The Growing Challenge of FECA Fraud, Waste, and Abuse
The Federal Employees’ Compensation Act (FECA) provides essential support for injured federal employees by covering medical treatment and offering compensation during recovery. However, the persistent challenge of Fraud Waste and Abuse threatens this vital safety net. Government agencies conducting Reductions in Force (RIF) face even greater risks, as they must ensure that positions do not remain open indefinitely for individuals who should return to work (RTW) but still receive compensation.
Fraudulent FECA claims deplete agency budgets, reduce workforce efficiency, and delay benefits for truly injured employees. Without proper oversight, individuals might continue receiving payments despite being capable of resuming their duties, and agencies struggle to fill essential positions. A robust administrative investigation program helps detect deceitful activities, ensures funds are used correctly, and supplies critical evidence for Department of Labor (DOL) investigations.
Examples of Fraud, Waste, and Abuse in FECA Claims
- Exaggerated or Fabricated Injuries
A federal employee reports an injury and collects total disability benefits. Investigators, however, discover this individual performing strenuous activities—like construction work or competitive sports—that conflict with the injury claim.
- Failure to Report Medical Improvements
An injured worker continues receiving benefits long after a significant medical recovery. They present ongoing restrictions to medical providers to maintain benefits. Because no timely investigative documentation challenges these claims, the case remains open and generates unnecessary chargeback costs for the agency.
- Working While Collecting FECA Benefits
An individual receives FECA compensation and secretly works in a second job. Through thorough investigative efforts, these cases come to light, but they often go undetected when oversight is lacking.
- Misrepresentation of Dependent Status
A claimant continues receiving higher compensation based on outdated or incorrect dependent information. Routine verification checks could prevent this overpayment.
How an Administrative Investigation Program Identifies and Reduces Fraud
- Conducting Alive and Well Checks
Regular Alive and Well checks confirm that claimants remain eligible for benefits. These checks are particularly crucial for claimants over 80 years old, ensuring payments do not go to deceased or ineligible individuals.
- Verifying Medical Status and RTW Capability
Investigators collect vital medical evidence to determine whether a claimant can return to duty. They provide real-world examples, including surveillance footage and social media activity, which medical providers compare against the claimant’s subjective complaints. This information prompts second-opinion exams and helps refute unjustified claims.
- Ensuring FECA Chargeback Savings
When agencies detect and resolve fraudulent claims, they lower their financial liability during the FECA chargeback process. A proactive program prevents ineligible employees from continuing to receive benefits.
- Supporting DOL OWCP in Fraud Investigations
Many FECA claims require substantial evidence before termination is possible. An administrative investigation program delivers detailed, admissible evidence to the DOL’s Office of Workers’ Compensation Programs (OWCP). This support helps identify cases of Fraud Waste and Abuse and ensures only valid claims remain active.
Why Now Is the Time to Act
Because of ongoing RIF measures, agencies must ensure capable employees fill positions rather than individuals who linger on FECA benefits when they can return to work. The need for an organized investigative program extends beyond cost savings; it preserves workforce integrity, defends taxpayer dollars, and assists the DOL in pinpointing fraudulent claims.
By implementing an effective administrative investigation program, agencies proactively monitor and verify claims to prevent Fraud Waste and Abuse. This approach fosters a more accountable, efficient, and transparent process.
Take Action
Federal agencies should partner with Frasco to guarantee every FECA claim flagged for possible Fraud Waste and Abuse undergoes thorough review. Vigilant oversight curbs wasteful spending, protects agency resources, and restricts benefits to genuine claimants.
Act now, before the costs spiral out of control.
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Disclaimer: This blog post is intended for informational purposes only and does not constitute legal advice. Please consult your general counsel for specific legal guidance. Frasco investigators are licensed, and our operations adhere to all relevant US industry, federal, state, and local laws.