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Archive for October, 2013

Andover restaurant owner pleads guilty to running business without workers’ compensation coverage

Cheryl Brenner, owner of Cranberry Station in Andover (Ashtabula County), was sentenced Oct. 15 in the Ashtabula County Court of Common Pleas for failing to maintain workers’ compensation insurance coverage.

BWC’s Employer Compliance Department attempted to work with Brenner to bring her policy into compliance after it lapsed, but she failed to cooperate and she continued operating the restaurant without coverage. The case was then turned over to the Special Investigations Department Employer Fraud Team.

Following a pre-trial on the charges, Brenner entered into a payment plan with BWC to repay her outstanding premiums of approximately $10,000, and her BWC policy was reinstated.

Brenner pleaded guilty to one count of failure to comply. The judge ordered her to remain compliant, assessed a $100 fine and court costs, and sentenced her to one year of community control.

All hands on deck: SID sails into the future

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From left: Jennifer Saunders, SID Assistant Director; Rick Gregory, SID Director; Amy Huth, Employer Services Specialist; and Steve Buehrer, BWC Administrator/CEO. Amy received a certificate in recognition of her extraordinary performance in pursuit of excellence.

In our constant quest for improvement, all members of the Special Investigations Department (SID) gathered last week at our Columbus main headquarters to successfully complete in-service training. We call this particular type of training event an “All Hands” meeting – as in all hands on deck. Led by SID Director Rick Gregory, we shared investigative successes, learned how to use new technology recently secured, and committed to operational strategies for even greater effectiveness.

We’ve found that one of the chief ways to find new or alternate methods of fraud detection and investigation is to consult counterpart agencies. Such collaboration allows SID to examine its own methods to see where improvements can be made, how tasks can be accomplished more efficiently, and what new strategies or technologies can be used in the course of an investigation. This is why Director Gregory invited a Department of Public Safety expert from the Ohio State Highway Patrol (OSHP) to be our “All Hands” keynote speaker (and what a prudent and wise decision it was!) In just 60 minutes, the dedicated and talented OSHP colleague increased our awareness and skills in ensuring agent safety while conducting effective criminal investigations.

It is an honor for us to recognize, praise and thank our OSHP colleagues. We respect and appreciate all of our law enforcement colleagues for their dedication to serving and protecting the citizens of the state of Ohio. Thanks to their willingness to effectively collaborate, our sails are filled.

You can read the past posts about our history here and our current efforts here.

Completing the circle of coverage: A look at our Safety Violations Investigation Unit

The Ohio Bureau of Workers’ Compensation (BWC) is one of only a few single-line workers’ compensation insurance companies in the country and has several service offerings to match its impressive title. Ohio’s complete circle of coverage to injured workers includes investigating violations of specific safety requirements (VSSR), which may result in a monetary award for injuries stemming from the workplace. Many times, these injuries are catastrophic. The Special Investigations Department’s Safety Violations Investigation Unit (SVIU) provides full-service investigations of an employer’s alleged violation of a specific safety requirement as outlined in the Ohio Administrative Code. Because these investigations examine the facts and determine the truth, they serve employers and injured workers.

Investigators’ work usually begins at the very end of the claims process. In cases of death, SVIU is typically one of the first responders on the scene along with police, ambulance and coroner investigators. The details following a catastrophic incident are vital to the VSSR process, and ultimately, to the award granted to workers or their estates.

“Even though our work is investigative in nature and all factual, a big part of our job is working one-on-one with both the employer and the worker,” said SVIU Supervisor Bill Garver. “The incidents we investigate can be life-altering for the injured worker, their families and the employer. We work tirelessly with the worker and employer to ensure a safe work place for all employees for the future.”

One example is the case of a metal fabrication industry worker whose injury was determined to be the result of his employer’s violation of a specific safety requirement. The worker sustained second and third-degree burns on his body after being splashed with caustic bath solution. The injury occurred while the worker, who wasn’t wearing any protective equipment, prepared metal for processing by removing surface solvents through high temperature chemical baths. After a comprehensive investigation with the employer and the worksite, an SVIU investigator interviewed the injured worker.

