Locate an article about worker’s compensation fraud. Read over the article and: 1. In your first post, answer the following questions: • Post a link to it so your classmates can locate it. Also post a brief summary, including a description of the type of fraud being committed.
• How do you feel about the state compensation fund hiring people to conduct sub rosa investigations?
• From an employee and employer’s perspective, how do you feel about worker’s compensation being a no-fault system?
2. Post responses to at least two classmates, critiquing their responses and commenting on the articles they found.
Student 1:
Hello everyone!
https://www.jernlaw.com/2018-top-ten-workers-compensation-fraud-cases/
The above link actually has 2018’s top ten worker’s compensation fraud cases. To describe 1 of the 10:
(NY) Doctor Suspended for $4.4 Million in False Billing (3/23/18).
Dr. Todd Sloan Koppel was indicted for first-degree conspiracy and money laundering for submitting over $4.4 million in fraudulent bills for service to insurance companies. Koppel’s authorization to treat injured workers was suspended by the New York State Workers’ Compensation Board.
Sub Rosa Investigations are done in secret. The term Sub Rosa comes from the Latin language and means under the rose. More specifically, in the area of private investigative work, it means gathering information on people without them being aware of it. I think that a Sub Rosa Investigation is appropriate using the state compensation. The reason that I think that this is acceptable is because those individuals that are committing fraud need to be caught. The people/companies that are victims of the fraud have the right to these individuals committing the fraud to get caught.
Workers’ compensation is a no-fault system of insurance that protects workers and employers from some of the losses caused by on-the-job accidents and job-related illnesses. The system aims to help workers return to work as quickly as possible. As an employee and an employer I support this system.
Student 2:
Hello Class,
Link: https://www.fbi.gov/news/stories/workers-compensation-fraud-conspirators-sentenced-070219
I selected the FBI News article of July 2, 2019, titled “Workers Compensation Fraud.” The article describes how a syndicate of fraudsters took advantage of injured workers. It reports that members of a California-based workers’ compensation fraud ring which includes doctors, lawyers, and patient brokers fraudulently bilked authorities of hundreds of millions of dollars in the name of workers compensation.
The San Diego-based fraud ring cheated the California workers’ compensation system and private insurance out of more than $200 million. They also subjected patients to unnecessary, and sometimes painful, medical procedures and corrupted the doctor-patient relationship.
The network took advantage of predominantly seasonal, migrant workers who travelled back and forth between California and Mexico. Their work in heavy labor industries, such as agriculture, can sometimes result in injuries.
The web of swindlers set up various patient recruiting and scheduling companies in Central America and Mexico to direct patients to medical service providers including Centro Legal, the main agency in the scheme. They utilized billboards, flyers, advertisements, and business cards, Centro Legal recruited workers to seek workers’ compensation benefits. When an injured worker called the number on the billboard or card, a scheduling company took over to maximize the profits from that individual worker.
The FBI heard of the infiltrated the group. To date, 32 people and companies in the scheme have pleaded guilty and some have been convicted by a jury, receiving prison sentences as high as 10 years.
Sub Rosa collects evidences secretly on employee who made a worker’s compensation claim. I support Sub Rosa because it secretly but legally documents evidences that supports claimant case or disprove the case if it were false.
I do not support workers’ compensation as “no-fault” system. Because no-fault system pays the injured regardless of who is at fault, per my perspective, it encourages false claims because claimants know they would be paid regardless of the nature or how injury occurred.
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