1 Workers Compensation ProsecutionsAssistant Attorney General Jake Westman

2 Workers Compensation & Unemployment Insurance Fraud UnitAAG Jake Westman- Former Assistant District Attorney 5 years in Juneau County Small office, prosecute everything Department of Workforce Development – Unemployment Insurance 3 years working with adjudication Part time WC Investigator – Vern Vandeburg Former DCI Agent 4 Investigators at UI for their cases

3 What are we looking for? Fraud §943.20(1)(d)[Someone] Obtains title to property of another person by intentionally deceiving the person with a false representation which is known to be false, made with intent to deceive Plain English: Someone lies to get something of value

4 Before we get to Worker’s Compensation FraudUnemployment Insurance Fraud is currently bulk of caseload Right now primarily claimant fraud Claimants getting benefits they aren’t eligible for Typically working when collecting benefits Easy to get paid, hard to get away with it Branching out into Employer Fraud as we go Purposeful Misclassification of workers Dissuading claimants from receiving benefits Typically monetary and criminal penalties Felony or misdemeanors depending on amount taken

5 What type of WC Fraud is out there?CLAIMANT FRAUD Fake Injury Actually injured but not at work Overstatement of Seriousness of injury Malingering Doctors, Attorneys can be in Unnecessary or even not done treatments billed

6 Second Category PREMIUM FRAUDPremium fraud happens when employers try to cheat their insurance carriers by either not paying for workers’ compensation coverage at all or by paying less than they should. Underreporting Payroll Misclassification of workers Not having coverage Uninsured employers fund

7 How much WC Fraud is there?Wide range of estimates 25 percent of insurance fraud or $7.2 billion a year – National Insurance Crime Bureau Lowest Estimates $1 Billion a year 1-2% of claims - University of California - Berkley

8 A few recent headlines “EMT Pleads Guilty to Comp Fraud for coaching Bowling while Collecting Benefits” – Ohio Truck driver Crystal Burrill got caught horsing around in California while she supposedly had spine and neck injuries. A videotape of her taking a spill at a rodeo event forced her to admit she'd committed perjury and lied to get benefits Shoveling Snow

9 Recognizing Fraud – A few red flagsIt's a Monday or Friday Incident There are No Witnesses There's a History There Was a Delay Descriptions Vary Can't Make Contact It's an All-Too Familiar Lawyer or Doctor There's a Different Doctor

10 How has Wisconsin traditionally address WC Fraud?Claimant Fraud In the past, cases could be referred to District Attorneys Insurers cutting off payments Felony Employer Fraud Civil Remedies through DWD Fines Administrative Remedies

11 Changes 2015 Amended and added to the statutes§ Fraud reporting, investigation, and prosecution. Amended to allow Department of Justice to prosecute on behalf of DWD DWD set up a website for tips to come in Set aside funds to hire staff

12 Goals Deterrence Punishment Strengthen Workers Compensation SystemRestitution

13 Why do this? Almost no prosecutions by District AttorneysUnderstaffing –few done Other States have extensive infrastructure for addressing WC Fraud Ohio Illinois Florida California

14 Where are we now? Started in November 1 part time investigatorTips/referrals coming from DWD Primarily through their website Primarily through citizen reporting Some tips/referrals from Government Units Very few right now from Insurers

15 Florida Referrals (tips)

16 Illinois – Tip sources

17 What are they doing differently?Not Apples to Apples comparison – Different WC laws Different behavior criminalized Criminal vs. Civil Penalties Mandatory reporting by Insurers California has mandatory reporting within 60 days Bigger staffs of dedicated investigators Also tackling a bigger variety of insurance fraud with same staff Numbers not directly applicable but give an idea as to what is out there

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19 How can you help us reach our goals?We need you! Referrals & Tips – ¾ from Insurers Quality tips – you have experienced investigators and staff As Volume increases so will the resources Low volume – the opposite Robust policies on what recipients must report to you Earlier in the process the better You and your investigators know the lay of the land Doctors, attorneys, claimants Without Insurers cooperation with investigations and tips, prosecution impossible

20 Where can I go with Referrals?DWD Website – contact info or report online https://dwd.wisconsin.gov/wc/insurance/fraud/ Contact me directly