Special Investigations Department identified $60.5 million in savings last year

We’re pleased to announce that SID identified $60.5 million in savings for the State Insurance Fund over the past year due to workers’ compensation fraud committed by claimants, employers and medical providers.

Recovered funds will go back to the State Insurance Fund to care for workers injured in Ohio. The Special Investigations Department Fiscal Year 2015 Annual Report was released today, and includes an overview of statistics and strategies for preventing and detecting fraud.

Since its inception in 1993, SID has completed more than 62,000 investigations and identified $1.6 billion in savings to the Ohio workers’ compensation system.

Among the more than 1,500 cases that were closed during FY 2015, 665 were closed founded, meaning the original allegation was proven. The average savings identified among the 665 cases was more than $90,903. Nearly 230 of these cases were referred for prosecution, resulting in 130 indictments and 151 convictions,  a 14 percent increase in convictions over the previous year.

During the past fiscal year, SID began implementing its fourth strategic plan, which serves as its operational guide through FY 2019. The plan includes initiatives that include implementing new technologies to conduct field work and detect cases for investigation, improving operational efficiency and ensuring employees are properly trained and appropriately assigned across our teams. This plan supports our overall mission to ensure that we effectively prevent, detect and investigate workers’ compensation fraud to protect the State Insurance Fund.

Thank you for supporting our efforts. Please keep those tips coming!

Categories: Uncategorized

Cleveland medical transport business owner sentenced for workers’ comp fraud

Ricky Hamed, owner of MZM Transport Inc. (Cleveland, Cuyahoga County), was sentenced Aug. 13 in Cuyahoga County Court of Common Pleas after pleading guilty earlier this year to one count of passing bad checks and one count of workers’ compensation fraud, both first-degree misdemeanors.

SID’s employer fraud team received an allegation from the agency’s employer compliance department after a November 2012 premium payment Hamed submitted to BWC was returned due to non-sufficient funds. Fraud agents contacted Hamed and provided him with information to bring his workers’ compensation policy back into compliance. Hamed failed to repay the dishonored check and also failed to file payroll reports and pay premiums in 2012 and 2013. BWC referred the matter to the Ohio Attorney General’s Office.

MZM Transport Inc. is no longer in business, but was a non-emergency medical transport business located at 11512 Superior Ave.

Hamed was sentenced to probation for six months and ordered to enter into a payment plan with BWC. If he fails to become compliant, Hamed could serve six months in jail.

Twinsburg business owner sentenced for workers’ comp fraud, ordered to repay $3K

Columbus – A Twinsburg (Summit County) business owner was sentenced Aug. 13 in the Summit County Court of Common Pleas on one count of workers’ compensation fraud, a fifth-degree felony. Richard Wey, owner of North Shore Security Systems Inc., 2206 Pine Tree Lane, Twinsburg, pleaded guilty to the charge on the same day.

“Falsifying workers’ compensation coverage isn’t fair to anyone involved,” said BWC Administrator/CEO Steve Buehrer. “It isn’t fair to employers who pay into the system and it isn’t fair to North Shore Security Systems’ business customers. Businesses in Ohio are required to maintain workers’ compensation coverage to protect their employees and care for them if injuries occur.”

An employee from an out-of-state company tipped off BWC that Wey presented what appeared to be a valid BWC certificate of premium payment, but BWC’s website indicated that the business had lapsed coverage. BWC provides employers with a certificate to prove they have current coverage. It is a crime to alter that certificate in order to make it appear coverage has been maintained. Fraud agents interviewed Wey, who would not admit to or deny altering the document.

Wey was sentenced to eight months of incarceration, which was suspended, and two years of community control. He was ordered to pay $3,587.63 in restitution, plus court costs, and was ordered to not have any additional law violations.

To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov. Check out our latest cases at ohiobwcfraud.wordpress.com, and see what workers’ compensation fraud looks like in our fraud awareness video on YouTube.

BWC investigations result in 12 workers’ comp fraud convictions in July

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer announced today that 12 individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in July 2015. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

“BWC takes very seriously our responsibility to protect injured workers and save employer dollars by holding those who commit fraud accountable,” said Buehrer. “The tips we receive, along with the careful work of our investigators, are crucial to identifying those who are skirting the law and dodging the rules designed to protect Ohio’s businesses and workforce.”

