3 tips for controlling your workers’ comp costs

Workers’ compensation is just one of many costs employers have to juggle. Fortunately, you can take small steps throughout the life of your policy to control your premiums. Follow these three tips to help make workers’ comp a smaller piece of your budget.

Prevent workplace accidents

Workplace accidents carry direct and indirect costs. Your insurance carrier covers direct costs, but indirect costs come out of your pocket.

Workplace accidents carry direct and indirect costs. Your insurance carrier covers direct costs, but indirect costs come out of your pocket.

The best way to manage costs is to prevent accidents. The Occupational Safety and Health Administration estimates that for every dollar you invest in safety, you could get up to $6 return in return. You should tailor your safety program to the unique hazards your employees face, but be sure to include these core elements:

  • Get management commitment and employee buy-in.
  • Identify the hazards associated with each job task.
  • Put control measures in place for each hazard.
  • Train employees on the safety program and the safest way to do each task.
  • Continuously evaluate and improve the safety program to ensure it meets your evolving needs.

Commit to return-to-work

Accidents happen, even in the safest workplaces. When they do, they carry human and monetary costs.

Injured workers tend to suffer stress, depression and financial hardship. Meanwhile, employers have to find a way to make up for lost productivity. That could include hiring extra help or paying overtime to current employees. Ultimately, the cost of replacing an experienced worker can be 50 to 150 percent of their salary.

A return-to-work program helps control the costs associated with workplace accidents. The goal is to get injured workers well and back on the job as soon as medically reasonable. Follow this five-step process to launch a return-to-work program:

  • Put the program in writing. Your written program should explain the steps the company will follow from the time the injury happens to the time the employee comes back to work.
  • Assess job tasks. Write down the separate activities or tasks that make up each job. Include physical demands (lifting, typing, standing), environmental conditions (noise, heat, vibration) and the time spent on each task.
  • Identify modified duties. Use your task list to match available work to injured employees’ work restrictions. Modified duties should be meaningful tasks that contribute to productivity.
  • Communicate with injured workers. Make sure injured workers receive company newsletters and other announcements. Call them regularly and ask if they need extra help with their recovery. By maintaining contact, you send the message that you care about injured workers and you want them back on the team.
  • Make a bona fide offer of employment. When you are ready to bring the injured worker back to the job, make a written, bona fide offer of employment that meets the requirements in Texas Department of Insurance, Division of Workers’ Compensation Rule 129.6.

Fight workers’ comp fraud

Anyone who has a stake in the workers' comp system, including claimants, employers and health care providers, can commit fraud.

Anyone who has a stake in the workers’ comp system, including claimants, employers and health care providers, can commit fraud.

Fraud costs the insurance industry about $80 billion each year. Those costs trickle down to everyone in the form of higher premiums. If you suspect an employee is committing workers’ comp fraud, you should remember three things:

Trust your workforce. Most claims are legitimate, and most injured workers want to get well and back to the team. It’s easy to jump to conclusions if you feel taken advantage of, but remember to keep an open mind.

Trust your instincts. Your employees deserve the benefit of the doubt, but you should trust your instincts if you recognize two or more red flags for fraud.

Trust the system. Insurance carriers and regulatory agencies work hard to stop fraud and protect your premium dollars. If you suspect fraud, contact your workers’ comp carrier or the Texas Department of Insurance fraud unit, and let your investigator take it from there.

More information

The Texas Department of Insurance hosts free workers’ comp seminars across the state for employers and injured workers. In addition, Texas Mutual invites the public to visit our Work Safe, Texas website for free workplace safety resources.

 

.

Your RX for health care fraud

Imagine visiting a clinic for a work-related injury and being treated by a foreign medical student who is not authorized to practice medicine in the United States. That’s what happened to patients at Rose’s Houston Healthcare Clinic.

Rosemary Phelan, the clinic’s owner, pleaded guilty to insurance fraud-related charges in the wake of a joint investigation between Texas Mutual Insurance Company and the Texas Department of Insurance.

“Fraudulent behavior not only harms the individual company but also places an unnecessary financial burden on all participants in the workers’ compensation system.” Tim Riley, vice president of special investigation at Texas Mutual

Phelan was sentenced to seven years’ deferred adjudication and ordered to pay $88,000 in restitution. But the fallout from fraud can be far-reaching and far more serious than any penalty levied by a court.

