Comcare issues new fraud detection guidance

comcare-fraud

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

Madame-Zena-authorPost by co-author Madame Zena

Using social media to catch workers’ comp cheats

THE AGE Monday 28 October 2012
Noel Towell

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.

http://www.canberratimes.com.au/national/public-service/using-social-media-to-catch-workers-comp-cheats-20131028-2wakb.html



This post has been seen 3479 times.

16 Responses to “Comcare issues new fraud detection guidance”

  1. suspicious behaviour mmmm this is what tax payers fork out money for, to pay some retard of a bureaucrat to put a report together about fraud maybe they should spend more time helping the injured yep asking to much fuck off and write another report on why you waste time and resources to say hey look at what ive done well catch more fraudsters this way what about writing about the biggest fraudsters in the biz ALLIANZ

    Thumb up 0 Thumb down 0

  2. I saw a surveillance report on me and they took great interest in a pair of overalls on my washing line once lol So does having a pair of overalls in the washing mean I am working somewhere? or is it possible I might have worn them to keep herbicide spray off my Skin….. Not according to dumb and dumber that wrote the report.

    Its a bit like some of the current affairs shows, they see something and try and think of what would make them look good to report. For example: one of these shows put a grainy clip of an injured person allegedly twirling a Crowbar around his Head; how did they know it was a Crowbar and not a stick? Answer: the Crowbar sounded better so their ratings might go up.

    Thumb up 0 Thumb down 0

  3. Too right Johnny they are the fraudsters with their report writing.

    Thumb up 0 Thumb down 0

  4. Its a sad state when they try to justify what they do for a living = their job and a retard like boof fall for what ever the ICA tells em but the cuts are coming and the buggars at workcover will ask why fuck em

    Thumb up 0 Thumb down 0

    • Fraud detection on injured workers? Allianz are the fucking fraudsters. They love filming a member of my family at the clothes line frequently, describing in detail their every move,only problem is they are not injured on workcover, I AM. Then terminate me using this footage of my 67 year old family member stating hat is me!! Any one on this sit unable to tell he difference between a 65 year old and a 30 year old.? Probe surveillance company can’t .better off employing a chimpanzee, at least they could get the job done ,very intelligent animals!!! Fuck allianz.

      Thumb up 0 Thumb down 0

      • As Allianz is notorious for rotating case managers and aiming for the lowest denominator, it is not surprising that they would employ incompetent people to film injured workers.

        Thumb up 0 Thumb down 0

  5. mmmmm dumb and dumber a crow bar sounds like Allianz to me did you know ive had over 20 case managers and they were all called either dumb and dumber no wonder im confused fuck confussed now the fuckers will tell me im a nutter mmm

    Thumb up 0 Thumb down 0

  6. What about a fraud detector for those assessors who work in the insurance companies or those whose reports are false and misleading?

    I cannot believe how many people are ripping off this system and none of them are injured workers.

    Thumb up 0 Thumb down 0

  7. “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”

    Oh my god, most case managers I’ve come into contact with are masters of intimidation, and are usually the ones that show aggression.
    How dare they, i’m just astounded at the lengths these bastards will go to to get out of paying a claim.

    Thumb up 0 Thumb down 0

  8. Yep, next time you see someone in the street in pajamas it will be me – LOL!

    Make sure you also read our previous article: http://workcovervictimsdiary.com/2013/05/workcover-case-managers-listen-to-background-noise-when-phoning-injured-workers-wtf/

    Thumb up 0 Thumb down 0

  9. bollocks bollocks after months of waiting and waiting my case goes to conciliation and even though the insurers wanted to accept my claim , although only up to today, my darling employer wants it rejected out of hand. Even though the shrink and all the evidence says i have a claim he disputes it and now wants even the bloody cleaner at my place of work interviewed. So now another three months of living on sickness benefit – workcover wont pay out a penny yet – and stress levels going through the roof! What does it take for someone to believe me? Best part is i work in south australia my employer, bless his cotton socks is in qld and visits three or if we are very lucky 4 times a year!

    Thumb up 0 Thumb down 0

  10. I agree with Mandy, but the whole paragraph is a joke!

    “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.”

    Considering the way injured workers are forced to deal with constantly rotating moronic glorified clerks, most of who suffer from delusions of grandeur, because they have “manager” in their job title, it is no wonder that eventually any injured worker will react with “aggression” when “discussing their case”. Do you know any other industry where entry level employees have the word “manager” in their title, who have no management training or in some cases, no work experience in an admin or office environment? All have no medical training and no common sense or the basic oral and written communication skills required. Many also desperately require psych evaluations, and their actions and decisions clearly aggravate existing injuries.

    Most “attempts to intimidate” comes from the case worker and directed towards the injured worker in the form of unjustified threats, and generic letter bombardment.

    Some injured workers are forced to “move from doctor to doctor during their period of “incapacity”” because some doctors get tired of payment delays by the agent and the frustration of dealing with them. Many doctors become do disillusioned by the system they opt out and refuse to take on WorkCover patients. Why is the word incapacity in inverted commas? Even this shows a biased writing style.

