NYSIF Announces 154 Arrests, $16.6M Anti-Fraud Savings in 2009
March 1, 2010
The New York State Insurance Fund announced that its program targeting workers’ compensation insurance fraud resulted in 154 arrests in 2009 and $16.6 million in recoveries and estimated savings.
NYSIF sells workers’ compensation and disability benefits insurance in the New York market. NYISF is a not-for-profit state agency that competes with private insurance companies for business, employing its own division of Confidential Investigations (DCI) to detect and investigate suspected fraud committed by claimants as well as policyholders.
Since 1995, NYSIF cases have accounted for 1,382 insurance fraud arrests, along with recoveries and estimated savings of $183.1 million.
During that time, NYSIF has established a national reputation for fighting workers’ compensation fraud by working cooperatively with the New York State Insurance Department Frauds Bureau, the Workers’ Compensation Board Inspector General’s Office, local, state and federal law enforcement authorities, and district attorneys in many jurisdictions in and out of state.
“NYSIF has long been a leader in the fight against workers’ compensation fraud and our results this year again show we continue to lead the fight,” NYSIF Chief Deputy Executive Director Francine James said. “That’s a commitment we make as the state’s largest workers’ compensation insurance company to the people and all businesses of the state of New York. Workers’ compensation fraud is not a victimless crime, it is a felony and we vow to pursue it as such.”
Among anti-fraud special investigation units, NYSIF DCI ranks near the top nationally in annual arrests, and in cumulative fraud savings. In addition, NYSIF auditors have established a standard among insurance carriers for conducting premium audits that discourage improper payroll reporting and worker misclassification.
“Our investigators, auditors and claims personnel train continually to recognize potential fraud,” NYSIF Director of Confidential Investigations Laurence LaPointe said. “There are numbers of red flags built into our training to help us detect possible fraudulent activity by claimants, policyholders, or medical providers with whom we work.”
Recent significant cases resulting in millions of dollars in savings to NYISF have included claimants who receive benefits while operating businesses or remain employed in other capacities, the most prevalent type of workers’ comp. fraud.
Other cases involve premium fraud, the most costly type, in construction, asbestos abatement and other contracting, including investigations in conjunction with the U.S. Department of Labor, the U.S. Postal Inspector, and local labor racketeering bureaus. Still other cases involve fraudulent provider billing.
The New York State Insurance Fund is a non-profit agency of the state of New York created as part of Workers’ Compensation Law of 1914. By law, NYSIF is a competitive insurance carrier that sells workers’ compensation and disability benefits insurance to any employer doing business in New York State. Approximately 180,000 employers hold NYSIF workers' compensation insurance policies, while 61,000 have active disability benefits policies.
NYSIF investigates only workers’ compensation and disability benefits fraud involving claimants, policyholders or medical providers who do business with NYSIF.