FECA investigators keep watchful eye for fraudsters

  • Published
  • By Amanda Creel
  • 78th ABW/PA
When it comes to being incognito, three men on base are always working to be beneath the radar in order to complete their mission.

The mission of these men is to build a case on present and former Robins' employees who are collecting Workers' Compensation fraudulently.

"This is a different type of fraud and it is hard to prove. So we have to develop a good case," said Tom, a Federal Employees Compensation Act investigator.

Because of the undercover nature of their job, FECA investigators will only be identified by first names.

The men can be found lurking around grocery stores or gyms hoping to catch a glimpse of someone in the program who is abusing the system even though they are physically able to return to the workplace.

"We want to look like Bubba whether they are fishing or at Wal-Mart we want to blend in," said Tom.

The men said they do whatever is necessary to secure evidence in cases where fraud is taking place and rely on the assistance of others to provide tips if they suspect someone is defrauding the government.

"You don't get a warning. If we catch you roofing a house, the hammer comes down," Tom said.

The investigators have been known to visit claimants' neighbors, do undercover work and do surveillance by documenting activity through videos or photographs.

"We will canvas a neighborhood in a heart beat," Tom said.

Most of the time, the evidence collected is used during court proceedings against an individual for defrauding the government, but sometimes the investigators show the videos or photos to the claimant's physicians as proof the person is capable of returning to work.

Though the men agree the percentage of people who are fraudulently claiming workers' compensation is small, a small group of people fraudulently collecting long-term benefits can be a huge financial loss to the base.

Tom said the program is designed for people who are legitimately hurt on the job and it is unfair for those who recover or aren't hurt to collect payments from the system.

The men said one person can earn more than a $1 million in injury compensation payments when collecting long-term benefits.

All injury compensation payments are taken off the top of the Robins' budget each fiscal year, so ensuring those who are collecting workers' compensation are legitimate is an important task, Tom said.

"That's money that could go to fixing planes or recreation for the troops," he said.

The efforts of the FECA investigators have already aided in the recovery of $350,000 to the base budget and provided cost avoidance of future base budget authorizations for workers' compensation claims of more than $12,000,000, Greg said.

"Cost avoidance is a real savings for the base," he said.

The investigators explained relocating doesn't hinder them from tracking someone who is suspected of Workers' Compensation fraud.

"Even if you are in jail we will come to look at you," Tom said.

Moving to a new state can't guarantee you are free of the FECA investigators watchful eyes either. The team has traveled to several other states, including Alabama, Florida and Texas, to investigate fraud tips, Greg said.

"We can call other FECA investigators at other bases and ask them to look into someone for us," said Bill, a FECA investigator who also works for the claims review office, of the times when the investigators are unable to follow-up on a tip themselves.

The men said those who are guilty of making fraudulent workers' compensation claims are often paranoid.

"I think there are a lot of them sitting on the edge wondering whose watching and when they are going to get caught," Tom said.

Bill added, "They expend more energy trying not to get caught than they would if they just returned to work."

If convicted of fraud you are convicted of a felony, Tom said.

"No voting, no hunting. You'll lose your rights," Bill said.

Other consequences of a felony conviction can include a fine of up to $10,000, incarceration for up to five years for each count and up to three years of probation.

However, felony charges are not the investigators only means of punishing fraudsters.

Alternate means of punishment can be sought through the Magistrate Court, Federal Civil Court and through administrative hearings through the Office of Workers' Compensation Program.

"Fraud is wrong, criminal, expensive, damaging and all too often overlooked," said Debra Foy, Injury Compensation and Retirements section chief. "Everyone can help Robins save thousands if not millions of dollars by reporting suspected workers' compensation fraud. FECA was created to protect employees who suffer work-related injuries, not to create a windfall for the undeserving who bilks the system." 

What to know
If you suspect someone is collecting workers' compensation fraudulently, call 926-3681 or 926-3769 to report your suspicions anonymously.