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Archive for March, 2014

Going after every dollar: Fraud investigators at OSC 2014

OSC14_FoxThe 2014 Ohio Safety Congress (OSC) came to a close yesterday and, in one of the final sessions, three supervisors from the Ohio Bureau of Workers’ Compensation (BWC) Special Investigations Department (SID) gave their presentation on Workers’ Compensation fraud, its “red flags” and what employers can do if they are suspicious. . Over the two-day conference, SID staff twice presented “Workers’ Compensation: Do You Know if it’s Happening to You?” to a crowded room.

Special Agents in Charge (SACs) Phill Brickman, Shawn Fox, and Doug Fisher took turns presenting an overview of SID, who we are, and what we do. Attendees were presented a breakdown of all the types of complaints SID receives, as well as the differences between claimant, provider, and employer fraud.

Though a serious topic, the session wasn’t without humor. “Our investigators love finding fraud and some people just love talking about how clever they are, so it works out” quipped SAC Shawn Fox, referencing those who brag on Facebook or to their friends about their crime.

The trio also fielded a variety of questions from the audience. One attendee asked what the cost of one investigation is and if it’s even worth it. SAC Doug Fisher replied investigations are indeed worth the effort, sharing the fact that each dollar spent on investigative costs brings five dollars back to BWC.”

OSC14_FraudAnother audience member relayed a story of a co-worker they suspected of filing a false claim and noted that had she known there was a dedicated fraud team in place at BWC, she would have dealt with her suspicion differently. While SID has been around for 20 years, we are still reminded that part of our mission is spreading awareness of who we are. “This is what we do,” stated SAC Phill Brickman, “we will go after every dollar and dime. Call us and put us to work.”

SID agents were eager to use their time presenting at OSC 2014 as an opportunity to explain workers’ compensation fraud and let employers know there is a dedicated team in place to combat fraud. When asked to summarize the purpose of the presentation in one sentence, SAC Fox offered that it was to “educate employers on what services the Special Investigations Department can provide to them to deter, investigate, and prosecute workers’ compensation fraud.”

Like maintaining a safe work environment, weeding out fraud and abuse of disability benefits may lead to lower premiums for employers and ensure that BWC remains an efficient system to aid those workers who are truly injured.

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Categories: News Articles

Fraud plans ‘scrapped,’ Grove City man ordered to repay $30K in workers’ comp benefits

Dale Richards booking photoColumbus – A Grove City (Franklin County) man was ordered to pay more than $30,000 in restitution for working while collecting workplace injury benefits. Dale Richards pleaded guilty March 12 to workers’ compensation fraud, a fifth-degree felony, after an investigation by the Ohio Bureau of Workers’ Compensation (BWC) revealed he was earning a living selling scrap metal.

“In addition to selling scrap metal, Mr. Richards also engaged in additional restricted work and physical activity,” said BWC Administrator/CEO Steve Buehrer. “An anonymous allegation put this investigation into motion. We take these allegations very seriously because they often help us put an end to fraud cases like this one.”

The Columbus Special Investigations Unit (SIU) received an allegation that Richards was working while receiving BWC benefits. The investigation showed that Richards was involved in construction and remodeling projects as well as selling scrap metal. He sold 74 tons of scrap metal in Columbus from 2009 to 2012 while receiving temporary total disability benefits.

Richards was ordered to pay $30,381.48 in restitution to the BWC. He was also sentenced to serve eight months at the Ohio Department of Rehabilitation and Correction, which was suspended for three years of community control as long as he doesn’t violate probation rules and pays restitution.

To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov.

Working while receiving?

Working while receiving benefits is one of the most common types of fraud our investigators uncover. So far, in 2014, 11 out of 16 criminal convictions were claimants working while receiving lost time benefits to which they were not entitled.

Working while receiving is one of the most obvious and flagrant abuses of the system. It is particularly regrettable since the claimants were, at one time, truly injured and entitled to workers’ compensation benefits.

We make every effort to ensure that each claimant knows the well-established rules. The fraud warning messages are clear, explicit and conspicuously placed on forms. For example, a fraud warning message (pictured below) appears on the BWC form to be signed by a claimant to request temporary total lost time benefits.

C84 statement

Fortunately, the vast majority of claimants return to work when they are able and notify BWC that they intend to do so. They understand and accept that their lost time benefits achieved their essential purpose – they provided compensation while the claimant temporarily could not work and was recuperating from an accident, illness or injury.

No matter how clever an individual may be, if he or she commits the crime of returning to work while receiving workers’ compensation benefits, the tell-tale signs remain. Rest assured, we are looking for, investigating, and prosecuting these cases. They will lose their lost time benefits and perhaps their freedom as well.

Categories: Fraud Awareness

Reynoldsburg man ordered to repay more than $7K in workers’ comp benefits

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Christopher Steele, of Reynoldsburg (Licking County), was sentenced in connection with receiving workplace injury benefits.

The BWC’s Columbus Special Investigations Unit (SIU) began investigating after receiving an allegation that Steele was working while receiving workers’ compensation benefits. Steele was receiving both Living Maintenance (LM) and Working Wage Loss (WWL) benefits.  Injured workers receiving LM are prohibited from working, while those receiving WWL are permitted to work but must report earnings to determine benefit levels.  The SIU obtained employment and payroll records, and confirmed that Steele worked as a carpenter and construction worker while receiving the LM compensation, and he didn’t report any earnings, resulting in a higher level of WWL benefits than he was entitled to receive.