    “long term health claims after previous rejections”. This one would fit most cases. Being constantly harassed by the case teams will guarantee long term health claims, where injured workers are not given the opportunity to recover. Physical claims often develop into secondary psychiatric claims as a direct result of surveillance and all the other indignities that injured workers are subjected to. Its a bit like using fire to treat a burn victim! “Previous rejections”, well we all know that standard. They even accept claims to only reject upon receipt of the first dodgy Dr Fraud “show me the money” IME report.

    Thumb up 0 Thumb down 0

    Propaganda Buster November 22, 2013 at 10:33 am
  11. Further on the subject of surveillance. Last week I attended a allianz psyc. Appointment in melbourne. I believe the whole purpose of this was to obtain surveillance of me as in 12 years they have not filmed me as I rarely go out. However they still like filming other family members and call them me in reports! Unbelievably, the clever surveillance man made a few fatal errors. He parked next to ius and filmed me on a recording device hidden behind his paper. Then he followed us to a cafe over the road and continued filming me. Dressed in dark pants and shirt with grey hair he could not have been more obvious in his actions. After tolerating this for over 15 minutes, we openly snapped him using our camera.he didn’t know where to look.we turned the tables on him. Good luck on them using his footage.Are they not to stop filming when they have “Been Made” .

    Thumb up 0 Thumb down 0

    • @ Sarah,

      These “PIs” are unbelievable. Most of the PIs I have followed, photographed or filmed don’t seem to like it either! 🙂

      I pretty sure having an inactive or a poorly functioning brain, must be part of the criterion for candidate selection in this low-life grubby “profession” (I use the term “profession” VERY loosely).

      Maybe we should set up a Facebook page and share our home movies of these low-life PIs doing their “mission impossible” impersonations? Or enter them in funniest home videos? lol

      Thumb up 0 Thumb down 0

  12. Sarah

    You obviously have proof of family members in your surveillance reports. This is contrary to the WorkSafe manual. Firstly, it states that the agent should only undertake surveillance if there is adequate evidence of some fraudulent activity, that is, grounds that the expenditure on the highly intrusive activity is justifiable, yet the insurers continue to surveil as a routine case management tool. With respect to filming others, the WorkSafe Code of Practice for PIs states:

    4.6.6. An Investigator must avoid any actions which may unreasonably impinge on the privacy or other rights of other people (eg, when taking photographs, avoid including, where practicable, other individuals such as relatives and friends, who may be in contact with the surveillance subject during the surveillance period).

    Surveillance is probably the most abused mis-use of tax payer funds and is so counter productive. The number of claims terminated as a result of this abuse , is far, far outweighed by the damage done. The damage extends also to the family members of the injured worker. How many of these agents actually have clear evidence of fraud/misrepresentation/malingering before they approve surveillance? What is the thousands spent on PIs based on? When surveillance is undertaken on psych injuries – how can physical surveillance prove anything? Like the letters they send out, it is just another way to intimidate the innocent injured worker, and also used as a “let’s see if we can use any activity filmed/photographed as a basis to terminate” tool. It comes back to accountability – the insurers don’t have to justify or prove their actions so they will continue this abuse! There is nothing legislated to protect injured workers from “bad faith” insurers when it comes to workers comp insurance.

    And there is NOTHING in the Workers Compensation Act about surveillance! It comes done to a breach of the Privacy Act. A highly intrusive action that cannot be justified to be in the best interests of the public or the Workers Comp scheme – the figures prove that!. It is just an abuse of Human Rights and the privacy of injured workers and their families.

    SARAH and MORE INJURED WORKERS NEED TO URGENTLY LODGE WRITTEN COMPLAINTS WITH THEIR STATE PRIVACY COMMISSIONER. There may be a basis for the Commissioner to investigate breaches of the Privacy Act. You don’t need a lawyer for this. The Vic Ombudsman Report May 2011 investigation into the record keeping failures of WorkSafe agents was only undertaken after they had received numerous complaints. Writing on this blog is good, but this covert activity will continue unless there is a general outcry or public exposure! Write a letter to the Commissioner, because collectively, it is not a waste of time.

    Like FU_CGU states, it’s only when you are in the system that you know what’s really going on. The general public think the system is in place to prevent injury and assist injured workers return to safe, sustainable employment, but if that was the case, they would not have sub-contracted the admin of the system to profit driven private insurance companies. Or at least the legislation would be clear and precise and not open to biased profit-driven and unethical interpretation.

    Thumb up 0 Thumb down 0

    White collar criminals November 25, 2013 at 3:14 pm
  13. Completely agree with White Collar Criminals.
    Attack is the best form of defense!!
    The insurers are meant to be managers of claims in the best interests of someone injured and unwell but it has become a them against us situation where everything is done to make the injured person worse. Make them all accountable.
    Each time they do something go back at them with a complaint to whoever you can.

    They way injured workers are treated as fraudulent criminals makes me sick!!

    Thumb up 0 Thumb down 0