The Ohio Bureau of Workers’ Compensation (BWC) Special Investigations Department’s (SID) employees recognize the importance of educating and informing stakeholders about how they may help us to deter and detect fraud.
We reported last July that we schedule and conduct dozens of fraud presentations to groups of internal and external stakeholders throughout the state each year. These groups include BWC employees, public and private employers, third-party administrators, medical providers, managed care organizations and members of associations, such as chambers of commerce, safety councils and bar associations.
We advised our blog readers last July that we welcome requests for fraud presentations from all interested organizations, and request you did. This month alone, SID employees shared examples of successful cases and the means to detect and report suspected fraud with the Ohio State Bar Association, the Huron County, Portage County and Marietta safety councils, and the International Association of Special Investigation Units.
And there are more. We have presentations scheduled monthly through March 2015, including multiple sessions at the Ohio Safety Congress & Expo at the Greater Columbus Convention Center.
To schedule a fraud presentation for your group, simply e-mail us and we will promptly contact you to discuss your event.
For more details pertaining to our fraud prevention efforts, view our SID fiscal year 2014 annual report.
The Ohio Bureau of Workers’ Compensation’s (BWC) special investigations unit received an allegation that Nassar returned to work as a roofer while receiving disability benefits. Investigators confirmed that Nassar worked as a roofer, snow-plower and general laborer for his own business while receiving temporary total disability benefits between November 2011 and September 2012. Injured workers are not permitted to work while receiving this type of benefit.
Nassar asked customers to write checks out to his then-girlfriend and to re-write checks that had already been made out to him to conceal his work activities. Multiple witnesses reported seeing him working during this time frame. His phone number contained a message for his roofing company.
Nassar was put on probation for four months, fined $250 and ordered to repay $800 in assigned attorney fees. BWC previously received $11,297.57 in restitution.
Today, on International Talk Like a Pirate Day, we tip our hats t’ pirates. After all, pirates o’ t’ 18th century helped with developin’ t’ concept o’ workers’ compensation.
Injury and death were risks of the trade. PiratesInfo.com says that losing an eye or a finger was worth 100 pieces of eight; an arm was worth 500 to 600 (more for the right, less for the left); a leg was worth 400 to 500 pieces of eight.
Colonial Americans around that time earned an average of two pieces of eight per week, according to Insurance Journal. In addition to compensation, injured pirates were offered less strenuous duty in their place of employment, like a return-to-work program.
We wonder if workers’ compensation fraud existed back then. In such close quarters, we imagine it would be difficult to feign injury. If there were any, offenders were surely punished.
Nowadays, it’s easy t’ report workers’ compensation fraud and keep yourself anonymous. For workers’ compensation fraud tips in Ohio, please call t’ Ohio Bureau o’ Workers’ Compensation at 1-800-644-6292 or visit bwc.ohio.gov.
The Ohio Bureau of Workers’ Compensation’s (BWC) Special Investigations Department (SID) received an allegation that Durieux was working as a licensed individual provider for the Ohio Department of Developmental Disabilities (DODD) while receiving temporary total disability benefits. Injured workers are not permitted to work while receiving this type of benefit.
Investigators obtained DODD records, which verified that Durieux billed DODD for work activity while at the same time advising BWC she was unable to work at all.
Durieux was sentenced to 12 months of incarceration, which was suspended for 18 months of community control. She must also pay $57,803.62 in restitution to BWC and court costs.
Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer announced today that eight individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in August 2014. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).
“Whether it’s an injured worker, a medical provider or an employer, workers’ compensation fraud is a crime,” Buehrer said. “BWC’s Special Investigations Department looks into allegations and also works to detect suspicious activity using information tracked by BWC. The money that’s recovered is returned to the State Insurance Fund, which employers pay premiums into for the care of injured workers.”
The following case information represents a sampling of cases that resulted in guilty pleas or convictions during August:
Robin Merchant (Columbus, Franklin County) was ordered to pay $1,517 in restitution after pleading guilty Aug. 12 to a fifth-degree felony charge of deception to obtain a dangerous drug in Franklin County Court of Common Pleas. SID’s intelligence unit detected suspicious behavior. The Columbus special investigation unit reviewed Merchant’s claim and found that 20 prescriptions for narcotics were written by four physicians between January and October 2012. Merchant was sentenced to serve six months of incarceration and 16 months of community control. The incarceration was suspended pending her compliance with community control.
Scott Riffle (Canton, Stark County) was ordered to pay $1,749.84 in restitution after being convicted Aug. 14 of workers’ compensation fraud, a fifth-degree felony. SID received an allegation that Riffle was working while receiving temporary total disability benefits. Investigators used employer records to confirm the allegation. In addition to restitution, Riffle was sentenced to nine months of community control.
