If you caught our last story on healthcare claimant fraud, you would have read that all federal workers’ compensation claim forms make two things abundantly clear: First, you must be honest and not falsify any information or omit anything that could be construed as fraud, such as a second income. Second, you must return to work as soon as you’ve recovered. Failure to follow one or both warnings leads to civil or criminal prosecution. This edition of Investigative Case Highlights covers how a postal retiree tried to find a workaround by claiming to go the extra mile — or several thousand extra miles at that.

The case caught our special agents’ attention when in-house analytics spotted a suspicious pattern of workers’ comp benefits going to a long-retired postal worker. It showed an unusually high amount of mileage reimbursements over eight years (the program reimburses employees who incur transportation costs to receive medical treatment). Our special agents began a thorough investigation analyzing records and collaborating with the Department of Labor (DOL), which administers the program, as well as participating healthcare providers.

Our special agents found the retiree had filed about 1,440 false claims, with over 530 of them reflecting inflated mileage to go to medical appointments. They also found over 910 claims didn’t coincide with actual medical appointments and claims submitted by the providers to the DOL for services rendered.

The woman’s career with the Postal Service had spanned several decades and, at the time of the investigation, she still had three open claims for medical and compensation benefits for which the DOL had paid upwards of $895,000. The claims stemmed from three injuries suffered between 2012 and 2019. It was time for our special agents to ask her what was going on, and what they found was that with every question her story unraveled.

When asked about travel reimbursement claims with no corresponding medical appointments, she said her doctor told her to do more physical activities outside the appointments. So, she completed a travel reimbursement form, using her doctor’s address, each time she did anything physical and thought of it as doctor prescribed. These additional claims were usually walks in the park or other activities within her own neighborhood. As a result, the woman claimed reimbursement almost daily, to include weekends and holidays.

When asked about the frequent trips to the pharmacy, she said she was taking 11 prescriptions that needed refills every 30 days. That would account for one to two, maybe three trips to the pharmacy each month, right? It turns out she said she went to the pharmacy three to four times a week to just see if the prescriptions were ready for pick up and then filed a claim.

And when asked about the high mileage for each claim, the woman said she asked friends and family to drive her to her appointments noting she had to inflate the trips up to 90 miles to pay drivers a few bucks for gas — something her DOL claims examiner supposedly told her to do. According to the retiree, the claims examiner also said she could include random stops along her route in her claims that had nothing to do with her medical treatment as long as it didn’t exceed 90 miles.

Who was this claims examiner? She couldn’t say — the person was no longer assigned to her case and she couldn’t remember the name. As the saying goes, all roads lead to Rome, but all the retiree’s led to anyone but her. And remember those 90-mile trips to the local pharmacy? It turns out each roundtrip was only 2 miles from her home.

The woman’s fraudulent claims led the DOL — and ultimately the Postal Service — to pay her more than $66,000 for inflated trips and non-existent appointments. Had she been truthful on the forms, she would have only received about $4,700 for travel expenses.

At the end of the interview, the woman admitted she had lied on her claims. She pleaded guilty and was sentenced to six months’ probation and ordered to pay more than $49,000 in restitution, after which her workers’ comp benefits were terminated. Thanks to our special agents, closing this case meant USPS could save more than $391,000 in future fraudulent workers’ comp payments.

If you suspect or know of healthcare claimant fraud involving Postal Service employees or contractors, go the distance and please report it to our Hotline.