NJ Workers’ Compensation Provider Fraud

Workers’ Compensation Attorney Protects Clients’ Interests If Their Medical Providers Engage In Fraud

When you seek treatment under workers’ compensation benefits for a work injury or occupational illness, you trust that your treating providers have your best interests as their primary duty. Unfortunately, some healthcare providers choose to maximize their profits by defrauding the workers’ compensation system. These providers put the health and recovery of workers at risk by doing so. Let an attorney from Camili & Capo, PA advocate on your behalf if there has been NJ workers’ compensation provider fraud in the course of your case. For years, our trusted firm has helped workers in Passaic County and across New Jersey obtain the benefits they need after serious work injuries and occupational illnesses. We will do everything in our power to ensure that healthcare provider fraud poses no obstacle to your recovery. 

If you believe that your workers’ compensation healthcare provider has engaged in fraud during your treatment, turn to a NJ workers’ compensation attorney for help in protecting your interests and your rights to receive medical treatment and rehabilitation for your work injury or occupational illness. Reach out to Camili & Capo, PA for a free initial consultation to see how our firm can assist you.

Examples Of Provider Fraud In Workers’ Compensation

Some of the ways that healthcare providers may try to defraud the workers’ compensation system include:

• Fraudulent billing, including billing for services that were never provided
• Up-coding, or billing for a more expensive treatment than was actually performed
• Unbundling, which involves billing multiple discrete procedures when only one service was performed
• Product switching, or billing for a more expensive brand name drug or medical device when the patient actually receives a generic or less expensive version
• Self-referral, or referring patients for treatment (especially unnecessary treatment) to another provider in which the referring provider has some interest (including ownership interest or receiving kickbacks

Some workers’ compensation insurers use a managed care arrangement with providers, in which the provider is compensated a certain amount, usually paid in installments, to render care to an injured or ill worker. But these arrangements may also lead to provider fraud, such as:

• Underutilization, or not providing a sufficient amount of care or medical service that would justify the prepaid fee
• Overutilization, or providing unnecessary medical services to justify charging higher prepaid fees in subsequent payment periods
• Paying kickbacks for patient referrals
• Upcoding

Healthcare providers may also conspire with workers’ compensation insurers for the purpose of defrauding employers, including by having providers engage in fraudulent billing, up-coding, unbundling, and overutilization to support the insurer by charging employers higher insurance premiums. Finally, healthcare providers may also conspire with attorneys, who recruit workers to file false workers’ compensation claims so that the provider can charge for treatment that is never rendered.

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How Workers’ Compensation Insurers Detect Fraud

Signs that a healthcare provider may be engaging in workers’ compensation fraud include:

• Invoices and explanations of services from providers seem inconsistent, unnecessary, or suspicious
• Medical reports provide nonspecific descriptions of treatment or the patient’s condition
• New reports appear to simply copy data and information from previously submitted reports
• Providers continue to render treatment to a worker who has no apparent improvement in their condition
• Treatment reportedly occurs on illogical dates, such as weekends or holidays, when non-emergency treatment is typically not scheduled
• Providers bill for more hours than can be reasonably worked in a day, or time stamps of services overlap
• Workers about not being able to see or contact their provider
• Providers have suspiciously close business relationships with insurers or workers’ comp attorneys
• There is a lack of evidence of the worker’s injury or illness

What Will A Workers’ Compensation Attorney From Camili & Capo, PA Do To Help Protect Your Rights To Medical Recovery If Your Providers Engaged In Fraud In Your Care

You should not have your recovery from a work injury or occupational illness derailed by your treating providers engaging in insurance fraud in connection with your care. If you have been the victim of NJ workers’ comp provider fraud, Camil & Capo, PA will fight to protect your rights to medical benefits under the workers’ comp system by:

• Gathering evidence of suspected provider fraud where necessary
• Assisting you with reporting potential fraud by your workers’ comp providers
• Advocating on your behalf if you are accused of participating in any fraudulent schemes
• Working with your employer and its workers’ compensation insurer to ensure that your treatment and benefits are not interrupted if you need to change providers

Contact Us For A Free Case Review To Learn More If Provider Fraud Occurred In Your Case

Do not let healthcare provider fraud jeopardize your recovery from a work-related injury or illness. Contact Camili & Capo, PA today for a free, no-obligation claim evaluation to go over your legal rights and options with a New Jersey workers’ compensation attorney from our firm.