Workers' Compensation Provider Fraud


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Inconsistent Diagnosis

The diagnosis is inconsistent with treatment. Medical treatment is protracted, even though the accident was minor. Beware if the claim is for an auto accident, and there is very little physical damage to the vehicle.

    Boilerplate Reports

    The doctor's report appears identical to other reports received from the same doctor or clinic.

      Claimant/Doctor Report Inconsistent

      Treatment reported by the claimant is inconsistent with the doctor's report.

        Payment Accepted By Both Parties

        Insurance and health carriers billed simultaneously. Billing claimants for services while receiving benefits.

          Incomplete Bills/Photocopies

          Summary medical bills are submitted without date, descriptions of office visits and treatments, or treatment extends for a lengthy period of time without interim bills. The medical bills submitted are photocopies of originals.

            Extensive Treatment

            Extensive treatment, especially for minor or subjective injuries; extensive x-rays, tests or diagnostic treatments.

              Financial Interest

              Treatment directed to a separate facility in which the referring physician has a financial interest.

                Weekend/Holiday Billings

                Medical services billed on Saturday, Sunday or Holidays.

                  Last reviewed 1/4/2015