Have presentation, will travel

As part of our mission to effectively and proactively prevent losses to the workers’ compensation system and to deter, detect, investigate and prosecute workers’ compensation fraud, we recognize the importance of educating and informing our stakeholders about how they may join us to combat fraud.

That’s why we annually schedule and conduct dozens of fraud presentations to groups of internal and external stakeholders throughout the state. These groups have included other BWC departments, public and private employers, third party administrators, medical providers, MCOs and members of associations, such as chambers of commerce, safety councils and bar associations.

During fiscal year 2015, we conducted 44 presentations describing and demonstrating how we accomplish our mission. Our SID employees share examples of successful cases and furnish all attendees with the means to detect and report suspected fraud.

In the photo below SID Special Agent in Charge Shawn Fox walks attendees of BWC’s 2016 Safety Congress & Expo through the steps he and his staff took when investigating the Hammond fraud case. More on that case here.

sid presentation

We welcome requests for fraud presentations from all interested organizations. To schedule a fraud presentation, simply e-mail your request to Jeffrey.B.1@bwc.state.oh.us and we will promptly contact you to discuss your group’s event.

We hope you’ll contact us and look forward to meeting you soon!

For more details pertaining to our fraud prevention efforts, view our Annual Report here.

BWC investigations result in eight workers’ comp fraud convictions in April

Eight individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in April 2016. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

“Investigating and putting an end to fraud helps protect the benefits of injured workers and keep employers’ premiums down,” said BWC Administrator/CEO Sarah Morrison. “That’s why BWC is so proactive in pursuing all employers, medical providers, workers and others who are committing fraud.”

Cases that resulted in guilty pleas or convictions during April include:

Mitchell Jones of Akron (Summit County) – Ordered to pay $1,824.73 in restitution after BWC investigators found he had returned to work as a truck driver while collecting BWC benefits. Jones pleaded guilty April 4 to one count of workers’ compensation fraud, a first-degree misdemeanor. He was sentenced to 90 days in jail, which was suspended for two years of community control.

William Harmon, dba Fork and Finger Café, Inc., of Portsmouth (Scioto County) – Pleaded guilty April 11 to one count of workers’ compensation fraud, a first-degree misdemeanor, for failing to bring his BWC policy back into compliance despite several warnings from the BWC. Harmon was sentenced to two years probation, 90 days incarceration (suspended), and ordered to pay monthly payments to the BWC. He was also ordered to keep current on all workers’ compensation obligations while maintaining an active worker’s compensation certificate.

Keith Mitchell of Columbus (Franklin County) – Ordered to pay the BWC $5,147.37 in restitution for intentionally misrepresenting and withholding his employment in order to continue collecting injured workers’ benefits. Mitchell pleaded guilty April 12 in the Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a first-degree misdemeanor. He was sentenced to 180 days in jail, which was suspended for two years of community control.

Susan Meaney (Columbus, Franklin County) – Ordered to repay more than $12,000 to BWC after investigators found she was working while receiving workers’ comp benefits. Meaney pleaded guilty to a fifth-degree felony count of workers’ compensation fraud on April 15 in Franklin County Court of Common Pleas. She was sentenced to 10 months of incarceration, which was suspended for three years of community control.

Mischelle Bensch of Weston, Michigan – Pleaded guilty April 18, 2016 in Franklin County Common Pleas Court to one count of workers’ compensation fraud, a fifth-degree felony. BWC initiated an investigation after identifying that wages were being reported for Bensch at a church in Michigan while she was receiving temporary total disability benefits. She is scheduled to be sentenced on June 23, 2016.

Angela Pugin of Spencerville (Allen County) – Sentenced April 18 for colluding to commit workers’ comp fraud with a co-worker who was sentenced last year for fraud in the same case. Pugin pleaded guilty in the Franklin County Court of Common Pleas to a felony count of complicity to commit workers’ compensation fraud.

BWC investigators found Pugin, an office manager for D&G Development and Restoration/1-800 BOARD UP in Lima, had paid Douglas Roop cash for work at D&G while Roop was receiving injured workers’ benefits from the BWC. Pugin paid $5,000 for investigative costs prior to her sentencing. She was also ordered to pay court costs.

Patrick H. Green, dba Pat’s Custom Painting, of Whitehall (Franklin County) – Convicted April 25 on one count of forgery, a fifth-degree felony, after BWC investigators found he had altered a BWC certificate of coverage to indicate valid coverage after his policy had lapsed. The BWC also found Green had obtained another certificate of coverage for his business but under a different business name so he could appear compliant and avoid the debt he owed on his lapsed policy.

Green was sentenced to six months in prison, which was suspended for two years of community control.

James Bulakovski of Mansfield (Richland County) – Ordered to repay the BWC nearly $1,700 for working concurrently in the insurance industry. Bulakovski pleaded guilty to workers’ compensation fraud, a first-degree misdemeanor, on April 27 in Franklin County Common Pleas Court. In addition to restitution, he was sentenced to 180 days in jail, which was suspended for one year of community control.

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

Employer Fraud: When your competition isn’t paying… you pay more!

Fraudulent employers hurt honest employers. When employers cheat the system, honest employers have to pay additional premiums and are placed at a competitive disadvantage. Here’s how:

BWC maintains a State Fund to pay for services provided to injured workers. This fund can be seen as a pot of money that must be filled by Ohio’s employers. For every dollar dishonest employers don’t contribute, honest employers are forced to pay an extra dollar. Fraudulent employers are then able to undersell honest employers due to their lower labor costs.

