The camera doesn’t lie. So when investigators with the TDCJ’s Office of the Inspector General (OIG) viewed the video surveillance tape, they knew they had their man.
The man on the tape had worked as a correctional officer at a Gatesville-area prison before claiming a debilitating back injury and filing for worker’s compensation benefits from TDCJ. But there he was on the tape six months later working a construction job without any sign of injury. In fact, investigators later learned that the man had been running a construction/handyman business out of his home while collecting temporary income benefits from the state.
No more. He was arrested by OIG investigators and charged with defrauding the workers’ compensation system, a third-degree felony punishable by a fine and two to ten years in prison. And because his fraud was spotted early on, the state was able to administratively terminate more than $45,200 in benefits the man would have received had he collected payments for the remaining 18 months he was to have been off work.
“The thing about it is that years ago he may have gotten away with it,” said TDCJ Inspector General John Moriarty said. “But not today. Now we’ve got people looking at it.”
And they’re looking hard. Working in conjunction with the State Office of Risk Management, which processes workers’ compensation claims, the State Auditor’s Office, CrimeStoppers and TDCJ’s Office of Risk Management, OIG has opened 28 criminal cases in the past 18 months. Over the same time period, TDCJ workers’ compensation claims have dropped by approximately $4 million.
“We believe that there is some manipulation of the system going on, and I think the combination of us doing the investigations and Risk Management being proactive that a four million dollar drop in payouts is pretty substantial,” Moriarty said.
Investigators with Moriarty’s office first started looking into workers’ compensation fraud at the request of prison wardens who suspected that some employees were feigning disabling injuries and abandoning their duty posts at a time when many units were short of officers.
“They brought it to our attention that they had some serious concerns, that with the staffing shortages, they had some people who were abusing the workers’ compensation program,” Moriarty said. “They had reports that some employees were working second jobs while out on workers’ compensation.”
In response, OIG opened investigations, and in May 2003, set up a toll-free Workers’ Compensation Hotline for employees to report suspected abuses around the clock. Fourteen calls have been made to the hotline since its activation and investigators have also received information directly from unit personnel regarding employees who may be fraudulently receiving workers’ compensation benefits. The State Office of Risk Management has also forwarded referrals to TDCJ investigators.
“We get all kinds of things coming in,” Moriarty said about the calls to the hotline. “And with some of them, we realize there are vendettas, and that’s our job to sort out. But the employee who calls in and has a legitimate concern, we’re checking it out.”
According to the State Office of Risk Management, OIG investigations of three suspected fraud cases during the 2003 fiscal year stopped $188,441 in payouts. Between September 2003 and May 2004, payouts of more than $262,000 were administratively terminated in seven cases investigated by OIG. In one case, investigators found that a man was working as a correctional officer for TDCJ while collecting workers’ compensation benefits from another state agency.
Ten of Moriarty’s investigators are now taking a certified fraud examiner’s course that trains them to conduct white-collar crime investigations dealing with financial records to detect fraud. Another 10 investigators will become certified later this year. In October, TDCJ also published a fraud prevention and detection plan in response to an initiative by the Governor’s Office to eliminate fraud, waste, and the abuse of state resources.
“The aim of the plan is to make sure that the checks and balances are in place by policy in order to deter fraud throughout the agency,” Moriarty said. “It affects every division of TDCJ.”
Moriarty said the focus on fraud is especially important at a time of tight budgets and staffing shortages in the agency.
“I think that the awareness that there is a good possibility that if you’re out perpetrating fraud against the agency there is a good chance you’re going to be caught now,” Moriarty said. “Even if they don’t go to prison, there’s restitution that they’ve got to pay and they’re convicted felons for the rest of their lives.”