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Archive for May, 2013

Social media helps secure conviction of Port Clinton woman committing workers’ comp fraud

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COLUMBUS – Kelley Wheeler of Port Clinton (Ottawa County) pleaded guilty to workers’ compensation fraud after her Facebook postings helped prove she was working while collecting benefits for a workplace injury.  Wheeler pleaded guilty May 16 in a Franklin County courtroom and was ordered to repay more than $61,000 she collected inappropriately.

“As social media has grown, BWC investigators have deployed enhanced analysis of these sites to support our investigations,” said BWC Administrator/CEO Steve Buehrer. “Our fraud team has proven very resourceful when it comes to ensuring dishonest employers, workers and providers do not escape detection.”

Wheeler was receiving working wage loss, which is available to injured workers who have found work other than their former position but receive less in pay than they did at the time of injury. BWC’s Special Investigations Department (SID) opened an investigation after receiving an allegation from a BWC claims services specialist who became suspicious of the employment documentation Wheeler submitted in order to qualify for these benefits.

The investigation showed Wheeler submitted 64 different false payroll documents indicating she worked at a Travelers Transport in Port Clinton, a business that never existed. Investigators found Wheeler created timesheets and submitted them to BWC to qualify for benefits. Investigators also found she was employed at Purrfect Paws Grooming Boutique in Sandusky and failed to report those wages, which were necessary to properly calculate her benefits.

SID’s Digital Forensics Team was also able to obtain photos and postings from the Wheeler’s Facebook page showing her while working at Purrfect Paws.  Additional postings and pictures from the Purrfect Paws Facebook page showed Wheeler at work during a period she was receiving disability.

Wheeler was interviewed and admitted the payroll documents she submitted from Travelers Transport were false, and she purposely did not report her earnings from Purrfect Paws.  She acknowledged knowing what she was doing was wrong but was did not want to lose the benefits.   

A judge ordered Wheeler to pay restitution totaling $61,213.72, in addition to a $500 fine and court costs, as well as 17 months of incarceration, suspended for five years of community control. 

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

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Surveillance video shows Cincinnati man committing workers’ comp fraud

A Cincinnati man who was the subject of an undercover investigation by the Ohio Bureau of Workers’ Compensation (BWC) has been sentenced for working while receiving benefits for a prior workplace injury. Michael Gundling was sentenced April 11 and has returned more than $3,000 to BWC.

“Our fraud agents captured video of Mr. Gundling driving a dump truck to work sites for a trucking company,” said BWC Administrator/CEO Steve Buehrer. “Injured workers are not permitted to work while receiving these funds, as Mr. Gundling did. That money will now be used for its intended purpose: to care for injured workers who cannot work.”

BWC’s Special Investigations Department started an investigation after receiving a tip that Gundling was working while receiving temporary total disability. Investigators found that Gundling collected these funds while simultaneously working as a dump truck driver between March 5, 2012 and June 2, 2012. Gundling was caught on camera working and admitted to committing fraud when investigators approached him on the job site.

Gundling appeared in the Franklin County Court of Common Pleas April 11 and entered a plea of guilty to one misdemeanor count of workers’ compensation fraud. He was given a suspended sentence of 60 days in jail as well as a $150 fine and court costs. The sentence was suspended on the condition that Gundling remain conviction-free for the next two years.

Gundling returned the $3,321.39 back to the BWC prior to the sentencing.

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

Coshocton woman pays restitution following workers’ comp fraud conviction

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BWC’s Special Investigations Department began an investigation into Ruth Brock of Coshocton (Coshocton County) after receiving an allegation that she was not truthful with BWC about job search activities, enabling her to continue receiving workers’ compensation benefits.

Brock 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.

The investigation showed Brock knowingly misrepresented her job searches to BWC in order to continue receiving these benefits.  Investigators reviewed the job searches Brock submitted and did not find a single business that had an application on file for her.  She was also submitting the forms with future dates in order to ensure an uninterrupted income stream. 

Brock pleaded guilty May 14 to one misdemeanor count of workers compensation fraud. The judge ordered $1,092.76 in restitution, and Brock paid in full.  She was also sentenced to one day in jail, suspended for time served.

BWC investigations result in 12 workers’ comp fraud convictions in April

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced 12 individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in April. 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.

“Their pleas to charges against them indicate they knew their actions were wrong,” said Buehrer.  “Ohio employers and workers surely know better than to exploit the system in place to protect those hurt on the job, but some of them will make an attempt regardless, and our dedicated team of investigators will be there to put an end to it.” 

