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Archive for December, 2012

Surveillance video of Youngstown doctor leads to ban on treating injured workers

December 21, 2012 6 comments

COLUMBUS – A Youngstown doctor has been decertified as a provider for the Ohio Bureau of Workers’ Compensation (BWC) and repaid more than $70,000 after pleading guilty to workers’ compensation fraud. Surveillance video captured by an undercover agent from BWC’s Special Investigations Department (SID) posing as a patient in need of psychotherapy services showed Anil C. Nalluri MD providing inadequate care. Nalluri later billed BWC for services he never provided.

“This video shows Mr. Nalluri’s appalling lack of concern for his patient and a substandard level of care that is clear even to a layperson,” said BWC Administrator/CEO Steve Buehrer. “The care of his patients should have been Mr. Nalluri’s first concern but he instead chose to put his patients at risk in order to squeeze the most dollars out of BWC as possible.”

SID began investigating Nalluri in 2003 after receiving a complaint from an injured worker that he was providing only 10 minutes of psychotherapy services during what was supposed to be a 45 minute session. The injured worker confronted Nalluri about the lack of care and Nalluri informed the patient that he would receive payment from BWC regardless of the treatment provided. Nalluri later removed the injured worker from treatment at the office and failed to provide the patient his medical records when requested.

Agents conducted an undercover operation and observed several patients exiting the office very soon after arriving. An agent also posed as a patient, visiting Nalluri 12 times and capturing video supporting the allegation, including an appointment that lasted one minute. In another instance, BWC was billed for a 20 – 30 minute psychotherapy session that video showed lasted three and a half minutes and consisted primarily of discussions about the economy.

After the undercover operation concluded, investigators conducted interviews with Nalluri’s employees and patients. A number of patients reported the services they received were less than adequate and often lasted just enough time for Nalluri to write a prescription.

Additionally, an expert witness who reviewed the video and documentation reported sub-optimal treatment that did not meet the standard of care. The expert reported Nalluri falsified documents to obtain payment from BWC and failed to justify the prescriptions he wrote for the agent.

Nalluri was indicted in March and pleaded guilty to workers’ compensation fraud December 13. He paid $71,669.62 in restitution and investigative costs. He was also voluntarily decertified as a BWC provider.

To report suspected workers’ compensation fraud, call 1-800-OHIOBWC, visit ohiobwc.com, or visit http://www.facebook.com/ohiobwcfraud.

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BWC investigations result in 15 workers’ comp fraud convictions in November

December 17, 2012 2 comments

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced 15 individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during November. The court actions are the result of investigations conducted by BWC’s special investigations department (SID). The department works to deter, detect, investigate and prosecute workers’ compensation fraud.

“Another 15 closed cases that will put an end to fraud and return employer dollars toward their intended purpose of assisting Ohio’s injured workers,” said Buehrer. “BWC will continue our focus in the new year on putting an end to fraud of any kind that diverts dollars from the care of injured workers.”

A sampling of the cases that resulted in a guilty plea or conviction during November follows.

Michael Paulsen (St. Louisville, Licking County) pleaded guilty November 14 to a felony count of workers’ compensation fraud for working while receiving benefits. SID received information indicating Paulsen was receiving wages from two businesses during periods he was receiving Working Wage Loss benefits. Paulsen was required to report all of his earnings to BWC in order to receive this type of benefit. The investigation confirmed that Paulsen was employed by both companies and he knowingly failed to report his earnings to BWC. Paulsen was sentenced to six months of incarceration, suspended for one year of community control if he pays $11,554.87 in restitution. He must also pay court costs and maintain viable employment.

Randall Willett (Zanesville, Muskingum County) pleaded guilty November 14 to a felony count of workers’ compensation fraud for working while receiving compensation. SID received an allegation from a BWC claims service specialist (CSS) alleging Willett may be operating a concrete business called Willett Concrete. The CSS noted that Willett’s work trucks were reportedly visible at his residence and business location. The investigation showed Willett did work on various concrete and construction projects during periods he was receiving Temporary Total and Living Maintenance benefits. Willett entered his guilty plea and will be required to pay BWC $9,570 in restitution. The judge ordered a pre-sentencing investigation and scheduled sentencing for January 17, 2013.