“Interviewing injured workers and employers can evoke raw emotion, causing increased anxiety,” an SVIU investigator has noted. “I understand that with each question I ask, I am bringing those involved right back to the day and moment of the incident.”

Conducting these types of investigations requires experience as an interviewer. The detailed chronicling of incident events originating from investigations and interviews allows the Ohio Industrial Commission to better assess whether the merits of Ohio’s safety violation requirements alleged were violated by the employer.

Safety violation additional awards granted by the Industrial Commission can range from 15 to 50 percent of Ohio’s average weekly wage and is paid directly to the injured worker. (The average weekly wage is the median weekly salary of all employees in the state of Ohio.) The monetary award granted to the injured worker is then directly billed – dollar for dollar – to the employer. Additionally, any such ruling can require the employer to correct violations that were determined the cause of the injury or death.

Learn more about VSSRs here.

Categories: SID Information

Cuyahoga County fugitive taken into custody

October 18, 2013 1 comment

???????????????????????????????A fugitive indicted on counts of workers’ comp fraud and theft was taken into custody last week by Deputies with the Cuyahoga County Sheriff’s Office. 

A warrant was issued for the arrest of Rita A. Lynch after she failed to appear at her arraignment in Franklin County. It initially appeared Lynch did not receive her court summons. Letters were delivered to Lynch’s residence and to her boyfriend’s residence and contact was finally made with Lynch via cell phone. She provided her current employment, verified her home address was correct, and stated she had accumulated a lot of junk in her mailbox and thrown everything away. Lynch stated she would turn herself in to the Strongsville Police on Oct. 4, but failed to do so. 

An agent with BWC’s Fugitive Task Force received a call from an attorney who stated Lynch would turn herself in to the Franklin County Sheriff’s Department on Oct. 9, the same day her boyfriend, Charles Hepner, was to appear at a pre-trial hearing on a Workers’ Comp Fraud charge. Once again, she failed to turn herself in.

Lynch was transported to the Cuyahoga County jail to await extradition back to Franklin County.

BWC investigations result in 14 workers’ comp fraud convictions in September

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced 14 individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in September. 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.

“Each of these cases is troubling, but the ones involving medical providers are particularly disturbing,” said Buehrer. “The cases brought forth by our Health Care Provider Team show that some healthcare professionals are not operating with the best interests of their patients in mind.”

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

Jeffrey Stychno DC and Michael Frasca DC/Integrated Health (Warren, Trumbull County) pleaded guilty in the Franklin County Court of Common Pleas to one felony count each of workers’ compensation fraud and Medicaid fraud for after they were found billing for services not rendered. BWC Special Investigations Department received an allegation that Michael A. Frasca, D.C., and Jeffrey L. Stychno, D.C., owners and practitioners at Integrated Health, billed BWC and other public and private health care programs for more complex treatment than was actually rendered, as well as billed for treatment patients did not receive altogether. In the course of the joint investigation with the Ohio Attorney General’s Medicaid Fraud Control Unit, agents conducted numerous patients and employee interviews. During these interviews, patients denied receiving treatment billed to their claims. Employees claimed Dr. Frasca and Dr. Stychno directed them to submit bills for treatment purportedly rendered on days on which patients did not even visit the clinic. To further this fraud, Dr. Frasca and Dr. Stychno directed their staff to create spurious treatment notes to give the false appearance the treatment was actually rendered. Frasca pleaded guilty in April and was placed on one year of community control. He was also ordered to pay restitution totaling $89,496.87, of which $69,781.17 was ordered to BWC and the remainder to other entities. Stychno pleaded guilty Sept. 25 and was sentenced to a five year term of community control, with a 12-month suspended sentence. He was ordered to pay BWC $69,781.17 in restitution and investigative costs; and was ordered to pay a combined total of $19,715.70 to Medicaid. Both have been decertified as BWC health care providers.

