A NY Criminal Defense Attorney Explains Workers’ Compensation Fraud Crimes
The workers’ compensation system in New York provides powerful protection to employees injured on-the-job. Injured workers are not required to prove negligence in order to obtain disability benefits or to get medical bills covered for on-the-job injuries. As long as an employee shows an injury or an illness is related to work tasks, the employee should receive benefits. These benefits can be substantial, especially when an employee is considered unable to work due to a disabling illness or injury. The problem, however, is that in some cases employees are accused of the crime of fraud when it comes to claiming or receiving benefits.
Workers’ compensation fraud is taken very seriously by authorities throughout New York State. The New York State Insurance Fund encourages people and organizations to report suspected workers’ compensation fraud and there is an Office of the Inspector General of the Workers’ Compensation Board, which is dedicated to investigating violations and finding fraud. Suspected fraud can lead to serious criminal charges, which may result in jail time, required restitution, fines, and other penalties.
Defendants who are accused of involvement with workers’ compensation fraud need to ensure they understand their legal options and that they fight aggressively and strategically against the serious accusations they are facing. At Bukh Law Firm, PLLC, our legal team understands the complexities associated with the workers’ compensation system and we have the knowledge and skill necessary to help defendants accused of fraud to raise strong arguments to protect their future. When you need a solid defense strategy and a strong legal mind to help you develop an approach to facing charges, give us a call to speak with a New York criminal defense lawyer who can provide the advocacy and representation you need.
What is Workers’ Compensation Fraud?
According to the Fraud Inspector for the Workers’ Compensation Office of the Inspector General: “Workers compensation fraud occurs when someone knowingly and intentionally makes a false, material statement in order to obtain or deny a benefit for themselves or another.”
Workers’ comp fraud may be committed by employees who apply for and receive workers’ compensation benefits. Employers and medical or health care providers may also commit workers’ compensation fraud. Any false or misleading statements that are made in order to save money, obtain money, or otherwise obtain an undeserved benefit can all be considered workers’ comp fraud.
Anyone involved in any aspect of a workers’ comp scam can end up facing charges for the criminal behavior that he or she perpetrates, but also for crimes that are perpetrated by co-conspirators. This means many defendants end up facing multiple charges when accused of being part of fraud rings or organized efforts to mislead insurers.
Examples of Workers’ Comp Fraud
Workers’ comp scams take many different forms, depending upon whether the scam is being carried out by an employee, by an employer, or by a medical or health care provider.
Examples of fraud committed by workers who unjustly claim benefits or who are misleading on an application for benefits include:
- Claiming that a job-related injury has occurred, even when no injury actually happened.
- Claiming that an injury was sustained through work tasks when the injury was caused by other factors.
- Exaggeration of symptoms to make a condition appear worse, with the goal of remaining on disability benefits for longer or qualifying for more benefits.
- Working “under-the-table” and not reporting income while collecting workers’ compensation disability benefits.
- Falsifying reports of mileage for driving to and from medical appointments.
Employers commit workers’ compensation fraud as well, but the fraud they commit is very different. Employers are required to purchase workers’ comp insurance and are forbidden from deducting the premium payments from the wages of covered workers. If an employer misclassifies employees as independent contractors, underreports payroll, or knowingly fails to purchase necessary coverage, these examples of fraud can result in serious penalties.
Finally, health care and medical care providers may commit workers’ compensation fraud as well. Often, these providers work in conjunction with employees who are committing fraud. The medical care providers may help employees to fake or exaggerate injuries so the employee is able to collect disability benefits and not work, and so the medical care provider is able to collect payment for medical services that are not necessary and that may not be performed. In other cases, however, providers defraud patients, insurers, and employers and the patient is unaware of the scam.
Examples of workers’ compensation fraud committed by medical care and health care providers may include:
- Unnecessary testing of injured workers in order to bill insurers.
- Unnecessary treatment of injured workers in order to bill insurers.
- Billing for medical treatment that was not performed.
- Double billing, charging both workers’ compensation insurers and health insurers for the same services.
Any employer, employee, medical care provider, or other individual or business involved in a scam to obtain unlawful benefits can be charged with a criminal fraud offense. All parties accused of fraud should consult with a NY defense attorney as soon as possible for assistance in fighting these serious charges.
Penalties for Workers’ Comp Scams
NY WKC Law Section 114 imposes penalties for workers’ compensation fraud. According to the relevant law, it is a Class E felony to knowingly prepare, submit, or cause to be submitted, a written statement as part of, or in support of, a workers’ compensation claim if the written statement contains false statements or material misrepresentations.
The same Code Section also imposes penalties on employers, insurance carriers, or their agents, who make false statements or misrepresentations when reporting, investigating, or adjusting benefit claims in order to avoid providing benefits or making payments. Employers who make these false misrepresentations may also be charged with a Class E felony.
Repeat offenders convicted of a second or subsequent similar offense within 10 years of a prior conviction, or who violate the laws in relation to two or more claimants, may be charged with a Class D felony.
Felony offenses are extremely serious, and a Class E felony can lead to a term of imprisonment between 1.5 and four years. Defendants can also be charged with other fraud crimes and related offenses, in addition to the crimes set forth under NY WKC Law Section 114.
In addition to jail time and other possible penalties associated with a Class E felony conviction, a defendant may also be required to forfeit all rights to compensation or payment of benefits and may be required to make restitution of any amounts received.
How a NY Criminal Defense Lawyer Can Help
At Bukh Law Firm, PLLC, we know that defendants accused of workers’ compensation fraud crimes deserve the strongest possible defense. There are many situations where determining whether a defendant has been misleading relies on subjective evidence and he said/she said statements. We know how to help defendants to make strong, compelling arguments and raise vigorous defenses to try to fight for their freedom. Let us bring our legal experience to work on your case. Give us a call today to learn more.
