Since 1996, professionals in the BWC Contact Center’s “fraud hotline” have effectively processed more than 30,000 allegations of workers’ compensation fraud. While this statement is comprised of simple words, the work required is far from simplistic.
To meet the expectations of fraud hotline customers, our BWC Contact Center colleagues:
- Conduct immediate interviews with sources contacting the BWC fraud hotline to furnish new allegations;
- Conduct follow-up interviews with sources and witnesses re-contacting the fraud hotline to either furnish additional information or to secure an investigative update;
- Process allegations submitted to BWC by means of an online allegation referral form accessed and completed by sources via the BWC’s “Reporting fraud” web page;
- Complete preliminary research pertaining to each subject before re-assigning the new allegations to the Fraud Management System work list of the respective special investigations unit.
The front end work performed by BWC Contact Center colleagues is instrumental to the success of our investigations. Their interviews with sources and preliminary research of BWC information are critical steps. Their considerable efforts have resulted in more than 2,500 cases closed founded (the original allegation was proven) and $163.8 million in savings identified to the Ohio State Fund.
You are our eyes and ears! Members of the BWC Contact Center fraud hotline understand, appreciate and thank you for your help in stamping out fraud. Please, keep those tips coming. To report workers’ comp fraud to one of our BWC Contact Center professionals, click here or call our fraud hotline at 1-800-644-6292.
COLUMBUS – A Dayton (Montgomery County) man was ordered to repay more than $60,000 to the Ohio Bureau of Workers’ Compensation (BWC) for working while receiving workers’ comp benefits. Elvin Hamilton pleaded guilty Nov. 22 to one count of workers’ compensation fraud, a fifth-degree felony.
“Mr. Hamilton took pictures for companies, athletic organizations, government entities and private individuals while receiving temporary total benefits – and that’s not permitted,” said BWC Administrator/CEO Steve Buehrer. “His blatant activities were discovered and we’re pleased that more than $60,000 will be returned to BWC. We’ll use that money to care for injured workers and help them get back on their feet.”
An investigation began following a claims service specialist’s tip to the Special Investigations Department that Hamilton may have a side photography business. Investigators found that he operated Hamilton Photography while receiving temporary total disability benefits from 2010 to 2013. Bank records revealed more than 1,000 checks were deposited into his personal and business checking accounts, and an analysis found that the average monthly deposits for the photography business totaled approximately $4,200 over multiple months’ time.
Temporary total compensation is for injured workers who are completely disabled from work for a short period of time due to work-related injuries or occupational diseases. Injured workers aren’t allowed to work while receiving these benefits.
The Ohio Attorney General filed a bill of information on Nov. 22 in Franklin County Common Pleas Court, charging Hamilton with workers’ comp fraud. Hamilton was found guilty and placed on community control for five years with conditions that he obtain and maintain employment and not obtain any new convictions. If he violates those terms, he’ll serve six months at the Ohio Department of Rehabilitation and Correction. Hamilton was also ordered to pay $63,196.35 in restitution to BWC. His supervision was transferred to Greene County.
To report suspected workers’ compensation fraud, call 1-800-644-6292, visit bwc.ohio.gov, or visit http://www.facebook.com/ohiobwcfraud. View and share BWC’s workers’ comp fraud awareness video on our YouTube channel.
Normally, when our readers think of the words “BWC” and “certificate”, they think of the BWC Certificate of Coverage. This makes sense. The certificate is widely seen and easily recognized. It is the official document employers often frame to display with pride within their business.
Understandably, the law-abiding business owner wants every employee and customer to see that they have secured workers’ compensation coverage from our agency. They know that others see it as proof of the business’s legitimacy and a sign of the owner’s prudence.
That might explain why Greg Bryant, the owner of a Toledo business, Snyder Snow Service, Inc. was surprised when we contacted him, asking to present him with another type of BWC certificate: a Certificate of Appreciation.
A SID Special Agent in Charge explained to Mr. Bryant that the certificate acknowledges the business owner’s referral of a fraud allegation to BWC – a referral that had resulted in the criminal conviction and sentencing of the subject, just weeks earlier.
Signed by our SID Director of Investigations Rick Gregory, the Certificate of Appreciation read, in part:
“In recognition of your exemplary citizenship and proven commitment to protecting the integrity of the Ohio State Insurance Fund for all Ohio employers. Your prompt reporting of suspected fraud resulted in a criminal conviction and the identification of more than $50,000 in savings. On behalf of all BWC Special Investigations staff, we extend our appreciation.”
