When navigating the complex federal and state laws, having a deep understanding of the intricacies involved can be the difference between freedom and incarceration.
Workers' compensation is a crucial safety net for a worker or employee injured on the job. Still, it is also a system that can be exploited through fraudulent claims, leading to severe penalties under federal and Arizona state law.
ⓘ In this article, we'll discuss the following topics:
- 18 U.S.C. § 1920 - Workers' Compensation Fraud
- Types of Behaviors Constituting Workers' Compensation Fraud
- The Intersection of Arizona State Laws and Federal Laws on Workers’ Compensation Fraud
- Legal Ramifications of Committing Workers’ Compensation Fraud in Arizona
- Defending Against Workers’ Compensation Fraud Charges: The Role of an Expert Defense Attorney
❗An interesting statistic: the National Insurance Crime Bureau (NICB) suggests that workers' compensation insurance fraud costs the insurance industry roughly $7.2 billion annually.
Because of this, the US government has put strict laws in place and take these type of fraud charges very seriously.
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18 U.S.C. § 1920 - Workers' Compensation Fraud
Workers' compensation fraud is an act committed by an employee, an employer, or a healthcare provider that defrauds the workers' compensation system for undue gain.
These fraudulent activities can range from exaggerated claims, faked injuries, and unreported income to over billing by healthcare providers.
At the federal level, 18 U.S.C. § 1920 addresses fraud in the context of workers' compensation claims. This law criminalizes knowingly and willfully falsifying, concealing, or covering up material facts or making any materially false, fictitious, or fraudulent statements concerning the application for and receipt of workers' compensation benefits.
Examples of Workers' Compensation Fraud
Under federal law, precisely 18 U.S.C. § 1920, there are several ways that a person could find themselves facing workers' compensation fraud charges. Even if the acts were purely unintentional, a person could still be charged.
These could include the following:
- Making deceptive claims or assertions to secure workers' compensation benefits;
- Engaging in collusion to perpetrate workers' compensation fraud with other associates;
- Filing multiple benefits claims for a single injury;
- Receiving clientele from an individual with a clear intent to defraud the workers' compensation system;
- Claiming for workers' compensation benefits for services not genuinely utilized;
- Feigning or overstating the severity of an injury;
- Engaging in "double-dipping" – maintaining employment elsewhere while receiving workers' compensation benefits;
- Receiving benefits for the same injury from multiple employers;
- Portraying an injury that didn't occur in the workplace as a work-related one;
- Intentionally withholding information about a pre-existing injury.
In essence, committing fraud in the federal workers' compensation system is a type of perjury—deliberately misleading a government agency with false information.
Misrepresenting injuries or damages from a workplace incident is illegal and can lead to severe repercussions if found guilty.
The crucial elements for prosecuting a workers' compensation fraud case under federal law revolve around the defendant's knowledge and intent behind the fraud.
Arizona State Laws and Federal Laws on Workers’ Compensation Fraud
Arizona state law, specifically under Arizona Revised Statutes (ARS) §§ 23-901 to 23-1105, also covers workers' compensation and related fraud.
As per ARS § 23-785, an employee who knowingly makes false or misleading statements intending to secure workers' compensation benefits is guilty of a Class 6 felony. These state laws work with federal laws to ensure comprehensive oversight and enforcement against fraud.
Interestingly, the boundaries between state and federal jurisdiction often intersect, especially when the fraud involves a federal employee or affects interstate commerce. In such scenarios, the charged party could face prosecution under Arizona statutes and federal law, such as 18 U.S.C. § 1920.
Penalties for Committing Workers’ Compensation Fraud in Arizona
The repercussions of committing workers' compensation fraud in Arizona can be substantial. As a Class 6 felony, workers' compensation fraud can lead to severe penalties, including a prison term of up to two years and a potential fine reaching $150,000 for each isolated deceptive claim submitted to the state.
At the federal level, violating 18 U.S.C. § 1920 can result in imprisonment of up to five years and fines.
If the fraudulent claim involves a disaster or emergency benefits, the punishment escalates dramatically, with a potential ten-year prison sentence under 18 U.S.C. § 1031.
Defending Against Workers’ Compensation Fraud Charges: The Role of an Expert Defense Attorney
As serious as workers' compensation fraud charges are, they are not insurmountable with the right legal representation at your side. A federal criminal defense attorney from the Kolsrud Law Office can scrutinize the evidence, construct a compelling defense strategy, and advocate vigorously on your behalf.
One of the crucial elements of workers' compensation fraud is intent. The prosecution must prove beyond a reasonable doubt that you deliberately intended to defraud the system.
An experienced defense attorney can challenge this aspect, exploring and exposing gaps in the prosecution's case. You may have made an honest mistake in the paperwork, or there's a valid medical basis for your claim that wasn't adequately considered.
Further, we can also evaluate the conduct of the investigation itself. If your rights were violated during the process, for instance, through unlawful search and seizure or coercive interrogation practices, we could push for the exclusion of tainted evidence.
Facing a Fraud Charge? We are Here to Help.
Our attorneys at the Kolsrud Law Office are well-versed with the Arizona Revised Statutes and the United States Code, providing a broad and detailed understanding of the legal landscape. This expertise and our commitment to clients' rights ensure we bring an uncompromising defense against workers' compensation fraud charges.
However, a charge is not a conviction. With the representation of a skilled federal criminal defense attorney, you'll have the best chance at building a solid defense. Our primary goal at the Kolsrud Law Offices is to secure the best possible outcome for our clients, regardless of the case's complexity.
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