Review of Federal Workers’ Compensation Fraud Charges and Defenses

Federal employees who are injured on the job are normally eligible for workers’ compensation benefits, regardless of who was at fault.

Due to the fact that workers’ compensation payments are frequently a significant amount, and have a high potential for fraud, government agencies will normally carefully review these type of claims.Federal Workers’ Compensation Fraud Defense Lawyer - 18 U.S.C. § 1920

Due to some complex language in the law, some people are falsely accused of deliberately committing 18 U.S.C. § 1920 workers’ compensation fraud, when they simply didn’t realize their actions were illegal. Put simply, they made an honest mistake.

When you’ve been accused of federal workers’ compensation fraud, it’s easy to feel overwhelmed. Such accusations are often grounds for employers and insurance companies to deny benefit claims.

Too often, though, false and unsubstantiated allegations of fraud are used to discourage injured employees from seeking the benefits they deserve.

In other cases, well-intentioned employees may make mistakes when pursuing such benefits. When those errors are misconstrued as intentional fraud, legal representation may be necessary.

As noted above, most of the time, workers who are injured on the job are eligible for workers’ compensation benefits.

Regardless of who is at fault for the injuries, the benefits help to provide healthcare and financial compensation to help workers heal. Sometimes, though, innocent claimants are accused of workers’ compensation fraud.

The fallout from such accusations can be significant, so if you or someone you love has been accused of such a crime, it’s important to reach out to an experienced federal criminal attorney for help.

Defining Workers’ Compensation Fraud

Federal workers’ compensation fraud is defined under 18 U.S.C. § 1920 which says:

  • “Anyone who knowingly and willfully falsifies, or conceals material facts, or makes false, fictitious, or fraudulent statements, or uses a false statement or report, knowing they are false, or a fictitious entry related with the application for or receipt of employee compensation or other benefit or payment, is guilty perjury, and if convicted, can be imprisoned and fined. “

The workers’ compensation system serves as a type of insurance that offers medical coverage and payments for income missed out on while recovering.

As noted, federal workers’ compensation fraud statutes are outlined by 18 U.S.C. § 1920. Though this is the only statutory federal law that governs federal workers’ compensation fraud, it can be applied to any number of related violations.

Types of Criminal Conduct Covered under Federal Law

You could face charges of 18 U.S.C. § 1920 workers’ compensation fraud for any of the following situations:

  • Presenting fraudulent statements in order to obtain workers’ compensation benefits;
  • Participating in a conspiracy to commit workers’ compensation fraud with other colleagues;
  • Submitting multiple claims for the same injury;
  • Accepting business from a person who intends to commit workers’ compensation fraud;
  • Submitting a claim for benefits covered by workers’ compensation that was not actually used;
  • Faking or exaggerating the extent of an injury;
  • Double-dipping – or working another job while collecting workers’ compensation benefits;
  • Collecting benefits for the same injury from multiple employers;
  • Claiming a non-work related injury as work-related;
  • Willfully failing to disclose a prior injury.

Ultimately, federal workers’ compensation is a form of perjury, the offense of willfully telling an untruth to a government entity.

Making false statements about injuries or damages stemming from a workplace accident is illegal, and the penalties for such crimes can be stiff.

The crucial factors in prosecuting a workers’ compensation fraud case under federal law are whether the suspect committed the fraud knowingly and willingly.

Thus, federal prosecutors will seek evidence they took some type of action to receive benefits that were not entitled to receive, and that they did so intentionally.

What are the Penalties?

Anyone who works for the federal government and makes false claims about their injuries or damages may be found guilty of perjury and punished by a fine or up to a year in prison under the sentencing guidelines.

As noted above, to convict a person of such a crime, prosecutors look for evidence that the accused took intentional action to receive benefits they weren’t entitled to.

For those who falsify information and receive more than $1,000 in benefits, higher fines and up to five years in prison are possible.

Since many instances of federal workers’ compensation fraud also violate state law, additional penalties may be handed down at the state level.

What are the Related Crimes?

Several additional crimes related to obtaining federal employee compensation through false statements or fraudulent means were encoded in 18 U.S.C. § 1920.

Perjury under 18 U.S.C. § 1621 is closely related to workers’ compensation fraud cases and applies when someone takes an oath, declaration, or written statement to give truthful information, but then breach their promise.

Many of the actions involved in committing this kind of fraud are components of related state law workers’ compensation fraud. Individuals may be charged with both state and federal crimes.

Federal Workers’ Compensation Investigations

The U.S. Department of Labor’s Office of Inspector General investigates fraudulent workers’ compensation claims.

They are responsible for conducting civil, criminal, and administrative investigations for possible violations of federal laws and regulations.

Most of these investigations involve staff interviews, subpoenas, and search warrants. They work in cooperation with other federal law enforcement agencies.

That’s why it’s important to pursue legal representation at the first sign you’re being investigated for workers’ compensation fraud.

Without adequate representation, you could find yourself in over your head when investigators visit you.

Legal Defense Strategies

A federal criminal attorney can use a number of strategies to help you defend against charges of 18 U.S.C. § 1920 workers’ compensation fraud. Common legal defenses include:

No Knowledge or Intent to Defraud 

The key element of the crime that has to be proven, beyond a reasonable doubt, is they you knew your statements were false.  We might be able to make an argument you simply made a careless mistake and there was no specific intent to defraud.Legal Defense Strategies for Federal Workers’ Compensation Fraud

The burden of proof is placed on the prosecutor. If our defense lawyers can cast reasonable doubt, you have a chance at avoiding a conviction.

Put simply, prosecutors must work to demonstrate that the accused knowingly and intentionally made false or fraudulent statements about their injuries or workers’ compensation eligibility.

In many cases, employees make honest mistakes in applying for benefits. As noted, it can’t be overstated that the burden of proof lies with the prosecution.

They must prove that the fraud was committed knowingly. An experienced lawyer can help cast reasonable doubt on their accusations.

Insufficient Evidence 

Many workers’ compensation fraud cases involve complex and detailed reports from healthcare professionals.

An attorney can present a successful argument that there’s not enough evidence to prove fraud beyond a reasonable doubt.

Again, because the burden of proof lies with the prosecution, an experienced federal defense lawyer may be able to show there is simply not enough evidence to convict you under this statute.

It’s crucial to remember that federal law on workers’ compensation fraud involves a “knowingly and willingly” requirement.  We know how to build a defense strategy to challenge this standard in order to obtain the best possible case result.

How Can a Defense Lawyer Help Me?

If you or a loved one have been accused of 18 U.S.C. § 1920 workers’ compensation fraud for any reason, our law firm can help you.Criminal Defense for Workers’ Compensation Fraud

We have an extensive background in federal criminal law and clearly understand the process of defending our clients who are under investigation, or already indicted for federal workers’ compensation fraud.

Early intervention into your case by our law firm is crucial. We might be able to negotiate with the federal prosecutor for a favorable outcome.

Our defense attorneys thoroughly understand how the government will attempt to build a workers’ compensation fraud case against you.

Eisner Gorin LLP has two office locations in Los Angeles County. Call us at (877) 781-1570 for an initial review of your case, or complete our contact form.