By Jeff Baker, Program Administrator, BWC Special Investigations Department
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 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.
Special Agent in Charge Scott Lape, Shelly Long, and Fraud Analyst Stuart Lee
That might explain why Shelly Long, the co-founder and co-owner of a Cambridge business, Acute Nursing Care LLC, was surprised when we contacted her, asking to present her with another type of BWC certificate: a Certificate of Appreciation.
Scott Lape, a Special Agent in Charge with the Special Investigations Department (SID), explained to Mrs. Long that the certificate acknowledges the business owner’s referral of a fraud allegation to BWC – a referral that had resulted in the successful prosecution of the subject. Mrs. Long promptly advised that she had read about the July 27 conviction of the subject, James E Harris (Guernsey County), when she visited the SID Facebook page.
Signed by SID Director Jim Wernecke, the framed certificate is a simple way to demonstrate our thanks to Shelly Long and others who are our partners in combating fraud.
Significantly, Mrs. Long received her Certificate of Appreciation during International Fraud Awareness Week (IFAW) 2015. Sponsored annually by the Association of Certified Fraud Examiners, IFAW is dedicated to the prevention, identification and investigation of fraud – wherever it might occur throughout the world.
Just like Shelly Long, you are our eyes and ears in Ohio! Thank you for your help in stamping out fraud, and please, keep those tips coming. To report workers’ comp fraud to BWC, click here or call our fraud hotline at 1-800-644-6292.
Brenda Pumphrey of Massillon (Stark County) claimed a workplace injury caused her to lose use of each hand, one arm and one leg. After surveillance at a West Virginia casino showed no limp and full use of her arms, Pumphrey’s luck ran out and she ended up pleading guilty to workers’ compensation fraud.
An investigation into Pumphrey’s claim started with a speeding ticket. SID received an allegation from a BWC Customer Service Specialist that Pumphrey was issued a speeding ticket in Stark County on a date following her claimed loss of her ability to use her upper extremities.
A case was opened and a review of the claim showed that Pumphrey’s physician of record had continuously advised that she was unable to use her extremities but was reluctant to obtain some treatment that was advised. Pumphrey’s roommate, Robin Hopton, was also noted in several physician visits assisting Pumphrey. Hopton told the doctor she had to assist Pumphrey with her daily activities at their residence.
Agents conducted surveillance of Pumphrey and Hopton visiting her doctor’s office. Additionally, Pumphrey’s bank records showed a high volume of ATM and debit card activity at the Mountaineer Casino, located in Chester, West Virginia. Video from the casino showed Pumphrey walking with no noticeable limp and with full use and range of motion of both arms. Hopton was also with Pumphrey at the casino.
The physician concluded after seeing the casino video that it appeared Pumphrey had intentionally deceived him. The Ohio Industrial Commission terminated her Permanent Total Disability benefits.
On Friday, Oct. 16, Brenda Pumphrey was sentenced on her previously entered guilty plea to a felony count of workers’ compensation fraud. She was placed on community control for three years and ordered to pay restitution of $9,192.75. Pumphrey will serve six months in jail if she violates the terms of community control.
Hopton was also convicted of a misdemeanor count of workers’ compensation fraud in August. She was sentenced 30 days jail, suspended, and ordered to pay court costs.
In our constant quest for improvement, all members of the Bureau of Workers’ Compensation Special Investigations Department (SID) annually complete in-service training. The theme of this year’s training event was “Our Journey to Excellence: Past, Present and Future.” On October 22, by SID Director James Wernecke, we shared investigative successes and presented awards to teams and individuals.
Preparations: In September, all 123 SID employees had been invited to nominate a peer to receive an individual award. A management committee furnished behavioral characteristics for use by SID employees when submitting written justifications for any peer nomination. These characteristics varied according to the type of award: Star; Excellence in Service; and Leadership. In reviewing all nominations, the committee members found that several nominees were nominated by multiple colleagues. Ultimately, the committee selected eight most-worthy SID employees.
Presentations: These talented and dedicated professionals received their awards at the culmination of the October 22 event.
Two employees received Star awards, including Karen McMahan (pictured at right), a Registered Nurse with the Health Care Provider Team (HCPT). They met five criteria including: approaching new challenges with a “can do” attitude; involving themselves above and beyond in community outreach and/or volunteerism; and encouraging and mentoring peers and co-workers;
Four employees earned Excellence in Service awards, including T. Michael Hostin (pictured at left), an investigator with the Safety Violations Investigation Unit (SVIU); and Pam Hunnicutt (pictured below right), an administrative professional with SVIU.
They met four standards including: demonstrating extraordinary commitment by continuously providing excellent service to internal and external customers; and demonstrating a positive attitude, using strong judgment and good communication skills while promoting teamwork.
Two other employees received Leadership awards. They satisfied six criteria, including: setting a high standard of integrity; leading by example and maintaining high personal standards; inspiring a high level of commitment from others when taking on new initiatives; and sharing responsibility, authority, information, and credit when working towards the achievement of a goal.
Please, join us in thanking and congratulating each of the SID award nominees and recipients. They are the reason we are able to confidently strive towards excellence.
