Workers' compensation fraud affects everyone. It increases costs, undermines trust in the workers' compensation system, and may impact benefits and premiums for North Dakota employers.
WSI investigates reports of suspected fraud involving employers, injured employees, medical providers, and others. If you suspect fraudulent activity, report it as soon as possible. Every report is reviewed to determine whether additional investigation is needed.
If you suspect workers' compensation fraud, report it as soon as possible.
Prefer to report by phone? Call the WSI Fraud Hotline at 800-243-3331.
What is workers' compensation fraud?
Workers' compensation fraud occurs when someone knowingly makes false statements, conceals information, or misrepresents facts to obtain workers' compensation benefits, reduce insurance costs, or gain another financial advantage.
Fraud can involve employers, injured employees, medical providers, or others. It may include actions such as underreporting payroll, billing for services not provided, or providing false information about a workplace injury or benefits.
Fraud increases costs, undermines trust in the workers' compensation system, and may affect North Dakota employers and injured employees. Reporting suspected fraud helps protect the integrity of the system and ensures benefits are available for those who legitimately need them.
Important: A suspected fraud indicator does not necessarily mean fraud has occurred. WSI reviews each report carefully to determine whether additional investigation is needed.
Examples of fraud and warning signs
Workers' compensation fraud can involve employers, injured employees, medical providers, or others. The examples below illustrate common situations that may require further review.
A warning sign does not necessarily mean fraud has occurred. It may indicate that additional investigation is needed.
Examples may include:
- Knowingly underreporting payroll to reduce premium costs.
- Misclassifying employees or reporting them in incorrect job classifications.
- Falsely identifying employees as independent contractors.
- Failing to obtain required workers' compensation coverage.
- Reporting fewer employees than are actually employed.
Examples may include:
- Knowingly providing false information about how an injury occurred.
- Working while receiving wage-loss benefits without reporting earnings.
- Misrepresenting physical abilities or work restrictions.
- Filing a claim for an injury that did not occur at work.
Examples may include:
- Billing for services that were not provided.
- Inflating charges or billing for unnecessary services.
- Submitting false or misleading information to obtain payment.
What happens after you report suspected fraud?
When WSI receives a report of suspected workers' compensation fraud, the information is reviewed by the Investigative Services department. Every report is evaluated to determine whether additional investigation is warranted.
WSI investigates allegations involving employers, injured employees, medical providers, and others. Investigators gather and review information, interview individuals when appropriate, and work with agency experts to determine the facts. When necessary, WSI may coordinate with law enforcement or prosecutors.
What happens after you submit a report?
- A report is received. Reports may be submitted online, by phone, or through other reporting methods.
- The information is reviewed. WSI evaluates the information to determine whether additional investigation is needed.
- An investigation may begin. Investigators gather facts and review available information.
- Appropriate action is taken. If evidence supports fraud, WSI takes appropriate administrative, civil, or criminal action as allowed by law.
Confidentiality
To protect the integrity of investigations and the privacy of those involved, WSI generally cannot provide updates or discuss the outcome of a report.
Penalties for workers' compensation fraud
Workers' compensation fraud is a serious offense. Depending on the circumstances, individuals or businesses may face administrative, civil, or criminal penalties under North Dakota law.
- Premium adjustments
- Repayment of unpaid premiums
- Civil penalties
- Criminal prosecution, when applicable
- Repayment of benefits
- Denial or termination of benefits
- Civil penalties
- Criminal prosecution, when applicable
- Recovery of improper payments
- Administrative sanctions
- Civil penalties
- Criminal prosecution, when applicable
Penalties vary depending on the facts of each case and applicable state law.
Learn more about fraud prevention
Fraud Prevention Tips for Employers
Learn practical steps employers can take to help prevent fraud, promote a culture of honesty, and respond consistently when workplace injuries occur.
Workers' Compensation Fraud Warning Signs
Review common warning signs involving employers, injured employees, medical providers, and workplace injuries. Remember, a warning sign alone does not necessarily mean fraud has occurred.