Fla. Workers’ Compensation Fraud Unit Commander Describes Four Common Claims Infractions

December 19, 2005

Four types of common workers’ compensation schemes encountered regularly by the Florida Bureau of Workers Compensation Fraud are premium fraud, working without workers’ compensation coverage, fraudulent certification and claimant fraud, according to Vincent Mazzara, central region commander.

Mazzara described how he fights fraud at a series of town hall meetings held in Fort Myers, Tampa and Orlando, Fla. Tanner Holloman, director of the Division of Workers’ Compensation Compliance, Sabolic and Jeff Korte, chief of the Division of Workers’ Compensation Fraud also spoke at the meetings.

“We are fully sworn law enforcement officers and work with Tom Gallagher, Florida CFO, because sometimes the people that Holloman and Sabolic deal with do not pay attention,” Mazzara explained. “Despite the fact that thousands of stop-work-orders are issued, employers and employees still attempt to circumvent the system.”

The Division of Insurance Fraud has 130 sworn law enforcement officers that cover all types of insurance fraud. The Workers’ Compensation Bureau, headed by Korte has 28 sworn law enforcement detectives that work strictly on workers’ compensation fraud and fraud allegations. He receives referrals from employers, employees, ex-spouses and even neighbors.

Last year Mazzara’s department arrested 213 people “with braces on their knees who said they were injured and collected checks.”

When referrals come in, investigators do a background check to find out if there are any prior claims.

“Some people try every way that they can to find a way to collect a check from an insurance company by claiming an injury,” Mazzara explained. “With 28 detectives and 2,200 referrals, you can imagine how much work goes into investigating an insurance fraud allegation.

“Unfortunately we can not just go out into the field, see someone committing workers’ compensation fraud and pick them up. Before we can present the information to the State Attorney who has jurisdiction to file a warrant so that we can arrest that person we have to go through medical records and examine certificates.”

Mazzara said that ultimately the division wants to arrest that person and get the restitution back to the state, the insurance company or additionally, obtain the costs of the investigation. Last year there were 100 convictions. Apprehended people are arrested, they go through the system and typically plead guilty so they will not have to do jail time if they offer restitution.

When employers are working without coverage, Mazzara said they hope and pray that an investigator won’t show up on the job site, they don’t have coverage and roll the dice hoping that their employees won’t get hurt.

Mazzara said his investigators are trained to recognize fraud indicators, when they take a photo of 20 roofers at a job site and then in checking the records find five roofers and 15 clerical or maintenance employees with a lower modifier they know workers’ comp fraud is taking place.

“We go to the job site and ask the workers on the roof who pays them,” Mazzara explained. “If that person can not provide the proper certification for those roofers, he can be arrested.”

Mazzara said under-reporting of payroll is common. They cut corners as much as they can.

As an example, Mazzara said his investigators were at a leasing company that had more than 200 employees, but only highlight 20 on its payroll.

“Those 20 were picked up under the certificate of coverage and were covered, while the other 180 did not have coverage,” Mazzara explained. “Many of the uncovered workers were illegal aliens and if they were hurt they would just walk away, leaving their family without income because they knew that they were illegal aliens, and if they reported the injury they would be deported.

“The employer was very conniving and used these employees to circumvent the system, and these employees were all electricians, plumbers and skilled workers who would be saving the company thousands of dollars in premiums.”

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