The following is a sampling of cases that resulted in guilty pleas or convictions during July:

Wayne Richardson, Columbus (Franklin County), pleaded guilty July 20 in the Franklin County Court of Common Pleas to a second-degree misdemeanor count of failure to comply for allowing his workers’ compensation coverage to lapse. SID identified Richardson operating a business without BWC coverage after he was previously investigated for the same issue. The Employer Fraud Team attempted to work with Richardson and his attorney to bring the policy back into compliance with state law, however, Richardson failed to submit payroll information. The Judge ordered court costs, which Richardson paid at the time of hearing.

David Robertson, Aurora (Portage County), pleaded guilty in the Franklin County Court of Common Pleas July 22 to a fifth-degree felony count of workers’ compensation fraud for working while receiving benefits. SID received an anonymous allegation indicating Robertson was working while receiving BWC benefits. Investigators conducted surveillance, retrieved records and gathered witness statements to prove Robertson returned to work at Jim’s Open Kitchen in Solon performing a variety of tasks including dish washer and cook. Robertson was interviewed and confessed to his activities. The judge ordered Robertson to one year of probation. If he fails to abide by the terms of the probation, he will receive six months in prison. An overpayment of $45,162.00 was recovered from his settlement.

Billy Schloss, Port Jefferson, (Shelby County), pleaded guilty July 13 in the Shelby County Court of Common Pleas to a first-degree misdemeanor count of attempted workers’ compensation fraud for working while receiving benefits. SID received an allegation indicating Schloss had returned to work for Statford Mader (Mader), owner of Graceway International in Port Jefferson. Investigators found Schloss was employed by Mader while consecutively receiving temporary total disability benefits. Mader advised that Schloss worked at his rental properties and mowed grass, swept floors, and completed general maintenance duties such as patching roofs. Sentencing has been scheduled for September 1.

Duane Collier, Lorain (Lorain County) was found guilty July 27 in the Stark County Court of Common Pleas of a fifth-degree felony count of forgery. A claims service specialist followed up with Collier’s physician when BWC received a request for disability form listing physical restrictions and an estimate of when Collier could return to work. The physician had not completed the form. SID’s investigation found that Collier forged his return to work dates, date of exam and the physician’s signature on the form in order to extend his benefits for six months. Collier will be sentenced on August 26.

Abdullahi Aden, Columbus (Franklin County), pleaded guilty July 8 in the Franklin County Court of Common Pleas to a first-degree misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID’s Intelligence Unit identified Aden as possibly working as a truck driver through a cross match with the Public Utilities Commission of Ohio (PUCO). The investigation found Aden knowingly worked as a driver during periods for which he received temporary total disability benefits and failed to notify the BWC or his physician of record of his employment. Aden was ordered to pay $1,397.48 and was sentenced to 30 days incarceration, suspended. Aden made the payment to the Clerk of Court’s office prior to the plea.

Kristopher Kildow, Galion (Richland County), pleaded guilty July 14 to one first-degree misdemeanor count of workers’ compensation fraud in the Franklin County Court of Common Pleas for working while receiving benefits. SID acted on an allegation indicating Kildow may be working while collecting BWC benefits. The source also found a listing for Kildow Construction operating with Kildow’s known telephone number listed as the business contact. Investigators confirmed that Kildow returned to work as a self employed contractor for Kildow Construction between September 2013 and February 2014, while concurrently receiving temporary total disability benefits. Kildow concealed his work activities and failed to disclose his employment when he submitted four requests to continue his benefits in order to receive benefits to which he would not have otherwise been entitled. He was ordered to pay court costs.

Craig Sealey, Dublin (Franklin County), pleaded guilty July 21 in the Franklin County Court of Common Pleas to a first-degree misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID’s Intelligence Unit learned through a cross-match with the Ohio Department of Job and Family Services (ODJFS) that Sealey may be working while receiving benefits. The investigation found Sealey knowingly and with fraudulent intent worked as a laborer while receiving temporary total disability benefits from the BWC. He was ordered to pay $2,147 in restitution and was sentenced to 14 days in jail, suspended if he pays his fines and court costs by November 21, 2015.

