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It’s Abuse (FMLA) I Tell You!

Since the Federal Family and Medical Leave Act (“FMLA”) was passed back in 1993, employers have frequently worried about one overarching issue: FMLA abuse and fraud.  Just recently I had a client ask: what can an employer do when it suspects that an employee is lying about the need for FMLA leave? I tell employers to fear not, and not fret, because there are in fact legal tools available to them to weed out FMLA fraud.

Under the FMLA, before an employee can get FMLA leave, the employee must obtain supporting medical information from a health care provider to justify the need for leave.  Typically, employers receive a signed medical health certification form from the health care provider, which is a form prescribed for such use by the US Department of Labor. This is the first place to look to detect fraud. Closely scrutinize the form to determine whether the health care provider actually provides support for the medical diagnosis for which the employee is seeking leave. Where there are discrepancies between what the health care provider indicates and what you are being told by the employee, the employer should follow what the health care provider notes in the form rather than what the employee is telling you. This way, the employer can weed out any misinformation being provided by the employee to justify a leave.

The second-place on the form that should be evaluated is the nature of the leave that the health care provider is prescribing for the employee. Look to see exactly how much time the health care provider believes the employee needs to be out of work, and when, especially if intermittent leave is sought by an employee. For example, where the employer finds that the employee is spending more time out of work on intermittent leave than what the health care provider has indicated is necessary on the form, this is a telltale sign of possible abuse. So, what can the employer do in such circumstance? For one thing, the employer can ask for a recertification form from that physician/health care provider if the pattern of use is different from what was previously prescribed. FMLA regulations provide this tool to the employer to control possible abuse by alerting the health care provider that the employee is using the leave in a way which is different than what was originally recommended and prescribed.

Another tool available in a suspected fraud situation is requesting a second opinion so that another health care provider paid by the employer can evaluate whether there is in fact the need at all for the FMLA leave. Where the second opinion differs from the original health care provider’s certification supporting the leave request, the FMLA statute and regulations provide for the obtaining of a third opinion, which is binding on both the employer and employee, and this becomes the final determination on whether leave is authorized. The final health care provider is chosen collectively by both the employee and employer. Clients of mine have used this method to stop potential FMLA fraud/abuse in its tracks where the employer reasonably suspected due to the circumstances presented that the requested leave was not needed by the employee.

Aside from the foregoing mechanisms, employee fraud has also actually been discovered through searches of the Internet and publicly available social media sites of the employee. Where an employer suspects fraud, taking a look on the Internet and conducting searches on the employee, especially on the publically accessible portions of social media site areas such as Facebook, can provide important information corroborating suspicions of fraud. In one reported case, an employee’s FMLA fraud was discovered from pictures posted by the employee on the Internet from a tropical island where the employee was vacationing at a time when he was out on FMLA leave. The employee tried to justify the vacation by arguing that his health care provider prescribed it to deal with the stress condition that prompted the request for FMLA leave, but the court did not buy that argument.

Sometimes, information about FMLA fraud will likewise come from co-employees who will report a violation because they too are upset that the employee is not at work. Similarly, I have had cases where an employee’s own relative reported the fraud in requesting FMLA to the employer so corrective action could be taken. In other extreme situations, private investigators can be used to monitor the daily activities of the employee to see whether the leave is truly needed.

The FMLA is very clear on this issue: fraud is not something that an employer must accept, and utilizing the tools available under the act will enable the employer to ferret out illegitimate requests for leave. Where fraud is discovered, employers have every right to take disciplinary action against the employee, including termination, as the employer did in the case involving the illicit vacation scenario mentioned above. So, if you are facing a situation where fraud is suspected, conduct an investigation, which sometimes will require that the employer directly confront the employee with the allegations. Employers will be amazed at how well you can guard against and remedy FMLA fraud by using the very mechanisms made available under the law and its accompanying regulations for combating such illegitimate practices.

 


Ralph R. Smith, 3rd is Co-Chair of the Employment and Labor Practice Group. He practices in employment litigation and preventative employment practices, including counseling employers on the creation of employment policies, non-compete and trade secret agreements, and training employers to avoid employment-related litigation. He represents both companies and individuals in related complex commercial litigation before federal states courts and administrative agencies in labor and employment cases including race, gender, age, national origin, disability and workplace harassment and discrimination matters, wage-and-hour disputes, restrictive covenants, grievances, arbitration, drug testing, and employment related contract issues.

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