Eric Harris (Bradford, Massachusetts) pleaded guilty November 5 to a misdemeanor count of workers’ compensation fraud for filing a false claim. SID received an allegation that Harris had informed his employer he was taking an extended vacation and asked to be “laid off” in order to collect unemployment benefits as the company did not have paid vacation leave. When the employer refused, he then stated that he would file a workplace injury claim to collect benefits. Harris did file a claim indicating he had been injured in a work related incident. Investigators examined the employer’s payroll records, which revealed Harris was not working on the alleged date of injury. Harris was sentenced to six months of incarceration, suspended for two years of community control if he pays BWC $1,360.99 in investigative costs. Harris did make that payment but will face the six month of sentence if he is convicted of any crime during his two years of community control.

Christopher Wilson, dba, Fostoria Monument Company LLC (Fostoria, Hancock County) pleaded guilty November 15 to one misdemeanor count of attempted workers’ compensation fraud for underreporting payroll. SID received an allegation from a BWC auditor that payroll reports filed by Fostoria Monument Company LLC did not include payroll for employees. The employer had been previously audited and placed on notice that all payroll must be reported, however, the office manager, Christopher Wilson, continued to report zero payroll. SID’s employer fraud team interviewed Wilson, who claimed he attended a local conference on workers’ compensation and was advised family members did not need to be reported. Wilson advised he didn’t recall being told that he must report his payroll after the BWC audit but did submit amended payroll reports after speaking with investigators. Wilson was sentenced to six months of incarceration, suspended for five years of probation and 50 hours of community service. He was also ordered to pay $5,999.38 in restitution and investigative costs.

Helen Huntington, dba, Helen’s Sunrise Café Inc., (Mentor on the Lake, Lake County) pleaded guilty November 2 to misdemeanor counts of attempted passing bad checks and attempted workers’ compensation fraud. SID received a referral from the BWC Employer Compliance Department indicating that Huntington, owner of Helen’s Sunrise Café, allowed her policy to lapse and remitted a dishonored payment to BWC. Investigators with the Employer Fraud Team interviewed Huntington and she was given 10 days to rectify the dishonored payment. Huntington was also advised she needed to submit outstanding payroll reports and either pay the resulting premiums or enter into a payment plan in order to reinstate her policy. Huntington failed to either rectify the bad payment or have her BWC coverage reinstated. Huntington was sentenced to one year of community control and 180 days in the Lake County jail, with 178 days suspended and credit for two days of time served. The court further ordered Huntington to complete 20 hours of community service.

Joann Martin (Cleveland, Cuyahoga County) pleaded guilty November 21 in a Franklin County courtroom to one felony count of workers’ compensation fraud for working while receiving benefits. SID received an allegation from an anonymous source stating Joann Martin was working for a home healthcare agency while receiving BWC benefits. A review of employment records, bank records and client records and statements confirmed he was working while receiving benefits. A Franklin County judge ordered Martin to serve 11 months of incarceration, suspended for five years of probation. Martin previously served twelve days in jail on this matter. The court ordered Martin to pay $39,583.07 in restitution and $2,000 in investigative costs

Ernest Harding (Miamisburg, Montgomery County) pleaded guilty November 26 to two misdemeanor counts of workers’ compensation fraud for filing a false claim. SID received an allegation from his employer that Harding was not working on the date he claimed he was injured on the job. SID’s investigation revealed Harding submitted multiple first reports of injury with conflicting information and dates. Additionally, investigators learned Harding entered the employer’s store on the date of injury while off work and stole money. He injured himself when he fell off a porch later that same day. Harding eventually admitted that he did not injure himself at work but sustained the injury at home. Harding appeared in the Vandalia Municipal Court where he was sentenced to one year of probation and ordered to pay $1,197.41 in restitution.

