Archive

Archive for November, 2013

Another type of BWC certificate — Showing our appreciation to a source

November 22, 2013 1 comment

Normally, when our readers think of the words “BWC” and “certificate”, they think of the BWC Certificate of Coverage. This makes sense. The certificate is widely seen and easily recognized. It is the official document employers often frame to display with pride within their business.

Understandably, the law-abiding business owner wants every employee and customer to11.22.13 blog post see that they have secured workers’ compensation coverage from our agency. They know that others see it as proof of the business’s legitimacy and a sign of the owner’s prudence.

That might explain why Greg Bryant, the owner of a Toledo business, Snyder Snow Service, Inc. was surprised when we contacted him, asking to present him with another type of BWC certificate: a Certificate of Appreciation.

A SID Special Agent in Charge explained to Mr. Bryant that the certificate acknowledges the business owner’s referral of a fraud allegation to BWC – a referral that had resulted in the criminal conviction and sentencing of the subject, just weeks earlier.

Signed by our SID Director of Investigations Rick Gregory, the Certificate of Appreciation read, in part:

“In recognition of your exemplary citizenship and proven commitment to protecting the integrity of the Ohio State Insurance Fund for all Ohio employers. Your prompt reporting of suspected fraud resulted in a criminal conviction and the identification of more than $50,000 in savings. On behalf of all BWC Special Investigations staff, we extend our appreciation.”

We believe that the simple certificate is the least we are willing to do to demonstrate our thanks to Greg Bryant and others who are our partners in combating fraud.

Significantly, Mr. Bryant received his Certificate of Appreciation on November 8th, the Friday of International Fraud Awareness Week.

Just like Greg Bryant, you are our eyes and ears! Thank you for your help in stamping out fraud, and please, keep those tips coming. To report workers’ comp fraud in Ohio, click here or call our fraud hotline at 1-800-644-6292.

Columbus man repays nearly $7,000 after he was caught committing workers’ comp fraud

???????????????????????????????Ghassan Awad of Columbus (Franklin County) pleaded guilty to workers’ comp fraud Nov. 18 and repaid nearly $7,000 in workplace injury benefits he collected illegally.

A cross match with the Ohio Department of Job and Family Services revealed Awad received wages from Rabi Inc. during the third and fourth quarters of 2011, a time when he was collecting temporary total disability compensation for a prior workplace injury.

SID’s investigation showed Awad knowingly worked for the company collecting bad checks during periods he was receiving disability compensation. The investigation also confirmed Awad failed to notify the BWC or his physician of record of his employment.

Awad pleaded guilty to one misdemeanor count of workers compensation fraud in the Franklin County Court of Common Pleas. He paid restitution in the amount of $6,897.87 prior to his plea and sentencing. Judge Horton sentenced also ordered Awad to pay court costs.

BWC investigations result in ten workers’ comp fraud convictions in October

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

“Fraud was proven in multiple investigations involving medical providers, employers and claimants that came to an end in October,” said Buehrer. “We are pleased to close these cases, but the regrettable reality is fraud exists elsewhere and our investigators are already busy working additional cases.”

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

Dr. Timothy Smith (Cincinnati, Hamilton County) entered a Pretrial Diversion Program Oct. 21 after he was found billing BWC for services not rendered. SID opened an investigation after receiving allegations that Smith fraudulently billed BWC, prescribed excessive amounts of narcotics and failed to maintain sanitary conditions at his medical clinic.  Investigators learned that Smith was hospitalized or unable to render medical treatment on two separate occasions when he claimed he had delivered care. Smith’s staff members prepared prescriptions and brought them to Smith at the hospital for his signature.  The prescriptions were later issued to patients by his staff members.  During these occasions, Smith claimed to have personally treated twenty-seven injured workers.  To substantiate his claims, Smith generated falsified medical treatment notes and billing forms.  Based on these falsified materials, BWC paid Smith for services not rendered. A Hamilton County judge approved Smith’s acceptance into the Hamilton County Pretrial Diversion Program. Smith was ordered to pay $1,699.32 in restitution to BWC, complete 120 community service hours, and attend critical thinking and counseling courses.  In a separate but related matter, Smith permanently surrendered his license to practice osteopathic medicine and surgery to the State Medical Board.