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

Trista Blose, dba Bolivar Pizza (Bolivar, Tuscarawas County) pleaded no contest April 8 in the Tuscarawas County Court of Common Pleas to one felony count of workers’ compensation fraud for allowing her coverage to lapse. SID received an allegation from BWC’s employer compliance department indicating Blose operated Bolivar Pizza in Bolivar without a valid policy. The employer fraud team conducted an investigation and interviewed Blose.  As a result of the investigation, Blose submitted outstanding payroll reports but failed to pay the premiums owed. As a result of the no contest plea, the court placed Blose in the Community Corrections Felony Diversion Program for a minimum of six months and a maximum of one year supervision.

Lawrence Blakeley (Van Wert, Van Wert County) pleaded guilty April 3 to nine felony counts of deception to obtain drugs, felonies of the fifth degree and one misdemeanor count of workers’ compensation fraud. SID found Blakeley deceptively obtained multiple narcotics from two physicians from January 2012 to September 2012. Blakeley admitted to agents that he did not disclose to either doctor that he received narcotics from the other doctor as he was concerned the doctors would stop prescribing the narcotics. Blakeley appeared in the Van Wert County Court of Common Pleas and was placed on community control supervision for one year and ordered to participate in drug treatment. He must also pay $774.29 in restitution and $1,238.87 in investigative costs.

Montoan Butler (Richmond, Indiana) pleaded no contest April 19 in the Franklin County Court of Common Pleas to one felony count of workers’ compensation fraud for working while receiving benefits. SID initiated an investigation after a data cross match revealed an employer reported wages while Butler collected benefits for a workplace injury. The investigation found Butler worked as an admissions counselor at Earlham College in Richmond, Ind. while receiving temporary total disability benefits. Butler was found guilty.  Sentencing is scheduled for June 5.

Julie Hiestand (New Weston, Darke County) was convicted April 23 of one felony count of forgery for altering documents to continue receiving workers’ compensation benefits. SID received an allegation that Hiestand had altered a BWC form in attempt to show a longer disability period.  The investigation found Hiestand altered the ending date of her total disability period on a physician’s report of work ability form and submitted it to her employer. SID obtained the original document and the altered document during the investigation. Hiestand admitted to changing the date on the form. However, she denied doing it to secure additional benefits she was not entitled to receive. Sentencing is scheduled for June 17.

Larry Duncan (Cleveland, Cuyahoga County) pleaded guilty April 1 to one felony count of workers’ compensation fraud for working while receiving benefits. SID received an allegation from an anonymous source who said Duncan was receiving injured worker benefits. In addition, the source reported Duncan had moved all of his welding equipment back into his garage from a warehouse that he had rented to do welding jobs. Investigators confirmed through bank records and customer interviews that Duncan was self-employed. He operated a welding business and performed paid welding services. Duncan appeared in the Franklin County Court of Common Pleas and was sentenced to 12 months incarceration, suspended for three years of community control. Terms of his community control include payment $25,000 in restitution, including $5,000 for investigative costs, random drug screens, verifiable employment and payment of court costs.

Miguel Santoni (Cleveland, Cuyahoga County) was convicted April 17 on one felony count of workers’ compensation fraud for working while receiving benefits. SID received an allegation that Santoni (formerly of Cleveland) filed a new workers’ compensation claim while receiving temporary total disability benefits from a previous workers’ compensation claim. The investigation found Area Temps employed Santoni from August 2009 to February 2010 while receiving BWC benefits.  Santoni was living in Puerto Rico, and BWC agents worked with the United States Marshals Service to coordinate his arrest. Santoni was arrested on Jan. 29 and extradited to Franklin County. Santoni was sentenced to serve 90 days in jail and ordered to pay $5,140.09 in restitution.

Danny McDonald (Columbus, Franklin County) pleaded guilty April 19 to one felony count of workers’ compensation fraud for falsifying wages. A tip led to an investigation of McDonald, and SID found he reported inaccurate wages to BWC to obtain living maintenance wage loss benefits he was not entitled to receive. McDonald completed a BWC rehabilitation program in 2008 and began working as a tow truck driver. To receive these benefits, he was supposed to report his bi-weekly earnings from his employer. This would allow BWC to 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 was sentenced in Franklin County to six months in prison, suspended for a three year period of community control. He must also pay $16,384.94 in restitution in addition to investigative costs of $3,312.08.