Joseph J. Yurigan, D.C. (Weirton, West Virginia) was sentenced Sept. 5 after he previously pleaded guilty to health care fraud and tax evasion. Yurigan is a chiropractor who formerly practiced in Weirton and Wheeling, WV, and treated Ohio injured workers. SID conducted an undercover operation in each of the two chiropractic offices he owned and operated after receiving an allegation of fraud in 2008. The investigation found Dr. Yurigan was routinely and consistently billing for services that he never provided to the undercover operatives. The Federal Bureau of Investigations, West Virginia Department of Insurance Commission, United States Treasury Department and the United States Attorney’s Office became involved in the investigation and executed a search warrant in Oct. 2009. Evidence obtained from the search warrant and information collected from numerous interviews confirmed Yurigan was billing multiple insurance providers for services that he never provided. Yurigan was ordered to make restitution totaling $836,065.93. He was also sentenced to 18 months in a federal institution. Dr. Yurigan was scheduled to report to the designated institution on Oct. 7.

Bruce Weimert (Lima, Allen County) pleaded guilty Sept. 18 in the Lima Municipal Court to one misdemeanor count of falsification for filing a false claim. SID received an internal allegation that Weimert may have filed a false claim. Evidence showed Weimert filed the claim indicating he was injured at work when was actually injured at home. Weimert also told two co-workers that he fell at home. Weimert received a suspended sentence of 180 days in jail, and two years of probation. He must pay a $150 fine, in addition to $1,000 in investigative costs.

Mario Scott (Renton, Washington) pleaded guilty Sept. 25 in the Franklin County Court of Common Pleas to one felony count of workers’ compensation fraud for working while receiving benefits. SID received an allegation from a BWC employee indicating Scott made contact complaining that his child support was being taken out of his BWC benefits and his employment wages. SID obtained evidence showing Scott worked for several employers through a temp agency in the state of Washington while collecting various benefits from the BWC. Scott was sentenced to five years of community control and ordered to repay restitution in the amount of $12,125.99, including $787.65 for investigative costs. Conditions of his community control include undergoing drug tests, obtaining/maintaining employment, and having no new arrests or convictions. If Scott violates the terms of his community control, he will serve eight months of incarceration. He has 30 days jail time credit.

James Putman and Juanita Kneisley (Toledo, Lucas County) pleaded no contest Sept. 3 in the Lucas County Court of Common Pleas to forgery and attempted forgery charges for cashing a BWC check that did not belong to them. BWC mailed the $847.53 check to the correct address, however, the post office forwarded the check to a prior address while the injured worker was recovering from her injuries and participating in rehabilitation. SID obtained the video from the Stop & Go carryout in Toledo where Putman and Kneisley cashed the BWC check. The carryout employee advised that Putman initially came in to cash the check and when the employee asked for identification, Putman told him his girlfriend was in an accident and her purse was left in the car with her license. Kneisley later came to the carryout presenting a Polaroid picture of herself and the carryout had Kneisley place her thumb print on the check. Their identities were confirmed by the carryout employee, and the Ohio Bureau of Criminal Investigation confirmed the thumb print belonged to Kneisley. Putman pleaded no contest to a felony count of forgery, and Kneisley pleaded no contest to a misdemeanor count of attempted forgery. Putman was remanded into the custody of the Lucas County Sheriff with $10,000 bond. Sentencing is scheduled for Oct. 16, and Putman’s sentence is to run concurrent with another felony charge for receiving stolen property.

John Perkins (Toledo, Lucas County) pleaded guilty Sept. 6 in the Franklin County Court of Common Pleas to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID received an allegation that Perkins was tearing down mobile home trailers while collecting benefits and obtained video evidence confirming the allegation. Perkins was working for John Rogers of Rogers Services demolishing old mobile home trailers from April 2010 to July 2010 while collecting Temporary Total Disability benefits. The video showed Perkins tore down trailers using various tools and equipment, loaded materials into a dumpster and took scrap materials to scrap yards. Perkins received a 90 day jail sentence, suspended for three years of community control. Conditions are that he pay restitution in the amount of $3,762, maintain employment or employment training and have no new convictions. He had 42 days of jail time credit.

