Showing posts with label Shared Economy. Show all posts
Showing posts with label Shared Economy. Show all posts
2016 Top Ten Workers’ Compensation Fraud Cases

2016 Top Ten Workers’ Compensation Fraud Cases

Today's guest post is authored by Leonard T. Jernigan, Jr., Esq. of the North Carolina Bar. Mr Jernigan's nationally recognized annual employer fraud review highlights "misclassification of employment status" as a major issue. As the "shared economy" continues to expand exponentially the concept of "employment status" becomes increasingly challenged in a workers' compensation system crafted over a century ago.  

Four of the top ten cases in 2016 [valued at $412,000] are from perennial offender California, three from Florida, one each from Massachusetts and Texas, and one involving 20 different states. The misclassification of employees by employers continues to create dramatic financial fraud, with resulting cost shifting, lost tax revenues and hardship to inured employees. As we noted last year, while the “gig economy” pioneered by technology companies has lead to debate about new classifications for workers, these companies remain subject to our laws. We are starting to see widespread litigation and settlements like Uber’s $100 million payment to disgruntled drivers in California and Massachusetts. We’ll keep tracking these new developments in the context of the misclassification and fraud actions that we’ve been tracking for many years.

1. (National) FedEx to Settle Driver Lawsuits in 20 States for $240 Million  (6/16/16) FedEx Ground Systems, Inc. has agreed to pay $240 million to resolve claims by 12,000 FedEx drivers in 20 states. FedEx was labeling the drivers as independent contractors to avoid paying additional taxes, fringe benefits, health care costs, workers’ compensation insurance, and much more. The drivers were also not paid overtime or reimbursed for expenses.
2. (California) Seven People Charged in $98 Million Workers’ Compensation Fraud Case (6/7/16) Seven people have been indicted with 107 felonies in a business scheme designed to commit workers’ compensation fraud. The ringleader, Peyman Heidary, owned or ran numerous businesses, including law firms and health clinics, and used other people to disguise his involvement and create an illegal ownership structure. The clinics were found to have inflated billings to insurance companies by exaggerating patient injuries and treatments. The businesses fraudulently billed more than $98 million to 18 insurance companies, resulting in the businesses receiving over $12.4 million in payments.
3. (Texas) Labor Department “Mole” Helps Business Maintain $30 Million Workers’ Compensation Scam (6/28/16) Lydia Taylor worked at the U.S. Department of Labor in Dallas and used her position to give her family members information about federal workers’ compensation claims and warn them when suspicions arose about their fraudulent billing. Taylor’s uncle, Tshombe Anderson, was the ringleader of the group. Anderson and others formed several businesses that fraudulently billed the federal workers’ compensation program $30 million for unneeded and unrequested medical equipment for rehabilitation patients.
4. (Florida) Fake Construction Company used to Process over $17.4 Million of Fraudulent Payroll (3/28/16) Orquidea Quezada set up Orquicely Construction LLC and used the company to process payroll for subcontractors who employed hundreds of people. In exchange for her services, Quezada kept a five percent fee. The scheme allowed the contractors to avoid paying payroll taxes, workers’ compensation insurance, and to conceal the employment of undocumented workers.
5. (Florida) Fake Construction Company Used to Cash $7.4 Million in Undocumented Worker Payroll (7/7/16) Two men set up a shell company, Sunrise All Contractor Corp., to receive payments and cash checks for a fee on behalf of other companies that would then pay their undocumented workers. The scheme enabled employers to avoid workers’ compensation premiums and payroll taxes. These schemes are popular among employers of undocumented employees because these employees are less likely to blow the whistle on the fraud out of fear of exposing their undocumented status.
6. (California) Insurance Company Agent Misappropriated $7.3 Million and Unable to Pay Workers’ Compensation Claims for California Indian Tribe (8/19/16) The operator of Management Resources Group California LLC, Gregory J. Chmielewski used more than $7.3 million from the company’s reserve accounts for his own personal investments. The company managed another company, Independent Management Resources, which sold workers’ compensation insurance to California Indian tribes. Chmielewski’s actions resulted in the company being unable to cover 117 claims.
7. (California) Contractor Cheated Workers’ Compensation Insurer Out of More Than $5.4 million in Premiums (10/5/16) Michael Harold Kreger, the owner of Michael Kreger Contracting was sentenced to 9 months in jail, 5 years of probation, 1500 hours of community service, and ordered to pay restitution of more than $5.4 million for underreporting his payroll and committing insurance fraud. Mr. Kreger cheated his company’s workers’ compensation insurer out of more than $5.4 million and his employees out of adequate protection for potential workplace injuries.
8. (Massachusetts) Construction Companies Ordered to Pay $2.6 Million for Fraud in Misclassifying Workers (8/2/16) Force Corporation, AB Construction Group, and employers Juliano Fernandes and Anderson Dos Santos were found by the U.S. Department of Labor to have misclassified the bulk of their employees to avoid paying overtime wages, workers compensation insurance, payroll taxes, and more. A consent judgment was entered requiring the companies and employers to pay more than $2.6 million in damages and penalties for their fraud.
9. (California) Company Underreporting Payroll Defrauds Insurer of $2.1 Million (6/7/16) Co-owners Alvin Shih Chen and Fiona Chen of Metro Worldwide, Inc., a trucking company, underreported payroll by $4.7 million. The owners paid their truck drivers in cash to avoid reporting them to the insurer and to reduce their payroll obligation. While the company reported nearly $3 million in payroll to California’s State Compensation Insurance Fund, the actual payroll amount was $7.6 million. An estimated $2.1 million in premiums was lost.
10. (Florida) Construction Company Defrauds Workers’ Compensation Insurer of $1.8 Million by Underreporting Payroll (4/6/16) Maira Chirinos, the owner of construction company Tocoa Builders, Inc. misrepresented information regarding the company’s operations, employees, and payroll when applying for a workers’ compensation policy. The misrepresentations enabled Chirinos to avoid paying at least $1.8 million in workers’ compensation premium payments. An investigation found Chrinos grossly underreported payroll to the insurance company. She reported a payroll of $76,000, but more than $11 million in payroll checks were cashed during the period covered by the policy.