John Horn (Felicity, Clermont County) was sentenced to serve 180 days in jail after being found guilty Aug. 8 in Clermont County Municipal Court of workers’ compensation fraud, a first-degree misdemeanor. SID received an allegation that Horn may have filed a false claim. Horn had filed a BWC claim indicating he was injured while employed in August 2013. Investigators found that there was no employee-employer relationship, nor was Horn ever employed by that employer. Horn was interviewed and admitted he did not work for the company, and that he filed the claim because he was attempting to get prescription drugs. Horn’s sentencing was combined with prior cases of theft, theft of gasoline, attempt to commit an offense and receiving stolen property. It was ordered that Horn be imprisoned in the Clermont County Jail for 476 days beginning Aug. 8.
Kevin Banner (Garfield Heights, Cuyahoga County) was ordered to repay $16,685.49 in restitution after he pleaded guilty Aug. 4 in Cuyahoga County Court of Common Pleas to one count of workers’ compensation fraud, a first-degree misdemeanor. BWC began investigating Banner after receiving a tip that Banner sold athletic shoes, sports clothes and other items on eBay. Investigators confirmed that Banner returned to work as a self-employed eBay salesperson between 2008 and 2011; during this time, he demonstrated his ability to return to work while receiving temporary total disability benefits. Banner was sentenced to 180 days in jail, which was suspended, and placed on one year of community control supervision.
John Ortiz (Cleveland, Cuyahoga County), owner of INT Collision Inc., was referred to SID by BWC’s employer compliance department after numerous, unsuccessful attempts were made to help the business bring its policy coverage back into compliance. Employer fraud team agents attempted to work with Ortiz, but he failed to remit outstanding payroll reports or to make any attempt to reinstate the policy. Ortiz owed more than $3,000 in past due premiums. Ortiz was charged May 13 by the City of Cleveland Prosecutor’s Office with four counts of failure to comply. After the charges were filed, Ortiz submitted the outstanding payroll reports and entered into an approved payment plan, which resulted in the policy’s reinstatement July 14. On Aug. 6, Ortiz pleaded no contest in Cleveland Municipal Court to one count of failure to comply, a second-degree misdemeanor. He was sentenced to a $200 fine plus court costs.
To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov. Check out our latest cases on our fraud blog, ohiobwcfraud.wordpress.com, follow Fraud Fridays on Twitter @OhioBWCFraud, or join in the conversation at www.facebook.com/ohiobwcfraud. View and share BWC’s workers’ comp fraud awareness video on our YouTube channel.
With staff throughout the state, the Ohio Bureau of Workers’ Compensation (BWC) Special Investigations Department’s (SID) health care provider team (HCPT) exclusively investigates alleged fraud committed by health care providers, pharmacies, durable medical equipment companies, third-party administrators and managed care organizations. We reported last October that with the hiring of additional special agents, BWC SID had expanded the bureau’s health care provider fraud program in fiscal year (FY) 2012 and FY 2013.
They delivered impressive results over the past fiscal year, identifying $19.5 million in savings for Ohio’s workers’ compensation system. That’s 64.7 percent – $7.6 million – more than the results generated in FY 2013. The team referred 32 subjects for criminal prosecution, 300 percent more than last year. Of course, these referrals generated criminal convictions.
During FY 2014, the HCPT aggressively investigated providers – including pill mills and injury mills – that commit fraud against the state workers’ compensation system. The team acted as both a lead and support agency to identify and investigate provider fraud subjects. Throughout Ohio, the HCPT launched joint investigations and search warrants with local, state and federal law enforcement agencies.
Our OhioBWCFraud Facebook page, our blog and the media are filled with examples of successfully prosecuted providers who committed workers’ compensation fraud. FY 2014 convictions include:
- Jeffrey Stychno, D.C. and Michael Frasca D.C., a Sept. 30, 2013 case summary titled, “Ohio AG and BWC Announce Chiropractor Fraud Convictions”; and
- Joseph J. Yurigan, D.C.; a Sept. 9, 2013 case summary.
With the help of HCPT, SID was able to identify $60.1 million in savings over the past year, according to statistics outlined in the SID FY 2014 annual report.
For more articles from our blog, please visit ohiobwcfraud.wordpress.com.
A judge has ordered a Huber Heights (Montgomery County) man to repay more than $8,000 following an investigation by BWC’s Special Investigations Department (SID) that showed he was working while receiving workers’ compensation benefits. Terrance Gier III was sentenced in the Franklin County Court of Common Pleas Sept. 3 after pleading guilty to workers’ compensation fraud.
SID received an anonymous allegation that Gier was working while collecting disability and was supposed to be off work recovering from an on-the-job-injury. The investigation revealed that Gier was performing odd jobs and maintenance for a landscaping business in Germantown.
The judge sentenced Gier to 180 days in jail, suspended for five years of community control. Conditions of community control are that he pay $8,455.37 in restitution, obtain/maintain employment, and have no new convictions.