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.
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 3)
Toll free (800) 332-0353 (option 3)
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:
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 email@example.com.
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 Claims Advisors Section