You can read the first article about our October 22 event here, the second article about the event here, and our most recent annual report here.
Two fraud analysts and a special agent from the Ohio Bureau of Workers’ Compensation’s Special Investigations Department (SID) attended the two-day Targeting Fraud: Safeguarding Integrity conference in Columbus. During the conference, they gleaned ideas from the latest information on specialized investigative topics, such as cybercrime, ethics laws, surveillance, social media and the investigative use of geocoded photo metadata.
The SID employees will share what they’ve learned with their colleagues, and use those strategies while conducting joint investigations with other law enforcement professionals, some of whom also attended the conference on November 4 and 5.
Ultimately, using what they learned at this and other training seminars, SID professionals seek to secure even more results than the $60.5 million in savings they identified last year, as outlined in our FY 2015 annual report.
For more articles from our blog, please visit ohiobwcfraud.wordpress.com.
As you can see from reading this blog, we take all types of fraud seriously and fraud committed by health care providers is no different.
In fact, in 1994 we created the Health Care Provider Team (HCPT) to exclusively investigate this type of fraud.
This past fiscal year HCPT closed 64 cases, identified $19M in savings, made 11 criminal prosecution referrals, and obtained 3 convictions.
Just to give you an idea of the types of fraud committed by health care providers, here are a few of our most notable, recent cases.
Lawanna Porter, of Shaker Heights, who operated Palladium Healthcare, a home healthcare agency with more than 100 employees, failed to report having employees to various state agencies or to secure workers’ compensation, and failed to report her payroll to BWC. SID conducted this joint investigation with the Ohio Attorney General’s Office, Medicaid Fraud Control Unit. In addition to restitution, Porter was ordered to pay BWC $15,000 in investigative costs, for a total of $139,573. She was also sentenced to five years of community control. If she violates the terms of her sentencing, Porter could be sent to prison for 11.5 years.
Nelsonville chiropractor Michael L. Brown, D.C., whose patients were not at his office on days that he billed BWC for treating them, including dates his office was closed, and who fabricated the amount of treatment he provided to patients to receive a higher payment for services. Brown was ordered to pay $394,021 in restitution, which includes approximately $60,000 in investigative costs. He was sentenced to five years of probation. If he fails to comply with the terms of his probation, Brown could be sentenced to serve nine months in jail. Brown voluntarily decertified himself as a BWC health care provider.
Jeffrey Stychno, D.C. and Michael Frasca, D.C., two Ohio chiropractors were sentenced to pay nearly $179,000 in combined restitution to Medicaid and the Bureau of Workers’ Compensation (BWC). Stychno and Frasca were each ordered to pay $69,781 to BWC and $19,715 to Medicaid after they were convicted of fraudulent billing practices during their time as co-owners of Integrated Health in Warren, Ohio.
Joseph J. Yurigan, D.C., a chiropractor who formerly practiced in Weirton and Wheeling West Virginia was sentenced for health care fraud and tax evasion. Our investigation revealed Yurigan was routinely and consistently billing for services that he never provided to undercover operatives. The Federal Bureau of Investigations, the West Virginia Department of Insurance Commission, United States Treasury Department and the United States Attorney’s Office became involved in the investigation and executed a search warrant. Yurigan pleaded guilty and yesterday was ordered to make restitution totaling $836,066.
After reading these cases you have most likely come to the same conclusion…this big business is just not worth it!
By Jeff Baker, Program Administrator, BWC Special Investigations Department
In our constant quest for improvement, all members of the Bureau of Workers’ Compensation Special Investigations Department (SID) gathered on October 22, 2015 at our Mansfield service office to successfully complete annual in-service training. The theme of this year’s training event was “Our Journey to Excellence: Past, Present and Future.” Led by SID Director Jim Wernecke, we shared investigative successes, learned how to use new technology recently secured, and committed to operational strategies for even greater effectiveness.
We’ve found that one of the chief ways to find new or alternate methods of fraud detection and investigation is to consult counterpart 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.
This is why Director Wernecke wisely invited Toby Smith, a talented Assistant Director of Security Services with the Industrial Commission of Ohio, to be our keynote speaker. In fewer than 90 minutes, the retired sergeant with the Ohio State Highway Patrol increased our awareness and skills in conducting “Crucial Conversations” to enhance organizational communication and investigative team work.
To acknowledge our appreciation of his training, Director Wernecke presented Assistant Director Smith with a certificate, noting that it is an honor for us to recognize, praise and thank him. We respect and appreciate all of our law enforcement colleagues for their dedication to serving and protecting the citizens of the state of Ohio. Thanks to their willingness to effectively guide others on their respective journeys, we may be confident in soon reaching our intended destination.
You can read the first article about the October 22 event here and our most recent annual report here.
Combating workers’ comp fraud in Ohio
It’s International Fraud Awareness Week and we’re on board to help educate the public about workers’ comp fraud.
In a nutshell, here’s who we are, what we do and why we do it…
Questions? Don’t hesitate to leave a comment below.
The following statistics are through June 30, 2015.