Did you know that some FECA claims have never been investigated—and they often hide the largest opportunities for future cost savings?
Fraud, waste, and abuse under the Federal Employees’ Compensation Act (FECA) persist as challenges for federal agencies. While the program protects injured employees, unchecked claims drain resources, erode trust, and compromise operational efficiency. The good news: agencies can make an immediate impact by targeting the low-hanging fruit—claims that no one has ever investigated.
Why Start with the Low-Hanging Fruit?
Uninvestigated claims often hide glaring inconsistencies. These cases may involve:
- Flagrant Abuse: Claimants who blatantly misrepresent their condition, sometimes while working another job or engaging in strenuous activities.
- Faking: Individuals exaggerating injuries to prolong benefits.
- Fraudulent Misrepresentation: Misreporting of dependent status, failure to report earnings, or submitting false travel reimbursements.
FECA oversight reports and agency investigations document these patterns. When agencies address them first, they deliver immediate savings and restore confidence in the system.
A Coordinated Investigative Approach
An Administrative Investigation bridges the gap between routine case management file handling and DOL criminal fraud investigations. Unlike medical centric file reviews, claims handling with an investigative focus, aim to gather objective, actionable evidence to support decisions on continuing, modifying, or terminating benefits. Key components include:
- Alive and Well Checks: Confirm claimant eligibility and prevent payments to deceased or ineligible individuals.
- Verification of Medical Status: Match restrictions to actual capabilities through direct observations.
- Surveillance and Social Media Review: Document activities inconsistent with reported limitations.
These programs deliver cost-effective, scalable results. Agencies often fund them with savings generated by a reduced agency chargeback.
Benefits Beyond Fraud Detection
- Cost Reduction: Early detection of medical end treatment helps bring an employee back to work sooner and reduces long-term payouts.
- Operational Efficiency: Agencies free resources for legitimate claims.
- Workforce Morale: Leaders reinforce fairness and integrity across the agency.
Moving Forward
Start the Administrative Investigation approach with claims that no one has ever investigated. These cases often yield the most significant results with minimal effort. From there, expand to more troubling claims.
Administrative Investigations don’t just catch bad actors; they build a culture of accountability and transparency. Agencies that tackle the low-hanging fruit reduce future claims costs, protect taxpayer dollars, and ensure FECA fulfills its intended purpose.
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Frasco® Government Services delivers ethical and efficient solutions tailored to your needs. Have questions or want to discuss your investigative needs further?
Schedule a call with Craig DeMello, a nationally recognized expert in Federal Workers’ Compensation. With over 30 years of experience in public service, Craig provides practical insight and proven expertise to help clients navigate complex federal claims. As a Government Services Specialist at Frasco, he is dedicated to delivering clear answers and effective strategies to support your agency’s goals.
Disclaimer: This blog post is for informational purposes only and should not be considered legal advice. Please consult your general counsel for specific legal guidance. Frasco investigators are licensed, and our operations comply with US industry, federal, state, and local laws.