Archive

Archive for June, 2011

Illinois Brothers’ Workers’ Comp Fraud Scheme Falls Apart

Data analysis exposes fraud; Psychiatrists and brothers now owe BWC a combined $100,000

COLUMBUS – A pair of Illinois brothers who traveled to Columbus to practice psychiatry were sentenced for workers’ compensation fraud after an investigation showed they were conducting inadequate examinations of injured workers and submitting false bills to the Ohio Bureau of Workers’ Compensation (BWC). Muhammed S. Choudhry, M.D., owner and practitioner at Nehal Psychiatric Group, located at 1100 Morse Rd. in Columbus, pleaded no contest to a felony charge in a Franklin County courtroom. His brother, Naseem M. Chaudhry, M.D, pleaded no contest to a misdemeanor.

“Using some very innovative tools and techniques, analysts in our Automated Detection and Intelligence Unit are able to identify instances of potential fraud,” said BWC Administrator/CEO Stephen Buehrer. “In this case, data analysis exposed the brothers’ wrongdoing and allowed us to bring their fraudulent activity to a halt.”

Dr. Muhammed Choudhry, who traveled from his home in Bolingbrook, Illinois to practice in Columbus three days a month, caught the attention of BWC’s Special Investigations Department (SID) after analysis revealed he billed BWC for more than twenty hours of individual psychotherapy on a single day. A subsequent investigation revealed he was significantly over reporting time spent with his patients, in some cases spending less than five minutes with a patient, while billing BWC in excess of 45 minutes of individual psychotherapy. Agents also found that both he and his brother, Dr. Nassem Chaudhry, who occasionally traveled to Columbus to fill in for him, billed BWC for services when patients did not even make it into the office. During their visits, patients were prescribed a wide variety of narcotics.

Ohio Attorney General Mike DeWine added, “The partnership between BWC and our Health Care Fraud section enables us to effectively expose and prosecute wrongdoing by those providers who try to defraud the workers’ compensation system. We will aggressively pursue this conduct wherever we see it and send the message that cheating the system does not pay.”

Muhammad Saleem Choudhry pleaded no contest and was ordered to pay $78,573.16 in restitution and investigative costs. He also received an eight month prison sentence suspended on the condition that he pay restitution and successfully complete community control. Naseem Chaudhry also pleaded no contest and was ordered to pay restitution and investigative costs totaling $27,422.60, a $250 fine and court costs. He will serve ninety days in jail if he does not pay the full restitution within ninety days.

To report fraud online, please visit: http://bit.ly/reportfraud.
To speak with a fraud hotline agent, please call: 1-800-OHIOBWC.

http://www.ohiobwc.com/home/current/releases/2011/062211.asp

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Barnesville Man Guilty of Fraud, Illegally Collected $30,000 in Workers’ Comp

Frank Fogle, a Barnesville (Belmont County) truck driver, has been sentenced for fraud after he concealed his employment in order to continue receiving workers’ compensation benefits. Fogle was found guilty in a Franklin County courtroom of a fifth degree felony of workers’ compensation fraud last week and must repay the Ohio Bureau of Workers’ Compensation (BWC) the more than $30,000 he collected illegally.

“The purpose of temporary disability is to assist those who are unable to return to work, not to serve as a supplemental source of income,” said BWC Administrator/CEO Stephen Buehrer. “Mr. Fogle made deliberate attempts to conceal his fraud and was clearly seeking compensation he was not eligible to receive.”

BWC’s Special Investigations Division received an allegation from an anonymous source in 2008 that Fogle was working as a truck driver for DB Trucking in Bethesda while receiving Temporary Total Disability benefits for a previous workplace injury. An investigation confirmed that Fogle was employed at DB Trucking and knowingly concealed his return to work so that he would continue to receive those benefits. Injured workers are prohibited from returning to work while on Temporary Total Disability.

As part of a guilty plea Fogle submitted in February, he agreed to pay restitution in the amount of $30,364.70 and $2,000 for investigative costs. On June 13, Fogle was sentenced to serve 12 months of incarceration, suspended for a five year term of community control, and ordered to pay the restitution. Fogle appeared in court with an $18,000 check and that amount was credited toward this restitution figure.

To report fraud online, please visit: http://bit.ly/reportfraud.
To speak with a fraud hotline agent, please call: 1-800-OHIOBWC.

http://www.ohiobwc.com/home/current/releases/2011/062011.asp

BWC Investigations Result in Seven Workers’ Comp Fraud Convictions in May

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Stephen Buehrer today announced seven individuals were convicted or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during the month of May. The court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID), which works to deter, detect, investigate, and prosecute workers’ compensation fraud.

“Those who seek workers’ compensation benefits not rightfully theirs is breaking the law and interfering with our ability to serve Ohio’s employers and truly injured workers,” said Buehrer. “By investigating suspicious activity, and putting an end to fraud, we are protecting the benefits of injured workers’ and keeping employers’ premiums down.”

Following is a sampling of cases that resulted in a guilty plea or conviction during the month of May.

