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Fraud

If you suspect a person or organisation is committing fraud related to workers' compensation—including a Comcare worker—any information you can give us will help us in our investigations.

What is fraud?

Fraud is dishonestly obtaining a benefit, or causing a loss, by deception or other means.

Types of fraudulent behaviour relating to workers' compensation from an employee include:

  • knowingly submitting a false claim
  • providing false information including failing to declare information where there is a legal requirement to do so
  • failing to declare employment income from any source while on compensation
  • altering a medical certificate or any other documents relating to the claim
  • submitting false travel expense claims
  • misrepresenting disabilities
  • remaining on payments to avoid returning to work.

Types of fraudulent behaviour relating to workers' compensation from a service provider include:

  • claiming for services that were not provided
  • providing false invoices or other documents.

Types of potential fraudulent behaviour relating to Comcare’s workers include:

  • receiving payment, other than payments from Comcare, for work performed as a Comcare worker or when they are deemed to be at work
  • seeking bribes or favours for decisions or actions taken as a Comcare worker.

How to report fraud

To report a suspected fraud, or discuss any concerns you may have, you can:

Investigating fraud allegations

When information is received about an alleged fraud, Comcare will carry out a comprehensive analysis to determine the appropriate response, which may include an investigation if needed.

During an investigation, evidence will be collected, which may involve both internal and third-party information checks, which help Comcare to work out if fraud or non-compliance has taken place. If there is sufficient evidence of fraud Comcare may refer the investigation to the Commonwealth Director of Public Prosecutions for prosecution of criminal fraud charges. The results or progress of an allegation and investigation remain confidential.

If an investigation does not proceed to a prosecution, the matter may be finalised through other avenues including administrative action (cessation or reduction in liability), civil action or referral for a Code of Conduct breach investigation under the Public Service Act.

Prevention and detection

Comcare can provide employers with:

  • advice on workers' compensation fraud prevention
  • guidance on specific instances or examples of suspected fraud or serious non-compliance.

Please contact FCIT on 1300 366 979 to find out more.

The risk of fraud is real

During the 2017–18 financial year, Comcare received 152 referrals regarding allegations of misconduct by recipients of workers’ compensation entitlements and third-party service providers.

Page last updated: 12 Nov 2018