Archive

Archive for January, 2013

Coshocton man guilty of workers’ comp fraud

Klein operated his own business while receiving benefits

COLUMBUS – Jason O. Klein of Coshocton (Coshocton County) pleaded guilty to workers’ compensation fraud after the Ohio Bureau of Workers’ Compensation (BWC) received two complaints about him on its anonymous fraud hotline. Klein appeared before Judge Pollitt in the Franklin County Municipal Court and was ordered to repay $2,040 for operating his own business while he was supposed to be recovering from a workplace injury.

“The fact that BWC received two separate tips on Mr. Klein’s activity provides evidence not only that many people won’t sit by idly and allow cheating,” said BWC Administrator/CEO Steve Buehrer. “BWC’s fraud hotline is a convenient way to anonymously help us uncover fraud that siphons employer premium dollars away from the care of those who legitimately need assistance following a workplace injury.”

BWC received a tip on its fraud hotline indicating Klein was selling equipment for natural gas pumps while he was supposed to be off work recovering from a workplace injury. A second caller alleged Klein was operating his own business called KBI Services and was hauling water, plowing snow and performing natural gas conversions.

Agents with BWC’s Special Investigations Department (SID) opened an investigation. A review of bank records and interviews with witnesses confirmed that Klein knowingly owned and operated KBI Services during periods he received Temporary Total and Living Maintenance compensation. An injured worker cannot work and receive these payments.

Klein pleaded guilty to one misdemeanor count of workers’ compensation fraud and was ordered to pay $2,040 in restitution and court costs of $250. He also received a ten day suspended jail sentence.

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

BWC investigations result in 11 workers’ comp fraud convictions in December

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced 11 individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during December. 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.

“Our investigators wrapped up 2012 with 125 convictions of employers, injured workers, providers, and others who committed fraud against the State Insurance Fund,” said Buehrer. “Their work helps keep employers from having to cover the cost of fraudulent claims, non-payment of premium, illegal billing, or any other illicit schemes designed to cheat the system.”

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

Eric Renzhofer, dba ARS Construction Inc., (Bowling Green, Wood County) was found guilty Dec. 3 of workers’ compensation fraud for altering his coverage certificate. SID received an allegation from a premium auditor that Renzhofer may be altering a certificate of coverage. While conducting an audit on an unrelated case, the auditor noticed the policy number listed did not match ARS Construction, Inc. The Employer Fraud team investigation found that Renzhofer altered a certificate belonging to another business to make it appear that his business (ARS Construction) had active coverage. Renzhofer confessed to altering the certificate and cooperated by providing business records to determine the premiums he owed. Renzhofer was ordered to pay fines of $250 and restitution.

Eugene Vaughn (Spencer, Medina County) was found guilty Dec. 28 on five felony counts of deception to obtain a dangerous drug after he was discovered doctor shopping. A pharmacy contacted SID and advised that Vaughn was receiving prescriptions from multiple insurers, including BWC. SID worked with the Medina County Drug Task Force on the investigation, which found Vaughn obtained narcotics from different doctors during the same prescription cycle, including prescription drugs paid by BWC. Vaughn also used multiple pharmacies to fill these prescriptions. Vaughn was sentenced in the Medina County Common Pleas Court to three years general supervision by the Adult Parole Authority, drug screening, and continued drug treatment. Vaughn’s driver’s license was suspended for six months with work privileges upon request. He must have only one prescribing doctor with those prescriptions verified by Adult Parole Authority.

Victor Figueroa (Columbus, Franklin County) pleaded guilty Dec. 13 to one count of workers’ compensation fraud for working while receiving benefits. SID’s Intelligence Unit detected that Figueroa was earning wages from multiple employers during periods he was collecting Temporary Total disability benefits from BWC. The investigation found Figueroa worked for Fairfield Insulation and Qualiteck, Inc. while collecting these benefits. Figueroa was ordered to pay restitution of $9,653.70 and he paid in full at the sentencing. He was also sentenced to one day in jail, suspended for time served.

Danny Albert (Columbus, Franklin County) pleaded guilty Dec. 17 to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID received an allegation that Albert was working for Southeast Mental Health as a Resident Specialist while he was receiving benefits and was prohibited from working. The investigation found Albert was in fact employed with Southeast, Inc, and Stevens Building Services while receiving Living Maintenance and Temporary Total benefits. Evidence obtained during the investigation also showed that Albert intentionally misrepresented and withheld employment activity in order to continue collecting these benefits. Albert was sentenced to 180 days in jail, suspended for 12 months of community control, and ordered to pay $7,051.75 in restitution.

