurance policy(ies); - Accident is not the type in which the claimant should be involved; - First Report of Claim differs significantly from description of accident in medical report(s); - Claimant reports an alleged injury immediately following disciplinary action, notice of probation, demotion or being passed over for a promotion; and/or - Alleged injury relates to a pre-existing injury or health problem. Investigating Suspected Fraud If there appears to be grounds for a case, an investigator is engaged. The first criterion for a special investigator, of course, is a valid and current license. Other criteria include: - Proven expertise in investigation of workers compensation claims; - A track record of well managed, efficient and cost-effective investigations; - Use of state-of-the-art technology for surveillance; - Current knowledge of applicable legislation; - Availability for courtroom testimony; - Online case management system; and - A process of internal audits. The investigator will monitor the individual s activities, talk to neighbors, review medical conflicts, and so forth. Observation, including video surveillance and recorded statements, usually takes place over a period of two to three days to identify consistent behavior patterns. Other resources include medical records, employment records, business/asset records, and the ISO Index of criminal records and previous injuries. Confirm all information with authenticated documentary evidence, which will be admissible
4 in court. And when documenting claim notes, do not use the term fraud, but instead use potential fraud or alleged fraud. Professionals who can assist in this process include defense counsel, regency investigations, accident reconstructionists, source/origin experts, AME/QME, technical experts and laboratories, and independent appraisers and analysts. The following are some guidelines on when to utilize telephone, on-site, and sub-rosa investigation methods: Telephone The least expensive method, telephone investigation should be used in the following situations: On-Site - The employer disputes the injury; - The injury was not reported to employee s supervisor, who can be interviewed by telephone; - There is another witness to the alleged injury; - Circumstances suggest that an on-site inspection is not required; - There is apportionment or preexisting injury; - The claim involves a short-term employee with a Monday morning injury; - The alleged injury was reported after termination; and - For preliminary subrogation investigations. On-site investigations are moderately expensive and should be used in the following situations: - There are multiple witnesses, unable to or uncomfortable with being interviewed by telephone; - The content of investigation is too extensive to be conducted by telephone; - The circumstances of alleged injury suggest the employee was not performing regular job duties at time of injury, was not supposed to be in the area where injury occurred, or was not making full use of available safety equipment; - A review of personnel records is required; - The employee has an extensive history of personal problems, medical problems, and/or drug/alcohol abuse; and - The employer disputes validity of claim. Activity Check/ Sub-Rosa This type of investigation is the most expensive and should be used in the following situations: - Interview of witnesses discloses employee boasted about claiming to be injured in order to collect workers compensation benefits; - Medical reports in the file do not appear to support the severity of alleged injury; - Claimant is never available to take telephone calls at claimant s residence; - No EDD or unemployment or temporary disability is being paid; - Information is received indicating that the employee is working; or
5 - Information is received indicating that the applicant participates in sports or other activities that could have caused the alleged injury. Best Practices Adhering to some overall best practices will significantly improve the validity of a case. Make sure to obtain authorizations for release of medical and employment records, request all records from the medical provider, do not include date of loss in records requested, closely review all documents and obtain records referred to in current records, and obtain complete written statements. If the claimant will not provide or counsel will not allow a written statement, request that the defense attorney perform a deposition if it has not already been done. Once the investigation is complete, the next step is an evaluation, typically by a district attorney and the Department of Insurance to determine the viability of a case and the chances for success. A case may take three to six months to build, part of which is to determine whether the situation involved abuse or fraud. The case is then presented to a judge, and, in California, the Department of Insurance makes the actual arrest. Post-Filing Investigation and Discovery Finally, once the decision is made to proceed, it is advisable to take an aggressive defense posture. If the case appears to be fraudulent, have counsel make clear at the beginning that you will try the case. Insist upon accurate and complete discovery. Closely review all discovery responses, especially verifications. Discuss with defense counsel the strategies for taking the offensive in litigation. Also, keep in mind that regardless of what happens in the criminal prosecution of a fraud case, the underlying workers compensation claim must still be administered. Benefits do not stop just because there is a suspicion of fraud. Administration of the compensation claim must continue according to workers compensation laws. Some claims may appear minor at first and then subsequently escalate, resulting in very costly surgery and indemnity costs, for example. Now more than ever, the role of the special investigations unit is absolutely critical in gathering accurate information quickly and helping to make strategic decisions early on that will impact the overall outcome of a claim. About The Author Stacey Golden is the Director of Claims at Keenan & Associates. Ms. Golden is responsible for leading the firm s SIU/Fraud Unit. She may be contacted at sgolden@keenan.com.
