The mission of the Office of the New York State Workers’ Compensation Fraud Inspector General (WCFIG) is to conduct and supervise investigations of possible fraud and other violations of the laws, rules, and regulations pertaining to New York State’s workers’ compensation system.

WCFIG’s investigations are complex and often involve detailed record analysis and interviews of employers, employees, health care providers, and insurance carriers. These investigations can result in criminal referrals, arrests, and prosecutions, as well as recoveries of restitution. Lucy Lang was appointed in 2021 to serve as the New York State Workers’ Compensation Fraud Inspector General.

New York State Workers’ Compensation Law§ 136 mandates that the WCFIG submit a report to the Governor and the Chair of the Workers’ Compensation Board that summarizes the activities of the office for each calendar year.

In 2022, Inspector General Lang received 1,462 complaints. This represents an increase of more than 30 percent compared to 2021. The investigations conducted by WCFIG in 2022 led to 16 arrests, more than double the number of 2021 arrests. In 2022, nearly 2.7 million dollars in workers’ compensation fraud was uncovered. Additionally, WCFIG investigations that culminated in prosecutions reclaimed nearly five million dollars through fines and court orders for defrauded New York State agencies, insurance carriers, and employers.

WCFIG investigations usually begin with either the lodging of a complaint alleging workers’ compensation fraud or the identification of potential fraud by the Inspector General in the course of WCFIG’s pro-active initiatives.

Cases opened by WCFIG for full investigation are assigned to multi-disciplinary teams led by an investigative counsel who is assisted by investigators, investigative auditors, medical professionals, and computer forensic specialists. The investigations are supervised by a regional Deputy Inspector General and the Attorney-in-Charge of workers’ compensation fraud.

Acting under WCFIG’s statutory authority, the investigative teams may subpoena witnesses, take sworn testimony, and compel the production of relevant records.

In 2022, WCFIG’s investigations led to criminal charges against 16 people. Ten of these matters involved employer fraud, while the remaining six were examples of claimant fraud. Of these 16 arrests in 2022, nine resulted in convictions and seven matters are still pending prosecutions. In addition, several criminal prosecutions initiated in prior years concluded in 2022, resulting in criminal convictions of six people.

In 2022, WCFIG also continued its investigations of medical providers and other professionals whose job responsibilities are integral to the proper administration of the workers’ compensation system. These professionals may include treating and independent physicians, physician assistants, nurses, home health aides, law judges, attorneys, court reporters, and insurance professionals.

Provider cases are often complex and involve longterm investigations. As a result of WCFIG’s investigations in 2022, several matters were referred to both licensing agencies and the Health Provider Discipline Unit of the Workers’ Compensation Board resulting in the loss of certifications.

Several other investigations involving medical providers and other professionals are ongoing. One such notable case concerned a medical provider who orchestrated a scheme to defraud the State of New York and insurers by falsifying medical prognoses and records of patients, many of them New York State Corrections officers, to keep them out of work for extended periods of time on false or exaggerated workers’ compensation claims. The physician also billed for services that were either never provided or provided by unlicensed or untrained staff while the physician was out of the state.