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Archive for December, 2011

Two Geauga County men owe a combined $200,000 for workers’ comp fraud

McElroy and Hill sentenced in separate cases 

Two Geauga County men have been sentenced after they were convicted of fraud for working while collecting workers’ compensation benefits.  Kenneth McElroy was self-employed performing equipment repair and snow plowing services and owes $80,000 to the Ohio Bureau of Workers’ Compensation (BWC).  William Hill was discovered operating his own business, Hill’s Contracting Company, and must repay more than $133,000.

“Disability benefits are not a way to boost your salary when you are perfectly capable of working,” said BWC Administrator/CEO Stephen Buehrer. “These men may have been feeling comfortable that they could continue their scams but both cases prove that cheaters can never assume they can continue undiscovered.”

BWC’s Special Investigations Division (SID) opened an investigation into Kenneth McElroy after learning he was self-employed snow plowing and repairing lawn mower/landscape and construction equipment while receiving temporary total disability benefits.  SID conducted numerous interviews confirming that the Chardon man was performing these services at his home and at customer’s residences.

The Ohio Industrial Commission issued an order in October finding all benefits McElroy received for the period of more than five years had been overpaid.  Additionally, his benefits were terminated due to a finding of fraud.  McElroy pleaded guilty to a felony count of theft on Dec. 14 in a Franklin County courtroom and was ordered to pay $80,000 in restitution.  The judge also sentenced McElroy to five years of community control and a suspended a six month prison sentence.

William Hill became the subject of an investigation after a BWC claims service specialist suspected he may be working for his own company while receiving temporary total disability benefits. An investigation verified the Chesterland man was operating Hill’s Contracting Company for three years in direct conflict with his disability benefits.

Hill pleaded guilty Dec. 6 to one felony count of workers’ compensation fraud in Franklin County Municipal Court. He was ordered to pay $131,919.43 in restitution and an additional $2,000 for investigative costs.  He was also sentenced to five years of community control.  As part of the agreement, Hill is ordered to pay $100 per month. If Hill does not comply with probation or make the required monthly payments, he will serve six months in prison.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/122111.asp

BWC Investigations Result in Five Workers’ Comp Fraud Convictions in November

December 21, 2011 1 comment

Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Stephen Buehrer announced five individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during the month of November. 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. The cases bring the total number of convictions this year to 119.

“With another month comes five more fraud convictions, the result of our investigators’ outstanding work following up on leads and proactively identifying fraud,” said Buehrer. “What many perpetrators often do not understand is that if their activity does not generate tips from suspicious neighbors, co-workers or others surrounding them, their activity will raise red flags among BWC staff trained to detect suspected fraud.”

Following are four of the cases that resulted in a guilty plea or conviction during the month of November.

Michael Roe Booking PhotoMichael Roe (Middletown, Butler County) was sentenced November 28 for working while receiving benefits. SID received an allegation through BWC’s fraud hotline indicating Roe was working for a friend while collecting temporary total disability benefits. Investigators found Roe was working as a part-time tow truck driver for Lightening Towing and Recovery in Middletown. Roe pleaded guilty in the Franklin County Common Pleas Court to a felony count of workers’ compensation fraud. Roe was ordered to pay restitution of $5,163.91, and another $2,000 for investigative costs. He was also placed on community control for two years. Roe must pay full restitution by June 15, 2012 and obtain no further felony convictions or he will serve six months in jail.

James Mann (Toledo, Lucas County) was sentenced November 30 for fraud after he was found treating injured workers without a medical license. BWC’s Health Care Provider team investigated Mann after an employer reported inconsistencies with the treatment provided to an injured worker by Mann, owner of Toledo Medical Evaluators, LLC. The team found Mann was performing disability exams and file reviews in both Ohio and federal workers’ compensation cases although he lost his license to practice medicine in 1991 after he was convicted of illegal processing of drug documents. Mann was attempting to conceal the fact that he was personally conducting exams by erroneously reporting that one of the licensed physicians in his practice conducted the exam. Mann then submitted the fraudulent exam reports to the Ohio Industrial Commission. Mann pleaded no contest to a bill of information in Lucas County Common Pleas Court to one count of workers’ compensation fraud. He was sentenced to serve five years of probation and pay $90,278 in restitution, in addition to $10,530 for investigative costs. Mann previously pleaded guilty in the United States District Court, Northern District of Ohio, to three counts of Mail Fraud.

