The Investigation Strategy

Relevant Legislation

The Criminal Code Act 1995 provides the main legal avenue for Comcare to investigate and prosecute persons suspected of committing criminal offences in relation to workers’ compensation matters.

Deterrence/Prevention

Comcare is committed to deterring fraudulent activity by creating a case management framework which makes detection more likely.

Detection

This is the process used to find instances of fraud. Comcare continues to train and educate its staff to identify potentially fraudulent claims.

The processes Comcare uses in the initial assessment of a claim ensures that indicators that fraud might be occurring are identified before liability is accepted. Claim Managers are educated to be alert to warning signs and changes to circumstances or arrangements and advise the FCIT of any suspicions they may have, even if relatively minor.

The investigation of criminal offences committed against the Commonwealth is primarily the responsibility of the Australian Federal Police (AFP). The Commonwealth Government has determined however, that selected Commonwealth agencies should undertake less complex investigations of offences. While the AFP concentrates on the more serious and complex cases, they also provide assistance and ongoing advice to agencies engaged in investigations.

Comcare investigates the majority of cases, only referring to the AFP those cases where certain police powers are needed i.e. the power of arrest, execution of search warrants, etc...

When there are indications that an investigation is likely to result in criminal proceedings, specialist legal advice is sought from the Commonwealth Director of Public Prosecutions (CDPP). When there is sufficient evidence that a criminal offence may have been committed this evidence will be compiled into a ‘Brief of Evidence’ and forwarded to the CDPP. The decision to prosecute and the actual prosecution rests with the CDPP.  Comcare provides whatever additional information or advice is required to successfully progress the matter.

The Investigative Process

Upon receipt of information (this can be from various sources), the FCIT conducts an analysis of the information and considers a course of action. They then conduct internal and external inquiries to validate any suspicions. The matter is then reviewed and, if appropriate investigated. Otherwise the matter is returned to the information source with a report.

If the matter is to proceed further an investigation plan is prepared.

During an investigation, an investigator will collect available evidence with a view to determining if a prosecution is ultimately warranted. During this phase, an investigator will speak to various individuals and obtain signed statements and collect documentary evidence. The alleged offender may be interviewed in a ‘Record of Interview’. This is usually done in a question and answer session recorded on a tape recorder.

Claim Managers will be consulted with a view to preparing an overpayment schedule.

Finally, a Brief of Evidence is prepared and with the approval of the Chief Executive Officer the matter is referred to the CDPP for prosecution. If the matter is to proceed to prosecution, the CDPP will prepare a summons and the alleged offender will appear in Court to answer charges. Comcare Investigators will assist CDPP in the prosecution of the matter.

If an investigation does not proceed to a prosecution, the matter may be finalised by other means. For example, Comcare and/or the customer agency may deal with the matter through other avenues including administrative action (cessation or reduction in liability), civil action or agency counseling. Whatever action is taken must be appropriate, balanced and fair.

Directions, Instructions, Guidelines, Controls

Comcare investigators are controlled by, and subject to, a wide range of legislation, directions, instructions and guidelines, including:

• Commonwealth Fraud Control Guidelines – 2002
• Australian Government Investigation Standards
• Prosecution Policy of the Commonwealth
• Privacy Act
• Freedom of Information Act
• The Privacy Commissioner’s Guidelines on Covert Surveillance
• Sections 61 & 62 Public Service Act
• Comcare policies, procedures and CEO Directions and Instructions
  
• APS Values and Code of Conduct