Douglas Bevis, dba Bevis Towing, (Cincinnati, Hamilton County) pleaded guilty Sept. 20 to one misdemeanor count of workers’ compensation fraud for allowing his coverage to lapse. SID received a referral from the BWC’s Employer Compliance Department indicating Bevis Towing was continuing to operate without the required workers’ compensation insurance coverage. The Employer Fraud Team attempted to work with the owner, Douglass Bevis, in an effort to bring him into compliance with state law. Bevis did submit completed payroll reports for the non-compliant periods but failed to make any attempts to become compliant. Bevis was sentenced to one year of community control. As part of the plea deal, he repaid $10,109.75 for outstanding premiums.

Donald Whitford (Brunswick, Medina County) pleaded guilty to workers’ compensation fraud Sept. 25 in the Franklin County Court of Common Pleas for working while receiving benefits. BWC opened an investigation after receiving an allegation that Whitford may be working while he was supposed to be recovering from a workplace injury. Further investigation revealed Whitford did work for Brunswick Home Improvement, as well as in a self-employed capacity, while receiving Temporary Total Disability benefits. Customer checks were identified and payroll records from Brunswick Home Improvement revealed he returned to work as a roofer and a general construction worker. Several customers identified and confirmed that they hired Whitford to complete some home repairs during the same time he was claiming to be disabled. Whitford was sentenced to a suspended jail sentence of 180 days, and ordered to pay restitution totaling $3,239.23.

Randall Bridges, Jr. (Steubenville, Jefferson County) pleaded guilty Sept. 17 in the Franklin County Court of Common Pleas to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID opened an investigation after receiving an anonymous allegation that Bridges was working as a sales person for Global Childcare Resources in Steubenville. The investigation revealed Bridges was employed as a sales person/independent contractor. He knowingly worked during periods he was receiving Temporary Total Disability benefits for a prior workplace injury. Bridges was sentenced to 90 days in jail, suspended for two years of community control under the condition that he pay restitution in the amount of $6,151.45, maintain employment and have no new convictions.

Jeffrey Bostic (Columbus, Franklin County) pleaded guilty to one misdemeanor count of theft for forgery. SID received an allegation from an injured worker indicating that someone in his previous apartment had stolen and cashed his BWC benefits check. The injured worker had moved out of the apartment but was continuing to pick up his mail at the apartment. The investigation found Jeffrey Bostic stole the $2,423.25 check and forged the claimant’s name on the back of the check. He made arrangements to deposit the check into a friend’s bank account and later had the friend withdraw the funds. Bostic was sentenced Sept. 5 to 180 days in jail, suspended in place of probation, which included five years of community control. Conditions are that he pay restitution in the amount of $2,423.25, receive alcohol/drug treatment, obtain/maintain fulltime verifiable employment and have no new convictions.

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

Provider fraud resources

Categories: SID Information

Combating workers’ compensation fraud committed by health care providers

Workers’ compensation fraud isn’t limited to injured workers, and the Special Investigations Department’s (SID) Health Care Provider Team (HCPT) exclusively investigates alleged fraud committed by health care providers, durable medical equipment companies, third-party administrators, and managed care organizations (MCOs). Since the expansion of the bureau’s health care provider fraud program, most notably in 2012 and 2013, the HCPT focused on detection and investigation.

According to our investigators, the following are common provider fraud schemes:

  • Pill mills, which provide limited or no medical treatment while heavily furnishing prescriptions for narcotics;
  • Billing for services not rendered;
  • Performing medically unnecessary treatments and diagnostics tests;
  • Upcoding, or billing for a more expensive procedure than was actually provided; and
  • Unbundling, or billing BWC separately for services that must be billed together as a single service.

Our OhioBWCFraud Facebook page, our blog and the media are filled with examples of successfully prosecuted providers who committed workers’ compensation fraud. Recent convictions include:

To learn more and help us in our efforts to combat workers’ comp fraud, check out archived articles in OhioBWCFraud.

SID encourages anyone who suspects a health care provider may be committing fraud to complete an online form or contact our toll-free fraud hotline, 1-800-644-6292.

Categories: SID Information