Home > SID Information > Combating workers’ compensation fraud committed by health care providers

Combating workers’ compensation fraud committed by health care providers

Workers’ compensation fraud isn’t limited to injured workers, and the Special Investigations Department’s (SID) Health Care Provider Team (HCPT) exclusively investigates alleged fraud committed by health care providers, durable medical equipment companies, third-party administrators, and managed care organizations (MCOs). Since the expansion of the bureau’s health care provider fraud program, most notably in 2012 and 2013, the HCPT focused on detection and investigation.

According to our investigators, the following are common provider fraud schemes:

  • Pill mills, which provide limited or no medical treatment while heavily furnishing prescriptions for narcotics;
  • Billing for services not rendered;
  • Performing medically unnecessary treatments and diagnostics tests;
  • Upcoding, or billing for a more expensive procedure than was actually provided; and
  • Unbundling, or billing BWC separately for services that must be billed together as a single service.

Our OhioBWCFraud Facebook page, our blog and the media are filled with examples of successfully prosecuted providers who committed workers’ compensation fraud. Recent convictions include:

To learn more and help us in our efforts to combat workers’ comp fraud, check out archived articles in OhioBWCFraud.

SID encourages anyone who suspects a health care provider may be committing fraud to complete an online form or contact our toll-free fraud hotline, 1-800-644-6292.

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Categories: SID Information
  1. December 17, 2013 at 4:34 pm

    I quite like reading a post that can make men and women think.
    Also, thank you for allowing for me to comment!

  1. September 12, 2014 at 1:08 pm

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