| PURPOSE
Workers' compensation fraud is committed when any
person intentionally makes false statements to obtain
(or assists in obtaining) workers' compensation benefits
to which they are not legally entitled; or when any
person knowingly misrepresents information necessary
to calculate payment or reimbursement relative to
workers' compensation.
The Reporting Suspected Fraudulent Workers' Compensation
Claims policy provides a mechanism for the reporting
of suspected fraudulent workers' compensation claims
against Escambia County. This policy also offers a
reward to pay $1,000.00 for information which
leads to the arrest and conviction of anyone
filing false information to obtain workers' compensation
benefits.
SCOPE
This policy pertains to all employees covered under
the County's Workers' Comp Insurance Program and any
individual having knowledge of a suspected fraudulent
workers' compensation claim.
GUIDELINES
- Information regarding suspected fraudulent workers'
compensation claims by employees, medical providers,
legal providers, etc., must be reported to the Office
of Risk Management.
- Reports will be documented by Risk Management.
To ensure confidentiality, all reports will be assigned
a file number which will be referenced on all future
communications regarding the report.
- Risk Management will initiate an investigation
of reports. Anonymous calls will not be investigated.
If fraud is detected, claims will be forwarded to
the County Attorney's office for review and submission
to the State's Bureau of Insurance Fraud. If fraud
is detected and proven in reports made by County
employees, County employment may be terminated.
- Risk Management will be responsible for the disbursement
of checks(s) once the investigation proves that
fraud has been committed. Only $1,000.00 per case
will be rewarded. If more than one person reports
information regarding the suspected fraudulent claim,
the reward will be divided equally among all callers.
- The Office of Risk Management will be responsible
for ongoing public awareness of the County's fraud
program via flyers, posters, advertisements, etc.
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