POSTERS GALARDONADOS

Analysis of Social Security fraud in ITCC patients

Elisa Salazar González, Eva Tejero Sancho y Noelia Montesinos Fernández

Key words: Fraud, inspection work, temporary disability, common contingency.

Objectives

Analyze the effectiveness of referred patients in ITCC situation (Temporary Incapacity by Common Contingency) on suspicion of social security fraud by Labour Inspection.

Detect cases with suspected Social Security fraud: in self-employed scheme by lack of activity, fraudulent register, or increase of regulatory base prior to starting a period of IT; and in the general scheme with collusion with the company.

Create a patient profile in which physicians suspect fraudulent activity, as well as analyze the progress of reported cases to the Labour Inspectorate and the amount finally returned to the social security.

Material and methods

112 ITCC records have been studied, a 0.2% of the total number of records, in which there has been suspected fraudulent action and a report sent to the Labour Inspection unit, for the years 2011 and 2012 Maz Zaragoza.

There has been a descriptive study on the patient profile of suspected fraud (age, sex, type of social security register, previous periods of sick leave and diagnosis of the current medical situation); and have analyzed the decisions of Labour Inspection, as well as the time it takes to be resolved and the amount to be paid back to the social security.

Results

From a total of 112 records analyzed these results have been obtained:

- Agricultural system 8%, freelance 62%, self employed entrepreneur 18%, employed worker 13%

- Gender: male 59%, female 41%.

- Age: 15% 30-40 years old, 18% 40-50 years, 29% aged 50-60, 38% older than 60.

- Average of previous sick leave: 584,6 days

- Diagnosis of the sick leave: 31% psychiatric causes, 46% trauma causes, 10% others 13% sense organs.

- Resolution of Labour Inspection in an average of 152 days, showing fraud in 44% of cases, in 51% of cases not shown and in 5% of cases are still unresolved.

Conclusions

In 44% of the reported cases sent on suspicion of fraud, according to decision of Labour Inspection, fraud has been demonstrated. The total amount returned to the social security is €169.933.

The profile of the patients that have been suspected of fraud is male, aged > 50, independent self employed, in a situation of temporary disability with trauma diagnosis and an average of 584,6 days of previous sick leave of IT's.

The reported cases have been resolved by Labour Inspection in an average of 152 days.