6 For more information, or to begin your free trial: Call: Online: FC&S Legal guarantees you instant access to the most authoritative and comprehensive insurance coverage law information available today. This powerful, up-to-the-minute online resource enables you to stay apprised of the latest developments through your desktop, laptop, tablet, or smart phone whenever and wherever you need it. NOTE: The content posted to this account from FC&S Legal: The Insurance Coverage Law Information Center is current to the date of its initial publication. There may have been further developments of the issues discussed since the original publication. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional service. If legal advice is required, the services of a competent professional person should be sought. Copyright 2014 The National Underwriter Company. All Rights Reserved.
Workers Compensation Claim Fraud
Workers Compensation Claim Fraud Small businesses don t have to be insurance experts to realize the many potential benefits associated with taking a strategic approach to workers compensation and risk
More informationWORKERS COMPENSATION FRAUD
WORKERS COMPENSATION FRAUD September 10, 2015 Dave Senott Special Investigations Unit Zurich Insurance Why Pursue a Fraudulent W/C Claim Financial savings for insurance company Estimated that 20% of W/C
More informationWORKERS COMPENSATION CLAIMS ADMINISTRATION STANDARDS
Proposal No. 961-4891 Page 1 WORKERS COMPENSATION CLAIMS ADMINISTRATION STANDARDS WORKERS' COMPENSATION CLAIMS ADMINISTRATION GUIDELINES The following Guidelines have been adopted by the CSAC Excess Insurance
More informationKansas Division of Workers Compensation Fraud and Abuse Unit Annual Report FY2004 Paula S. Greathouse, Director
Kansas Division of Workers Compensation Fraud and Abuse Unit Annual Report FY2004 Paula S. Greathouse, Director Division of Workers Compensation Kansas Department of Human Resources 800 SW Jackson Topeka,
More informationFraud. Baldomero Gonzalez. Our reputation for excellence is no accident. TM
Fraud Baldomero Gonzalez Workers Compensation Fraud It is estimated that ten percent of all claims, nearly $31 billion dollars, is paid annually in fraudulent workers compensation claims. Workers compensation
More informationWILLIAMSON COUNTY, TENNESSEE WORKERS COMPENSATION ANTI-FRAUD PLAN
WILLIAMSON COUNTY, TENNESSEE WORKERS COMPENSATION ANTI-FRAUD PLAN I. Provisions for the prevention, detection and investigation of workers compensation fraud. Williamson County Government will take all
More informationThe Insurance Coverage Law Information Center
The following article is from National Underwriter s latest online resource, FC&S Legal: The Insurance Coverage Law Information Center. The Insurance Coverage Law Information Center LIABILITY CLAIMS COSTS
More informationAnne M. Noonan, Commissioner, Vermont Department of Labor WORKERS COMPENSATION FRAUD STUDY AND REPORT
Memorandum To: From: House Committee on Commerce and Economic Development; Senate Economic Development, Housing and General Affairs Anne M. Noonan, Commissioner, Vermont Department of Labor Date: 1/15/2015
More informationWorkers Compensation Fraud
Workers Compensation Fraud Martin Gonzalez Chief Investigator CA Department of Insurance Fraud Division 5999 E. Slauson Ave. Commerce, CA 90040 (323) 278-5000 1 State of California Department of Insurance
More informationOklahoma FALSE CLAIMS LAWS
Oklahoma Company-affiliated facilities in Oklahoma must ensure that all employees, including management, and any contractors or agents are educated regarding the federal and state false claims statutes
More informationRULE 4-1.5 FEES AND COSTS FOR LEGAL SERVICES
RULE 4-1.5 FEES AND COSTS FOR LEGAL SERVICES (a) Illegal, Prohibited, or Clearly Excessive Fees and Costs. [no change] (b) Factors to Be Considered in Determining Reasonable Fees and Costs. [no change]
More informationGLOSSARY OF SELECTED LEGAL TERMS
GLOSSARY OF SELECTED LEGAL TERMS Sources: US Courts : http://www.uscourts.gov/library/glossary.html New York State Unified Court System: http://www.nycourts.gov/lawlibraries/glossary.shtml Acquittal A
More informationPolicy-Standard heading. Fraud and Corruption Policy
Policy-Standard heading Fraud and Corruption Policy September 2013 Table of contents Introduction 3 Purpose 3 Scope 3 Related Policies and Processes 3 Definition of Fraud and Corruption 4 Policy 4 Code
More informationCALIFORNIA FALSE CLAIMS ACT GOVERNMENT CODE SECTION 12650-12656
CALIFORNIA FALSE CLAIMS ACT GOVERNMENT CODE SECTION 12650-12656 12650. (a) This article shall be known and may be cited as the False Claims Act. (b) For purposes of this article: (1) "Claim" includes any
More informationMaricopa County Attorney s Office Adult Criminal Case Process