Thomas McallisterThomas McAllister (Steubenville, Jefferson County) pleaded guilty to deception to obtain narcotics. BWC’s Intelligence Unit identified Thomas McAllister as potentially receiving prescriptions from several physicians and pharmacies. SID’s investigation confirmed that he used deception to obtain 11 prescriptions from three prescribing physicians. McAllister entered a guilty plea in October to a felony count of deception to obtain dangerous drugs. A Franklin County judge sentenced McAllister November 30 to 30 days in jail. He was also ordered to pay $424 in restitution, and his driver’s license will be suspended for six months.

Gary Metz (Sharonville, Hamilton County) was sentenced November 22 for working while receiving benefits. BWC’s Special Investigations Department investigated Metz after receiving a tip and found he was working as a cable technician for his brother’s company Comteam, Inc., while receiving Living Maintenance and Non-Working Wage Loss benefits. Metz pleaded guilty in the Franklin County Common Pleas court to one felony count of workers’ compensation fraud. He was ordered to pay restitution of $6,165 and investigative costs of $1,000. He was also sentenced to six months in Ohio Department of Rehabilitation and Correction, suspended if he pays restitution and court costs by Dec. 30.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/121511.asp

BWC SID spreads holiday joy with toy drive

The Special Investigations Department (SID) achieved another successful toy drive. For the sixth year in a row, SID has collected toys for local toy drives in the Columbus area.

A sampling of toys from SID's toy drive.

A sampling of toys from SID’s toy drive.

“The SID staff really gets into this event every year and it keeps growing as other special investigations units around the state do their own collection” says Director of Special Investigations Tom Wersell.

For those in the Columbus area, you still have an opportunity to contribute. Join Director Wersell at the NBC4 Firefighters 4 Kids Toy Drive on Saturday, December 10th from 8:00 am to 3:00 pm. All Columbus fire stations also accept toy donations until December 24th. Visit https://www.firefighters4kids.com/donations.html more details. The Marine Toys for Tots program have collection sites located throughout Columbus. Visit http://columbus-oh.toysfortots.org/local-coordinator-sites/lco-sites/default.asp for donation locations.

Categories: SID Information Tags: ,

We are hiring!

We are hiring various investigative positions throughout the state. Apply to each position below or visit http://careers.ohio.gov/.

Canton

Position

Team

Closing Date

Fraud Investigator

Region 1

12/14/2011

Cincinnati

Position

Team

Closing Date

Fraud Investigator

Health Care Provider Team

12/14/2011

Cleveland

Position

Team

Closing Date

Fraud Investigator

Region 1

12/14/2011

 Fraud Investigator 

Employer Fraud

12/14/2011

 

Columbus

Position

Team

Closing Date

Criminal Investigator

Region 2

12/14/2011

Lima

Position

Team

Closing Date

Criminal Investigator

Region 3

12/14/2011

Fraud Investigator

Employer Fraud

12/14/2011

Mansfield

Position

Team

Closing Date

Fraud Investigator

Region 1

12/14/2011

Regional Locations TBD (Canton, Cleveland, Mansfield and Youngstown)

Position

Team

Closing Date

Assistant Special Agent In Charge

Region 1

12/08/2011

Lack of medical license not enough to keep Toledo man from treating injured workers

James E. Mann sentenced for workers’ comp fraud

A Toledo (Lucas County) man who treated injured workers without a medical license must repay the Ohio Bureau of Workers’ Compensation (BWC) more than $100,000 as a result of his sentencing yesterday for workers’ compensation fraud. James E. Mann owned and operated Toledo Medical Evaluators, LLC, and performed disability exams and file reviews in both Ohio and federal workers’ compensation cases although he lost his license to practice medicine in two decades ago.

“We cannot endanger the health of injured workers by allowing anyone who is not a licensed physician to direct their care,” said BWC Administrator/CEO Stephen Buehrer. “Employers have workers’ comp coverage to ensure their workers receive quality care and they rightfully do not expect their premiums to go to anyone who would take advantage of the system.”

Mann, who has not held a medical license since his conviction in 1991 on nine counts of illegal processing of drug documents, contracted with two licensed physicians to perform exams on injured workers. However, an investigation by the BWC Special Investigations Department showed Mann personally conducted exams and erroneously reported that one of the licensed physicians conducted the exam. Mann then submitted the fraudulent exam reports to the Ohio Industrial Commission.

Mann pleaded no contest to a bill of information charging him with one felony count of Workers’ Compensation Fraud. Judge James Jensen of the Lucas County Court of Common Pleas found him guilty and ordered he pay $90,278.86 in restitution and $10,530.17 in investigative costs, as well as court costs and a supervision fee. Mann was also sentenced to five years of community control. He will serve 12 months in prison if he violates community control.