Christopher Fay, dba Full Scope Construction, (Lima, Allen County) pleaded guilty Oct. 25 to two misdemeanor counts of failure to comply for operating his business without workers’ compensation insurance coverage. SID’s Employer Fraud Team opened an investigation on Fay after he was discovered operating Full Scope Construction without coverage. The case was initiated after investigators interviewed Fay regarding a prior company he operated by the name of CDAF LLC, which was also under investigation for lapsed coverage. When operating CDAF LLC, Fay hired and leased several employees to Douglas Fay Construction, his brother’s construction business, which also had lapsed coverage.  BWC ultimately combined the two policies as the result of an audit and Fay was found to owe approximately $90,000 in past due premiums.  During the recent investigation, agents observed workers arriving at Fay’s residence and then leaving with him and traveling to construction job sites. When interviewed, Fay indicated his workers were subcontractors, not employees, however, subpoenaed bank records revealed regular payments were being made to the workers. Some of the workers were also past employees of Fay’s prior business. Fay was ordered to pay the outstanding premiums as well as court costs and fees of $258.21.

Todd Bittner, dba Bittner Construction, (Cincinnati, Hamilton County) pleaded guilty Oct. 29 to two felony counts of workers’ compensation fraud for operating his business without workers’ compensation coverage. BWC’s Employer Compliance Department informed SID that co-owners Todd and Ross Bittner operated Bittner Construction with lapsed coverage since 2007.  This is the second case the EFT has had on this business for lapsed coverage.  During the first case, Bittner became compliant; however, Bittner subsequently stopped making efforts to become compliant resulting in a second allegation. Investigators attempted to work with Todd Bittner and he submitted all outstanding payroll reports but failed to pay the related premiums or enter into a payment plan.  Todd Bittner ultimately completed a second application for coverage, changing the business name slightly, but failing to list the information regarding the existing policy on the application.  BWC identified this new application as a potential duplicate policy for Bittner Construction and denied the coverage due to the unpaid balance.  In addition, Ross Bittner filed an injury claim against the lapsed policy and was collecting working wage loss benefits. Ross Bittner submitted wages from Bittner Construction in order to receive these benefits. As part of a plea deal, Todd Bittner will have to become compliant and will be responsible for the $50,306.20 he owes BWC.  A pre-sentence investigation was ordered and sentencing was scheduled for December 9, 2013.

Harry Livingston (Parma Heights, Cuyahoga County) pleaded guilty Oct. 31 to one felony count of workers’ compensation fraud for working while receiving benefits. SID opened an investigation after receiving an allegation from an anonymous source that Livingston was working as a dump truck driver. SID conducted surveillance of Livingston in which he was observed arriving at the locations that the dump truck was parked, driving the dump truck to and from the job site, and returning to parking lot.  They also confirmed that he worked as a dump truck driver from May to November 2012 while receiving the temporary total benefits. Livingston repaid more than $19,000 in restitution prior to his sentencing. He was sentenced to serve six months in prison, which was suspended for a term of community control. He was also fined $500 and ordered to pay court costs.

Richard Matt (Mayfield Village, Cuyahoga County) pleaded guilty to a misdemeanor count of workers’ compensation fraud Oct. 28 for working while receiving benefits. Matt was receiving temporary total disability benefits when a cross match with the Ohio Department of Jobs & Family Services indicated he was concurrently receiving wages.  SID’s investigation found Matt was employed as a sales broker for Music Blast/Beverage Plus based in Las Vegas, NV.  Company records confirmed Matt was working during the period of time in which he was also receiving workplace injury benefits from the BWC. Matt pleaded guilty to a misdemeanor count of workers’ compensation fraud October 28.  Franklin County Judge Sheward ordered Matt to pay restitution in the amount of $3,421.34 by Oct. 28, 2014.  He will serve 180 days at the Franklin County Corrections Center if he fails to make full restitution.  Matt made a restitution payment of $500 at his sentencing.

Mary Martin (Columbus, Franklin County) pleaded guilty to one count of workers’ compensation fraud Oct. 24 for deception to obtain dangerous drugs. SID’s Intelligence Unit discovered Martin had received narcotic prescriptions from multiple physicians during overlapping periods.  The investigation that followed revealed she was deceiving several physicians and that she filled those prescriptions at multiple pharmacies as a way to conceal her drug-seeking behavior. Martin was sentenced in the Franklin County Court of Common Pleas to four years of community control, under the conditions that she pay court costs and restitution in the amount of $3,473.65, and obtain no new convictions.

Eric Mariol (Canton, Stark County) pleaded guilty to a misdemeanor count of workers’ compensation fraud Oct. 22 for working while receiving benefits. Mariol was receiving living maintenance benefits and temporary total disability benefits when a cross match with the Ohio Department of Jobs & Family Services indicated he was concurrently receiving wages.  SID’s investigation confirmed Mariol was working as a laborer/helper for Brad Bonsky Sheet Metal and Miracle Solutions. Mariol pleaded guilty to a misdemeanor count of Workers’ Compensation Fraud October 22.  Judge Pollitt ordered Mariol to pay restitution in the amount of $1,322.88 by April 30, 2014.  He will serve 30 days at the Franklin County Corrections Center if he fails to make full restitution.  Additionally, Mariol was ordered to pay a $250 fine and serve 72 hours of community service.

