It has been speculated and rumors have flown about the activities of the Bureau of Workers’ Compensation (BWC) Special Investigations Unit, commonly referred to as the “fraud squad”. For years people have questioned whether there were quotas within the system and performance incentives that drove the investigators to pursue allegations of fraud without foundation. In a recent investigative report the allegations have proven to be true.
Former investigators have now blown the whistle on the BWC SIU practices. They allege that there are performance evaluation quotas for investigators as to the number of surveillances they perform, the number of cases they close, the number of criminal referrals they make and the number of convictions that ensue. The former investigators say this leads to an incentive to find wrong doing where there is no wrong doing and to railroad innocent people in the process. There are concerns that evidence is being withheld that may vindicate the person being investigated simply to make a better case. Additionally, amazing sums of money are being spent to try to recover very small sums that may have been overpaid but were not paid fraudulently.
Certainly, none of us in the profession condone fraud. It hurts the entire system. Yet, if the BWC would spend as much money servicing injured workers and not disputing legitimate treatment request then we would all be better off.