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This fraud case began with the help of an alert CompSource claims adjuster who noticed the claimant was using two different Social Security numbers. Although the use of two Social Security numbers does not constitute workers’ compensation fraud, it can be a red flag requiring further investigation. The claimant’s work history revealed three prior workers’ compensation claims. Each claim involved a different nursing home and a different insurer – another red flag.
The medical authorization allowed the fraud investigator to obtain detailed information about the prior claims, which consisted of sprains and strains to the back and neck. The current claim alleged the same injury, but in the medical reports, the claimant had denied prior injury to the treating doctors. This constituted fraud.
The claimant’s answers to the interrogatories revealed further deception. The claimant acknowledged only one prior workers’ compensation claim and denied a prior back injury. Each denial provided further evidence of fraud against the claimant.
The evidence was referred to the Office of the Attorney General where one charge of fraud was filed for making false statements to a doctor along with one count of perjury. Wrapping the two charges together strengthened the prosecution’s case by showing a clear pattern of fraud to a potential judge and jury.
The claimant pled guilty in exchange for a deferred sentence and agreed to pay restitution in the amount of $28,000.
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