Being accused of benefits fraud can feel scary.
Jessyca Greenwood
At Greenwood Law, we guide individuals and employers through benefits fraud investigations. We offer the best advice to protect your interests, rights, and reputation.
Understanding the 6 things you should know:
1. If you’re contacted about benefits fraud, your first response is critical:
- Stay calm and gather information: request detailed allegations, including specific claims, dates, and amounts.
- Review your claims: collect all related documentation, such as receipts or invoices, to identify discrepancies.
- Seek legal advice: avoid admitting guilt or responsibility before consulting a lawyer. Even minor mistakes can be misinterpreted.
How Greenwood Law can help:
We’ll review the allegations, assess your documentation, and guide you in crafting an appropriate response to your insurer or employer.
2. Understand the common scenarios and allegations
Benefits fraud investigations often arise from situations such as:
- Unintentional errors: Duplicate submissions, missing receipts, or misunderstanding coverage limits.
- Disputed claims: Insurers questioning service necessity or billing accuracy.
- Misunderstanding of coverage: Claims for non-covered services or incorrect co-pay submissions.
Case example: How we can help
A recent client accidentally submitted the same claim twice after rescheduling an appointment. Greenwood Law provided evidence of good faith, resolving the issue without further repercussions.
3. Know your rights during a benefits fraud investigation
Even if accused of benefits fraud, you have rights:
- Fair Process: Insurers must investigate claims fairly and provide specific details.
- Representation: You can have legal representation during all communications.
- Confidentiality: Investigations should remain private to protect your reputation.
How Greenwood Law can help:
We understand the law and advocate for you throughout the process. Your rights will be respected while minimizing any potential fallout.
4. Understand the potential consequences of benefits fraud
Benefits fraud allegations can lead to:
- Job loss: termination “with cause,” which may impact severance.
- Criminal charges: fraud is a serious criminal matter, and may have serious impact upon the life of you or a loved one.
- Financial penalties: repayment of claims, fines, or increased premiums.
Fraud affects more than just the accused—it increases premiums and damages trust in workplace benefits programs.
5. Supporting employers in benefits fraud cases
Employers face significant risks from benefits fraud. These risks can include significant financial losses and company morale issues.
Greenwood Law offers services to employers:
- Independent investigations: impartial reviews of suspected fraud.
- Policy development: guidance on creating policies to detect and prevent fraud.
- Representation: support during disputes and investigations.
6. Preventing benefits fraud
To avoid allegations, follow these best practices:
- Keep records: maintain receipts and documentation.
- Understand your plan: familiarize yourself with coverage details.
- Report irregularities: notify your insurer or employer of suspicious activity.
How Greenwood Law can help:
We provide training and resources for employers and proactive advice for individuals to ensure compliance with benefits policies.
Why Choose Greenwood Law?
At Greenwood Law, we understand the complexities of benefits and fraud investigations. Our experience will help individuals facing allegations, or an employer managing a case. Our expert advice will consider all of the unique circumstances of the case.
We understand and build strong defenses. We minimize penalties and achieve your best possible outcome.
Contact us today to protect your rights and reputation. And preserve your peace of mind.