James Benvenuto (Lima, Allen County) pleaded guilty November 7 to one felony count of workers’ compensation fraud for failing to report wages. SID received an allegation from Benvenuto’s parole officer that he was scrapping metals to provide extra income while receiving workers’ compensation benefits. SID obtained evidence showing Benvenuto was self-employed scrapping metal in the Lima area but failed to report any of his wages to BWC. BWC had already recouped $10,325.43 from Benvenuto and he paid an additional $6,150.50 during his court appearance. The court ordered him to have no new conviction during the next two years.

William Bosstic (Chillicothe, Ross County) pleaded guilty November 13 to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID received an allegation from a BWC claims service specialist and their investigation confirmed Bosstic worked as a self–employed electrician while receiving Temporary Total benefits. The evidence collected revealed Bosstic was an active participant in his daughter’s business, MRB Electric. Bosstic performed work in a supervisory capacity at times and also personally performed the electrical work while receiving benefits. The court suspended Bosstic’s sentence based on his guilty plea and payment of $3,563.90 in restitution.

David Esarco, DC (Boardman, Mahoning County) pleaded guilty November 15 to one felony count of workers’ compensation fraud for billing for services not rendered. (SID) opened in an investigation into David Esarco after receiving information he was billing BWC for services he was not providing and billing for dates when injured workers were never scheduled for an office visit. SID conducted a search warrant after several interviews and surveillance supported the allegation. An undercover operative posed as a patient and Esarco later billed for services he never provided and billed on dates when the operative never had a scheduled office visit. Esarco He was ordered to pay restitution of $55,577.65 and $20,000 for investigative costs. He also agreed to voluntarily decertification as a BWC provider. Esarco has paid the full amount totaling $75,577.65. David Esarco’s brother, Dr. John Esarco, was already decertified as a BWC provider after pleading guilty last year fraud for similar offenses. John Esarco pleaded guilty in August 2011. He was sentenced to a six month suspended jail sentence, and ordered to pay restitution of $44,184.80. Esarco also signed a voluntary BWC decertification letter and repaid the full amount.

Michael Dickerson (Columbus, Franklin County) pleaded guilty November 14 to one felony count of workers’ compensation fraud for working while receiving benefits. SID received an anonymous allegation that Dickerson was operating a lawn care business while receiving workers’ compensation benefits following a workplace injury. The allegation also indicated Dickerson was asking his customers to pay him in cash so he would not be traced by BWC. SID conducted surveillance on multiple occasions and observed Dickerson using a push mower, riding mower, leaf blower and weed trimmer at residential, retail and church properties. This work activity all occurred while Dickerson was receiving Permanent Total Disability. Dickerson was sentenced to 12 months in prison, suspended for a three year period of community control. He was also ordered to pay $18,673.06 in restitution and $10,000 in investigation costs. Surveillance video is available here.

To report suspected workers’ compensation fraud, call 1-800-OHIOBWC, visit ohiobwc.com or visit www.facebook.com/ohiobwcfraud.

Probation violation leads to prison for Trotwood home health aide

Clinton McKinney convicted in 2010 for workers’ comp and Medicaid fraud

COLUMBUS – A Trotwood (Montgomery County) home health aide has been sentenced to prison for failing to pay restitution related to a 2010 conviction for workers’ compensation and Medicaid fraud. Clinton McKinney was originally sentenced in 2010 for falsifying the length of time he spent providing care to an injured worker and a Medicaid recipient. He was back in court November 16 and was sentenced to a 22 month term for violating probation.

“Injured workers who need home health care deserve an attentive caregiver who will provide the appropriate care they need,” said BWC Administrator/CEO Steve Buehrer. “BWC also expects those we pay to provide that care to be responsible partners in getting injured workers healthy and back on the job.”

An injured worker alleged McKinney was falsifying the length of time he was spending at the residence. The injured worker reported there were many days McKinney provided far fewer than the required eight hours of care. McKinney reportedly left the residence in the middle of his shift to tend to a Medicaid recipient. He also allegedly forged the injured worker’s signature on the daily timesheets he was required to submit to his employer.

