Fraud and Abuse

In any types of institutions be it government owned or private, the relevant considerations involving money matters are always given priority. Apparently, an office wouldn’t be able to accomplish its tasks if budgetary concerns are present. Therefore, there should always be means to control any kinds of transactions involving the use of money resources, a true concern even in terms of costs of benefits. Generally, institutions which are related to providing financial values to its beneficiaries are very much particular in assessing the level of benefits that they can provide in a particular time frame.

Of course, there is always the necessity to effectively distribute the financial compensation and aid to the right recipients at the right time. It is always important to control the benefit costs which the holding institution distributes. Apparently, these benefits are always materialized on the actual stock money resources of the company. If there is a significant margin of limitation for the benefits being dispersed, then the company can save additional funds for more investment processes.

Another advantage is that all members or employees of the office will be able to acquire stable and exact funding for their benefit rights. Lastly, there is no need to request for subsidy from third party financier in fulfilling the variable benefits requests if there is an uncontrolled compensation value. In a larger perspective, the institution may significantly control the expenses in benefits or compensation rates if it will provide measures of safety, well being and training for the employees and members of the organization (AllBusiness, 1999).

This will greatly balance the possible expense risks on the part of the administration while keeping the upbeat of the good productivity of the entire population of the employees or members. (7) 1. When it comes to workers’ compensation programs, an insurance fraud may be identified by merely analyzing the way an individual or group intends to execute a certain objective. In a more simple explanation, insurance fraud is committed if one intentionally presents a document or material in written form which can be use to mislead or to give false information and claim for the executioner to take a certain degree of benefit.

Most of the time, this act can be initiated to take advantage of a resource which has been previously denied of him. Although fraud is usually associated with a material or tool in order to be identified, in the aspect of workers’ compensation, fraud can still be committed using only verbal arguments (DFA). On the other hand, an abuse has a wider scope of identification because it is committed by doing an act which is practically against the law’s or rules’ intended principles in running a particular system.

Fraud is considered to be a physical form of abuse. 2. Technically speaking, the absence of a ‘fraud material’ can provide very poor evidence against the person who would want to violate the rules of the workers’ compensation system. If the system and the individuals running it will grant the intention of the person to file a claim based on what the system perceives to be valid, then there is no way to deny it even if deep inside the person he is actually committing abuse.

This can be very well observed even in the field of insurance system wherein a member can easily file a claim just by presenting fake cases or scenarios which can also be identified as valid reasons. Therefore, in a valid philosophical standpoint, it is not a crime.


  • AllBusiness. 1999. How Can You Control Workers' Compensation Costs?. AllBusiness. Retrieved November 22 2007 from http://www. allbusiness. com/human-resources/benefits-insurance-workers-compensation/825-1. html
  • DFA. N. D. What is Fraud and Abuse. TNCAREFRAUD. Retrieved November 22 2007 from http://www. tncarefraud. tennessee. gov/what_is_Fraud_abuse. aspx