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Archive for August, 2013

Celebrating 20 Years: How SID stays fresh

August 30, 2013 Leave a comment

In honor of our 20th anniversary of the BWC’s Special Investigations Department (SID), we welcome you to the second of a three-part series of blog posts outlining the history of the department, its current offerings and its future goals. We welcome your thoughts and comments!

SID agents, analysts, and supervisors are constantly training both internally and externally to improve and develop new skills.

The department also adapted itself to a myriad legal, technological, and social changes in order to better protect Ohio’s workers and employers, including BWC’s own employees. Think of it this way: SID began in 1993, before the existence of tools like Google, which was founded in 1998, and Facebook, which was founded in 2004.

While much has changed over the last 20 years – from the digital revolution to more sophisticated methods of committing crimes – the mission of SID remains the same: to effectively and proactively prevent losses to the workers’ compensation system and to deter, detect, investigate, and prosecute worker’s compensation fraud. As SID reflects on the past 20 years of service to Ohio, we also find it important to address not only the whole, but also the sum of its parts. Each year, the SID analyzes the effectiveness of its investigations.

Back in 2007, Senate Bill 7 designated the SID as a criminal justice agency, which allowed for cooperation with other state and law enforcement agencies and the strengthening of fraud statutes and sanctions.

With technology forecasting showing the growth of mobile “smart” devices and cloud computing, the SID expanded its Digital Forensics Unit by securing new technology and training to allow for digital analysis of evidence. In the social climate of 2013, the SID security team is committed to education and protection by holding active shooter presentations for all of its employees as well as conducting thorough risk assessments for any threat.

Stay tuned for our third and final post in this series about SID’s future goals.

Categories: SID Information

Ohio man ran tattoo shop while on workers’ comp

August 27, 2013 1 comment

COLUMBUS – A former Columbiana (Columbiana/Mahoning Counties) man was sentenced recently for running a tattoo shop in Pennsylvania while receiving benefits from the Ohio Bureau of Workers’ Compensation (BWC) following a workplace injury. Randy Bartosh pleaded guilty in Franklin County August 15 after repaying more than $4,500.

Randy Bartosh

Randy Bartosh

“Opening a small business is an admirable endeavor, but it is unfortunate Mr. Bartosh chose to do so at a time when he knew his work would conflict with workers’ compensation benefits,” said BWC Administrator/CEO Steve Buehrer.

BWC’s Special Investigations Department opened an investigation after a confidential source contacted the fraud hotline advising Randy Bartosh was engaging physical activity inconsistent with his complaints to doctors in his workers’ compensation claim. Bartosh was receiving the benefits for an injury that occurred while working for Zarbana Industries in Columbiana.

Investigators conducted social media searches, undercover operations and obtained bank records discovering that Bartosh opened in fact owned a tattoo shop called 213’s Tattoo U in Coraopolis, Pennsylvania while receiving temporary total disability benefits. Bartosh tattooed customers, and managed business and marketing operations.

The Ohio Industrial Commission found Bartosh was overpaid and ordered him to return $4541.70, which has since been repaid to BWC. Additionally, Bartosh pleaded guilty to one count of workers’ compensation fraud and one count of theft. A Franklin County Court of Common Pleas judge ordered him to pay a $100 fine.

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

Annual report highlights SID activities in the last year

August 23, 2013 Leave a comment

SID FY 2013 Annual ReportSID recently published its annual report for fiscal year (FY) 2013. The report reflects and reviews recent performance statistics, ongoing trends, as well as future strategies for preventing and detecting fraud.

We are pleased to report that SID identified $55 million in savings during FY 2013. Among the more than 2,000 cases that were closed, 915 were founded, meaning the original allegation was proven. The average savings identified among the 915 cases was more than $60,000. 236 of these cases were referred for prosecution, resulting in 134 indictments and 140 convictions to date. These 140 convictions were a 14 percent increase over last year. Additionally, SID received more than 3,300 allegations and teams are currently investigating approximately 1,000 open cases.

During the last twelve months, SID staff members remained tuned to emerging trends that affect their work, such as the rise in prescription fraud. The department also creatively utilized available resources such as social media and data digital forensics to root out otherwise undetected fraudulent activity and bring public attention to combating wrongdoing. This resourcefulness and persistence is prevalent in the work of each SID team and reflects the department’s commitment to protecting the Ohio State Insurance Fund. The FY 2013 fraud report includes information about these efforts and the condition of workers’ compensation fraud in Ohio.

