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Archive for April, 2013

Convoy landscaper ordered to pay $18,000 for workers’ comp fraud

???????????????????????????????COLUMBUS – A Convoy (Van Wert County) man was sentenced for working at his landscaping business while receiving Ohio Bureau of Workers’ Compensation (BWC) benefits for a prior workplace injury. Mark Mefferd was ordered to repay more than $18,000 after he was convicted of fraud for improperly collecting those benefits from BWC.

“Mr. Mefferd collected BWC benefits while trimming trees, pulling weeds, planting flowers and spreading mulch,” said BWC Administrator/CEO Steve Buehrer. “We do not tolerate those who try to defraud the workers’ compensation system. Every dollar that is collected to care for injured workers must be used for its intended purpose.”

BWC’s Special Investigations Unit received an allegation that Mefferd may have returned to work while receiving BWC benefits. Evidence indicated that Mefferd continued to operate his business and performed landscaping services for numerous businesses in northwest Ohio. He was receiving temporary total, living maintenance and non-working wage loss benefits while operating the business.

Mefferd pleaded guilty Feb. 28 to one count of workers’ compensation fraud, a fifth-degree felony. He was sentenced April 19 and ordered to pay restitution in the amount of $18,690.63, plus court costs. He was placed on community control for five years and was informed that he will serve 11 months at the Ohio Department of Rehabilitation and Correction if he violates the terms of his community control.

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

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Columbus man owes $16,000 in workers’ comp fraud case

???????????????????????????????Danny McDonald of Columbus (Franklin County) recently pleaded guilty to workers’ compensation fraud and must pay restitution of more than $16,000.  A tip led to an investigation of McDonald and BWC’s Special Investigations Department (SID) found he reported inaccurate wages to BWC to obtain Living Maintenance Wage Loss (LMWL) benefits he was not entitled to receive.  McDonald completed a BWC rehabilitation program in 2008 and began working as a tow truck driver.  In order to receive LMWL, he was supposed to report his bi-weekly earnings from his employer so BWC could pay him the difference between his current earnings and his earnings prior to his industrial injury.  McDonald began reporting earnings that were significantly less than his actual earnings, causing BWC to pay him a higher amount than he was entitled to receive.  McDonald entered his guilty plea April 19.  He was sentenced to three years of community control and ordered to pay restitution in the amount of $16,384.94, in addition to investigative costs totaling $3,312.08.

Former Cleveland man extradited, sentenced for workers’ comp fraud

Miguel SantoniMiguel Santoni (formerly of Cleveland, Cuyahoga County) pleaded guilty April 17 to a fifth-degree felony count of workers’ compensation fraud for working while receiving Temporary Total Disability benefits for a prior workplace injury.

An allegation was received that Santoni filed a new workers’ compensation claim while receiving disability benefits from one of his prior workers’ compensation claims, according to the Ohio Bureau of Workers’ Compensation (BWC) Special Investigations Department (SID). Injured workers are not permitted to work while receiving temporary total disability benefits.

Santoni was indicted in September 2011 on charges of workers’ compensation fraud and theft. After the indictment, it was determined that that he was living in Puerto Rico. BWC’s SID agents worked with the United States Marshals Service to coordinate his arrest. He was arrested Jan. 29 in Puerto Rico and extradited to Franklin County, Ohio.

On April 17, Santoni was convicted of the fifth-degree felony count of workers’ compensation fraud. He was sentenced to serve 90 days in jail and ordered to pay restitution to the BWC in the amount of $5,140.09.

Help us detect fraud

BWC takes fraud very seriously. Since January 2011, the BWC’s fraud department obtained 290 convictions and identified $128 million in savings for the State Insurance Fund. We receive a 6-to-1 return on investment in fraud detection.

Injured workers, providers and employers alike may be involved in fraudulent activity. Keeping fraud at bay helps BWC achieve its goals of providing high-quality care to injured workers and financial stability for Ohio’s employers.

Visit ohiobwc.com to review the red flags that may indicate fraudulent activity.
If you suspect fraud, let us know by filling out our online form or by calling 1-800-OHIOBWC.

Check here for frequent updates about recent fraud cases and other items of interest. Follow us on Twitter @OhioBWCFraud and visit our Facebook page as well!

BWC investigations result in 10 workers’ comp fraud convictions in March

April 16, 2013 2 comments

 Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced 10 individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in March. 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.

“Workers’ compensation benefits support the recovery of Ohio workers who have been injured on the job until they can return to work,” said Buehrer. “From injured workers to employers, Ohio will not stand for any abuse of the system, which only takes resources away from their intended purpose.”