BWC’S Special Investigations Department (SID) conducted a joint investigation with the Ohio Attorney General’s Medicaid Fraud Control Unit. Employment records obtained from the two home health agencies that employed McKinney revealed numerous overlaps in the times he reported to have been caring for both patients. Specifically, there were 180.08 hours in which McKinney reportedly provided care at both residences simultaneously. McKinney also admitted during an interview to falsifying the length of time he spent with the two patients.

“One thing we always know for sure is that a person cannot be in two places at once,” said Attorney General DeWine. “We are glad to work with BWC to investigate fraud and forgery that can harm patients and cost taxpayers and businesses.”

McKinney entered a guilty plea in 2010 to felony counts of workers’ compensation fraud and forgery. Franklin County Judge Sheward sentenced him to five years of probation for each count, court cost and restitution to BWC in the amount of $6,691.67, including $3,000 for investigative costs.

He was also charged for a misdemeanor count of theft in relation to falsifying the time he spent caring for the Medicaid recipient. He was sentenced to five years probation and a 180-day suspended jail sentence. He was also ordered to pay restitution of $4,950.16 to the Ohio Department of Job & Family Services.

McKinney again appeared in court on November 16, 2012 for a revocation hearing. Judge Sheward sentenced him to 11 months in prison on each of the felonies related to the workers’ comp fraud case. The two counts will run consecutive for a total of 22 months. He was also sentenced to 180 days in jail in the Medicaid fraud case.

He was again ordered to pay the $11,412.83 he still owes the Ohio Bureau of Workers’ Compensation (BWC) and Ohio Department of Job and Family Services.

To report suspected workers’ compensation fraud, call 1-800-OHIOBWC, visit ohiobwc.com, or visit http://www.facebook.com/ohiobwcfraud.

Boardman doctor’s workers’ comp fraud conviction second in family

December 10, 2012 3 comments

BWC, Attorney General wrap up cases against Esarco brothers O

COLUMBUS – A Boardman (Mahoning County) doctor is the second in his family to be convicted of workers’ compensation fraud and banned from treating Ohio injured workers. Dr. David Esarco pleaded guilty to workers’ compensation fraud for improper billing practices a year after his brother, Dr. John Esarco, was in court for similar offenses. The Ohio Bureau of Workers’ Compensation (BWC) and the Office of Attorney General Mike DeWine teamed to pursue fraud charges against the brothers, who practiced medicine in the same office. The two have now paid restitution totaling nearly $120,000.

“It is disappointing when a provider commits fraud at the expense of Ohio employers and injured workers in order to pad their paycheck,” said BWC Administrator/CEO Steve Buehrer. “We are pleased they have returned what they owe to the State Insurance Fund, but decertifying them as providers was important to ensuring other injured workers in northeast Ohio receive the quality treatment they deserve from physicians with their best interests in mind.”

BWC’s Special Investigations Department (SID) opened in an investigation into David Esarco after receiving information he was billing BWC for services he was not providing and billing for dates when injured workers were never scheduled for an office visit.
SID conducted a search warrant after several interviews and surveillance supported the allegation. An undercover operative posed as a patient and Esarco later billed for services he never provided and billed on dates when the operative never had a scheduled office visit.

Esarco pleaded guilty to a felony count of workers’ compensation fraud November 15. He was ordered to pay restitution of $55,577.65 and $20,000 for investigative costs. He also agreed to voluntarily decertification as a BWC provider. Esarco has paid the full amount totaling $75,577.65.

“It’s as upsetting as it is illegal when fraud is involved in the medical care of injured workers,” said Attorney General DeWine. “We will continue to work with other agencies, such as the Bureau of Workers’ Compensation, to ensure that billed care is provided, or restitution is made.”

David Esarco’s brother, Dr. John Esarco, was already decertified as a BWC provider after pleading guilty last year fraud for similar offenses. The chiropractor was improperly billing BWC for exercise therapy, a service which he did not perform.

John Esarco pleaded guilty in August 2011. He was sentenced to a six month suspended jail sentence, and ordered to pay restitution of $44,184.80. Esarco also signed a voluntary BWC decertification letter and repaid the full amount.

To report suspected workers’ compensation fraud, call 1-800-OHIOBWC, visit ohiobwc.com, or visit http://www.facebook.com/ohiobwcfraud.