The following is a brief description of the process to prosecute an adult accused of committing a felony offense. Most misdemeanor offenses are handled by municipal prosecutors; cases involving minors
More informationSCAN Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005
Health Plan Policy and Procedure Number: CRP-0067, False Claims Act & Deficit Reduction Act 2005 Approver Approval Stage Date Chris Zorn Approval Event (Authoring) 12/09/2013 Nancy Monk Approval Event
More informationReports of Compliance Concerns and Violations
The University of Chicago Medical Center Compliance Manual (UCHHS;BSD;UCPP) Reports of Compliance Concerns and Violations Issued: November 1, 1999 Reports of Compliance Concerns and Violations Revised:
More informationHP0868, LD 1187, item 1, 123rd Maine State Legislature An Act To Recoup Health Care Funds through the Maine False Claims Act
PLEASE NOTE: Legislative Information cannot perform research, provide legal advice, or interpret Maine law. For legal assistance, please contact a qualified attorney. Be it enacted by the People of the
More informationSECURITIES EXAMINER (ENTRY) 5670
SECURITIES EXAMINER (ENTRY) 5670 GENERAL DESCRIPTION OF CLASS The SECURITIES EXAMINER (ENTRY), under the guidance of a Securities Examiner, analyzes and evaluates the activities of individuals and businesses
More informationWisconsin Operating While Intoxicated Law A Client's Guide to the Language and Procedure
Wisconsin Operating While Intoxicated Law A Client's Guide to the Language and Procedure BAKKE NORMAN L A W O F F I C E S Welcome Thank you for considering Bakke Norman, S.C. to represent your interests.
More informationEMPLOYEES GUIDE TO APPEALING A WORKERS COMPENSATION CLAIM DENIAL
EMPLOYEES GUIDE TO APPEALING A WORKERS COMPENSATION CLAIM DENIAL Appeals of workers compensation claim denials are handled by the Labor Commission s Adjudication Division. If you disagree with the claim
More informationManaging Jones Act Personal Injury Litigation The Vessel Owner s Perspective. Lawrence R. DeMarcay, III
Managing Jones Act Personal Injury Litigation The Vessel Owner s Perspective by Lawrence R. DeMarcay, III Presented to the Offshore Marine Services Association / Loyola College of Law Industry Seminar
More informationADMINISTRATIVE POLICY SECTION: CORPORATE COMPLIANCE Revised Date: 2/26/15 TITLE: FALSE CLAIMS ACT & WHISTLEBLOWER PROVISIONS
Corporate Compliance Plan AD-819-0 Reporting of Compliance Concerns & Non-retaliation AD-807-0 Compliance Training Policy CFC ADMINISTRATIVE POLICY AD-819-1 SECTION: CORPORATE COMPLIANCE Revised Date:
More informationA Bill Regular Session, 2015 SENATE BILL 830
Stricken language would be deleted from and underlined language would be added to present law. State of Arkansas 90th General Assembly A Bill Regular Session, 2015 SENATE BILL 830 By: Senator D. Sanders
More informationKansas Division of Workers Compensation Fraud and Abuse Unit Annual Report FY2003 Paula S. Greathouse, Director
Kansas Division of Workers Compensation Fraud and Abuse Unit Annual Report FY2003 Paula S. Greathouse, Director Division of Workers Compensation Kansas Department of Human Resources 800 SW Jackson Topeka,
More informationCLAIMS AGAINST TELEPHONE ANSWERING SERVICES: THE TRILOGY OF PREVENTION, HANDLING AND RESOLUTION PART TWO: WHAT TO DO WHEN A CLAIM HAPPENS
CLAIMS AGAINST TELEPHONE ANSWERING SERVICES: THE TRILOGY OF PREVENTION, HANDLING AND RESOLUTION PART TWO: WHAT TO DO WHEN A CLAIM HAPPENS Martin M. Ween, Esq. Partner Wilson, Elser, Moskowitz, Edelman
More informationCore Competencies. Investigation
Core Competencies Investigation Claim Investigation Verify coverage for claimant / employer Three point contact (employer, claimant and medical provider) Recorded / written statements (claimant, witnesses,
More informationMorgan County Prosecuting Attorney Debra MH McLaughlin
Morgan County Prosecuting Attorney Debra MH McLaughlin Directions: From Fairfax Street Entrance, Enter Main Door, turn Right through door, up the narrow staircase. Office is at top of steps. (Old Circuit
More informationCompliance Plan False Claims Act & Whistleblower Provisions Purpose/Policy/Procedures
CATHOLIC CHARITIES OF THE ROMAN CATHOLIC DIOCESE OF SYRACUSE, NY and TOOMEY RESIDENTIAL AND COMMUNITY SERVICES Compliance Plan False Claims Act & Whistleblower Provisions Purpose/Policy/Procedures Purpose:
More informationGlossary of Terms Acquittal Affidavit Allegation Appeal Arraignment Arrest Warrant Assistant District Attorney General Attachment Bail Bailiff Bench
Glossary of Terms The Glossary of Terms defines some of the most common legal terms in easy-tounderstand language. Terms are listed in alphabetical order. A B C D E F G H I J K L M N O P Q R S T U V W
