Kansas.gov

Workers Compensation Fraud and Abuse

Following a 1993 mandate from the Kansas legislature, the Fraud and Abuse Section was first staffed in January 1994. Its mission is to combat fraudulent or abusive acts and practices by employers, employees, and healthcare providers. This unit does not investigate misconduct by insurance carriers or agents. Instead, the Kansas Insurance Department (www.ksinsurance.org) addresses these complaints.

The section is responsible for the investigation of alleged violations of the Workers Compensation Act. Most of the fraud and abuse violations are listed under K.S.A. 44-532, K.S.A. 44-5,120, and K.S.A. 44-5,125. If a violation of the Act is discovered, the section is willing to pursue administrative remedies. In certain cases, the section may ask a county or district attorney to file criminal charges.

Identifying and prosecuting workers compensation fraud is a priority for Kansas. Per Kansas Law, an Assistant Attorney General is assigned to direct and assist in the investigation and prosecution of alleged fraudulent or abusive acts or practices.

Areas of Investigation

Fraudulent or Abusive Acts: Administrative and Criminal

Defined in K.S.A. 44-5,120(d) and 44-5,125. Examples of fraudulent or abusive acts include but are not limited to:

  • making false or misleading statements to obtain benefits
  • presenting a false certificate of insurance
  • submitting a charge for health care not furnished

The penalty for committing such acts:

  • $2,000 fine for each act of fraud or abuse
  • misdemeanor or felony criminal charges

Employer Failure to Secure Workers Compensation Insurance

In general, an employer with a payroll exceeding $20,000 must secure workers compensation coverage for its employees. The penalty for violating this provision is twice the annual premium or $25,000, whichever is greater.

Employer Failure to Timely File Accident Report

Every employer has a duty to report employee accidents within 28 days if the injuries wholly or partially incapacitate the person for more than the day, shift or turn. Penalty for repeated violations is a $250 fine for each violation.

Reporting Fraud

Reports of fraud come into the Fraud and Abuse Section from many sources:

  • Anonymous Tips
  • Employers and Employees
  • General Public
  • Insurance Companies
  • Kansas Insurance Department

If you believe or have knowledge that a violation of the Workers Compensation Act has occurred or is occurring, you may notify the Division of Workers Compensation, Fraud and Abuse Investigation section by using the online reporting option, downloading a printable form or using the address or phone number below.

Online Fraud Reporting (this opens an email form)

Fillable Reporting Form

Or contact us at:

Kansas Workers Compensation
Fraud and Abuse Investigation Section
401 SW Topeka Blvd, Suite 2
Topeka, Kansas 66603-3105
(785) 296-4000 (option 4)
Toll free (800) 332-0353 (option 3) wcfraud@dol.ks.gov

What is Immunity?

Any person who refers a possibly fraudulent or abusive practice to any state or governmental investigative agency, shall be immune from civil or criminal liability arising from the supply or release of such referral as long as such referral is made in good faith with the belief that a fraudulent or abusive practice has, is or will occur and said referral is not made by the person or persons who are in violation of the workers compensation act, to avoid criminal prosecution or administrative hearings.

Who's Who in Fraud and Abuse

Assistant Attorney General:
Ezra Ginzburg

Investigators:
Jon Flippin
Sam Grant
George Schureman

Educating the Public

The Kansas Insurance Department's Fraud unit is also available to make presentations to groups about fraud and related issues. Please contact the Department's Government and Public Affairs Division at (785) 296-3918 to schedule a speaker or email antifraud@ksinsurance.org.

If you are an employee or an employer and are not sure if a violation has occurred, please feel free to contact the Workers Compensation Ombudsman Section

Fraud and Abuse Annual Reports

Fraud and Abuse Annual Report 2005
Fraud and Abuse Annual Report 2004
Fraud and Abuse Annual Report 2003
Fraud and Abuse Annual Report 2002
Fraud and Abuse Annual Report 2001
Errata Sheet

These are excerpted from the Kansas Division of Workers Compensation Annual Reports for the same years.

Notice: The 2005 Fraud and Abuse annual report has been revised with a new Table 4-1 as of February 24, 2006. If you downloaded this report prior to that date, please replace your file with the new one.