We recognize the impact this causes to Ohio’s employers. In 2005, our department created the Employer Fraud Team to exclusively investigate this type of fraud. Since its existence, the Employer Fraud Team has identified the following common employer fraud schemes:

  • Employers operating without workers’ compensation coverage or ceasing to pay for their workers’ compensation coverage;
  • Underreporting payroll by misclassifying and misrepresenting types of employees;
  • Falsifying a BWC Certificate of Premium Coverage to appear to be compliant; and
  • Shifting payroll to different policies to avoid negative experience ratings.

Do you suspect an Ohio employer isn’t playing by the rules? Let the Employer Fraud Team know. Visit http://bit.ly/reportfraud to anonymously report fraud online, or call 1-800-644-6292 to speak with a fraud hotline agent.

Two Ohio employers convicted on charges related to workers’ comp fraud

A Columbus painter and a southern Ohio restaurant owner were convicted last month on charges related to workers compensation fraud, one for forgery and both involving lapsed coverage.

Investigators with the Ohio Bureau of Workers’ Compensation say Patrick H. Green of Columbus (Franklin County) forged documents to make it appear his business, Pat’s Custom Painting, was current in its workers’ compensation insurance when the policy was lapsed.

In an interview with BWC Employer Fraud Team agents, Green admitted to having a friend alter his BWC certificate so he could prove coverage to a vendor and receive payment for services he had rendered. Agents also pressed him about a second BWC policy they found under the name Jodi Green, DBA Custom Color Finishes, at the same address as Pat’s Custom Painting. Green said he had his then-wife apply for the coverage under a different business name so he could obtain a valid BWC certificate and avoid the debt he owed on his lapsed policy.

Green was convicted on a fifth-degree felony forgery count and sentenced April 25 in Franklin County Common Pleas Court to 6 months in prison, which was suspended for two years community control.

In another case, BWC investigators say they warned Fork and Finger Café owner William Harmon five times that his workers compensation insurance had lapsed, but the Portsmouth (Scioto County) businessman failed to bring his policy back into compliance.

Harmon was indicted in May 2014 on 10 counts of workers compensation fraud, nine of them fifth-degree felonies and one count a first-degree misdemeanor. After taking steps to become compliant, Harmon pleaded guilty to the first-degree misdemeanor.

He was sentenced last month in Scioto Common Pleas Court to two years of probation, 90 days incarceration (suspended) and ordered to pay monthly installments to the BWC per an agreement he made with the Attorney General’s Office. He was also was ordered to keep current on all workers compensation obligations while maintaining an active workers’ compensation certificate.

Ohio woman sentenced for colluding with claimant who alleged he was totally disabled

A Spencerville (Lima County) woman has been sentenced for colluding to commit workers’ comp fraud with an acquaintance who was sentenced for fraud last year. Angela Pugin pleaded guilty to a felony count of complicity to commit workers’ compensation fraud on April 18 in the Franklin County Court of Common Pleas.

BWC’s Special Investigations Department (SID) began investigating Pugin after receiving an allegation that a claimant, Douglas Roop, may have been working while receiving permanent total disability benefits he was awarded following a workplace injury.  Roop had filed for a settlement and noted that his brother-in-law owned a business and he was interested in working for him.

SID and the Lima Police Department executed a search warrant at D&G Development and Restoration/1-800 BOARD UP in Lima and obtained evidence proving that Roop had returned to work while collecting the benefits.

The investigation proved that Roop had been working for his brother-in-law, Darrell Pugin, who owned and operated the company. Angela Pugin, Darrell’s wife, also worked at D&G Development and 1-800-BOARD UP as the office manager. Evidence from the search warrant showed that she was paying Roop cash for work done at D&G while Roop was receiving benefits from the BWC.

Pugin paid $5,000 for investigative costs prior to her sentencing. She was also ordered to pay court costs.

Douglas Roop was sentenced on June 1, 2015 and ordered to pay restitution to BWC totaling more than $20,000. Read more about his case here.

Mansfield man ordered to repay nearly $1,700 in workers’ comp benefits

Bulakovski photoA Mansfield man has been ordered to repay the BWC nearly $1,700 in injured workers’ benefits he received while working concurrently in the insurance industry. James Bulakovski, 40, was sentenced April 27 in Franklin County Court of Common Pleas.

Acting on a tip, the BWC’s Northeast Regional Special Investigations Unit (SIU) found Bulakovski working as an independent insurance agent for a life insurance company while recovering from a finger laceration and receiving BWC benefits from April 28, 2014 through Aug. 1 that same year.

Bulakovski pleaded guilty to workers’ compensation fraud, a misdemeanor of the first degree. A judge ordered him to pay $1,674 in restitution to the BWC and sentenced him to 180 days in jail, suspended for one year of community control.

Columbus woman will repay $12,000 in ill-gotten workers’ comp benefits

A Columbus (Franklin County) woman has been ordered to repay more than $12,000 to BWC after investigators found she was working while receiving workers’ comp benefits. Susan Meaney was sentenced in the Franklin County Court of Common Pleas on April 15.

SID’s Intelligence Unit found during a database cross-match with the Ohio Department of Job and Family Service that Meaney earned wages from The Kroger Company during the period she also collected temporary total disability benefits from BWC.

SID collected employment records from The Kroger Company that confirmed Meaney worked and receive wages during the same time period she was supposed to be recovering from a workplace injury and was restricted from working. Further, the evidence obtained during the course of the investigation revealed Meaney intentionally misrepresented and withheld her employment in order to continue receiving the benefits.

Susan Meaney pleaded guilty to a fifth-degree felony count of workers’ compensation fraud and was sentenced to ten months of incarceration, suspended for three years of community control.  She was also ordered to pay restitution in the amount of $12,718.74.

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