More informationwww.shawnsteel.com Shawn Steel ServicesI 10/28/2013 The first thing we do is kill all the lawyers (Shakespeare s Henry VI)
www.shawnsteel.com 1(800)-626-0003 Palos Verdes Newport Beach Visit our website! Shawn Steel ServicesI www.shawnsteel.com New Personal Injury Cases - We review any serious case in California - We travel
More informationManaging the Care and Return to Work of Injured Workers (and controlling your Workers Compensation Costs)
Managing the Care and Return to Work of Injured Workers (and controlling your Workers Compensation Costs) This Guide was developed to provide you with valuable information regarding our managed care program,
More informationCompulsory Arbitration
Local Rule 1301 Scope. Compulsory Arbitration Local Rule 1301 Scope. (1) The following civil actions shall first be submitted to and heard by a Board of Arbitrators: (a) (b) (c) (d) Civil actions, proceedings
More informationRule 6 Adopted at a joint meeting of the District and County Court at Law Judges of Webb County on December 2, 2009
Rule 6 Adopted at a joint meeting of the District and County Court at Law Judges of Webb County on December 2, 2009 Committee Members Pete Garza Hugo Martinez Richard Gonzalez Fernando Sanchez Eduardo
More informationDEALING WITH POLICE MISCONDUCT OR EXCESSIVE FORCE IN WISCONSIN
DEALING WITH POLICE MISCONDUCT OR EXCESSIVE FORCE IN WISCONSIN Written by: Jonathan S. Safran This guide attempts to answer some of the most common questions and provides a basic understanding of the steps
More informationCHAPTER 26.1-02.1 INSURANCE FRAUD
CHAPTER 26.1-02.1 INSURANCE FRAUD 26.1-02.1-01. Definitions. As used in this chapter: 1. "Business of insurance" means the writing of insurance or the reinsuring of risks by an insurer, including acts
More informationInformation for Crime Victims and Witnesses
Office of the Attorney General Information for Crime Victims and Witnesses MARCH 2009 LAWRENCE WASDEN Attorney General Criminal Law Division Special Prosecutions Unit Telephone: (208) 332-3096 Fax: (208)
More informationINDEPENDENT CITIES RISK MANAGEMENT AUTHORITY WORKERS COMPENSATION LITIGATION MANAGEMENT POLICIES AND PROCEDURES
INDEPENDENT CITIES RISK MANAGEMENT AUTHORITY WORKERS COMPENSATION LITIGATION MANAGEMENT POLICIES AND PROCEDURES In order to strengthen partnerships with claims defense counsel, ICRMA has adopted Workers
More informationJUVENILE JUSTICE SYSTEM
JUVENILE JUSTICE SYSTEM A delinquency petition is a court document alleging that a juvenile, between ages 10-16, has violated a law which would be a criminal offense if committed by an adult. Disposition
More informationCITY OF SALINA MUNICIPAL COURT DIVERSION INFORMATION AND APPLICATION
CITY OF SALINA MUNICIPAL COURT DIVERSION INFORMATION AND APPLICATION A diversion is a written agreement between the City Prosecutor and the defendant. During the diversion period, the prosecutor agrees
More informationGENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2011 SESSION LAW 2011-19 HOUSE BILL 27
GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2011 SESSION LAW 2011-19 HOUSE BILL 27 AN ACT TO (1) CREATE THE NORTH CAROLINA FORENSIC SCIENCE ADVISORY BOARD, (2) ENCOURAGE EFFORTS TO ELIMINATE SOURCES OF
More informationUSC Office of Compliance
PURPOSE This policy complies with requirements under the Deficit Reduction Act of 2005 and other federal and state fraud and abuse laws. It provides guidance on activities that could result in incidents
More informationUAB MY HEALTH REWARDS BIOMETRIC SCREENING PROGRAM NOTICE OF HEALTH INFORMATION PRACTICES
UAB MY HEALTH REWARDS BIOMETRIC SCREENING PROGRAM NOTICE OF HEALTH INFORMATION PRACTICES 1 Effective Date: January 26, 2015 THIS NOTICE APPLIES TO THE UAB MY HEALTH REWARDS BIOMETRIC SCREENING PROGRAM
More informationUNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF TENNESSEE DIVISION. UNITED STATES OF AMERICA ) ) ) v. ) No. ) (Judge ) ) )
UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF TENNESSEE DIVISION UNITED STATES OF AMERICA ) ) ) v. ) No. ) (Judge ) ) ) PETITION TO ENTER A PLEA OF GUILTY (Misdemeanor) I,, respectfully represent
More informationJanuary 11, 2002. Mr. Robert R. Snashall Chairman Workers Compensation Board 20 Park Street Albany, New York 12207. Re: Report 2001-F-34
H. CARL McCALL STATE COMPTROLLER A.E. SMITH STATE OFFICE BUILDING ALBANY, NEW YORK 12236 STATE OF NEW YORK OFFICE OF THE STATE COMPTROLLER January 11, 2002 Mr. Robert R. Snashall Chairman Workers Compensation
More informationMedical Malpractice Litigation. What to Expect as a Defendant
Medical Malpractice Litigation What to Expect as a Defendant Being named as a defendant in a malpractice suit may be your first exposure to civil litigation. You will probably wish it would just go away.
