Tag Archives: fraud

Why an Obscure Securities Law Case Could Affect SSDI

Today’s post comes from guest author Jon Rehm, from Rehm, Bennett & Moore.

Social Security Disability Insurance (SSDI) cases are largely decided by administrative law judges (ALJs). A decision questioning the role of ALJs in another area of the law could cause some major complications for SSDI applicants and SSDI beneficiaries.

The 10th U.S. Circuit Court of Appeals recently set aside a conviction for securities fraud by the Securities and Exchange Commission (SEC) because the ALJ who decided the case should have been appointed under the Appointments Clause rather than hired by the SEC. The 10th Circuit’s decision directly conflicts with a recent decision made by the District of Columbia  Circuit Court of Appeals, which means the U.S. Supreme Court could take up the issue.

This matters to SSDI applicants, their attorneys and even present SSDI beneficiaries because the vast majority of administrative law judges, roughly 1,200 of 1,400, have been hired by the Social Security Administration to hear Social Security Disability appeals. Similar to ALJs from the SEC, ALJs who hear SSDI appeals are hired on merit and are federal employees.

If the U.S. Supreme Court followed the recent 10th Circuit decision and applied it to ALJs who heard Social Security Disability appeals, at least 1,200 ALJs would have to be appointed by the president and confirmed by the Senate. This could lead to further delays and uncertainty related to SSDI appeals. If the 10th Circuit decision were applied to SSDI judges, it is uncertain as to whether awards of disability would still be valid if they were made by unconstitutionally chosen ALJs. In 2014, in National Labor Relations Board v. Noel Canning, the Supreme Court held that the NLRB’s decision made by commissioners who were appointed by constitutionally invalid recess appointments was invalid.

The Social Security Administration has recently moved to abolish the treating physician rule in an effort to decrease claim payments. Uncertainty over whether the awards of SSDI benefits are constitutional would add additional hurdles to those needing SSDI benefits. If you are applying for Social Security Disability or thinking about it, contact an experienced attorney. Also, contact your lawmakers to express your concerns about the SSDI system to them.

Workers’ Compensation Fraud – North Carolina Statistics for 2014 – 2015

Several months ago, the North Carolina Industrial Commission published their Annual Report for 2014 – 2015. Based on the Annual Report, employer fraud was by far the overwhelming majority of investigated fraud in the North Carolina workers’ compensation system.

 

The Annual Report tracked investigations of suspected fraud and violations related to workers’ compensation involving employees, employers, insurers, health care providers, attorneys, and rehabilitation providers. The total figure of fraud investigations for 2014 – 2015 was 1,474 cases. Of those 1,474 cases, 1,336 cases related to employer fraud. That means that 90.64% of the investigated workers’ comp fraud was fraud on the part of the employer.  Whereas there were 129 cases of suspected employee fraud (i.e. 8.75% of the total investigated fraud cases).

 

The silver lining? Of the employer fraud that was prosecuted, the State of North Carolina was able to collect nearly $1,000,000 in revenue just in 2014 – 2015 in fraud penalties paid by noncompliant employers. 

Insult to Injury: ProPublica’s Series “Demolition of Workers’ Compensation” Focuses on Ongoing Workers’ Comp Woes Faced by Injured Workers Nationally

Recent years have not been favorable to injured workers. States across the nation have enacted “reform” measures curbing injured workers benefits. Disability caps have been introduced, medical care restricted. In our last blog, we discussed Oklahoma’s Opt Out provisions as an example of the court system declaring that the legislature had legislated away too much of the injured worker’s protections. A couple years ago, Florida workers’ comp laws were declared unconstitutional by a judge. Although the decision was later reversed, the Florida judge (Judge Cueto) expressed concerns regarding the loss of an employee’s right to wage-loss benefits after an accident.  

 

NPR and ProPublica have been authoring an in-depth series on national workers’ compensation issues. ProPublica reviewed “reams of insurance industry data” and their findings confirmed what many workers’ compensation attorneys suspected for years:  insurance companies are increasingly controlling medical decisions, workers are unable to pick their own doctor in many states, and insurers are denying medical care based on internal “guidelines.”

 

As an example, ProPublica’s article talks about a case in California where the insurance company reopened an old case and denied medical care based on the opinion of a doctor who never even saw the patient. “Joel Ramirez, who was paralyzed in a warehouse accident, had his home health aide taken away, leaving him to sit in his own feces for up to eight hours.”

 

The article also brings up a good point about workers’ comp fraud. Repeatedly studies show “most of the money lost to fraud results not from workers making false claims but from employers misclassifying workers and underreporting payroll to get cheaper insurance rates.”

 

N.C. Workplace Deaths Being Under-Reported

The News & Observer recently published an article exposing the under-reporting of workplace deaths by the North Carolina State Department of Labor. The Department reported only 23 deaths for 2013 and for 2014, the Department reported 44 deaths. However, even 44 deaths is significantly less than the 243 workplace deaths reported by the Department in 2001. In a 2009 press release by the Department of Labor, NC was “one of the safest states to work.” However, according to the N&O, this reduction in reported fatalities is due to a change in methodology, not safety.

In 2006 the N.C. Department of Labor began reporting only the deaths that the Department had authority to investigate. That policy change excluded independent contractors (self-employed workers) as well as any death that falls under federal jurisdiction. Federal jurisdiction includes the death of a federal employee, any worker who dies while working on a military base or at a federal facility, any death in the mining industry, and any death that occurs around open waters including firefighters and divers. The State’s total also excludes laborers at small farms, owners of unincorporated companies, most workers who die on roads, and many workers who died months or years after the injury that eventually killed them.

