By: Matt Ignoffo
Synopsis: The Wisconsin Department of Workforce Development strengthens and streamlines the ability to report WC fraud!!! News and analysis by Matt Ignoffo, J.D., MSCC.
Editor’s Comment: The generally excellent DWD website was made even better recently as it now includes the ability to fill out an email web form when WC fraud is suspected.
The new anti-fraud form can be viewed here. Our research finds the suspects for the reported fraud may be employers, insurers, providers, or workers.
The DWD indicates, generally, it will refer the matter to an insurance carrier for investigation. See Section 102.125 of the Wisconsin statutes.
The carrier will be required to report back to the Department the results of its investigation. However, an insurer is not required to report back until it is satisfied that making the results of investigation known to the Department will not hurt its ability to handle the workers’ compensation claim.
It appears the individual reporting the possible fraud can remain anonymous, but providing contact information may be “very helpful.” If contact information is provided it will not be public, but may be available to the parties involved in the alleged workers’ compensation claim.
Based on the results of the insurer's investigation, the Department will make a decision about whether there is a reasonable basis to believe fraud has occurred. If so, the Department will refer the case to the Wisconsin Department of Justice or local District Attorney for prosecution. An assistant attorney general or the local District Attorney must then decide whether to start criminal proceedings.
It would appear that this updated process is in line with Governor Scott Walker's signing of legislation authorizing a special prosecutor for WC fraud.
Governor Walker signed 2015 Wisconsin Act 180, which includes funds to support a position at the Department of Justice to investigate and prosecute WC fraud.
This article was researched and written by Matthew Ignoffo, J.D., M.S.C.C. (Medicare Set-Aside Consultant Certified) licensed in IL and WI.
The foregoing was originally published on the Keefe, Campbell, Beiry Blog and is reproduced here with permission of the author. No further republication is permitted without the author’s consent.