As reported in The Age on 28/10, the federal workers’ compensation insurer Comcare has released new fraud detection guidance including the comically titled circular – “Fraud: What Suspicious Behavior Looks Like” (sic).
Perhaps we could issue a circular to Comcare titled – “English language: What the correct spelling of the word “Behaviour” actually Looks Like”!
Comcare issues new fraud detection guidance
Using social media to catch workers’ comp cheats
THE AGE Monday 28 October 2012
Facebook and Google have emerged as potent weapons in the fight against against the public service’s compensation cheats.
The latest fraud guidance from federal workplace insurer Comcare encourages government officials to be on the look-out for “injured” colleagues posting pictures of their sporting triumphs on social networking sites.
Other tell-tale signs that all is not as it seems with an “injured” colleague is spotting them carrying sports equipment on their cars, with surfboards nominated as a particular red flag.
More than 150 allegations of fraud were made against workers or healthcare providers in the Comcare scheme in the past financial year, and federal prosecutors are now pursuing three cases.
The Comcare circular “Fraud: What Suspicious Behavior Looks Like” says clothing choices can be a giveaway for compo fraudsters, with work clothes, sports clothes or overalls tipped to attract the attention of investigators.
Public servants are warned not to directly confront suspected fraudsters but instead to report their suspicions to the insurer’s in-house investigations unit.
Scams against the $500 million insurance scheme are not limited to exaggerated or fabricated injuries but can include dodgy doctors, pharmacists or alternative health gurus claiming money for services they have not provided.
Attempts to bribe Comcare inspectors to turn a blind eye to workplace hazards have also been cited as examples of fraud against the insurer.
Bureaucrats were told to keep their eyes peeled for time-honoured swindles like the dodgy medical certificate, the colleague moonlighting while claiming workers’ compensation or working the system to enjoy an extended break for work.
Other behaviours that might lead to suspicions of fraud are aggression by a claimant when discussing their case or attempts to intimidate their case worker, moving from doctor to doctor during their period of “incapacity”, or long-term mental-health claims after previous rejections.
Manager should stay alert when talking to an injured worker on the telephone, according to Comcare’s advice, for background noise that might indicate home renovations in progress or the claimant looking after children.
Consequences for fraudulent claims can include “administrative action” in the workplace, a civil court process to recover payments or criminal charges in the most serious cases.
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