We believe that the simple certificate is the least we are willing to do to demonstrate our thanks to Greg Bryant and others who are our partners in combating fraud.
Significantly, Mr. Bryant received his Certificate of Appreciation on November 8th, the Friday of International Fraud Awareness Week.
Just like Greg Bryant, you are our eyes and ears! Thank you for your help in stamping out fraud, and please, keep those tips coming. To report workers’ comp fraud in Ohio, click here or call our fraud hotline at 1-800-644-6292.
A cross match with the Ohio Department of Job and Family Services revealed Awad received wages from Rabi Inc. during the third and fourth quarters of 2011, a time when he was collecting temporary total disability compensation for a prior workplace injury.
SID’s investigation showed Awad knowingly worked for the company collecting bad checks during periods he was receiving disability compensation. The investigation also confirmed Awad failed to notify the BWC or his physician of record of his employment.
Awad pleaded guilty to one misdemeanor count of workers compensation fraud in the Franklin County Court of Common Pleas. He paid restitution in the amount of $6,897.87 prior to his plea and sentencing. Judge Horton sentenced also ordered Awad to pay court costs.
Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced ten individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in October. The court actions are the result of investigations conducted by BWC’s special investigations department (SID). The department works to deter, detect, investigate and prosecute workers’ compensation fraud.
“Fraud was proven in multiple investigations involving medical providers, employers and claimants that came to an end in October,” said Buehrer. “We are pleased to close these cases, but the regrettable reality is fraud exists elsewhere and our investigators are already busy working additional cases.”
Following is a sampling of the cases that resulted in a guilty plea or conviction during October.
Dr. Timothy Smith (Cincinnati, Hamilton County) entered a Pretrial Diversion Program Oct. 21 after he was found billing BWC for services not rendered. SID opened an investigation after receiving allegations that Smith fraudulently billed BWC, prescribed excessive amounts of narcotics and failed to maintain sanitary conditions at his medical clinic. Investigators learned that Smith was hospitalized or unable to render medical treatment on two separate occasions when he claimed he had delivered care. Smith’s staff members prepared prescriptions and brought them to Smith at the hospital for his signature. The prescriptions were later issued to patients by his staff members. During these occasions, Smith claimed to have personally treated twenty-seven injured workers. To substantiate his claims, Smith generated falsified medical treatment notes and billing forms. Based on these falsified materials, BWC paid Smith for services not rendered. A Hamilton County judge approved Smith’s acceptance into the Hamilton County Pretrial Diversion Program. Smith was ordered to pay $1,699.32 in restitution to BWC, complete 120 community service hours, and attend critical thinking and counseling courses. In a separate but related matter, Smith permanently surrendered his license to practice osteopathic medicine and surgery to the State Medical Board.
Christopher Fay, dba Full Scope Construction, (Lima, Allen County) pleaded guilty Oct. 25 to two misdemeanor counts of failure to comply for operating his business without workers’ compensation insurance coverage. SID’s Employer Fraud Team opened an investigation on Fay after he was discovered operating Full Scope Construction without coverage. The case was initiated after investigators interviewed Fay regarding a prior company he operated by the name of CDAF LLC, which was also under investigation for lapsed coverage. When operating CDAF LLC, Fay hired and leased several employees to Douglas Fay Construction, his brother’s construction business, which also had lapsed coverage. BWC ultimately combined the two policies as the result of an audit and Fay was found to owe approximately $90,000 in past due premiums. During the recent investigation, agents observed workers arriving at Fay’s residence and then leaving with him and traveling to construction job sites. When interviewed, Fay indicated his workers were subcontractors, not employees, however, subpoenaed bank records revealed regular payments were being made to the workers. Some of the workers were also past employees of Fay’s prior business. Fay was ordered to pay the outstanding premiums as well as court costs and fees of $258.21.