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

John Burgin (Toledo, Lucas County) was found guilty March 5 in the Toledo Municipal Court of attempting to commit an offense, a second degree misdemeanor, for filing a false claim. SID received an allegation that Burgin filed a false claim against the Grand Rapids Club. Investigators found the injury he claimed happened at work actually occurred when he fell through a glass door at home. Additionally, he punched a wall at a hospital two weeks prior to his alleged work injury. Burgin did not immediately seek treatment because he did not have personal medical insurance. Burgin’s case was set for trial in January 2013; however, Burgin left court before the case was called and a bench warrant was issued. Burgin was sentenced to thirty days, suspended, and placed on probation for one year.

Clareta Fisher (Cleveland, Cuyahoga County) pleaded no contest to one count of workers’ compensation fraud for inappropriately receiving wage loss benefits. SID received a fraud referral from a BWC employee indicating Fisher was not reporting all of her work activity and wages in order to receive a higher weekly wage loss benefit. Investigators confirmed that Fisher did fail to properly report all earnings for her work as a licensed practical nurse. Fisher appeared in the Franklin County Municipal Court and sentencing is set for May 29. If she pays restitution of $3,082.03 and $890.90 investigative costs, the judge indicated he would fine her and that would conclude her obligations. However, she will be placed on probation if payment is not made in full.

Dr. Darrell Hall (Toledo, Lucas County) pleaded guilty to one count each of conspiracy to distribute a controlled substance, health care fraud and failure to account for and pay employment tax. SID received multiple allegations that Hall was prescribing an excessive amount of narcotics, prescriptions written by a nurse practitioner, and continuing to prescribe following inconsistent drug screens. BWC’s Health Care Provider fraud team participated with the Drug Enforcement to conduct a search warrant of Hall’s office, EDM Health Services LLC (EDM) in Toledo. Interviews with staff and patients revealed that EDM staff would sell prescriptions, write prescriptions based on pill bottles that a patient brought in, or give patients unsigned prescriptions at one office and direct to take them to where Hall was working in order to get them signed. EDM staff were told to use “hot keys” to create fictitious treatment notes for patients not seen or examined. Hall was sentenced March 25 to five years in prison and ordered to pay $78,113 in restitution to Ohio Medicaid, in addition to $97,384 to the federal government for unpaid payroll taxes.

Dr. Eric Barker (Dayton, Greene County) pleaded guilty to a felony count of workers’ compensation fraud in Franklin County for using the information of another physician in order to receive reimbursement from BWC. SID opened an investigation into the chiropractor after receiving an allegation that Barker was inappropriately utilizing Health Insurance Claim Forms for the treatment of injured workers. Investigators learned the business, located at 1353 Woodman Drive, had been sold to Barker, who was decertified as a BWC provider in 2009 due to a felony conviction. An analysis revealed BWC reimbursed approximately $8,000 to Teeters Chiropractic after that sale for chiropractic manipulation, evaluation and management and consultation services that were in fact rendered by Barker. The bills were submitted using another assigned BWC provider number as a way of circumventing Barker’s exclusion from the workers’ compensation system. Barker was ordered to pay $8,587.57 in restitution, in addition to and $8,000 for investigative costs. He was also sentenced to five years of community control, which will cease once he pays full restitution. He will serve a 12 month prison term if he violates these conditions.

Patsy Krise, dba Sandusky Torching (Holland, Lucas County) pleaded guilty to workers’ compensation fraud March 20 for submitting premium payment checks that were returned due to nonsufficient funds. SID received a referral from BWC Collections after receiving a non-sufficient funds check from Krise, owner of Sandusky Torching. Investigators met with Krise in an attempt to work with her to pay back the more than $1,300 owed, as well as close the policy as the business had been shut down. However, Krise again failed to remit appropriate payment. Krise was ordered to a period of rehabilitation under control and supervision of the Lucas County Adult Probation Department for two years. She was ordered to immediately pay all financial obligations.

???????????????????????????????Carolann Humberston (Howard, Knox County) pleaded guilty March 12 to one count of workers’ comp fraud for working while receiving benefits. BWC’s Intelligence Unit reported that an Ohio Department of Job and Family Services wage cross match indicated that Humberston earned wages from a Columbus business during the same time period she received the BWC funds. The investigation produced evidence that Humberston knowingly worked as a nurse while receiving temporary total disability benefits. Humberston was sentenced to six months in prison, suspended for a year of community control. She was ordered to pay restitution to BWC in the amount of $11,157.03, plus court costs. Humberston presented a check for the entire amount. Community control will end upon payment of court costs.

