There is a variety of claim related service providers in the workers compensation system, including accredited rehabilitation providers, allied health professionals, doctors and solicitors.
Health service providers
Health service providers who deliberately over-service an injured worker, or continue treatment when no longer necessary, or claim for non-existent procedures are defrauding the workers compensation system and will be liable to prosecution.
Service providers
Service providers are governed by legislation that sets out the maximum fees payable for services provided as a result of a workers compensation claim, ie section 339(3) of the Workplace Injury Management and Workers Compensation Act 1998 (Act).
Legal professionals
Legal professionals payable fees are governed by schedule 6 of the Workers Compensation Regulation 2003.
Service providers are not entitled to be paid or recover any fee that exceeds any fixed maximum fee; doing so would be in contravention of the Act.
Examples of service provider fraud
Examples of service provider fraud include:
- billing for consultations that didn't occur.
- billing for services not provided.
- service provider and/or medical practitioner providing false or misleading information on a medical certificate or other documents.
- a legal professional knowingly submits false documents on behalf of a client.
Fraud indicators
It may indicate fraud if:
- a service provider provides receipts for individual consultations when group rehabilitation has occurred.
- a service provider requests an injured worker to sign more than one worker's compensation certificate for one consultation.
NB: On their own fraud indicators do not conclusively establish the existence of fraud. Further investigation is required to determine if fraud does exist.
To report suspected fraud
To report suspected fraud:
Note: fraud referrals can be made anonymously.
Call 13 10 50 for more information about service provider fraud.