Robert Bailey (Miamisburg, Montgomery County) pleaded guilty to one count of workers’ compensation fraud, a misdemeanor of the first degree, for working while receiving benefits. BWC investigators found Bailey worked as a cook for Hickory House Bar-B-Que for nearly four months while receiving Temporary Total Disability benefits. A judge sentenced Bailey to serve 60 days in jail, suspended on the condition that he pay restitution of investigative costs in the amount of $1,223.57 in addition to a fine of $250 and court costs by November 11, 2011. He must pay the ordered restitution, fine, and court costs by 9 a.m. that day, or begin immediately serving the 60 day sentence.

Tiffany Belohlavek (Olmstead Falls, Cuyahoga County) pleaded guilty to one count of workers’ compensation fraud, a fourth degree felony, for working while receiving benefits. An investigation opened as a result of an allegation revealed Belohlavek provided BWC with fictitious timecards and employment information after she no longer worked for Physician’s Edge, a medical billing company. The fraudulent documentation allowed her to continue receiving Living Maintenance Wage Loss benefits she was awarded for a previous workplace injury for more than two years beyond her eligibility. Belohlavek was sentenced June 14 to one year of probation, court community service, and ordered to repay $53,223.57 in restitution in addition to $7,109.60 in investigative costs. She also must attend Alcoholics Anonymous/Narcotics Anonymous meetings, obtain and maintain verifiable employment, submit to random drug testing, and undergo mental health treatment and follow treatment recommendations.

Brian Jones (Elyria, Lorain County) pleaded guilty to two counts of deception to obtain a dangerous drug, a fourth degree felony for attempting to submit false prescriptions in order to obtain narcotics. SID found Jones obtained 11 narcotic prescriptions by falsifying or altering prescriptions. Jones entered his plea May 6 and sentencing is pending.

James Sanders (Dayton, Montgomery County) pleaded guilty to one count of workers’ compensation fraud for filing a false claim. Sanders submitted a First Report of Injury in March, 2010 indicating his lower back was injured as he was loading a semi tanker while employed by Clean Water Limited in Dayton. The claim was subsequently denied by the BWC, and no benefits were paid in the claim. SID verified that Sanders had been involved in a motor vehicle accident the weekend prior to his alleged work related injury, and copies of his medical records showed he gave treating physicians inconsistent descriptions of how he was injured. A judge placed Sanders on probation for one year and ordered him to pay investigative costs totaling $2072.31.

Stephen Shirley (Hamilton, Butler County) pleaded guilty to one count of workers’ compensation fraud, a felony in the fifth degree, for working while receiving disability benefits. Investigators found Shirley worked for Cincinnati Children’s Hospital as a mental health specialist while receiving $30,655.29 in Temporary Total Disability benefits resulting from a previous workers’ compensation claim. When he entered his guilty plea May 18, Shirley arrived to court with a personal check to cover the $30,655.29 restitution and $1,700.89 for investigative costs. He was placed on probation during his May 31 sentencing.

Norbert Sims (Columbus, Franklin County) pleaded guilty May 24 to one count of workers’ compensation fraud, a first degree misdemeanor, for submitting false paperwork in order to receive benefits while incarcerated. SID found that, with the assistance of family members, Sims submitted 58 falsified documents while serving a sentence in a Florida prison. The court proceeded directly to sentencing and Sims was ordered to pay restitution in the amount of $4,941.62 and investigative costs in the amount of $1,500. He also received 15 days in jail, suspended for five years of community control.

To report fraud online, please visit: http://bit.ly/reportfraud.
To speak with a fraud hotline agent, please call: 1-800-OHIOBWC.

http://www.ohiobwc.com/home/current/releases/2011/061511.asp

Pepper Pike Businessman Sentenced for Workers’ Comp Fraud Now Faces Civil Action

25 employees filed claims while Anthony Gray conducted business without proper insurance

COLUMBUS – The Ohio Bureau of Workers’ Compensation (BWC) is seeking an injunction against a Pepper Pike man recently sentenced for operating his business without proper workers’ compensation insurance coverage while his employees filed multiple claims. The injunction would require Anthony Gray, owner of Gray Container, to discontinue operations until he becomes fully compliant with workers’ compensation law and takes action to repay the more than $600,000 he owes BWC. It is the first time the bureau has sought this type of injunction.

“This is one of the most egregious cases of an employer simply ignoring laws meant to protect workers,” said BWC Administrator/CEO Stephen Buehrer. “His indifference to the law and the wellbeing of his workers has compelled us to seek an injunction to ensure the company meets its obligations.”

Gray allowed his policy to lapse in September, 2006 and despite repeated attempts by BWC to assist Gray in becoming compliant, he continued operating his business without coverage. During that time, 25 claims filed against his policy and he now owes BWC in excess of $600,000. Ohio law ensures benefits for the injured workers even if the employer is without coverage, and the money owed will help reimburse BWC for the cost of treating those workers.

The injunction, which is scheduled for a June 21 hearing in Cuyahoga County, is not the first legal action related to the case. On May 4, Gray entered a no contest plea and consented to a finding of guilty to two counts of failure to comply with workers’ compensation law. He was sentenced to one year of active probation, ordered to complete 80 hours of community work service, and sentenced to 90 days of suspended incarceration.

To report fraud online, please visit: http://bit.ly/reportfraud.
To speak with a fraud hotline agent, please call: 1-800-OHIOBWC.

http://www.ohiobwc.com/home/current/releases/2011/061311.asp