Most importantly, Phelan jeopardized patients’ health by staffing her clinic with unlicensed physicians. And then there are the monetary costs of fraud, which affect everyone in the form of higher premiums.

State regulators and insurance carriers are working hard to stop health care fraud. In fact, Texas Mutual maintains a team of investigators who specialize in protecting our policyholders’ premium dollars from the trickle down effects of health care fraud. You can do the same for your business if you learn what to look for and how to respond.

Common schemes
The National Health Care Anti-Fraud Association estimates the financial losses due to health care fraud are in the tens of billions of dollars each year. Here are some common fraud schemes Texas Mutual investigators have seen:

  • Up-coding involves submitting bills for more serious or expensive diagnoses or procedures than were actually performed.
  • Unbundling means marketing or charging for items or services separately rather than as a package.
  • Prescription drug diversion is increasingly common in the midst of America’s opioid epidemic. Diversion means abusing or illegally distributing prescription drugs, or using them for purposes not intended by the prescriber.
  • Unnecessary treatment, supplies and tests, also known as overuse, is particularly egregious because it also affects patients’ health. The Lowe Institute estimates overuse accounts for between 10-30 percent of U.S. health care spending.

Red flags
Employers can help fight fraud if they know what to look for. Here are some common red flags for health care fraud:

  • The employer receives a notice that a claimant has changed his/her treating doctor and is then taken off work after receiving a release to return to modified or full duty. Usually, the claimant also seeks attorney representation.

    Employers who commit premium fraud get an unfair advantage over honest competitors.

    The Coalition Against Insurance Fraud estimates health care fraud steals tens of billions across all lines of insurance annually.

  • The treating doctor extends off-work status without treating the claimant for an extended time. For example, the doctor documents that the claimant should remain off work until the next office visit, which is scheduled one to two months after the date of service.
  • The health care provider uses templated documentation, which means using the same language on medical reports for all patients. You may notice that the report does not have the claimants’ correct name or that the gender references do not match. This is a red flag because it could signal that the physician is not truly evaluating patients or spending the amount of time they billed for.
  • The health care provider uses rubber-stamped signatures on DWC-73/office visit reports. This indicator could point to a provider billing for services he/she did not actually perform.
  • The claimant complains about the health care provider’s services or the treatment facility’s conditions. For example, the claimant might report that the office clerk performed the treatment or the clinic was dirty and did not have the appropriate therapy equipment.
  • Claimants complain that they are ready to return to work, but the doctor keeps them in an off-work status and continues to order treatment such as physical therapy.

Reporting suspected fraud
Investigators acknowledge three types of workers’ compensation fraud: claimant fraud, premium fraud and health care fraud. All steal money from the workers’ comp system and honest stakeholders. If you suspect fraud in a claim, contact your insurance carrier and/or the Texas Department of Insurance fraud unit.

Protect yourself against health care fraud

Identity theft and Social Security card

About 2.3 million Americans spent an average of 200 hours and $13,500 to resolve medical ID theft cases in 2014.

Imagine someone offering you the chance to get cutting-edge genetic tests for cancer and other serious diseases at no cost to you. For just a few hours of your time, you walk away with peace of mind and a $50 Walmart gift card.

If you’re thinking it sounds too good to be true, you’re probably right.

A large group of unsuspecting Central Texans recently fell victim to this scam. When reporters began investigating the scam, they found the “clinics” boarded up and the saliva samples discarded in a shed.

Like workers’ comp fraud, health care fraud comes in many forms. In some cases, perpetrators bill for services they never provided. In other cases, they overbill for services or provide services patients don’t need. In all cases, the costs trickle down to consumers in the form of higher premiums.

You can protect yourself from health care fraud by following these simple tips:

  • Guard your health insurance information. More than 2 million Americans fall victim to health care identity theft every year. Protect yourself by guarding your health care information the same way you guard your Social Security number, your credit card numbers and your internet passwords. Never give your medical ID card information to a stranger on the phone, in an email or on a website.
  • Review your statements. Review your bills and explanation of benefits to make sure you and your health plan were only charged for services you received. If you see errors, contact you plan’s customer service center or the provider.
  • Ask questions. Ask questions to make sure the treatment your doctor recommends is necessary. Be skeptical if a doctor recommends a new, unusual or experimental procedure.
  • Remember that nothing is free. Don’t accept offers of money or gifts in exchange for your medical ID or other personal information. While many research studies are legitimate, they should never ask for your medical ID or submit claims to your health plan.
  • Report your suspicions. If you suspect someone is trying to lure you into a health care scam, contact your plan’s customer service center, your employer’s human resources department or the Texas Department of Insurance fraud line at (800) 252-3439.

