NEWS RELATED TO THE OWCP, MSPB, EEOC/EEO, and OSC
Protect Yourself Against
Charges of Fraud
Several clients have sought our counsel on charges of
workers’ comp. fraud during the last few years.
Sometimes these charges have arisen in situations where
the clients did not suspect that their activities could
be seen as fraudulent. I represented some of these
clients in administrative hearings, but I did not
represent them in any criminal cases. I was also asked
to advise some on the ramifications of a finding of
fraud for their workers’ comp. claims. I relate these
cases below in an attempt to warn unwary Federal
workers’ comp. recipients.
Many OWCP clients have
reported they were the subjects of surveillance. Some
were receiving wage replacement benefits while others
were on light duty on the job. Sometimes the
surveillance was conducted by agents of the employing
agency, and other times it was conducted by private
investigation firms. Although Federal employers have the
right to investigate suspected fraud, clients often
report behavior of investigators which borders on
harassment.
In one case, the client had a serious
physical injury. The only way to take the edge off of
her significant, constant, pain was to take large doses
of pain medications. The injuries she suffered and
strong pain medications she took, made her unable to
perform useful work. Her husband provided the main
support for the family through his operation of a
business enterprise. Once or twice a month, the
claimant’s husband would ask her to deliver documents to
clients of the business. She was never paid for doing
this and she did not report this activity to OWCP.
Someone reported to OWCP that the client said she was a
part-owner of the business. This prompted an
investigation. The claimant was ultimately prosecuted
criminally and convicted of workers’ comp. fraud because
she helped her husband in his business and failed to
inform OWCP. Her sentence involved time in prison, a
large fine, restitution of money paid for benefits, and
a life-time bar to any future OWCP benefits. The couple
will probably lose their home and end up in bankruptcy,
and the claimant will carry a felony conviction for
life.
We have also represented clients before the
Merit Systems Protection Board in removal cases where
employing agencies attempted to fire employees for
various offenses which amounted to claims of workers’
compensation fraud. These cases were sometimes cast as
failure to promptly report injuries, lying to the
employees' doctors, or knowingly filing false official
government forms. We have had good success in refuting
such charges in most cases.
These cases show that
Federal agencies, including the Postal Service,
aggressively investigate and prosecute workers’
compensation fraud and failure to report work
activities. They are motivated to do so because they
must reimburse OWCP for the workers’ comp. benefits
received by their employees. Recipients of such benefits
should make sure they know the rules governing reporting
of their activities and comply with them. In addition,
they should be careful not to exceed the restrictions
placed on their activities by their physicians.
Otherwise, they may be subject to administrative and
criminal sanctions which can be most severe.
Don't Be the Victim of
Intimidation
In previous cases,
supervisors as well as agency investigators have used
the threat of potential prosecution for fraud as a
deterrent, in an effort to prevent injured workers from
filing a claim or to get them to drop an existing claim
altogether. This type of harassment is illegal, and any
person who coerces an injured employee to forego filing
a legitimate claim is in direct violation of the law,
and could face prosecution with potential imprisonment.
Additionally, it is unlawful for agency representatives
to contact an injured employee's physician, either by
telephone or personal visit.
In spite of these
employee protections, this kind of harassment happens
often. Agency investigators carrying badges and firearms
have marched into doctors' offices making baseless
allegations of employee fraud, dropping hints that the
doctors themselves are being investigated, and that
through their medical care and documentation they are
somehow involved in fraud. Many doctors are unprepared
for these allegations and are not used to interacting
with investigators. If left unchallenged, this sort of
intimidation could undermine the impartiality of the
doctor's medical assessment and ultimately complicate
the injured employee's ability to file a legitimate
claim.
If an injured employee finds themselves to
be the subject of an agency investigation, including
surveillance, interrogation, or threat of prosecution,
it is imperative for them to seek legal advice from a
licensed attorney. Employees should never submit to any
interrogation which pertains to alleged fraud or any
other alleged criminal offense without first consulting
an attorney.