More informationIMPERIAL COUNTY. Review police reports to determine if criminal complaints should be filed.
IMPERIAL COUNTY CLASS TITLE: DEPUTY DISTRICT ATTORNEY I BASIC FUNCTION: Under the direction of the Assistant District Attorney, prosecutes criminal cases in the municipal and superior courts; conducts
More informationRestitution Basics for Victims of Crimes by Adults
Restitution Basics for Victims of Crimes by Adults If you are the victim of a crime, you have a right to be repaid for losses that resulted from the crime. This booklet will help you understand: How to
More informationNYSIF is leading the fight against workers compensation fraud. You can help.
NYSIF is leading the fight against workers compensation fraud. You can help. Red Flags of Claims Fraud Policy and Provider Fraud David A. Paterson Governor Robert H. Hurlbut Chairman Reporting Fraud to
More informationTo: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center
To: All Vendors, Agents and Contractors of Hutchinson Regional Medical Center From: Corporate Compliance Department Re: Deficit Reduction Act of 2005 Dear Vendor/Agent/Contractor: Under the Deficit Reduction
More informationCuellar, Coleman, Maxey, Dukes ORGANIZATION bill analysis 4/30/97 (CSHB 820 by Berlanga) Civil actions to recover fraudulent Medicaid claims
HOUSE HB 820 RESEARCH Cuellar, Coleman, Maxey, Dukes ORGANIZATION bill analysis 4/30/97 (CSHB 820 by Berlanga) SUBJECT: COMMITTEE: VOTE: Civil actions to recover fraudulent Medicaid claims Public Health
More informationAN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
AN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA To amend the District of Columbia Procurement Practices Act of 1985 to make the District s false claims act consistent with federal law and thereby qualify
More informationOASIS GROUP. Workers Compensation Claims Call Center. Workers Compensation Injury Reporting Guide
OASIS GROUP Workers Compensation Claims Call Center Workers Compensation Injury Reporting Guide Workers Compensation Injury Reporting Oasis Risk Department 2601 Cattlemen Road Suite 300 Sarasota, FL 34232
More information(to be shown on policy declarations page) City State Zip
Clubs/Groups & Special Event Insurance Request for Quote Instructions to obtain a Quote: 1. Complete form entirely to receive a quote. If the form is not completed, additional information will have to
More informationAn Introduction to the Federal Public Defender=s Office and the Federal Court System
Some Things You Should Know An Introduction to the Federal Public Defender=s Office and the Federal Court System Office of the Federal Public Defender Southern District of West Virginia 300 Virginia Street
More informationWORKERS COMPENSATION BOARD SPECIAL INVESTIGATIONS
WORKERS COMPENSATION BOARD SPECIAL INVESTIGATIONS Objective To understand the role of the Special Investigations Unit and how to access investigation services. Agenda SIU duties and responsibilities Legislative
More informationLegalFormsForTexas.Com
Information or instructions: acknowledgment Personal injury settlement statement and client 1. The following form may be used as part of a personal injury settlement. 2. The form is a disclosure statement
More informationAPPLICATION TO THE SACRAMENTO COUNTY BAR/ INDIGENT DEFENSE PANEL (IDP)
APPLICATION TO THE SACRAMENTO COUNTY BAR/ INDIGENT DEFENSE PANEL (IDP) 1. Read the enclosed summary of Program Description, Trial Requirements, Rules, Application, Agreement and Authorization and Release
More informationLAWYERS PROFESSIONAL LIABILITY APPLICATION
LAWYERS PROFESSIONAL LIABILITY APPLICATION If the space given is insufficient, please attach a separate sheet referenced to the specific question being answered. 1. A. Name of Applicant Firm: Partnership:
More informationHow to Save Money on Your Divorce
