What is disability benefits fraud?
Disability benefits fraud generally occurs when you intentionally misrepresent your situation by concealing information or providing false or misleading information for the purposes of financial gain.
The following are some examples of plan sponsor disability fraud and other situations where there may be direct intentional misrepresentation or concealment of a material fact, medical, financial, and/or functional condition for financial gain.
A plan sponsor that:
- Adds non-employees to their benefit plan to allow them to collect disability benefits.
- Creates a shell company for the purpose of administering benefits.
- Inflates their disabled employee’s income to increase the employee’s benefits.
- Moves the employee to a new employment category for the sole purpose of getting benefits, or better benefits.
- Backdates the date of employment to make an employee eligible for
benefits. - Hires someone for the sole purpose of providing benefits.
- Adds to their plan non-eligible employees that do not meet the definition of an employee (e.g. seasonal or part time).