NCJ Number
176569
Journal
Crime Volume: w and Social Change Issue: Dated: Pages: 3 (1996-97)-270
Date Published
1997
Length
18 pages
Annotation
The case of the Workcover Corporation of South Australia provides an example from the practitioner perspective on the analysis of fraud in benefit programs for occupational injury and on the cost-effective targeting of resources for the prevention, detection, and prosecution of such fraud.
Abstract
These benefit programs are susceptible to fraud from internal sources, claimants, and professionals involved in claims. The pressure to reduce expenditures, together with changes in the public sector generally, have affected the handling of such fraud. The Workcover Corporation was established by legislation in 1986 to replace the private workers compensation system. The system is employer-funded, but it is accountable to the South Australian Parliament and reports to a State government official. The program has been recognized as one of the most generous in Australia in terms of benefits paid to claimants. The Workcover system assumes that the majority of claimants have strong work ethics and would like to overcome their injury or illness quickly and return to work. However, it became clear that this philosophy did not hold for a minority of claimants. Therefore, the Fraud Prevention Department was established to control fraud. Its 20 employees have three functions: referral, intelligence, and investigation. Claimant fraud uses the majority of investigative resources. Other forms of fraud include employer fraud, service provider fraud, and internal fraud. Current data protection laws hinder effective efforts against fraud. Frequent legislative changes have also made the system extremely fluid and difficult to control. A telephone hotline, a monthly newsletter, and other efforts have produced a more public image, but Workcover lacks appropriate penalties for those who abuse the system. Legislative changes are needed, but the current situation is likely to persist and make fraud continue to be an attractive opportunity.