David Elwood, Lima (Allen County), pleaded guilty in Lima Municipal Court on July 24 to one first-degree misdemeanor count of falsification for filing a false claim. SID received an allegation from a claims service specialist indicating Elwood had received treatment prior to his alleged workplace injury. SID obtained documentation that Elwood received treatment seven hours prior to his alleged injury at work. Elwood reported that his injury occurred while stepping out of his delivery van within fifteen minutes of his start time. When confronted with the documentation, Elwood withdrew his claim. Elwood was ordered to pay investigative costs of $1,226.88, $150 in fines, and $25 for public defender fees and costs. He was also sentenced to 30 days in jail, suspended.

To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov.

Check out our latest cases at ohiobwcfraud.wordpress.com and view BWC’s workers’ comp fraud awareness video on YouTube.

Cincinnati woman falsified job searches to receive workers’ comp benefits

A Cincinnati (Hamilton County) woman pleaded guilty to a first-degree misdemeanor charge of workers’ compensation fraud on August 6.

BWC’s Special Investigation Department opened an investigation into Charlotte Ellison after receiving an allegation from a BWC employee who suspected she was submitting false job searches in order to qualify for non-working wage loss disability benefits. The Investigation revealed Ellison did submit false job searches resulting in $3,896.93 in disability payments. During this period, Ellison submitted 63 pages with 154 in-person alleged job searches and 83 alleged online job searches via Craigslist.com, for a total of 237 job searches. All 65 job contacts interviewed indicated that Ellison never sought employment or submitted an application as she indicated to BWC in order to receive her disability.

Prior to sentencing, Ellison paid all but $540.29 of the $3,896.93 she owed BWC. A judge in the Franklin County Court of Common Pleas ordered her to repay the remaining $540.29 and sentenced her to days in jail, which will be suspended if restitution is paid in full by February 6, 2016.

Video shows Portage County man committing workers’ compensation fraud

David Robertson of Aurora (Portage County) has been sentenced for committing fraud after BWC investigators captured him on video working while receiving workers’ compensation benefits.

BWC’ Special Investigations Department (SID) received an anonymous allegation stating Robertson was employed although he was not permitted to work while receiving benefits for a prior workplace injury. Investigators conducted surveillance, retrieved records and gathered witness statements to prove Robertson returned to work at a restaurant performing a variety of tasks including dish washer and cook. Robertson was interviewed and confessed to his activities.

Robertson pleaded guilty to one felony count of workers’ compensation fraud on July 22. A Franklin County judge sentenced him to one year of probation.  He will receive six months in prison if he fails to abide by the terms of the probation.  Additionally, BWC has recovered $45,162.

Categories: Uncategorized

Guernsey County hot dog vendor sentenced for workers’ comp fraud

Columbus – A Cambridge (Guernsey County) man has been sentenced for workers’ compensation fraud after investigators with the Ohio Bureau of Workers’ Compensation (BWC) captured him on video operating a hot dog cart while he was supposed to be recovering from a workplace injury. James E. Harris appeared in a Franklin County courtroom on July 27 and paid restitution totaling more than $4,000.

“Any type of work, whether in an office or outside at a food truck, is a violation of the law for claimants receiving benefits that do not permit employment,” said BWC Administrator/CEO Steve Buehrer. “Returning to work, and concealing that employment, brings into question not only the need for that claimant to be receiving workers’ comp benefits, but their truthfulness as well.”

BWC’s Special Investigations Department received an allegation indicating Harris was operating a hot dog cart called ED-DEE’s Dog Wagon while receiving Temporary Total Disability compensation. Claimants are not permitted to work while receiving this type of benefit.

HarrisInvestigators performed surveillance documenting Harris working at the hot dog cart, cooking and serving food to customers.  They also located pictures Harris had posted to Facebook that showed him working at the cart. Vendor agreements were obtained from two local festivals and Harris listed himself as the contact person on both agreements. Finally, records from the Guernsey County Health Department showed Harris had taken an online food safety course and his name was listed on a food commissary agreement.

The investigation confirmed Harris knowingly operated ED-DEE’s Dog Wagon during periods for which he received benefits from BWC. He failed to notify BWC, his physician of record or his employer of his work activities.

Harris entered a guilty plea to one misdemeanor count of workers’ compensation fraud.  He paid full restitution of $4,234.99 prior to pleading and was also ordered by Judge Beatty to pay court costs.

Surveillance video is available here and a photo of Harris is available here.

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