Four claim types common at Bureau of Workers’ Compensation Fraud

Premium fraud, working without workers’ compensation coverage, fraudulent certification and claimant fraud are common types of fraud encountered by the Bureau of Workers’ Compensation Fraud, Vincent Mazzara, central region commander, said at a series of town hall meetings across Florida.

“We are fully sworn law enforcement officers and work with Tom Gallagher, Florida CFO, because sometimes people do not pay attention,” Mazzara explained. “Despite the fact that thousands of stop-work-orders are issued, employers and employees still attempt to circumvent the system.”

The Division of Insurance Fraud has 130 sworn law enforcement officers that cover all types of insurance fraud. Last year there were 2,200 referrals from employers, employees, ex-spouses and even neighbors.

“One employer would call me on about the third of each month when he would pay a check to cover his employees,” Mazzara said. “At the same time he would see his neighbor collecting his disability check at his mailbox.

“That neighbor was water-skiing, pushing a lawn mower and yet when it was time to go to the doctor, he would put on his leg brace and knee brace and hobble into the doctor just so he could collect that check. That’s the type of person we want to put into jail, because that is costing all the taxpayers in Florida.”

Last year Mazzara’s department arrested 213 people “with braces on their knees who said they were injured and collected checks.

“Some people will try every way that they can to find a way to collect a check from an insurance company by claiming they have an injury,” Mazzara explained. “With 28 detectives and 2,200 referrals, you can imagine how much work goes into investigating an insurance fraud allegation.

“Unfortunately we can not just go out into the field, see someone committing workers’ compensation fraud and pick them up. Before we can present the information to the State Attorney who has jurisdiction to file a warrant so that we can arrest that person we have to go through medical records and examine certificates.”

Last year there were 100 convictions. According to Mazzara, apprehended people are arrested, go through the system and typically plead guilty so they will not have to do jail time if they offer restitution.

Mazzara said that last year the total value of reported fraud jumped from $10 million to $15 million.

When employers are working without coverage, Mazzara said they hope and pray that an investigator won’t show up on the job site, they don’t have coverage and roll the dice hoping that their employees won’t get hurt.

Mazzara said his investigators are trained to recognize fraud indicators, when they take a photo of 20 roofers at a job site and then in checking the records find five roofers and 15 clerical or maintenance employees with a lower modifier they know workers’ comp fraud is taking place.

“We go to the job site and ask the workers on the roof who pays them,” Mazzara explained. “If that person can not provide the proper certification for those roofers, he can be arrested.”

Under-reporting common
Mazzara said under-reporting of payroll is common. As an example he said investigators were at a leasing company that had more than 200 employees, but only highlighted 20 on its payroll.

“Those 20 were named under the certificate of coverage and were covered, while the other 180 did not have coverage,” Mazzara explained. “Many uncovered workers were illegal aliens. If they were hurt they would just walk away, leaving their family without income because they knew if they reported the injury they would be deported.

Mazzara receives hundreds of claimant fraud reports. “Sometimes we just can’t decide if it is a comedy or if people are that smart,” Mazzara said. “If they used their cleverness in business, they would be wealthy.

“We have seen people get hurt and file a claim to force a settlement. They plead to their doctor about how badly they are hurt, that they are traumatized for life and that they will have to change their career.

“We ask for surveillance and find them riding a bicycle and water skiing,” he said. “Yet when it comes time to go to the doctor they are back with the knee brace again and hobbling. We make arrests for those kinds of things all the time.”

Providing an example, Mazzara described a St. Petersburg bus driver who claimed he fell off the steps of his bus and onto the sidewalk striking his head. He claimed he sustained an injury that physically and mentally incapacitated him, after which he reverted back to five-years old and his wife became his care giver.

“From that one intentional fraudulent claim he and his wife collected $1.4 million over 10 years,” Mazzara said. “This cost each and every one of us causing higher rates for employers and by taking money out of every employee’s pockets.

“Our investigators went back after several years to look at him and interview him. On video they have him talking like a five-year-old, talking about pasquetti, and where’s mommy but they noticed this person who was injured and traumatized over a period of 10 years and apparently suffered brain damage, was wearing a gold Rolex watch.

“That $1.4 million went to him and his wife to take care of them and give them the lifestyle that would enable them to afford the watch,” Mazzara said. “The investigators asked for surveillance and watched this man when he didn’t think anyone was watching and saw him driving his truck like a normal adult, carrying his rifle back and forth to his truck, and finally arrested him when they discovered he had signed up in a golf tournament. The detectives followed him onto the golf course and arrested him.”

Mazzara said that the interesting thing was that while the detectives were putting handcuffs on him he reverted back to the five-year-old and asked for his “mommy.”

Topics Florida Fraud Workers' Compensation Talent Numbers