The U.S. Postal Service Office of Inspector General (OIG) investigates two types of cases under the healthcare program: Office of Workers’ Compensation Program (OWCP) claimant fraud and OWCP medical provider fraud.
OWCP Claimant Fraud. A critical cost control area within the Postal Service is the funding of workers’ compensation benefits for employees who sustain job-related injuries.
It is a violation of federal criminal law for a claimant to knowingly make a false representation on an OWCP claim. (A false representation typically involves unreported income or misrepresentation of one’s physical limitation.) The OIG works closely with injury compensation units and postal management to identify instances of suspected workers’ compensation fraud. When the OIG special agents find instances of fraud, they gather facts and report findings to management and prosecutors. Criminal prosecutions of these offenders are an effective deterrent to combating workers’ compensation fraud. A conviction prevents those claimants from obtaining future OWCP benefits.
Based on the OIG’s successful investigative activity, the U.S. Department of Labor (DOL) can remove claimants who fraudulently obtain workers’ compensation benefits from the DOL periodic and daily rolls. As a result, the Postal Service avoids future compensation liability payments to DOL. The savings experienced by the Postal Service is called a cost avoidance. From the April 1, 2011, through September 30, 2011, OIG special agents conducting healthcare investigations realized $65 million in cost savings or avoidances. Additionally, the OIG workers’ compensation fraud investigations resulted in 19 arrests, and 60 administrative personnel actions, including removals and suspensions and termination of benefits.
The OIG investigative goal in this area is to prevent and deter workers’ compensation fraud, not simply detect and investigate it. For example, to examine additional ways to control the escalating workers’ compensation costs, the Postal Service and the OIG, along with officials from DOL, convened in Arlington, Virginia, at the National Injury Compensation Symposium and Training Conference in April 2007. More than 200 attendees shared executive-level knowledge of the workers’ compensation program, discussed the program’s design and intended function, as well as the challenges facing the program, and provided investigative training to OIG special agents.
OWCP Medical Provider Fraud. The OIG also investigates allegations of fraud against medical providers who treat multiple Postal Service OWCP claimants.
The OIG also publicizes criminal workers’ compensation fraud to the Postal Service through an “Injury Compensation Fraud Highlights Newsletter.” The newsletter is designed to raise awareness and deter other attempts to defraud the government.