Fraud Bites

10269592 - injured male hand with upper part of body. hand is bandaged with red plaster focus set on thumb

One of the first rules that any kid learns in school is “don’t bite.” Maybe another important directive would be “don’t bite the teacher.” A full-time special education aide assistant in Los Angeles alleged that one of her students bit her finger, leaving her unable to work. (Really? Could she not use the other nine to get by until it healed?) Consequently, she collected nearly $16,000 she did not deserve.

The wounded teacher claimed that the injury was so bad that she had to be put on disability. (She complained that she had severe and constant pain.) Her physician eventually placed her on modified work restrictions, but unfortunately, the employer couldn’t accommodate the request. Over three months, the woman ran up a $16,000 bill including disability and medical costs. (That must have been some bite.)

The claims examiner working on the injured teacher’s case became suspicious and referred the case to an investigative unit for surveillance. It was determined that the woman made false statements so that she could obtain workers’ compensation benefits. During the period of disability, she collected $3,390 in temporary disability benefits over about three months, plus another $3,825 in permanent disability benefits. On top of that, she received $9,192.64 for medical treatment.

The fraudster was found guilty of making false and fraudulent material statements for obtaining workers’ compensation benefits. She was sentenced to three years of probation and ordered to put in 200 hours of community service. She must also pay formal restitution of $18,720 to her employer.

It looks like the government is tired of fraudsters taking a piece of the workers’ compensation pie that they don’t deserve. This time, let’s hope that the teacher’s aide learned an important lesson: when attacked by criminals, the government bites back.

Source: Today’s “Fraud of the Day” is based on an article entitled, Special education aide convicted of workers comp fraudpublished by Business Insurance on July 7, 2017.

A full-time special education aide assistant in Los Angeles has been convicted of workers compensation fraud after an investigation found that she made false statements to obtain benefits after a student allegedly bit her finger in 2012, according to a statement from Torrance, California-based Keenan & Associates, a third-party administrator that uncovered the fraud.

Shavonna Ashley was found guilty on June 13 of making false and fraudulent material statements for obtaining workers comp benefits and was sentenced to three years of formal probation. She was also ordered to perform 200 hours of community service and to pay formal restitution of $18,720 to her employer, the Inglewood Unified School District, according to the statement.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.