Cheryl Brenner, dba Cranberry Station, (Andover, Ashtabula County) pleaded guilty to one felony count of failure to comply Oct. 15 for operating her business with lapsed workers’ compensation insurance coverage. BWC’s Employer Compliance Department attempted to work with Brenner, owner of Cranberry Station in Andover, 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 policy was reinstated. A judge ordered Brenner to remain compliant, assessed a $100 fine and court costs, and sentenced her to one year of community control.

To report suspected workers’ compensation fraud, call 1-800-OHIOBWC, visit bwc.ohio.gov, or visit www.facebook.com/ohiobwcfraud. View and share BWC’s workers’ comp fraud awareness video on our YouTube channel.

Collaboration: The source of our success – Part 2 of 2

We’ve found that one of the most effective ways to discover alternate methods of fraud detection and investigation is to consult or partner with other criminal justice and law enforcement 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. Examples of our partnerships include:

  • Networking with professionals via active and productive memberships in dozens of anti-fraud associations, including: Association of Certified Fraud Examiners (ACFE), Central Ohio Investigative Network (COIN), National Association of Drug Diversion Investigators (NADDI), National Health Care Anti-Fraud Association (NHCAA), National Society of Professional Insurance Investigators (NSPII), National White Collar Crime Center (NW3C), Ohio High Intensity Drug Trafficking Area (OHIDTA), and Ohio Investigators Association (OIA).
  • Participating in the anti-fraud conferences. This week, selected SID fraud analysts are attending the “2013 Targeting Fraud – Safeguarding Integrity” conference, hosted by Franklin University, National White Collar Crime Center, Ohio Ethics Commission and the Ohio Investigators Association.
  • Benchmarking with the experts from the workers’ compensation systems in dozens of other states. These esteemed benchmarking partners include the Florida Department of Financial Services, Division of Workers’ Compensation; and the Washington State Department of Labor & Industries. Moreover, since 1993, delegations from other workers’ compensation systems have benchmarked with BWC to learn our best practices. These include the states of Kentucky, New York, North Dakota and West Virginia.
  • Conducting operational training for law enforcement colleagues. For example, two of our SID special agents in charge have presented surveillance training at the Ohio Peace Officer Training Academy.
  • Receiving specialized operational training from law enforcement colleagues. Just last month, a Department of Public Safety expert from the Ohio State Highway Patrol (OSHP) was the keynote speaker at our annual in-service training session for all SID professionals.

It’s an honor to be associated with other criminal justice and law enforcement agencies and the many professionals who make up these organizations. We respect and appreciate their dedication to serving and protecting the citizens of Ohio.

In case you missed it, you can find yesterday’s post about collaboration here.

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

Categories: SID Information

Cincinnati janitor used fake ID to obtain employment while on workers’ comp

OLYMPUS DIGITAL CAMERACOLUMBUS – A Cincinnati (Hamilton County) man owes the Ohio Bureau of Workers’ Compensation (BWC) more than $100,000 in workers’ compensation benefits he received while employed as a janitor, a job he got using a fake ID. John Monday, aka John Turner, pleaded guilty to fraud in the Franklin County Court of Common Pleas Nov. 5.

“Mr. Monday clearly took deliberate steps to conceal his employment, and worse, he claimed to be permanently disabled, a designation reserved for only the most severely injured,” said BWC Administrator/CEO Steve Buehrer. “Our investigators did an outstanding job, and we are especially grateful to the Spine Institute for turning over information that allowed us to put an end to Mr. Monday’s deception.”

BWC’s Special Investigations Department (SID) opened an investigation after receiving information from the Cincinnati Spine Institute that Monday has been working for their office performing janitorial services for more than twenty years under the name of John Turner.

SID learned that Monday, under his alias of John Turner, sought afterhours treatment for pain from a physician at the Spine Institute, where he worked as a janitor. He told this physician that he already had a physician who treated him for injuries related to a previous workers’ comp claim. Monday then stated his intention to change physicians and supplied his medical records to the physician who treated him afterhours.

Monday later realized the records were under his real name, John Monday, and asked the office not to file the most recent visit with BWC because he was not supposed to be working.

