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We’re pleased to announce that SID identified $60.5 million in savings for the State Insurance Fund over the past year due to workers’ compensation fraud committed by claimants, employers and medical providers.

Recovered funds will go back to the State Insurance Fund to care for workers injured in Ohio. The Special Investigations Department Fiscal Year 2015 Annual Report was released today, and includes an overview of statistics and strategies for preventing and detecting fraud.

Since its inception in 1993, SID has completed more than 62,000 investigations and identified $1.6 billion in savings to the Ohio workers’ compensation system.

Among the more than 1,500 cases that were closed during FY 2015, 665 were closed founded, meaning the original allegation was proven. The average savings identified among the 665 cases was more than $90,903. Nearly 230 of these cases were referred for prosecution, resulting in 130 indictments and 151 convictions,  a 14 percent increase in convictions over the previous year.

During the past fiscal year, SID began implementing its fourth strategic plan, which serves as its operational guide through FY 2019. The plan includes initiatives that include implementing new technologies to conduct field work and detect cases for investigation, improving operational efficiency and ensuring employees are properly trained and appropriately assigned across our teams. This plan supports our overall mission to ensure that we effectively prevent, detect and investigate workers’ compensation fraud to protect the State Insurance Fund.

Oct. 1: BWC, MCOs ready for ICD-10

BWC is prepared for the International Classification of Diseases (ICD-10) national implementation that is fast approaching on Oct. 1. This means Health Insurance Portability and Accountability Act (HIPAA)-compliant providers do not need to make special accommodations for their patients with a workers’ compensation claim resulting in uninterrupted services for your employees.

More specific for injuries
Remember for workers’ compensation, claims determinations are based on injury descriptions, not disease codes. The new ICD-10 code set offers the medical community the ability to be more specific in how they document the location and severity of workplace injuries.

Bottom line for employers
Therefore, you may see more (and/or different) codes in existing workers’ compensation claims after Oct. 1. However, that does not mean there are more allowances in the claims. The bottom line is more (or different) codes do not equal more allowed conditions. The legal narrative descriptions originally allowed in a claim will not change with ICD-10.