The Difficult Task of the Florida Supreme Court

The Florida Supreme has before it a constitutional challenge once again concerning workers’ compensation. The scope of the controversy remains undefined and the ultimate impact equally uncertain. I have found over the years that one cannot predict the outcome of a case by merely watching an oral argument.

After hearing the argument this week in Stahl v Hialeah Hospital one comes away with ambiguity over the issues before the Court. Complicating the controversy is a shallow record below, which, of itself, maybe not be so important. Landmark cases have been decided on limited trial court records before.

The constitutional challenge to the century old exclusive remedy for the injured worker was bolstered by both objective and philosophical concerns. They involve many present day social/economic issues facing the United States. Over one-hundred years ago, the enactment of the European based compensation system  of workers' compensation, established an administrative system of benefits for occupational accidents. Incidentally, the Europeans have already adopted universal health care. 

On the objective side of the argument the worker presented is concern on how to adapt a changing medical delivery scheme and benefit structure, i.e.. co-pays, scheduled impairment benefits and age payment limitations, to the needs of a changing employment market, ie. the shared economy. In the shared economy employment status has becomes elusive.

The employer argues that the record below lacked the constitutional challenges and supporting evidence. Also, the philosophical challenges are ill placed.  Even so, one cannot turn back the clock to an age when horseless wagons were emerging as a mode of transportation, and anesthesia and antiseptic were just ideas. 

Legislative intent alters to meet changing times.  Legislatures modify laws over time to meet the new demands of society.  Courts universally struggle to interpret laws in the continually changing arena of life. It is an awesome task.

Arguments before a Supreme Court usually seem academic and theoretical. Courts attempt to rationally approach an issue in an effort to resolve a controversy that most likely will have wide application. Justices handle these matters in an organized and structured framework so that an issue can be crystallized, researched and  reviewed. That process is defined by the record below, the briefs presented by the parties and discussion at oral argument.

The Florida Supreme Court will now be reviewing those elements as it weighs the arguments and issues. It is indeed a difficult task. The impact of which may have far reaching implications on a national scale.

Florida Supreme Court DocketCase Number: SC15-725 - Active DANIEL STAHL vs. HIALEAH HOSPITAL, ET AL.Lower Tribunal Case(s): 1D14-3077, 04-022489