How to Save Money on Your Divorce An overview of the Divorce process in California, and how to choose the right Attorney for your budget. Brought to you by: Legal Action Workshop The Law Firm that offers
More informationNOTICE OF CLASS ACTION SETTLEMENT GRECO V. SELECTION MANAGEMENT SYSTEMS, INC. San Diego Superior Court Case No. 37-2014-00085074-CU-BT-CTL
NOTICE OF CLASS ACTION SETTLEMENT GRECO V. SELECTION MANAGEMENT SYSTEMS, INC. San Diego Superior Court Case No. 37-2014-00085074-CU-BT-CTL The Superior Court has authorized this notice. This is not a solicitation
More informationThe only Workers Compensation Services Provider with a Mission to Protect & Grow Ohio Manufacturing
The only Workers Compensation Services Provider with a Mission to Protect & Grow Ohio Manufacturing Table of Contents: A Comprehensive System for Managing Workers Compensation Claims.... 1 Not All Workers
More informationMETHODIST HEALTH SYSTEM ADMINISTRATIVE TITLE: DETECTING FRAUD AND ABUSE AND AN OVERVIEW OF THE FEDERAL AND STATE FALSE CLAIMS ACTS
METHODIST HEALTH SYSTEM ADMINISTRATIVE Formulated: 6/19/07 Reviewed: Revised: Effective: 10/30/07 TITLE: DETECTING FRAUD AND ABUSE AND AN OVERVIEW OF THE FEDERAL AND STATE FALSE CLAIMS ACTS PURPOSE: Methodist
More informationINDIANA FALSE CLAIMS AND WHISTLEBLOWER PROTECTION ACT. IC 5-11-5.5 Chapter 5.5. False Claims and Whistleblower Protection
As amended by P.L.79-2007. INDIANA FALSE CLAIMS AND WHISTLEBLOWER PROTECTION ACT IC 5-11-5.5 Chapter 5.5. False Claims and Whistleblower Protection IC 5-11-5.5-1 Definitions Sec. 1. The following definitions
More informationGeneral Information on Representing Yourself in a Workers Compensation Case
General Information on Representing Yourself in a Workers Compensation Case Idaho Industrial Commission PO Box 83720 Boise, ID 83720-0041 Telephone: (208) 334-6000 Fax: (208) 332-7558 www.iic.idaho.gov
More informationDecades of Successful Sex Crimes Defense Contact the Innocence Legal Team Now
Criminal Court Felonies The U.S. has the highest rate of felony conviction and imprisonment of any industrialized nation. A felony crime is more serious than a misdemeanor, but the same offense can be
More informationAddressing Abusive Lawyer Conduct in Relation to Litigation Proceedings
Author: Attorney Dan A. Riegleman N63 W23965 Main Street Sussex, Wisconsin 53089 Prepared: 06/01/10 WHITE PAPER: DR2504 Addressing Abusive Lawyer Conduct in Relation to Litigation Proceedings There are
More informationACCIDENT INSURANCE CLAIM
ACCIDENT INSURANCE CLAIM ReliaStar Life Insurance Company A member of the ING family of companies Administered by: Key Benefit Administrators, Inc., P.O. Box 1238 Fort Mill, SC 29716 Phone: 866-225-8704,
More informationNEW YORK CITY FALSE CLAIMS ACT Administrative Code 7-801 through 7-810 *
NEW YORK CITY FALSE CLAIMS ACT Administrative Code 7-801 through 7-810 * 7-801. Short title. This chapter shall be known as the "New York city false claims act." 7-802. Definitions. For purposes of this
More informationNORTHCARE NETWORK. POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy
NORTHCARE NETWORK POLICY TITLE: Deficit Reduction Act (DRA) EFFECTIVE DATE: 1/1/15 REVIEW DATE: New Policy RESPONSIBLE PARTY: Chief Executive Officer/Compliance Officer CATEGORY: Compliance BOARD APPROVAL
More informationQueensland PERSONAL INJURIES PROCEEDINGS ACT 2002
Queensland PERSONAL INJURIES PROCEEDINGS ACT 2002 Act No. 24 of 2002 Queensland PERSONAL INJURIES PROCEEDINGS ACT 2002 TABLE OF PROVISIONS Section Page CHAPTER 1 PRELIMINARY PART 1 INTRODUCTION 1 Short
More informationDepartment of Public Safety and Correctional Services Criminal Injuries Compensation Board
Audit Report Department of Public Safety and Correctional Services Criminal Injuries Compensation Board February 2012 OFFICE OF LEGISLATIVE AUDITS DEPARTMENT OF LEGISLATIVE SERVICES MARYLAND GENERAL ASSEMBLY
