Unlawful acts, penalties
This law makes it illegal to cheat the workers' compensation system. A person cannot file fake injury claims, submit the same claim more than once, lie to get insurance at a lower price, or try to talk an injured worker out of filing a real claim. An insurance company cannot refuse to pay what it legally owes on purpose. An employer cannot skip out on getting workers' compensation insurance. Breaking these rules can result in fines and criminal charges — from a misdemeanor up to a felony, depending on what was done and whether the person has broken the rules before. A special unit inside the state workers' compensation division investigates complaints of cheating, and the attorney general can take cheaters to court.
Classifications stated in the statute. Actual outcomes vary.
287.128. acts, penalties — or , may be filed, effect — fraud and noncompliance unit established, purpose, of records — , contents. — 1. It shall be unlawful for any person to present or cause to be presented any false or for the payment of s a .
2. It shall be unlawful for any insurance company or in this state to knowingly and intentionally refuse to comply with known and legally indisputable obligations with .
3. It shall be unlawful for any person to:
(1) Knowingly present multiple for the same with intent to defraud;
(2) Knowingly assist, , or with:
(a) Any person who knowingly presents any false or fraudulent claim for the payment of benefits;
(b) Any person who knowingly presents multiple claims for the same occurrence with an intent to defraud; or
(c) Any person who prepares, makes or subscribes to any writing with the intent to present or use the same, or to allow it to be presented in support of any such claim;
(3) Knowingly make or cause to be made any false or fraudulent claim for payment of a health care benefit;
(4) Knowingly submit a claim for a health care benefit which was not used by, or on behalf of, the ;
(5) Knowingly present multiple claims for payment of the same health care benefit with an intent to defraud;
(6) Knowingly make or cause to be made any false or fraudulent or representation for the purpose of obtaining or denying any benefit;
(7) Knowingly make or cause to be made any false or fraudulent statements with regard to to benefits with the intent to discourage an injured worker from making a claim;
(8) Knowingly make or cause to be made a false or fraudulent material statement to an investigator of the in the course of the investigation of fraud or noncompliance.
4. Any person violating any of the of 1 or 2 of this section shall be guilty of a . In addition, the person shall be to the state of Missouri for a fine up to ten thousand dollars or double the value of the fraud whichever is greater. Any person violating any of the provisions of subsection 3 of this section shall be guilty of a and the person shall be liable to the state of Missouri for a fine up to ten thousand dollars. Any person who has previously been of violating any of the provisions of subsection 1, 2 or 3 of this section and who subsequently violates any of the provisions of subsection 1, 2 or 3 of this section shall be guilty of a .
5. It shall be unlawful for any person, company, or other to prepare or provide an as of . Any person violating any of the provisions of this subsection shall be guilty of a class E felony and, in addition, shall be liable to the state of Missouri for a fine up to ten thousand dollars or double the value of the fraud, whichever is greater.
6. Any person who knowingly misrepresents any fact in to obtain workers' compensation insurance at less than the proper rate for that insurance shall be guilty of a class A misdemeanor. Any person who has previously been found guilty of violating any of the provisions of this section and who subsequently violates any of the provisions of this section shall be guilty of a class E felony.
7. Any employer who knowingly fails to insure his pursuant to this chapter shall be guilty of a class A misdemeanor and, in addition, shall be liable to the state of Missouri for a in an amount up to three times the annual the employer would have paid had such employer been or up to fifty thousand dollars, whichever amount is greater. Any person who has previously been found guilty of violating any of the provisions of this section and who subsequently violates any of the provisions of this section shall be guilty of a class E felony.
8. Any person may file a complaint alleging fraud or noncompliance with this chapter with a in the . The legal advisor shall refer the complaint to the fraud and noncompliance unit within the division. The unit shall investigate all complaints and present any finding of fraud or noncompliance to the , who may refer the file to the . The attorney general may any fraud or noncompliance associated with this chapter. All costs incurred by the attorney general associated with any investigation and pursuant to this subsection shall be paid out of the . Any fines or penalties levied and received as a result of any prosecution under this section shall be paid to the workers' compensation fund. Any ordered as a part of the shall be paid to the person or persons who were defrauded.
9. Any and all reports, records, tapes, photographs, and similar materials or documentation submitted by any person, including the of commerce and insurance, to the fraud and noncompliance unit or otherwise obtained by the unit pursuant to this section, used to conduct an investigation for any violation under this chapter, shall be considered confidential and not subject to the requirements of chapter 610. Nothing in this subsection prohibits the fraud and noncompliance unit from releasing records used to conduct an investigation to the local, state, or federal or federal or conducting an investigation, upon written request.
10. There is hereby established in the division of workers' compensation a fraud and noncompliance unit responsible for investigating incidences of fraud and failure to comply with the provisions of this chapter.
11. Any prosecution for a violation of the provisions of this section or section 287.129 shall be commenced within three years after of the by an or by a person who has a legal duty to represent an aggrieved party and who is not a to the offense. As used in this subsection, the term "person who has a legal duty to represent an aggrieved party" shall mean the attorney general or the having to prosecute the .
12. By January 1, 2006, the attorney general shall forward to the division and the members of the the first edition of an annual report of the costs of prosecuting fraud and noncompliance under this chapter. The report shall include the number of cases filed with the attorney general by county by the fraud and noncompliance unit, the number of cases by county by the attorney general, fines and penalties levied and received, and all costs.
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Source & history notes
(L. 1992 H.B. 975, A.L. 1993 S.B. 251, A.L. 1998 H.B. 1237, et al., A.L. 2005 S.B. 1 & 130, A.L. 2014 S.B. 491) Effective 1-01-17
Legal information, not legal advice. Always confirm with the official source at revisor.mo.gov.