New York State Insurance Fund Anti-Fraud Program Netted 154 Arrests

The New York State Insurance Fund (NYSIF) says its program targeting workers’ compensation insurance fraud resulted in 154 arrests and $16.6 million in recoveries and estimated savings last year.

NYSIF is the Empire State’s largest workers’ compensation insurer and employs its own division of Confidential Investigations 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.

“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 Director Francine James said.

Among anti-fraud special investigation units, the NYSIF anti-fraud unit ranks near the top nationally in annual arrests and cumulative fraud savings, NYSIF said. In addition, NYSIF auditors have established a standard among insurance carriers for conducting premium audits that discourage improper payroll reporting and worker misclassification.

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’ compensation 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.

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Source: New York State Insurance Fund