Misclassification of workers as independent contractors (the topic of another investigation by the N&O) not only results in employers cheating the workers’ compensation system by failing to obtain insurance, but it also results in inaccurate data reported by the Department of Labor. This under-reporting is not due to increased safety and enforcement by our State, it is due, in part, to employer fraud of misclassifying workers.

Read more here.

McCrory’s Fraud Statistics Questioned by Experts

Governor Pat McCrory

According to N.C. Governor Pat McCrory, workers’ compensation claims cause the state to spend about $150 million per year. He claims that research by CorVel, the state’s administrator for state employee claims, shows that roughly 40% of the workers’ compensation claims are related to abuse or fraud.

When attorneys, professors, and state employee representatives questioned this number, State Personnel Director Neal Alexander and McCrory spokesman Josh Ellis were unable to provide any statistical support for this claim.

It is uncertain why the Governor would make a serious allegation of this nature without the numbers to back it up, but if the goal is to cut fraud and abuse in the system he may want to start with evaluating why so many employers are “gaming” the system by misclassifying their employees as independent contractors, and not providing any workers’ compensation coverage at all. Taxpayers often end up footing the medical bills for disabled employees because the state has no uninsured fund.

An investigation by The News & Observer newspaper revealed last year that N.C. was losing approximately $467 million a year in lost tax revenue because of employer misclassification. That is real and tangible fraud, and legislation is needed to give state agencies the tools to go after these cheaters. 

For more information please read this article on WRAL by Mark Binker and Cullen Browder.

Are You Misclassifying Your Workers and Committing A Fraud?

To avoid misclassifying your workers follow these tips:

  • Don’t make assumptions. If you are a business owner you should consult a tax professional and an attorney to ensure you are complying with IRS and labor laws when hiring staff or contractors.
  • If contracting with staffing companies or labor brokers, make sure those agencies are properly classifying its workers as employees. Companies can be held responsible for labor violations of their contractors.
  • Consider filing a SS-8 Form (Determination of Worker Status) with the IRS and ask that agency to determine whether the worker is an employee or independent contractor.
  • Be aware that contractors set their own schedules and pricing, and perform the work as they see fit. If you want control over these areas, make sure you hire an employee.
  • Check the workers’ compensation policies of any subcontractor you hire. (Look out for “ghost policies,” which aren’t designed to cover known employees.)
  • Don’t rely on excuses such as “He only works a few days a week.” “She agreed to be an independent contractor.” “They use their own tools.” “He’s done this for so long he doesn’t need my supervision.”

Thanks to McClatchy DC!

 

Injured Worker Stakeouts: Do Private Investigators Commit Fraud?

Have you noticed a suspicious vehicle lurking in your neighborhood lately, or is there a stranger that seems to be everywhere you go? If you have an active workers’ compensation claim, then you may not be imaging things. More and more, we are seeing insurance companies willing to spend thousands of dollars to hire private investigators to conduct clandestine surveillance of an injured worker’s daily activities and documenting these activities with video cameras. This type of surveillance often comes as a shock to our clients.

When these situations arise, the question we hear most often is, “Can they do that? Is this legal?” The answer is yes. Private investigators may photograph or video people in their private residences so long as they are clearly visible to the general public and there is no expectation of privacy. They can also conduct a full background investigation and obtain information about any other claims you made for personal injuries or if you have ever been charged with a crime.

While there are honest private investigators in the field, there are also those who will cheat. One investigator deflated an injured worker’s tire and then videotaped the person “working” to fix the flat tire. Another investigator reported talking on the phone to someone who told him that an injured worker was working while also receiving workers’ compensation benefits. A follow up done by our firm proved that the person with whom the investigator claimed to have talked has a serious hearing impairment and could not use the telephone.  

Injured workers need to be aware that surveillance can happen in any case. It has become part of the workers’ compensation system. By the way, if you do notice a suspicious car parked near your home, call the police.

Whistleblower Protection for Reporting Fraud? Must File OSHA Complaint within 30 Days

AARP reports that Dr. Farid Fata in Michigan has been accused of prescribing unnecessary chemotherapy treatments to his patients, including some who didn’t even have cancer. Dr. Fata’s nurse, Angela Swantek, noticed that medications were being administered improperly and patients were in the chair longer than necessary, which created more money for the doctor. Dr. Fata allegedly bilked Medicare for $91 million. Ms. Swantek was afraid of retaliation because Fata “oversees my license.”

The Occupational Safety and Health Act of 1970 (OSHA) has a Whistleblower Protection Program that protects workers from adverse action by employers (such as firing or laying off, blacklisting, demotion, denial of benefits, intimidation, threats, and/or reduction of pay or hours) for exercising their rights under OSHA. An employee has the right to file an OSHA complaint, participate in an inspection, talk to an inspector, seek access to employer exposure and injury records and raise a safety or health complaint with the employer. If your employer does discriminate or retaliate against you, you have the right to file a retaliation complaint with OSHA.

No specific form is required to file a complaint but you can: (1) send a letter to OSHA (to find the contact information for your nearest OSHA office go to www.osha.gov/html/RAmap.html); (2) call the OSHA area office located nearest to you; (3) download and send a completed Notice of Whistleblower Complaint Form to your OSHA area office (www.whistleblowers.gov/whistleblower_complaint.pdf); or (4) file an online complaint (https://www.osha.gov/whistleblower/WBComplaint.html). However, your discrimination complaint must be filed with OSHA within 30 days of the alleged retaliation.