Todd Bittner, dba Bittner Construction, (Cincinnati, Hamilton County) pleaded guilty Oct. 29 to two felony counts of workers’ compensation fraud for operating his business without workers’ compensation coverage. BWC’s Employer Compliance Department informed SID that co-owners Todd and Ross Bittner operated Bittner Construction with lapsed coverage since 2007. This is the second case the EFT has had on this business for lapsed coverage. During the first case, Bittner became compliant; however, Bittner subsequently stopped making efforts to become compliant resulting in a second allegation. Investigators attempted to work with Todd Bittner and he submitted all outstanding payroll reports but failed to pay the related premiums or enter into a payment plan. Todd Bittner ultimately completed a second application for coverage, changing the business name slightly, but failing to list the information regarding the existing policy on the application. BWC identified this new application as a potential duplicate policy for Bittner Construction and denied the coverage due to the unpaid balance. In addition, Ross Bittner filed an injury claim against the lapsed policy and was collecting working wage loss benefits. Ross Bittner submitted wages from Bittner Construction in order to receive these benefits. As part of a plea deal, Todd Bittner will have to become compliant and will be responsible for the $50,306.20 he owes BWC. A pre-sentence investigation was ordered and sentencing was scheduled for December 9, 2013.
Harry Livingston (Parma Heights, Cuyahoga County) pleaded guilty Oct. 31 to one felony count of workers’ compensation fraud for working while receiving benefits. SID opened an investigation after receiving an allegation from an anonymous source that Livingston was working as a dump truck driver. SID conducted surveillance of Livingston in which he was observed arriving at the locations that the dump truck was parked, driving the dump truck to and from the job site, and returning to parking lot. They also confirmed that he worked as a dump truck driver from May to November 2012 while receiving the temporary total benefits. Livingston repaid more than $19,000 in restitution prior to his sentencing. He was sentenced to serve six months in prison, which was suspended for a term of community control. He was also fined $500 and ordered to pay court costs.
Richard Matt (Mayfield Village, Cuyahoga County) pleaded guilty to a misdemeanor count of workers’ compensation fraud Oct. 28 for working while receiving benefits. Matt was receiving temporary total disability benefits when a cross match with the Ohio Department of Jobs & Family Services indicated he was concurrently receiving wages. SID’s investigation found Matt was employed as a sales broker for Music Blast/Beverage Plus based in Las Vegas, NV. Company records confirmed Matt was working during the period of time in which he was also receiving workplace injury benefits from the BWC. Matt pleaded guilty to a misdemeanor count of workers’ compensation fraud October 28. Franklin County Judge Sheward ordered Matt to pay restitution in the amount of $3,421.34 by Oct. 28, 2014. He will serve 180 days at the Franklin County Corrections Center if he fails to make full restitution. Matt made a restitution payment of $500 at his sentencing.
Mary Martin (Columbus, Franklin County) pleaded guilty to one count of workers’ compensation fraud Oct. 24 for deception to obtain dangerous drugs. SID’s Intelligence Unit discovered Martin had received narcotic prescriptions from multiple physicians during overlapping periods. The investigation that followed revealed she was deceiving several physicians and that she filled those prescriptions at multiple pharmacies as a way to conceal her drug-seeking behavior. Martin was sentenced in the Franklin County Court of Common Pleas to four years of community control, under the conditions that she pay court costs and restitution in the amount of $3,473.65, and obtain no new convictions.
Eric Mariol (Canton, Stark County) pleaded guilty to a misdemeanor count of workers’ compensation fraud Oct. 22 for working while receiving benefits. Mariol was receiving living maintenance benefits and temporary total disability benefits when a cross match with the Ohio Department of Jobs & Family Services indicated he was concurrently receiving wages. SID’s investigation confirmed Mariol was working as a laborer/helper for Brad Bonsky Sheet Metal and Miracle Solutions. Mariol pleaded guilty to a misdemeanor count of Workers’ Compensation Fraud October 22. Judge Pollitt ordered Mariol to pay restitution in the amount of $1,322.88 by April 30, 2014. He will serve 30 days at the Franklin County Corrections Center if he fails to make full restitution. Additionally, Mariol was ordered to pay a $250 fine and serve 72 hours of community service.
Cheryl Brenner, dba Cranberry Station, (Andover, Ashtabula County) pleaded guilty to one felony count of failure to comply Oct. 15 for operating her business with lapsed workers’ compensation insurance coverage. BWC’s Employer Compliance Department attempted to work with Brenner, owner of Cranberry Station in Andover, to bring her policy into compliance after it lapsed, but she failed to cooperate and she continued operating the restaurant without coverage. The case was then turned over to the Special Investigations Department Employer Fraud Team. Following a pre-trial on the charges, Brenner entered into a payment plan with BWC to repay her outstanding premiums of approximately $10,000, and her policy was reinstated. A judge ordered Brenner to remain compliant, assessed a $100 fine and court costs, and sentenced her to one year of community control.