More informationBRYCE A. FETTER ORLANDO JUVENILE CHARGES ATTORNEY
BRYCE A. FETTER ORLANDO JUVENILE CHARGES ATTORNEY People make mistakes, especially young people. Juvenile lawyer Bryce Fetter believes children should get a second chance through rehabilitation rather
More informationHERITAGE FARM POLICY AND PROCEDURES. Policy: False Claims Act and Whistleblower Provisions
HERITAGE FARM POLICY AND PROCEDURES Policy: False Claims Act and Whistleblower Provisions Date: October 8, 2013 Rationale: It is Heritage Farm s intent to make sure all claims are submitted in a timely
More informationVICTIM COMPENSATION APPLICATION
OFFICE OF THE ATTORNEY GENERAL Crime Prevention & Victim Services Crime Victim Compensation Division Post Office Box 220 Jackson, Mississippi 39205-0220 1-800-829-6766 or 601-359-6766 601-576-4445 (FAX)
More informationA Victim s Guide to Understanding the Criminal Justice System
A Victim s Guide to Understanding the Criminal Justice System The Bartholomew County Prosecutor s Office Victim Assistance Program Prosecutor: William Nash 234 Washington Street Columbus, IN 47201 Telephone:
More informationWhistleblower Protection Policy
Responsible Officer: SVP - Chief Compliance & Audit Officer Responsible Office: EC - Ethics, Compliance & Audit Services Issuance Date: April 23, 2015 Effective Date: May 1, 2015 Last Review Date: March
More informationIndividual Pharmacist Professional Liability Insurance Policy
THIS IS A LEGAL CONTRACT -- PLEASE READ THIS CAREFULLY -- Individual Pharmacist Professional Liability Insurance Policy Table of Contents Page DEFINITIONS... 1 PROFESSIONAL LIABILITY COVERAGE... 3 SUPPLEMENTAL
More informationAllied Health Professional Liability Insurance Application Form
Allied Health Professional Liability Insurance Application Form With your fully completed, signed and dated application, you must submit the following information: 1. Current insurance policy declarations
More informationRESIDENTIAL LIMITED COVERAGE MORTGAGE MODIFICATION POLICY Issued By WFG NATIONAL TITLE INSURANCE COMPANY
RESIDENTIAL LIMITED COVERAGE MORTGAGE MODIFICATION POLICY Issued By WFG NATIONAL TITLE INSURANCE COMPANY Any notice of claim and any other notice or statement in writing required to be given to the Company
More informationHousing Benefit & Council Tax Benefit. Fraud Prosecution Policy
Housing Benefit & Council Tax Benefit Fraud Prosecution Policy Policy Updated March 2009 Contents Page Introduction... 1 Policy statement... 1 Procedures and Guidelines... 3 1. Introduction... 3 2. Background...
More informationNine Question You Should Always Ask Every Lawyer You Interview in a Personal Injury or Wrongful Death Case
Nine Question You Should Always Ask Every Lawyer You Interview in a Personal Injury or Wrongful Death Case Here are 9 questions you should ask EVERY lawyer you interview to represent you in a personal
More informationLAW FIRMS ERRORS & OMISSIONS APPLICATION
APPLICANT S INFORMATION: LEGAL NAME OF FIRM: BUSINESS ADDRESS: COUNTY: DATE FIRM ESTABLISHED: LAW FIRMS ERRORS & OMISSIONS APPLICATION WEB ADDRESS: DATE PRESENT OWNERSHIP ASSUMED CONTROL: Corporation Individual
More informationINTRODUCTION GENERAL INFORMATION
Workers Compensation Benefits Summary For dates of injury occurring on or after July 1, 2013 through June 30, 2014 Employment Relations Division Department of Labor and Industry PO Box 8011 Helena, MT
More informationWhat to Expect In Your Lawsuit
What to Expect In Your Lawsuit A lawsuit is a marathon not a sprint. Stewart R. Albertson. There is a saying that the wheels of justice move slowly. That is as true today as when it was initially stated.
More informationWORKERS COMPENSATION CLAIM KIT. Workers Compensation That Works...With You and For You.