Ricky Davis (Wellston, Jackson County) pleaded guilty March 18 to workers’ compensation fraud for working while receiving benefits. BWC’s Intelligence Unit received a cross match report from the Public Utilities Commission of Ohio that indicated Davis underwent a commercial vehicle inspection during the time period he was receiving temporary total disability benefits. An investigation revealed he knowingly worked as a commercial truck driver while concurrently collecting Temporary Total disability benefits. He was sentenced to 12 months in prison, suspended for five years of community control. He was also ordered to pay restitution in the amount of $57,533.14, plus investigative costs of $3,201.08.

Mark Wasko (Struthers, Mahoning County) pleaded guilty March 26 in the Franklin County Common Pleas Court to one count of Mark Waskoworkers’ compensation fraud for working while receiving benefits. BWC’s Special Investigations Department (SID) began an investigation after receiving an allegation about Wasko from a state agency computer cross-match. Documented evidence supported the allegation that Wasko returned to work as a truck driver while receiving the temporary total disability benefits. SID personnel conducted interviews and analyzed financial records, and Wasko confessed to working while receiving the benefits. Franklin County Judge Richard Sheward sentenced Wasko to a suspended 180 days in jail, and ordered him to pay restitution in the amount of $8,622.06 by Sept. 26. Wasko deposited $5,600 at the clerk’s office to be used toward restitution.

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

Truck driver sentenced for workers’ comp fraud, ordered to pay $8,600

April 16, 2013 Leave a comment

COLUMBUS – A Struthers (Mahoning County) man was sentenced for working as a truck driver while receiving funds from the Ohio Bureau of Workers’ Compensation (BWC) for a prior workplace injury. Mark Wasko was sentenced March 26 and ordered to repay more than $8,600 he improperly collected from the BWC.

“Ohio has demonstrated once again it will not tolerate those who try to defraud its workers’ compensation system,” said Steve Buehrer, BWC CEO/Administrator. “BWC and its partners will continue to work together to aggressively seek out and report false claims to save money and ensure that law-abiding injured workers receive their benefits in a timely manner.”

The BWC’s Special Investigations Department (SID) began an investigation after receiving an allegation about Wasko from a state agency computer cross-match. Documented evidence supported the allegation that Wasko returned to work as a truck driver while receiving the temporary total disability benefits. SID personnel conducted interviews and analyzed financial records, and Wasko confessed to working while receiving the benefits.

Wasko pleaded guilty March 26 in the Franklin County Common Pleas Court to one count of workers’ compensation fraud, a first-degree misdemeanor. Judge Richard Sheward sentenced Wasko to a suspended 180 days in jail, and ordered him to pay restitution in the amount of $8,622.06 by Sept. 26. Wasko deposited $5,600 at the clerk’s office to be used toward restitution.

Since January 2011, the BWC’s fraud department obtained nearly 300 convictions and identified more than $121 million in savings for the State Insurance Fund. BWC receives a 6-to-1 return on investment in fraud detection.

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

Cuyahoga Falls truck driver sentenced for workers’ comp fraud

April 16, 2013 1 comment

COLUMBUS – A Cuyahoga Falls (Summit County) man was sentenced for continuing to work as a truck driver while receiving workers’ compensation benefits for a prior workplace injury. James Lee was sentenced in the Summit County Court of Common Pleas and must repay close to $70,000 he improperly collected from the Ohio Bureau of Workers’ Compensation (BWC).

OLYMPUS DIGITAL CAMERA“Mr. Lee engaged in the same type of work as before becoming injured while receiving Temporary Total Disability benefits,” said BWC Administrator/CEO Steve Buehrer. “He pocketed a large sum of money that wasn’t rightfully his, and thanks to our investigators and our Fraud Hotline, he’s returning that money, so BWC can provide compensation and medical care to truly injured workers.”

Temporary total disability benefits are typically the first form of compensation awarded during injured workers’ recoveries from work-related injuries. Injured workers cannot work while receiving temporary total disability payments.

The BWC Fraud Hotline received an allegation that Lee worked since the time of his injury and drove a truck for three different businesses. Investigators found that Lee continued to be employed as a truck driver between 2006 and 2010 while receiving temporary total disability benefits.

Lee pleaded guilty to theft by deception, a fifth-degree felony, on March 11 and was sentenced the same day. He received 12 months in jail, suspended for three years of community control. Under the terms of Lee’s probation, he must pay restitution to BWC in the amount of $69,604.57, plus court costs. He was also ordered not to drive tractor-trailers.

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