Furthermore, the conclusion of FY 2013 also brings to a conclusion the third five-year SID strategic plan. The results of this level of planning are responsible for the success SID experienced in this past fiscal year. Comparatively, SID achieved:

  • The lowest number of cases open at year end;
  • The highest number of terabytes of data processed by Digital Forensics Unit;
  • Second lowest number of investigative lag days per closed case in the past five years;
  • Second highest number of convictions in the past eight years;
  • Second highest percentage of founded cases referred for criminal prosecution in the past six years; and
  • Second highest savings identified per closed and per founded case in the past six years.

Lastly, the report reviews results since our department’s inception in 1993 – including that we have closed nearly 59,000 cases and identified more than $1.5 billion in savings to the Ohio workers’ compensation system.

Cleveland business owner sentenced for failing to maintain workers’ comp coverage

August 23, 2013 1 comment

Conviction could land Donnie Schilling in jail for 99 years on unrelated drug charges in Texas

CLEVELAND – A Cleveland (Cuyahoga County) man has been sentenced after a jury convicted him of failing to maintain workers’ compensation coverage for his business. Donald L. “Donnie” Schilling, owner of Cleveland Tire & Wheel, was found to be concealing employee payroll figures so he could operate his business without workers’ compensation coverage. Schilling is currently on probation from a drug conviction in Texas and this violation of his probation could result in a sentence there of up to 99 years of incarceration.

“Mr. Schilling’s failure to secure workers’ compensation insurance jeopardizes funds allocated for Ohio workers and employers who follow the law,” said Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer. “BWC is committed to investigating and prosecuting any type of fraud that undermines the care of an injured worker and their ability to return to work.”

BWC’s Special Investigations Department (SID) Employer Fraud Team began investigating Schilling after receiving information that he was operating his business without coverage. Schilling refused to cooperate although he was repeatedly warned by BWC’s Employer Compliance Department of the law requiring workers’ compensation coverage. The Employer Fraud Team then put Schilling on notice but he still failed to obtain a policy while continuing to operate his business and conceal his employee payroll. In addition, three workers’ compensation claims were filed by employees of Cleveland Tire & Wheel costing the State Insurance Fund more than $30,000.

Schilling’s case went to trial and he was found guilty of one felony count of workers’ compensation fraud in the Cuyahoga County Court of Common Pleas. Schilling was sentenced Aug, 22 to 120 days in jail and will serve his time every Monday and Tuesday for 60 weeks beginning Sept. 9. He will also be under the supervision of community control for the next two years. In addition, Schilling will be required within the next 60 days to enter into a payment plan with BWC so he can pay overdue premiums totaling $61,101.59.

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

Celebrating 20 Years: How SID Began

August 23, 2013 Leave a comment

In honor of our 20th anniversary of the BWC’s Special Investigations Department (SID), we welcome you to the first of a three-part series of blog posts outlining the history of the department, its current offerings and its future goals. We welcome your thoughts and comments! 

SID was created in June 1993 to protect the State Insurance Fund by preventing, detecting, and convicting those who commit fraudulent activity. Over the past 20 years, SID identified more than$1.5 billion dollars in savings tDoc12newo the state fund.

Prior to June 1993, fraud detection and investigation existed within BWC and the Ohio Industrial Commission (IC). It was at this time, however, when the department broadened its scope to include Special Investigations Units (SIUs) and officially became the Special Investigations Department. Since then, SID continues to uphold the dual functions of fraud investigation and special investigations. Under the guidance of Ohio criminal fraud statutes found in 2913.48 of the Ohio Revised Code (ORC) put into effect on July 21, 1993, SID is charged with deterring and investigating workers’ compensation fraud. The law made it easier for workers’ compensation crimes to be prosecuted. Previous sections of the ORC were far too general and not specifically written to prohibit this type of fraud.

SID defines its main responsibility as preventing, detecting, investigating, and ultimately prosecuting workers’ compensation fraud. With the development of specialized and innovative teams of employees, SID adopted techniques to support its main goal beyond the typical processes of identifying and investigating fraud allegations.

Significant interagency cooperation has been essential to its success. For example, the Intelligence Unit exchanges data with other agencies, such as the Ohio Department of Job and Family Services, to identify potential claimant fraud as well as the Attorney General to locate subjects with outstanding fraud warrants. Moreover, SID members collaborate with one another through think tank sessions designed to identify fraud red flags. Social media monitoring allows for discreet and easily-accessible fraud identification and investigation.

Stay tuned for our next post about how SID stays one step ahead of fraudsters!

Categories: SID Information

Happy 20th birthday to us!

August 19, 2013 Leave a comment

In June 1993, the Ohio Bureau of Workers’ Compensation (BWC) created its Special Investigations Department (SID) to protect the State Insurance Fund by preventing, detecting, and convicting fraudulent activity.  Since its inception 20 years ago, SID has identified over $1.5 billion dollars in savings to the state fund.

As we begin our New Year—fiscal year 2014, SID and BWC ask our family of stakeholders to join us in our celebration of 20 years of dedicated service to Ohio.

In the coming weeks, we will be featuring a three-part 20th Anniversary series that reflects on SID’s past successes and envisions those yet to come.  Stay tuned for part one of the series which outlines the history of the Special Investigations Department, including some of our most noteworthy cases.

Categories: SID Information

Facebook photos reveal Ohio man fraudulently collecting workers’ comp benefits

August 16, 2013 1 comment

Michael Mallory2COLUMBUS – Michael Mallory, formerly of New Bremen (Auglaize County), pleaded guilty in Franklin Common Pleas Court to workers’ compensation fraud after relocating and posting on Facebook photos of his work for an Arizona employer. Mallory was ordered to pay BWC $7,644.08 in restitution and investigative costs to the Ohio Bureau of Workers’ Compensation (BWC).

“Injured workers are often not permitted to work while receiving workers’ comp benefits,” said BWC Administrator/CEO Steve Buehrer. “This particular case is a clear example of someone who knowingly broke those rules, flaunted his crime, and generated convincing evidence for our investigators to prove his wrongdoing.”

Mallory resided in New Bremen but relocated to Scottsdale, Arizona after he was injured and began collecting benefits. BWC opened an investigation after receiving a tip that Mallory was doing construction work in Arizona while collecting Ohio workers’ compensation benefits.

Michael Mallory1After checking with Arizona state officials, investigators found that Mallory was working for Safety Compliance Services. BWC investigators also found photos of Mallory wearing rappelling gear and doing repelling work on his Facebook page. The company also confirmed that Mallory was employed with them as a rescue technician.

Mallory paid $6,000 at sentencing and was given a six month suspended jail sentence, provided the balance of the restitution and investigative costs are paid by Oct. 13.

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

BWC investigations result in six workers’ comp fraud convictions in July

August 15, 2013 1 comment

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced six individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in July. 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 pursuit of fraud reflects our commitment to ensuring employer premium dollars are being protected, and we are providing care to injured workers so they can return to work,” said Buehrer.  “We will continue to highlight our fraud efforts at every opportunity to promote awareness and deterrence.”

Following is a sampling of the cases that resulted in a guilty plea or conviction during July.

Sarah BarajasSarah Barajas, dba, Bane Specialty Services (Dayton, Montgomery County) entered a diversion program after investigators confirmed she falsified her application for workers’ compensation insurance coverage. SID’s Employer Fraud Team received an anonymous allegation that Bane Specialty Services/David Bane, a temporary employment agency, had been under-reporting payroll premiums. The investigation found Bane Specialty Services canceled its policy effective January 2011, indicating the business had ceased operation. On the same date, David Bane filed his final payroll report indicating he owed BWC premiums of $116,677.12. Bane did not make any payments toward the outstanding premiums. The investigation further found that Bane’s daughter, Sarah Barajas, opened a new policy in November 2010 for Bane and Associates, also a temporary employment agency. The application contained no information on the previous business. The investigation found that not only the location, employees, and services offered were the same for both businesses, but the clients were also the same. Agents interviewed a few clients who confirmed that nothing other than the business name had changed. The Montgomery County grand jury indicted Barajas in March for tampering with records since she was the person who submitted the new application excluding the information of the existing policy. Barajas was allowed to enter into a diversion program for first time offenders on July 9. Diversion is to run 12 months. The outstanding balance due to the BWC was paid in full.

Patricia A. Rohman (Parma, Cuyahoga County) was sentenced July 25 after pleading guilty to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. The investigation began when an allegation indicated Rohman was delivering Cleveland Plain Dealer newspapers while receiving disability benefits from BWC. Investigators obtained employment records that confirmed she did work for the paper and her employment was inconsistent with her entitlement to benefits. Rohman withdrew her original not guilty plea and entered a plea of guilty. She was sentenced to 180 days incarceration, suspended, and ordered to pay restitution and investigative costs in the amount of $9,359.15.

Cecil Ball (New Philadelphia, Tuscarawas County) pleaded guilty to one felony count of theft for working while receiving benefits. SID’s Intelligence Unit performed a cross match with the Ohio Department of Jobs and Family Services and identified Ball as possibly working while receiving temporary total disability benefits. The investigation found that Ball was working as a truck driver for KTS Transportation between July 2011 and January 2012.  Agents interviewed Ball and he acknowledged that he drove a truck for KTS Transportation and was paid wages while receiving workers’ compensation. Sentencing is scheduled for Sept. 18.

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

SID annual report highlights $55 million in savings identified last year

August 12, 2013 Leave a comment

SID FY 2013 Annual ReportSID recently published its annual report for fiscal year (FY) 2013. The report reflects and reviews recent performance statistics, ongoing trends, as well as future strategies for preventing and detecting fraud.

We are pleased to report that SID identified $55 million in savings during FY 2013. Among the more than 2,000 cases that were closed, 915 were founded, meaning the original allegation was proven. The average savings identified among the 915 cases was more than $60,000. 236 of these cases were referred for prosecution, resulting in 134 indictments and 140 convictions to date. These 140 convictions were a 14 percent increase over last year.

Additionally, SID received more than 3,300 allegations and teams are currently investigating approximately 1,000 open cases.

During the last twelve months, SID staff members remained tuned to emerging trends that affect their work, such as the rise in prescription fraud. The department also creatively utilized available resources such as social media and data digital forensics to root out otherwise undetected fraudulent activity and bring public attention to combating wrongdoing. This resourcefulness and persistence is prevalent in the work of each SID team and reflects the department’s commitment to protecting the Ohio State Insurance Fund. The FY 2013 fraud report includes information about these efforts and the condition of workers’ compensation fraud in Ohio.

Furthermore, the conclusion of FY 2013 also brings to a conclusion the third five-year SID strategic plan. The results of this level of planning are responsible for the success SID experienced in this past fiscal year. Comparatively, SID achieved:

  • The lowest number of cases open at year end;
  • The highest number of terabytes of data processed by Digital Forensics Unit;
  • Second lowest number of investigative lag days per closed case in the past five years;
  • Second highest number of convictions in the past eight years;
  • Second highest percentage of founded cases referred for criminal prosecution in the past six years; and
  • Second highest savings identified per closed and per founded case in the past six years.

Lastly, the report reviews results since our department’s inception in 1993 – including that we have closed nearly 59,000 cases and identified more than $1.5 billion in savings to the Ohio workers’ compensation system.

Cleveland woman caught delivering papers while on workers’ comp, owes $9,000

August 5, 2013 Leave a comment

Patricia RohmanPatricia A. Rohman of Cleveland pleaded guilty to workers’ compensation fraud after BWC investigators found she was delivering newspapers while receiving Temporary Total Disability benefits.

The investigation began when an allegation indicated Rohman was delivering Cleveland Plain Dealer newspapers while receiving disability benefits from BWC. Investigators obtained employment records that confirmed she did work for the paper and her employment was inconsistent with her entitlement to benefits.

Rohman withdrew her original not guilty plea on July 25 and entered a plea of guilty to one misdemeanor count of workers’ compensation fraud. Rohman was sentenced to 180 days incarceration, suspended, and ordered to pay restitution and investigative costs in the amount of $9,359.15.

Congratulations, Rich!

August 1, 2013 Leave a comment

SID Director Rick Gregory and Assistant Director Jennifer Saunders honored Rich during a ceremony recognizing his achievement.

BWC Special Investigations Department Director Rick Gregory yesterday recognized Rich Hamilton, a special agent with the Digital Forensics Unit, on completing the Special Investigations field training officer program. 

Congratulations, Rich!  We look forward to your contributions to BWC’s investigative efforts to combat workers’ compensation fraud.

Categories: SID Information