Dale Reed (Mason, Montgomery County) pleaded guilty April 29 to one felony count of workers’ compensation fraud for working while receiving benefits. BWC’s intelligence unit completed a cross match with the Public Utilities Commission of Ohio and found Reed received a commercial vehicle inspection while operating a vehicle for Scheiderer Transport. The unit completed the inspection during the same period Reed was receiving temporary total disability benefits. The investigation confirmed that Reed knowingly worked as a truck driver and was paid wages while he received these benefits. Reed appeared in a Franklin County courtroom and was ordered to pay $9,042.43 in restitution in addition to court costs. Reed presented a check for $9,042.43 and informed the court that he would pay court cost. The court imposed a 30-day jail sentence, suspended for 10 days in order to allow Reed to pay court costs.

Rodger Jones (Cleveland, Cuyahoga County) pleaded guilty April 2 in the Franklin County Court of Common Pleas to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. A tip on the BWC Fraud Hotline alleged Jones worked as a tow truck driver while receiving compensation from BWC. Through employment records and interviews, investigators found Jones returned to employment as a light service tow truck driver while receiving temporary total and living maintenance benefits. When investigators interviewed Jones, he admitted to responding to a vehicle service call at the BWC Garfield Heights Service Office while receiving compensation and thought he might be doing something wrong. Therefore, he quit working shortly afterward. Jones was sentenced to 180 days in jail, suspended for two years of community control, and was ordered to repay $1,320.93 in restitution and $500 investigative costs.

Bruno Sestito (Berea, Cuyahoga County) pleaded guilty April 4 in a Franklin County courtroom to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID received an allegation that Sestito worked at his wife’s tanning salon, Hang Tan, located in Columbia Township. The investigation found Sestito participated in all aspects of the operation of Hang Tan, including opening the business, selling tans, providing receipts, assisting customers, receiving phone calls, writing checks, paying bills, operating equipment, cleaning and maintaining equipment. Sestito collected temporary total disability benefits while working for Hang Tan. Sestito was ordered to repay $4,792.03. He submitted a check for the entire amount during the hearing.

Cheryl Horvath (Bedford, Cuyahoga County) pleaded guilty April 8 in the Franklin County Court of Common Pleas to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID’s intelligence unit identified Horvath as possibly working from a cross match with the Ohio Department of Jobs and Family Services.  Employment records confirmed t Horvath worked as a Pet Training Associate/Clerk while receiving temporary total disability benefits. Horvath received a suspended jail sentence of 30 days of jail, and must pay $4,171.73 in court costs and restitution by Aug. 1, or the judge will impose the prison term. Horvath had already spent six days in jail after his arrest on a warrant related to the fraud charges.

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

Marion doctor to repay $150,000 for fraudulent workers’ comp bills

MARION – A Marion psychiatrist agreed to repay the Ohio Bureau of Workers’ Compensation (BWC) for improperly billing the agency for more than 1,100 psychotherapy sessions conducted by under-qualified staff members. Dr. Joseph Spare and the Marion Independent Physicians Association (MIPA), of which Spare is a member, agreed to repay BWC $150,000 to cover the overpayment and investigative costs.

“Dr. Spare billed the BWC for a much higher number of services than his peers, and we took notice of that,” said BWC Administrator/CEO Steve Buehrer. “When people think of workers’ compensation fraud, they often picture injured workers. However, workers’ compensation fraud can and does include employers and providers. We’re committed to bringing anyone who commits fraudulent activity to justice.”

The BWC’s Intelligence Unit detected that Spare was billing for a large number of counseling and medication management sessions. BWC received bills indicating Spare performed both services for each session, but the Special Investigations Department’s Healthcare Provider Fraud Team found the counseling sessions were actually being performed by three of his staff members, MIPA employees who weren’t licensed to provide counseling. Dr. Spare was only checking the patients’ medication at the end of their counseling sessions.

The three under qualified MIPA personnel conducted more than 1,100 psychotherapy sessions between January 2004 and August 2007. As a result of using these improperly-licensed staff to perform counseling services, Spare’s office was able to see more patients per day, generating more revenue than it was entitled to receive.

The matter was settled outside of court after the Ohio Attorney General’s Office filed a civil suit in Marion County Common Pleas Court; Spare and MIPA were named as defendants. BWC was fraudulently billed a total of $74,667.68. Reimbursements for the services Spare rendered were paid to MIPA.

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