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PRIOR TO REFERRING an alleged fraud case to the Nevada Attorney General for possible criminal prosecution on workers’ compensation fraud, the following items should be considered.
REQUEST FOR BENEFIT FORMS COMPLETED BY THE CLAIMANT
These forms are critical evidence. The more forms in which the claimant has falsely stated that he/she is unable to work and has not worked when, in fact, we can prove that they are or were
working, the more appealing the case is to a jury.
SELFINSURED WITHOUT BENEFIT CLAIM FORMS
If you do not utilize benefit claim forms, consider placing a waiver on the endorsement side of the check, which says in essence, that by cashing the check, the payee is claiming that they are unable to work and have not worked for the time period specified on the check. SIIS uses the following language on the back of its checks:
“If this check is for temporary disability, permanent total disability or rehabilitation maintenance, by signing you are representing to SIIS under penalty of perjury that you have been continuously disabled and unable to work in any occupation for the 14 days prior to the date of this check.”
SURVEILLANCE
For surveillance to be useful to prove criminal charges, videotaping must show that the suspect is working and able to do more than what is being reported to his/her doctor. It should be able to refute the false statements made. In other words, the closer the video is to being before and after a false statement, the better it is for demonstrating fraud. Likewise, the more days of taping around the false statements, the stronger the fraud case.
STATEMENTS MADE DURING A HEARING OR INTERVIEW
If there is a suspicion that the claimant will be making a false statement during a hearing or interview, hire a court reporter or tape record the statements, stating the date, time and name of all individuals who are in attendance. Any record should be transcribed. Note: Do not destroy this tape.
STATUS OF A CASE
Please advise this office of ANY CASE STATUS, especially if a hearing decision is being appealed by the claimant.
INDIVIDUALS WORKING ON A CASE
Provide this office with a list of personnel or persons who have worked on the claim and in what capacity, noting which individuals can identify the claimant. It is very helpful if someone in your office can identify the claimant. If the case goes to a preliminary hearing and for trial, someone will have to testify that the defendant is the person who submitted fraudulent documents. If possible, claimants who are suspected of fraud should be required to come to your offices to fill out forms in front of one of your claims examiners. Also, if possible, the examiner should go over each question with the claimant. After the meeting, the examiner should write some notes documenting what took place and what the claimant said. Perhaps, consider having each claimant submit a photograph or take a Polaroid instant picture in the office.
COSTS and/or FEES INCURRED
Provide this office with any amounts of monies that have been expended on the case, including but not limited to: investigative fees, court reporting or transcription fees. Upon a successful prosecution, the Attorney General will request that the court order that the claimant reimburse these costs.
COMPROMISE OR PROMISES TO CLAIMANTS
Any promise or compromise made to a claimant that the case would not be referred for criminal prosecution on condition of repayment of any overpayment made and when the claimant fails to comply with that agreement, nullifies the ability of the Attorney General to prosecute. THEREFORE, PLEASE NOTIFY THE ATTORNEY GENERAL’S OFFICE OF ALL AGREEMENTS WITH A CLAIMANT.
SUPPORTING DOCUMENTATION
Supply this office with ANY AND ALL supporting documentation (i.e., copies FRONT AND BACK of NEGOTIATED checks, copies of hearing decisions, initial reports of industrial accident, any applicable medical reports, benefit claim requests.)
REFERRALS CONSIDERED CRIMINAL INVESTIGATIONS
Any case reported to this office is a criminal investigation and considered by the court to be confidential. As a result, the Attorney General cannot provide ongoing status to you until the case is closed. The office does attempt to notify the referring official once the determination of the case has been made by the Deputy Attorney General.
EDITOR’S NOTE: THIS LIST WAS SUPPLIED BY THE NEVADA ATTORNEY GENERAL’S OFFICE AND APPLIES TO NEVADA PROSECUTIONS. Attorney General’s Workers’ Compensation FRAUD HOTLINE (800) 266-8688
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