For more information on medical ID theft, visit the Texas Department of Insurance fraud unit online.

This Week in Comp, October 27-31

This Week in Comp provides an overview of workers’ compensation news from across the country.

TRIA expiration fast approaching
With TRIA set to expire at the end of the year, its renewal remains in limbo…MORE

Wellness as an injury prevention tool
The proportion of older workers (55 years and older) in the U.S. climbed from 16% in 2004 to 22% in 2013, according to the U.S. Bureau of Labor Statistics. The aging workforce presents new opportunities for safety professionals to implement wellness as an injury prevention tool…MORE

NNT in pain management: You’ve been right all along
The National Safety Council’s Dr. Don Teater, M.D. has penned a white paper that contains powerful data and interesting insights regarding the use of opioids for chronic non-cancer pain. Essentially, Dr. Teater’s research indicates that for most patients, ibuprofen and acetaminophen are safer and more effective than opioids…MORE

Distracted driving: The self-correcting nature of science
A majority of research on driver distractions has focused on cell phones. More recent studies remind us that other distractions, such as daydreaming, talking to passengers or correcting children also take our focus off the task at hand…MORE

CDC tightens PPE guidelines for health care workers
The new guidelines focus on three areas: 1. Training, including how to put on and remove PPE. 2. No skin exposure when PPE is worn. 3. Supervision by a trained monitor while putting on and removing PPE…MORE

No chief’s disease here
David DePaolo recounts a workers’ comp success story from the California Highway Patrol…MORE

Regulatory roundup
Texas Mutual’s weekly mash-up of health and safety-related regulatory news…MORE

Workers’ comp study looks at California’s reforms
Large increases in office visit fee schedule rates under SB 863 will likely lead to substantial increases in prices paid in California, as the reforms intended.  However, the reimbursement rule change regarding reports, record review, and consultation codes may moderate the potential increase in payments, according to a recent study released by the Workers’ Compensation Research Institute…MORE

Consequences of failing to report & respond to work injuries
Even for the best employers following workplace safety guidelines, accidents happen. When they do, it is important to follow recognized procedures when responding to work injuries. Failure to properly report and respond to the injury can have significant adverse consequences…MORE

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

This Week in Comp, October 13 – 17

This Week in Comp provides an overview of workers’ compensation news from across the country.

Ohio man fakes workplace injury, employer discovers it on security video
The employer’s security video revealed that the employee  stomped a hole in a wooden floor the night before he said he was injured and on the following day, lowered his foot into the floor and laid down on the platform…MORE

Click the image above for a Centers for Disease Control and Prevention podcast on driving safety.

Click the image above for a Centers for Disease Control and Prevention podcast on driving safety.

Ebola: Call for preparedness
At this time, Ebola is not a major workplace health hazard for most workplaces in the United States. Nevertheless, being prepared for any infectious disease event should be a priority for every employer…MORE

Test your driving IQ in the Oct. edition of TDI’s newsletter
The Oct. edition of “Safety and Health Update” includes a short quiz on driving laws, eye safety tips and the benefits of return-to-work…MORE 

Study compares medical costs across 16 states, including Texas 
The Workers’ Compensation Research Institute study provides a baseline of current medical costs and trends for policymakers and other stakeholders by documenting how medical payments per claim and their cost components compare over time with other states….MORE

OSHA releases Oct. 15 edition of QuickTakes
The edition features OSHA alliances with the Association of Energy Service Companies and the Federal Communications Commission. The alliances’ goal is to reduce workplace injuries among cell phone tower and oil field workers, respectively…MORE

Regulatory roundup
Texas Mutual’s weekly mash-up of health and safety-related regulatory news…MORE

OSHA: proposed fines up, inspections down for FY 2014
OSHA initiated 30,679 inspections and cited 55,163 alleged violations during the first 10 months of the current fiscal year, compared to 39,228 inspections and 78,196 alleged violations in FY 2013…MORE

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

This Week in Comp, October 6 – 10

This Week in Comp provides an overview of workers’ compensation news from across the country.