Sheldon Greene (Middletown, Butler County) pleaded guilty Dec. 6 to one felony count of workers’ compensation fraud for working while receiving benefits. SID received an allegation that Greene had returned to work at Michael’s Dining and Jazz restaurant in Dayton. The investigation found Greene was working at Michael’s Dining and Jazz restaurant as a chef and was operating his own catering company, Liberty City BBQ, in the Cincinnati and Dayton areas while receiving BWC disability benefits. Greene appeared in the Franklin County Court of Common Pleas and the judge terminated the case after he repaid BWC $9,992.28.

Jerry Adams, dba Quaker Pool & Spa, (Calcutta, Columbiana) was found guilty Dec. 13 of one felony count of fraud for allowing his workers’ compensation insurance coverage to lapse. BWC’s Employer Compliance Department attempted to work with Adams, owner of Quaker Pool & Spa, after he allowed his coverage to lapse. After multiple attempts, Adams still failed to submit outstanding payroll reports and the case was turned over to SID for a fraud investigation. Employer fraud team agents met with Adams and his accountant on multiple occasions and facilitated the receipt of all but one of the outstanding payroll reports. Adams was given instructions on how to request a payment plan in order to get the policy reinstated. However, Adams again failed to follow through. Adams paid $4,226.34 as a down payment and signed a Payment Plan with the Attorney General’s Special Counsel agreeing to pay the remaining balance of $11,495.50 over the course of the next year. His sentencing is scheduled for February 21, 2013.

Anil Nalluri, MD (Youngstown, Mahoning County) pleaded guilty Dec. 13 to one misdemeanor count of workers’ compensation fraud for billing for services not rendered. 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. Nalluri was 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.

Video of Mercer County man lifting weights puts an end to his workers’ comp benefits

COLUMBUS – A Celina (Mercer County) man has been sentenced for workers’ compensation fraud after investigators with the Ohio Bureau of Workers’ Compensation (BWC) captured undercover video contradicting his claim that he couldn’t lift more than 10 pounds.  The video of Jason Dross bench pressing more than 500 pounds at the Celina YMCA garnered a guilty plea and he has been ordered to repay BWC more than $30,000.

“Many do have a difficult time finding employment when an injury has left them with certain physical restrictions,” said BWC Administrator/CEO Steve Buehrer. “However, this video makes it very clear that Mr. Dross was not being truthful about his restrictions and he has now been ordered to repay the funds that he received deceptively.”

Dross was receiving non-working wage loss, which is payable to injured workers who are unable to find suitable employment   In order to qualify, the injured worker must demonstrate a good faith effort to secure employment within physical restrictions. Dross claimed he was looking for work but was having difficulties because he could not find a job that would not require him to lift more than 10 pounds.O

BWC’s Special Investigations Department (SID) began investigating after receiving an allegation that Dross was engaged in heavy weightlifting at the Celina YMCA.  Agents conducted numerous undercover operations inside the YMCA and obtained the video of Dross bench pressing more than 500 pounds consistently over a period of one month.  The video was captured during the time he was misrepresenting his physical capabilities to BWC and his physician.

Dross pleaded guilty Nov. 29 to one felony count of workers’ compensation fraud.  He was sentenced today in the Franklin County Court of Common Pleas to nine months in jail, suspended for three years of community control under the conditions that he maintain employment and pay restitution in the amount of $31,736.98.

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

Meigs County business owner sentenced for workers’ comp fraud

COLUMBUS – A Middleport (Meigs County) man has been sentenced in Franklin County for working while receiving workers’ compensation benefits for a prior workplace injury.  Charles Morris, Jr. was sentenced last week and must repay nearly $30,000 he improperly collected from the Ohio Bureau of Workers’ Compensation (BWC).O

“Mr. Morris was free to continue ownership of his business but actually doing the work of an HVAC technician was prohibited and calls into question whether he needed these benefits in the first place,” said BWC Administrator/CEO Steve Buehrer. “The amount he collected while supposedly unable to work was significant, and should have been reserved for injured workers who are actually unable to work.”

Morris was receiving Temporary Total Disability benefits, which is usually the first form of compensation awarded during an injured worker’s recovery from a work-related injury. An injured worker cannot work and receive temporary total disability payments.

BWC’s Special Investigations Division (SID) received an allegation that Morris was working as the owner/operator of Chuck’s Heating and Cooling while on Temporary Total Disability.  Investigators found Morris was performing work as an HVAC technician.  A review of his bank records identified numerous customers who confirmed they hired and paid Morris for HVAC work he completed himself.

Morris pleaded guilty Nov. 6 and was sentenced Jan. 3 in the Franklin County Court of Common Pleas.  Judge Sheeren ordered him to pay restitution and investigation cost in the amount of $29.415.27, as well as court costs.  He also received a prison sentence of nine months, suspended for a three year period of community control. 

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