SID later learned that Monday worked as a janitor at the Cincinnati Spine Institute since 1990 while receiving permanent total disability and disabled workers’ relief fund benefits. Monday used an Ohio driver’s license and a state Identification card under the name John Turner in order to obtain employment at the Spine Institute while on workers’ comp.

Monday was found guilty of one felony count of workers’ compensation fraud and the judge proceeded immediately to sentencing. Monday was ordered to pay restitution of $105,169.23, in addition to court costs and $3,692.84 for investigative costs. He was also placed on community control for five years under the conditions that he has no new convictions, and establishes an income within 60 days. If Monday violates the terms of his community control, he will serve 18 months in prison.

To report suspected workers’ compensation fraud, call 1-800-644-6292, visit http://www.bwc.ohio.gov, or visit http://www.facebook.com/ohiobwcfraud.

Cleveland woman worked for several dry cleaners while receiving workers’ comp benefits

November 8, 2013 1 comment

TWANA-BROWN__1988809Tawana Brown of Cleveland (Cuyahoga County) must repay more than $8,000 after she was discovered working at several area dry cleaners while receiving workers’ comp benefits, and attempting to collect a lump sum settlement from BWC.

SID received an allegation through the Fraud Hotline that Brown may have been working for Avon Cleaners in Cleveland while receiving temporary total disability payments. The investigation confirmed Brown had worked at both Avon Cleaners and Kingsbury Cleaners in Shaker Heights.

Brown had returned to work as a shirt press operation, the same job she was doing at the time of her injury. She was also in the process of attempting to receive a lump sum settlement from BWC after claiming to have minimal use of her hand. However, it was discovered she had been working as much as five to eight hours a day, five days a week on a fast-paced shirt press line that required the use of both hands.

Brown failed to appear for her arraignment and a warrant was issued in April. She was arrested in August while a passenger in a vehicle that was stopped by police for a traffic violation in Montgomery County.

On Oct. 29, Brown entered a guilty plea to count one felony of workers’ compensation fraud. The judge sentenced her to seven months in prison, suspended for three years of community control. The terms of community control include paying restitution to BWC in the amount of $8,823.32.

Collaboration: The source of our success – Part 1 of 2

November 7, 2013 1 comment

Criminal justice and law enforcement agencies are often portrayed as caught up in turfism. We’ve all viewed the all-too-common plot line wherein either “the feds” or “the locals” usurp control of, take credit for or even attempt to thwart an investigation. Perhaps, movie and television producers believe that this dramatic tension is real, as part of the American experience as independence, individualism and athletic competition. But, no matter their rationale, we find such occurrences of turfism are far and few in between.

The reality in our profession is that — driven by their constant, common quest to deter, detect, investigate and prosecute crime — members of the criminal justice and law enforcement community routinely offer cooperation and invite collaboration with other agencies in all jurisdictions.

Most frequently, members of our Special Investigations Department (SID) collaborate with other agencies to share information about and conduct joint criminal investigations of fraud suspects. Throughout Ohio, SID agents consistently launch joint investigations and execute search warrants with local, state and federal law enforcement agencies. Since 1993, we have closed thousands of cases with the direct assistance of countless agencies and entities.

For years, we’ve chronicled these investigative successes and credited the other agencies by name within our annual SID fraud report. For example, in our FY 2012 fraud report, we summarized the investigation and prosecution of Randy and Robin Hammond (formerly of Galion, Ohio). We credited the Office of the Attorney General of Ohio with having issued a nationwide warrant for the arrest of the Hammonds after they fled the state in a futile attempt to avoid prosecution. We thanked the U.S. Marshals Service for arresting the Hammonds, after our Fugitive Task Force and Digital Forensics Unit located them at a Hurricane, Utah mobile home park. Thanks to this effective collaboration, the Hammonds were found guilty. The court sentenced Randy Hammond to serve five years of probation, Robin Hammond to serve one year of incarceration, and both to jointly pay BWC $173,332 in restitution.

In many of these annual fraud reports, we’ve included an appendix listing each agency with which we conducted a joint investigation during the fiscal year. In the FY 2009 report, we listed 91 agencies. Current examples include:

  • Municipal police departments;
  • County sheriff offices;
  • Dozens of state agencies and task forces–in Ohio and elsewhere;
  • Federal administrations, bureaus, commissions, departments, offices and services; and
  • City, county, state and federal prosecutors.

We recognize, praise and thank all of our colleagues and other stakeholders for their successful collaboration with us and others. We respect and appreciate their dedication to serving and protecting the citizens of the state of Ohio.

Check out tomorrow’s post, part two of two, where we’ll give you an inside look at our partnerships with others.

Want to learn more? You can read the past posts about our history here and our current efforts here.

Categories: SID Information