NETS encourages Americans to observe Drive Safely Work Week

Click the image above for a Centers for Disease Control and Prevention podcast on driving safety.

Click the image above for a Centers for Disease Control and Prevention podcast on driving safety.

Nearly two-thirds of all people killed on U.S. roadways were members of the nation’s workforce, according to the Network of Employers for Traffic Safety (NETS). During Drive Safely Work Week, NETS offers free resources to help employers promote safe driving among their workforce..MORE

Heroin death rates doubled in 28 states, 2010-2012
Despite the spike in heroin-related deaths, the Centers for Disease Control and Prevention noted more than twice as many people died from prescription opioid overdoses in those states…MORE

Regulatory spotlight
The Occupational Safety and Health Administration has revised its hazard communication standard (HCS), which helps employees understand the hazards associated with chemicals they use in the workplace. This brief post explains employers’ obligations under the revised HCS..MORE

NSC study: Over-the-counter pain medications more effective for acute pain than prescribed painkillers
Pills White BackgroundThe combination of over-the-counter pain medications ibuprofen and acetaminophen is more effective at treating acute pain than opioid painkillers, according to a white paper released by the National Safety Council. The white paper comes on the heels of a new law that makes it more difficult for doctors to prescribe hydrocodone combination products…MORE

What insurers can learn from states’ workers’ compensation reforms
Reforms that include employer-directed care, limitations on prescription drugs and objective standards of medical care have produced some of the most meaningful cost savings in the 20 largest workers’ compensation markets, according to a study by Conning…MORE

OR DCBS releases national study on workers’ compensation costs
The study ranked workers’ compensation costs in all 50 states. California’s rates were the highest, and North Dakota’s were the lowest…MORE

??????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????OSHA resources help protect workers from Ebola
The Occupational Safety and Health Administration offers free resources on recognizing and controlling the risks associated with Ebola…MORE

Regulatory roundup
Texas Mutual’s weekly mash-up of health and safety-related regulatory news…MORE

Study: Formulary could save California workers’ comp $124M-$420M
If California adopted a prescription drug formulary similar to the one Texas adopted, it could save up to $420 million a year in workers’ compensation costs, according to a study by the California Workers’ Compensation Institute…MORE

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

This Week in Comp, September 29 – October 3

This Week in Comp provides an overview of workers’ compensation news from across the country.

OSHA releases October edition of QuickTakes
The October edition of OSHA’s newsletter features the agency’s new home page, the revised injury reporting rule and a message from Assistant Secretary Dr. David Michaels…MORE

Safety never sleeps
If we want to protect employees from the hazards of their jobs, we cannot afford to focus on safety only when it’s convenient. Safety has to be a constant presence that continuously evolves to meet our changing needs. It has to be a value that never gets compromised, even when we have to drag ourselves out of bed before the sun comes up. For safety to thrive, it can never sleep…MORE

IAIABC: Making Return-to-Work Easy Peasy Committee Style
The Disability Management and Return to Work Committee met in Austin this week to continue work on its RTW policy paper. Bob Wilson reports that although the members bring varying opinions and priorities to the conversation, they agree on one thing: We have a disability problem in this nation, and the status quo is no longer acceptable…MORE

Study shows driving while texting with Google Glass as distracting phone
This year, eight states have considered laws to ban drivers from using Google Glass and other head-mounted computers or displays…MORE

Regulatory Roundup
Texas Mutual’s weekly mash-up of health and safety-related regulatory news…MORE

The Health and Safety at Work Act turns forty
The Act sets out guidelines and rules for employees to follow to protect not only their employees, but also members of the public, as well as guidelines for employees to follow to avoid injuries in the workplace. Since its introduction, there has been a staggering 80% decrease in fatal accidents in the workplace…MORE

TX court orders employer to pay $35K to Texas Mutual
Everest Contract Services, LLC of Irving, Texas, pled guilty to workers’ compensation fraud-related charges. The company misrepresented numbers of employees and payroll associated with a related company, Premrock Commercial Drywall Ltd…MORE

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

%d bloggers like this: