Anatomy of a criminal – Who commits workers’ compensation fraud?

Have you ever wondered what kind of person would commit workers’ compensation fraud against the Ohio Bureau of Workers’ Compensation (BWC)? We are often asked this question. Usually the questioner implies a belief that our answer should include a data-based “profile” of the so-called “typical” white-collar fraudster. Admittedly, we have analyzed millions of data records pertaining to fraud committed against our State Fund. Sure, we have all the means necessary to identify suspect key characteristics and discern patterns of criminal behavior. However, what our experience proves to us is something altogether different. Namely, we know with certainty that those who commit workers’ compensation fraud vary dramatically by age, location, culture, nationality, ethnicity, level of education, income bracket, criminal history, etc. They come in all forms with a multitude of backgrounds. Motivated by greed, the perpetrators who attempt to victimize the State of Ohio fit no one’s stereotype of a criminal.

This is true in part because workers’ compensation – in any workers’ compensation system in all countries, states or other jurisdictions – involves so many different “actors” or parties to a claim.

You need only browse through the cases summarized on our OhioBWCFraud Facebook page to see criminals who have committed workers’ compensation fraud, including:

• Employees who hide the fact that they have returned to work in order to continue to be paid lost time benefits or who use deception to illegally receive prescription medicine. For examples, see any of the following August convictions of Angel Ocasio, Randy Bartosh, Bob Morgan, Stephen Byrne, or Lawrence Blakeley.
• Business owners who knowingly employ lost time benefit recipients and fail to report their wages or who underreport payroll and misclassify employees in order to pay less than the true premium amounts owed (see Sarah Barajas, dba Bane Specialty Services); and
• Health-care providers who bill for medical treatments they have not rendered, upcode bills to charge us for more expensive treatment than they actually furnished, or unnecessarily prescribe narcotics to innocent claimants until these patients are addicted (see the Sept. 9, 2013 case summary pertaining to Joseph J. Yurigan, D.C.).

Ultimately, the variability in our suspects, while it may challenge our detection skills, simply serves to remind us of the importance of our mission to relentlessly deter, detect, investigate and prosecute crimes perpetrated by anyone against the State Fund.

Thank you for your interest in learning more about those criminals who seek to cheat a system that so effectively serves hundreds of thousands of deserving, law-abiding citizens in the State of Ohio. As our BWC Administrator/CEO Steve Buehrer recently noted: “Investigating and putting a stop to fraud helps protect the benefits of injured workers and keep employers’ premiums down. Those who break the rules are interfering with our ability to serve Ohio’s employers and truly injured workers.”

Check out archived articles in OhioBWCFraud to learn more about how you may help us protect the State of Ohio.