WORKERS COMPENSATION CLAIM KIT Workers Compensation That Works...With You and For You. CNA ASAP Now, One Phone Call, Fax or E-mail Can Get Results ASAP, 24 Hours a Day, Seven Days a Week Toll Free: 877-CNA-ASAP
More informationJob Description ORM-C600... 4. Claims Adjuster 1-4... 4 INTRODUCTION ORM-C601... 7 SET UP NEW CLAIM FILE ORM-C602... 8
Table of Contents Job Description ORM-C600... 4 Claims Adjuster 1-4... 4 INTRODUCTION ORM-C601... 7 SET UP NEW CLAIM FILE ORM-C602... 8 Litigated Claims... 8 Medical Record Review... 9 Investigation...
More informationPART II - CODE OF ORDINANCES GENERAL ORDINANCES Chapter 2 - ADMINISTRATION ARTICLE XVI. - BOARDS, COUNCILS, COMMISSIONS AND AUTHORITIES
DIVISION 11. CITIZEN REVIEW BOARD Sec. 2-2201. Establishment of the Atlanta Citizen Review Board. Sec. 2-2202. Appointment of members. Sec. 2-2203. Composition of board. Sec. 2-2204. Time limit on appointments.
More informationPolicy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act
Policy and Procedure: Corporate Compliance Topic: False Claims Act and Whistleblower Provisions, Deficit Reduction Act SCOPE OF POLICY This policy applies to all CFS employees, including trainees, volunteers,
More informationMINNESOTA FALSE CLAIMS ACT. Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings given them.
As amended by Chapter 16 of the 2013 Minnesota Session Laws. 15C.01 DEFINITIONS MINNESOTA FALSE CLAIMS ACT Subdivision 1. Scope. --For purposes of this chapter, the terms in this section have the meanings
More informationMANDATORY REPORTING LAWS & RULES
Janet Napolitano Governor Joey Ridenour Executive Director Arizona State Board of Nursing 4747 North 7th Street, Suite 200 Phoenix AZ 85014-3653 Phone (602) 889-5150 Fax (602) 889-5155 E-Mail: arizona@azbn.org
More informationDriving Down Claim Costs With PREDICTIVE MODELING. December 2011. Sponsored by:
Driving Down Claim Costs With PREDICTIVE MODELING December 2011 Sponsored by: Driving Down Claim Costs With PREDICTIVE MODELING Executive Summary Tools based on predictive modeling are transforming claims
More information12 LC 33 4683S. The House Committee on Health and Human Services offers the following substitute to HB 972: A BILL TO BE ENTITLED AN ACT
The House Committee on Health and Human Services offers the following substitute to HB 972: A BILL TO BE ENTITLED AN ACT 1 2 3 4 5 6 7 8 9 10 11 12 13 To amend Chapter 34 of Title 43 of the Official Code
More informationHow To File A Family Law Case In California
DIVISION 7 FAMILY LAW Rule Effective 700. Subject Matter of the Family Law Court 07/01/2011 700.5 Attorneys and Self Represented Parties 07/01/2011 700.6 Family Law Filings 01/01/2012 701. Assignment of
More informationPITTSBURGH CARE PARTNERSHIP, INC. COMMUNITY LIFE PROGRAM POLICY AND PROCEDURE MANUAL. False Claims Act Explanation and Reporting Requirements
SUBJECT: False Claims Act Explanation and Reporting Requirements NUMBER: 1004 CROSS REFERENCE NUMBER: 1823 REG. REF.: 31 U.S.C. 37-29 PURPOSE: POLICY: The purposes of this policy are to describe the Federal
More informationPrevention of Fraud, Waste and Abuse
Procedure 1910 Responsible Office: Yale Medical Group Effective Date: 01/01/2007 Responsible Department: Administration Last Revision Date: 09/20/2013 Prevention of Fraud, Waste and Abuse Policy Statement...
More informationPolicies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005
POLICY/PROCEDURE NO.: B-17 Effective date: Jan. 1, 2007 Date(s) of review/revision: Nov. 1, 2015 Policies and Procedures: WVUPC Policy Pursuant to the Requirements of the Deficit Reduction Act of 2005
More informationCOUNCIL TAX REDUCTION, DISCOUNT & EXEMPTION ANTI- FRAUD POLICY
COUNCIL TAX REDUCTION, DISCOUNT & EXEMPTION ANTI- FRAUD POLICY December 2014 1 Contents Section Page Council Tax Reduction, Discount & Exemption Anti-Fraud Policy 1 Introduction 3 2 Definition of Council
More informationSTATE OF MICHIGAN DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES BUREAU OF HEARINGS
STATE OF MICHIGAN DEPARTMENT OF CONSUMER AND INDUSTRY SERVICES BUREAU OF HEARINGS In the matter of Bureau of Health Services, Petitioner v Marie L. Falquet, Respondent / Docket No. 2000-1297 Agency No.
More information