Surveillance Leads to Finding of Workers' Comp Fraud

It may seem obvious to most people, but it is worth noting that when a workers' compensation doctor places someone under physical restrictions these restrictions apply not just when that individual is at work, but also when he or she is away from work. 

It is common for insurance companies to order video surveillance of a person who is under work restrictions. A private investigator may tape that worker while they are entering or exiting their home, while they are shopping, or even while they are exercising. 

If an injured worker is caught doing something beyond their restrictions, their doctor may release them back to full-duty work as a result. If a person is receiving income benefits when they are caught doing something beyond their restrictions, the consequences may be far more serious.

Recently an Ohio man, who had been placed under 10 pound lifting restrictions, and who was receiving income benefits, was caught bench pressing hundreds of pounds in free weights at a local gym. Not only were his workers' compensation benefits stopped, but he was also found guilty of fraud and ordered to repay more than $31,000.00 of benefits that he had already received.

Norcross Chiropractor Sentenced for Fraud

Stephen Catterton, a chiropractor in Norcross, Georgia, was recently sentenced to prison for health-care fraud and possession with intent to distribute testosterone.  According to U.S. Attorney David E. Nahmias, Catterton "lied to insurers about what services he was providing to patients, defrauding the insurers of more than $1.2 million."

Catterton was sentenced to three years and one month in prison, and was ordered to make full restitution to all of his victims.  Of course, Catterton, and others like him, can never really make full restitution because, as Nahmias explained, "False claims like these . . . lead to higher health care costs for everyone."

 

Charlton County Insurance Agent Arrested For Fraud

Employers in and around Charlton County who have purchased workers' compensation insurance through Risi Insurance have been advised to confirm their policy by calling the State Board of Workers' Compensation's Coverage Unit or by going to the State Board's insurance coverage verification database.

Following an investigation by the State Board's Enforcement Division, James "Jim" Risi, owner of Risi Insurance - an insurance agency with offices in Brunswick, Folkston, Jesup, and Nahunta, Georgia - was arrested and charged with four counts of felony insurance fraud.  According to reports, the investigation revealed that on four separate occasions, Risi took money from customers on the pretext of obtaining workers' compensation insurance and then issued bogus Certificates of Insurance as "proof" of coverage.

Concerned that others may have been defrauded by Risi, Stan Bexley, the Enforcement Division's Executive Director, recently put out the following statement:

Anyone in the  Folkston/Charlton County area who has purchased workers' compensation insurance through the Risi Agency should confirm the policy by either going to the workers' compensation board website or calling the board's coverage unit.  If coverage cannot be confirmed, please file a complaint with our agency.

Bexley also stated that the investigation is ongoing and that additional charges are anticipated.

According to its website, the Enforcement Division's primary goal is to "educate[ ] and assist[ ] businesses, medical providers and others who are involved in workers' compensation to achieve a climate which will assure that legitimately injured workers receive benefits allowable under Workers' Compensation Law."

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