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workmans comp fraud

Unfortunately, there are some people who cheat Workers Comp programs and get money they don't deserve for injuries that are either nonexistent or exaggerated. How big is this problem? Well, it is almost impossible to say since nobody collects reliable data on Workers Comp fraud. The most frequently cited estimate comes from the National Insurance Crime Bureau, which has said that $7.2 billion is lost annually to Workers Comp fraud.

just for your information, i found this article and figure on the internet. 7.2 billion lost per year due to workmans comp fraud. fyi this figure is an estimate on the figures since there is not really hard research on the topic. but right or wrong, that is a lot of money that is fraud and paid for by the taxpayers. no wonder people who are trying to get workman.s comp have a hard time. for those who really need it and are truly injured on the job it is a shame but i bet there are those who exaggerate or file nonexistent claims are the ones who are hurting those who really deserve it. once again don't blame the government, the doctors, or the pharmacies and hospitals, blame the people who are scamming the system.like i said before it is people who want narcotics that don't need them that are hurting honest people.
jon
I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
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Comments

  • I know there are 'watch dog' type shows in England where you see the 'crippled, can't work' guy spring out of his house & swing the golf bag over his shoulder.. It happens everywhere but shouldn't this be a legal issue? It's like the prescription drug issue. I just don't think it should be a medical concern. I found this NHS doctor guidelines site last night. It says Info & articles "are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use". I found it interesting that abuse & drug dealers, urine tests, how to spot the faker etc wasn't really mentioned & I read a lot of the pain management pages. Even prescription heroin was just discussed as an option for treatment. Maybe because the site was public.. I don't know.

    This seems to be a bigger problem in America. Benefit fraud & drugs are a big issue everywhere. I mean an issue for honest patients & doctors.

    Yes, a doctor should have guidelines for WC, disability, prescribing narcotics etc. but this is clearly affecting genuine patients & good doctors in the USA. I know I'm a bleeding heart but you must believe a good percentage of the people who post here saying they're tied up in red tape for years over WC or they are in agony, doing everything they're told & not getting meds. I don't know why it's so different here. Maybe it's because doctors are so independent & more corruption took place in the past.

    I watched the movie Oxyana about prescription drug abuse. The dealer said he pays $1000 for a doctors appointment & receives prescriptions. 15 Oxycodone 30's a DAY & a similar amount of methadone in the same visit. He had the prescription bottles. Can any big muscle guy who can run & jump be honestly needing that quantity of meds? Why isn't that doctor treated as any other dealer & sent to prison?

    Sorry Jon, I know I'm just asking questions & not really 'discussing' your post but I didn't live here when this all started. I'm trying to educate myself but with social issues like this it's hard. It seems that a lot of responsibility is put on honest doctors & it's having a bad effect on people with genuine pain.
    Osteoarthritis & DDD.
  • When these doctors get busted are they charged as dealers & sent to prison or is it a fine? Do they loose their licenses?

    I read an interview with the Texas DEA a while ago & he made it very clear that it was the trafficking & big dealers they were after, not small doctors using their best judgement. He finished by saying 'God forbid I'm ever a chronic pain sufferer who can't get the medications I need. That's the last thing I want'. Since becoming a member here I can't help but feel that his nightmare is coming true.
    Osteoarthritis & DDD.
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  • terror8396tterror8396 Posts: 1,832
    edited 04/17/2014 - 10:22 AM
    aaron
    you are correct but i believe it is the patients fault 95% of the time for fraud. drs scam to get more money and if they are caught they do lose their liscenses. depending on the judge, they can do prison but some just lose liscense depending on how bad they scamed the system and if they have done it before
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • I know my experience is very limited but when I watched the film I realized these people are injecting OxyContin. How can someone with all of those holes & bruises not raise a huge 'red flag'? They've got the enormous prescription bottles with the doctors name on them. Are there people who legitimately need 15 OxyContin 30mgs a day for breakthrough pain?
    Osteoarthritis & DDD.
  • no way imho
    i take a max of 40 mg 4x a day. 15 a day is ridiculous and if the say my dr prescribes that amount they are either not being truthful or their doctor should lose their liscense. that is 450 mg a day where as i use 160mg a day.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
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  • That's what I thought. When he showed the huge bottle of methadone & then the OxyContin I couldn't believe it. His doctor is a common criminal in my opinion & should be treated as such. He said he paid $1000 for an 'appointment' but I know drug dealers aren't known for their honesty. The bottles were clearly labelled. It was disgusting! If that doctor was investigated would he go to prison?
    Osteoarthritis & DDD.
  • terror8396tterror8396 Posts: 1,832
    edited 04/18/2014 - 3:52 AM
    back pain is easy to fake. one can have all of the tests done but one can say is still have pain. what is the doctor to do? a lot of doctors just to placate the patient will prescribe some narcotics just to cya. this is what a lot of scamers learn. it is your word against the doctors and to be safe doctors will give out meds. the workmans comp program is such a laugh that it needs to be overhauled. back pain is the commonest form of complaint there is. i feel at work and hurt my back. there does not have to be structural damage, just back pain which is a muscle pull which can not be diagnosed at all. so to show he treated the guy, they will give out narcotics. it happens all of the time.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • terror8396tterror8396 Posts: 1,832
    edited 04/18/2014 - 6:18 AM
    it beats nothing and if you are a drug seeker, addict , then you can figure out other ways like going to a doctor who is not with WC at all. some of these guys have numerous doctors who give out meds and with the scrutnity now i don.t know how they do it but they will find a way, like illegal buying of oxy off the street. there was a drug doctor about a mile from my pain guy who sold oxy and other drugs from the parking lot for years until she was found out and busted. she altered her books to make it look like she was dispensing legally. there is all sorts of stuff and ways for drug addicts to get narcotics. everyone knows that. and if they are hard up enough, illegally does not matter.
    jon
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • EnglishGirlEEnglishGirl Posts: 1,825
    edited 04/18/2014 - 7:33 AM
    The quantity of medications I have per day (ER + breakthrough) would not sustain a drug addict & it's my understanding that ER can't be injected..doctors say that's true but I've seen/read dealers saying there are ways around that. So if to be a user you need more meds than me how can you possibly be a dealer without corrupt doctors behind you? I watched 'Addicted' on TV last week. He was burning & in hailing oxy through a straw. He would go through my months supply in days & he was dealing more than he used! How can there still be so many people doing this?
    Is OxyContin coming into America from abroad? I'm new to this subject & you can tell I'm influenced by my recent viewing choices. I had no idea how many pills a drug addict needs. The supply should of been stopped. If 15 30mg pills a day (just for breakthrough pain, methadone was his 'main' prescription) doesn't raise a red flag & get the doctor closed down what does? I know the dealers I've watched had prescriptions but could the 'doctor' be getting his supply from imported meds not in the system?
    Osteoarthritis & DDD.
  • Work comp fraud with the injured worker does happen but I know in my state the injured worker is less then 1% of all fraud, the media makes it sound like the injured worker is the biggest fraudster when in fact they are not.
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