To report suspected workers’ compensation fraud, call 1-800-OHIOBWC, visit bwc.ohio.gov, or visit www.facebook.com/ohiobwcfraud. View and share BWC’s workers’ comp fraud awareness video on our YouTube channel.
We’ve found that one of the most effective ways to discover alternate methods of fraud detection and investigation is to consult or partner with other criminal justice and law enforcement agencies. Such collaboration allows SID to examine its own methods to see where improvements can be made, how tasks can be accomplished more efficiently, and what new strategies or technologies can be used in the course of an investigation. Examples of our partnerships include:
- Networking with professionals via active and productive memberships in dozens of anti-fraud associations, including: Association of Certified Fraud Examiners (ACFE), Central Ohio Investigative Network (COIN), National Association of Drug Diversion Investigators (NADDI), National Health Care Anti-Fraud Association (NHCAA), National Society of Professional Insurance Investigators (NSPII), National White Collar Crime Center (NW3C), Ohio High Intensity Drug Trafficking Area (OHIDTA), and Ohio Investigators Association (OIA).
- Participating in the anti-fraud conferences. This week, selected SID fraud analysts are attending the “2013 Targeting Fraud – Safeguarding Integrity” conference, hosted by Franklin University, National White Collar Crime Center, Ohio Ethics Commission and the Ohio Investigators Association.
- Benchmarking with the experts from the workers’ compensation systems in dozens of other states. These esteemed benchmarking partners include the Florida Department of Financial Services, Division of Workers’ Compensation; and the Washington State Department of Labor & Industries. Moreover, since 1993, delegations from other workers’ compensation systems have benchmarked with BWC to learn our best practices. These include the states of Kentucky, New York, North Dakota and West Virginia.
- Conducting operational training for law enforcement colleagues. For example, two of our SID special agents in charge have presented surveillance training at the Ohio Peace Officer Training Academy.
- Receiving specialized operational training from law enforcement colleagues. Just last month, a Department of Public Safety expert from the Ohio State Highway Patrol (OSHP) was the keynote speaker at our annual in-service training session for all SID professionals.
It’s an honor to be associated with other criminal justice and law enforcement agencies and the many professionals who make up these organizations. We respect and appreciate their dedication to serving and protecting the citizens of Ohio.
In case you missed it, you can find yesterday’s post about collaboration here.
COLUMBUS – A Cincinnati (Hamilton County) man owes the Ohio Bureau of Workers’ Compensation (BWC) more than $100,000 in workers’ compensation benefits he received while employed as a janitor, a job he got using a fake ID. John Monday, aka John Turner, pleaded guilty to fraud in the Franklin County Court of Common Pleas Nov. 5.
“Mr. Monday clearly took deliberate steps to conceal his employment, and worse, he claimed to be permanently disabled, a designation reserved for only the most severely injured,” said BWC Administrator/CEO Steve Buehrer. “Our investigators did an outstanding job, and we are especially grateful to the Spine Institute for turning over information that allowed us to put an end to Mr. Monday’s deception.”
BWC’s Special Investigations Department (SID) opened an investigation after receiving information from the Cincinnati Spine Institute that Monday has been working for their office performing janitorial services for more than twenty years under the name of John Turner.
SID learned that Monday, under his alias of John Turner, sought afterhours treatment for pain from a physician at the Spine Institute, where he worked as a janitor. He told this physician that he already had a physician who treated him for injuries related to a previous workers’ comp claim. Monday then stated his intention to change physicians and supplied his medical records to the physician who treated him afterhours.
Monday later realized the records were under his real name, John Monday, and asked the office not to file the most recent visit with BWC because he was not supposed to be working.
SID later learned that Monday worked as a janitor at the Cincinnati Spine Institute since 1990 while receiving permanent total disability and disabled workers’ relief fund benefits. Monday used an Ohio driver’s license and a state Identification card under the name John Turner in order to obtain employment at the Spine Institute while on workers’ comp.
Monday was found guilty of one felony count of workers’ compensation fraud and the judge proceeded immediately to sentencing. Monday was ordered to pay restitution of $105,169.23, in addition to court costs and $3,692.84 for investigative costs. He was also placed on community control for five years under the conditions that he has no new convictions, and establishes an income within 60 days. If Monday violates the terms of his community control, he will serve 18 months in prison.