Workers’ Compensation Commission strengthens enforcement with i-Sight

Workers’ Compensation Commission

Workers’ Compensation Commission Snapshot

In 2003, the State of West Virginia launched a major reform of its workers’ compensation system to reduce the incidence of fraud and abuse, by stepping up enforcement and by ensuring greater coordination among those responsible for overseeing the system.

Previously, the enforcement role was divided among staff in three separate offices, each with its own system of reporting. Under the new legislation they were combined to form a single Office of the Inspector General (OIG) within the Workers’ Compensation Commission. In order for the new structure to succeed, a robust case management software solution was needed.

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The Challenge

Needed a single, easy-to-use case management software solution to replace three separate reporting systems that had been used by staff in different offices. Wanted a system that would improve communication and collaboration among investigators and legal experts. And also wanted to make it easier for members of the public to report suspected cases of fraud and abuse.

i-Sight Fact

Automatic alerts ensure that no case is overlooked or ignored

Workers’ Compensation Commission


The Solution
  • Selected i-Sight case management software for its flexibility, customizability and ease of use
  • i-Sight makes it easy for investigators and other officials to record their activities and the time they spend working on a case
  • As various workflow milestones are reached, i-Sight automatically generates template letters and emails to relevant recipients
  • Automatic alerts ensure that no case is overlooked or ignored
Results
  • i-Sight strengthens the commission’s enforcement capabilities by enabling staff to more effectively uncover cases of insurance fraud and prosecute those responsible
  • i-Sight also provides a convenient way for the commission to track and monitor court-ordered restitution and repayments
  • Managers benefit from enhanced reporting abilities and improved oversight of the investigative and enforcement process

Case Study


“By implementing i-Sight case management software, Greg Burton, Executive Director for the Workers’ Compensation Commission is letting our customers know that he is deadly serious and committed to stopping fraud and abuse within the Commission”, said Christopher A. Bailes, Director of Operations for the Workers’ Compensation Commission’s Office of Inspector General.


The i-Sight case management software will strengthen the commission’s enforcement capabilities in three ways:

Previously, the enforcement role was divided among staff in three separate offices – an investigations unit, a legal unit and a special projects unit.
  • By enabling staff at the commission to more effectively track and manage cases involving suspected fraud and abuse;
  • By making it easier for state employees and other citizens to report cases of suspected fraud and abuse;
  • And by enabling Workers’ Compensation Commission investigators to more easily analyze and detect patterns of suspicious behavior on the part of claimants, employers and medical vendors;

According to Bailes, “The i-Sight case management software will allow us to manage our system, our people and our performance much more effectively than ever before.”

The Challenge

In 2003, the State of West Virginia launched a major reform of its workers’ compensation system, which was then heavily in debt and losing close to $1 million a day. A key goal of the initiative was to reduce the incidence of fraud and abuse, by stepping up enforcement and by ensuring greater coordination among the state officials who were responsible for overseeing the system. Previously, the enforcement role was divided among staff in three separate offices – an investigations unit, a legal unit and a special projects unit. Under new legislation passed in July 2003, all three offices were combined to form a single Office of the Inspector General (OIG) within the Workers’ Compensation Commission.

“We knew that to succeed, we had to have a proper case management system.”

Merging the three groups, however, was only the first step. “In the past, each office had its own separate system of reporting, which meant there were a lot of communication problems,” said Chris Bailes, the OIG’s Director of Operations. Indeed, Bailes said that under the old system, there was some reluctance to report suspected cases of abuse because of the slow pace of the enforcement process and because of the lack of feedback related to ongoing investigations. “We realized that when we brought all these people together, getting quality reports and being consistent was going to be a challenge,” Bailes said. “We knew that to succeed, we had to have a proper case management system.”

The Solution

The Office of Inspector General evaluated a variety of case management solutions before choosing i-Sight. Two factors in particular drove the decision. “First, we found that the reporting features within i-Sight were excellent,” Bailes said. “That is really key, because without good data we can’t make good decisions. And second, we appreciated the flexibility that i-Sight gave us. We liked the fact that if we wanted to change our internal procedures six months down the road, i-Sight would allow us to do that.”

“We appreciated the flexibility that i-Sight gave us”

One of the many benefits of the new system is that it is now much easier for citizens and state government employees to report suspected cases of fraud and abuse. If they wish, they can call a toll-free number and speak to a Workers’ Compensation Commission staff member, who will enter the information into the system. Alternatively, members of the public can visit the Commission’s website and submit the information themselves via a secure, customized web form. The system includes a series of built-in prompts to reduce the possibility of incomplete reports and ensure more effective enforcement.

Once submitted, each report of suspected fraud or abuse is routed automatically to a staff member who is qualified to decide whether the situation warrants further action. When appropriate, the case is assigned to a team consisting of a research analyst, investigator, and prosecutor. At each stage in the enforcement process, i-Sight ensures that all relevant officials are kept fully informed and can easily record their activities and the time spent working on the case. As various workflow milestones are reached, the i-Sight system also automatically generates template letters and emails to relevant recipients. For example, the person who originally submitted the tip can, if he or she wishes, receive regular email updates at 30-day intervals.

“We need to know where every one of our cases is in our system, in what unit and at what stage of prosecution,” Bailes said. “The i-Sight software gives our managers the tools to manage their caseloads effectively.” At the same time, the reporting tools within i-Sight will make it easier for staff to analyze data and detect patterns of fraud and abuse that might otherwise have gone unnoticed. That, combined with the ease with which state employees and members of the public can now report suspected cases of fraud and abuse, creates a powerful deterrent for anyone who might be thinking of committing fraudulent of abusive behavior. “The i-Sight case management system is helping us to increase public awareness of the Office of Inspector General,” Bailes said. “If someone is doing something wrong, we want them to know that we’re looking at them, and we want them to be very nervous about it.”

Bailes is clearly impressed by the professionalism of the team at i-Sight.

Yet another benefit is that, for the first time, the Office of Inspector General now has a convenient way of tracking and monitoring court-ordered restitution and repayments. “We have over $6 million dollars in restitution and repayment agreements, and to date a little over 10 per cent of that has been paid,” Bailes said. “We needed a way to monitor that situation the same way a bank monitors its loan repayments, with automatic alerts when people are missing their payments. The i-Sight case management software does that for us, and it’s a fantastic feature.”

Bailes is clearly impressed by the professionalism of the team at i-Sight. “The implementation and launch of the i-Sight case management software has been very smooth – much easier than I have experienced with other software implementations. And the technical staff at i-Sight is one of the most responsive groups I have ever worked with. They’ve been right on top of everything – just gems to work with.”

“i-Sight case management software allows us to manage our system, our people and our performance much more effectively than ever before.”

“And the technical staff at i-Sight is one of the most responsive groups I have ever worked with. They’ve been right on top of everything – just gems to work with.”

Christopher A. Bailes, Director of Operations for the WCC