Mann previously pleaded guilty in the United States District Court, Northern District of Ohio, to three counts of mail fraud. He was sentenced in that case on November 21 to one year of supervised release. Judge James Carr ordered Mann to pay $91,482.81 in restitution to the federal workers’ compensation program, in addition to a $100,000 fine and a $300 special assessment fee.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/120111a.asp

Sharonville man on workers’ comp caught working for brother’s company

December 1, 2011 1 comment

Gary Metz was installing cable for Comteam, Inc.

A Sharonville (Hamilton County) man was sentenced in court last week after the Ohio Bureau of Workers’ Compensation (BWC) discovered he was working as a cable installer for his brother’s Milford company. Gary Metz must repay BWC $7,165 by Dec. 30 or risk jail time.

“The majority of injured workers are conscientious of the rules and would never purposely break them,” said BWC Administrator/CEO Stephen Buehrer. “Regrettably, BWC’s investigators must remain alert for others like Mr. Metz who knowingly commit fraud hoping it will go unnoticed while they pocket checks they are not eligible to receive.”

BWC’s Special Investigations Department investigated Metz and found he was working as a cable technician for Comteam, Inc., owned by his brother. Metz was working full time for the company while receiving Living Maintenance and Non-Working Wage Loss benefits. Non-Working Wage Loss is payable to injured workers who are unable to find suitable employment, and Living Maintenance is paid to an injured worker while they are participating in a vocational rehabilitation plan.

Metz pleaded guilty November 22 in the Franklin County Common Pleas court to one felony count of workers’ compensation fraud. He was ordered to pay restitution of $6,165 and investigative costs of $1,000. He was also sentenced to six months in Ohio Department of Rehabilitation and Correction, suspended if he pays restitution and court costs by December 30.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/120111.asp

Safe and secure: BWC Security ensures we are both

The Bureau of Workers’ Compensation is comprised of 1,985 dedicated professionals providing exemplary workers’ compensation services from 15 customer service offices located in 16 facilities throughout the state. Some of these facilities also host employees of the Industrial Commission (IC) of Ohio, including the hearing officers who conduct all IC claim-related administrative hearings. Moreover, the site of our main headquarters – the William Green Building, 30 West Spring Street, in Columbus, Ohio – furnishes office space to other agencies, such as the Ohio Ethics Commission, Ohio Industrial Commission, Ohio Department of Alcohol and Drug Addiction Services, and Ohio Administrative Knowledge Systems. The William Green Building also hosts many large events throughout the year in its auditorium which seats 375 audience members.

BWC facilities annually experience tens of thousands of visits from employees, customers and members of the general public. Moreover, from these BWC facilities, employees also annually experience hundreds of millions of direct customer service interactions. These include more than one hundred million hits to our e-commerce based Web site, www.ohiobwc.com; and hundreds of thousands of incoming and outgoing telephone calls, more than four million pieces of mail, and countless e-mails. Each employee, customer, and visitor deserves and receives our very best. Most essentially, all interactions must be safe and secure.

Ensuring the safety and security for employees and customers is the mission of BWC Security. To meet its mission, a team of 41 dedicated professionals furnishes security services, threat assessments and investigations for all BWC staff statewide. The team uses dozens of key strategies, including:

  • Co-conduct security and safety training for all BWC employees located in each facility;
  • Conduct audits of each facility’s access control cards;
  • Provide quick reference guides detailing the optimal response to any building emergency;
  • Budget security equipment enhancements for facilities;
  • Monitor the security equipment installations and upgrades in all facilities;
  • Maintain an Automated Critical Asset Management System in conjunction with the Ohio Department of Homeland Security and the Ohio Department of Public Safety for first responders during a building emergency;
  • Initiate an Employee Emergency Notification System due to any business interruption or office closure; and
  • Conduct joint investigations with local and state law enforcement officers.

A Case In Point

The BWC SID safety violations investigation unit (SVIU) received an anonymous voice mail message. The caller threatened to “blow up” the SVIU office. BWC Security worked with the SVIU, Ohio State Patrol, and other Special Investigations Department staff to identify the threatening caller as a management employee of an employer investigated by the SVIU.

In the Franklin County Court of Common Pleas, the management employee was charged with two second-degree misdemeanor counts of telephone harassment and one fourth-degree misdemeanor count of disorderly conduct. The defendant pled guilty to one second-degree misdemeanor count of telephone harassment. The court sentenced the convicted subject to serve one year of community control and to pay $189 in court costs, a $100 fine and a $50 probation fee.

Be on the Lookout

This concludes our fraud awareness series. Be sure to read more about BWC fraud investigations in our SID FY 2011 Annual Report.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.