Steele pleaded guilty to workers’ compensation fraud, a first-degree misdemeanor.  He was ordered to pay $7,680.54 in restitution by March 31, 2016. He was given 60 days in jail, which was suspended on the condition that he pay restitution in full. If he fails to do so, he will serve 60 days in the Franklin County Jail. All fines were waived and Steele was ordered to pay court costs. He made a $2,500 restitution payment after the hearing.

Macedonia man ordered to pay more than $5K for workers’ comp fraud

Daniel Verlinger

Columbus – A Macedonia (Summit County) man was ordered to pay more than $5,000 in restitution for working while collecting workplace injury benefits. Investigators with the Ohio Bureau of Workers’ Compensation caught Daniel Verlinger on camera as they posed as customers of his shoe repair store. Verlinger pleaded guilty Feb. 26 in the Franklin County Court of Common Pleas to a charge of attempted theft, a first-degree misdemeanor.

“We received an allegation that Mr. Verlinger continued to work at his business while receiving BWC benefits intended to assist injured workers who are unable to work,” said BWC Administrator/CEO Steve Buehrer. “Workers’ compensation fraud is a crime. Our agents conducted a thorough investigation, and were able to get compelling evidence on video to bring this crime to light.”

While conducting undercover operations and surveillance, agents with BWC’s Northeast Regional Special Investigations Unit (SIU) observed Verlinger arriving at Together Leather and Shoe Repair, assisting customers and completing leather/shoe repairs. The SIU confirmed that Verlinger continued working while collecting temporary total benefits from October 2011 through April 2012.

Verlinger was sentenced to serve 90 days in jail, which was suspended for five years of community control. He is to pay $5,371.95 in restitution to BWC as a condition of his community control.

Surveillance video of Verlinger is available here. A photo is available here.

To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov. Check out our latest cases at ohiobwcfraud.wordpress.com, follow Fraud Fridays on Twitter @OhioBWCFraud, or join in the conversation at facebook.com/ohiobwcfraud. View and share BWC’s workers’ comp fraud awareness video on our YouTube channel.

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

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced that six individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in February 2014. 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.

“From investigators to claims service specialists, and even other agencies, we have many sets of eyes watching for signs of workers’ compensation fraud,” Buehrer said. “These attentive eyes, along with valuable tips from across the state that bring attention to potential fraud, provide outstanding support in our work to protect the State Insurance Fund.”

The following case information represents a sampling of cases that resulted in guilty pleas or convictions during February.

William Mcie (Lake Milton, Mahoning County) pleaded guilty to one count of workers’ compensation fraud, a fifth-degree felony, for working while receiving workplace injury benefits. An allegation was received that Mcie was working as a self-employed carpenter. Mcie was observed arriving at multiple work locations and suppliers. Interviews with Mcie’s customers and suppliers confirmed he returned to work while concurrently receiving temporary total disability benefits between May 2008 and September 2012. Sentencing is set for April 2.

Lonnie Mace (New Plymouth, Hocking County) pleaded guilty to workers’ compensation fraud, a fifth-degree felony, for working while receiving workplace injury benefits. An allegation was made after a cross match with the Public Utilities Commission of Ohio (PUCO). Investigators found Mace was receiving permanent total disability benefits while a driver of a commercial vehicle during a 2010 safety inspection. They also found that Mace was employed by a trucking company prior to and during the inception of his benefits. Mace’s benefits were terminated and a lump sum advancement of his benefits was declared overpaid, totaling $103,174.34 due to BWC. Sentencing is scheduled for April 3.

Joshua Collmar (Barberton, Summit County) was sentenced to six months of incarceration after pleading guilty to workers’ compensation fraud, a fifth-degree felony, for working while receiving workplace injury benefits. He was credited for serving six months in jail. He’s currently serving a prison sentence until 2015 for an unrelated matter. The overpayment amount is $6,021.07. Investigators opened an investigation after receiving an allegation that Collmar was scrapping junk vehicles while collecting temporary total disability benefits. SID agents obtained evidence from scrap yards and interviewed customers, who verified that Collmar scrapped junk vehicles and was paid cash for his services.

Adam Osterman (Monroe, Butler County) was placed on community control for five years after he pleaded guilty to one count of workers’ compensation fraud, a fifth-degree felony. The conditions of his community control include paying restitution to the BWC in the amount of $59,213.83, obtaining/maintaining employment, and paying court costs.  If he violates the terms of his community control, Osterman will serve eight months in prison. Osterman was a death benefit recipient after his father was killed in an industrial accident.  Osterman was eligible to receive death benefits up to age 25 if enrolled at an accredited educational institution. An allegation was received that Osterman bragged about enrolling in classes and dropping them to obtain BWC death benefits. The investigation found that from January 2010 to November 2012, Osterman submitted documentation to the BWC to show that he enrolled in classes at a community college in Dayton, but never attended classes or dropped the classes after submitting the documentation to the BWC.

John Neeley (Lima, Allen County) was sentenced to 180 days in jail with credit for 59 days, and 121 days were suspended for three years of community control, after pleading guilty to one count of workers’ compensation fraud, a first-degree misdemeanor, for working while receiving workplace injury benefits. An allegation was received that Neeley was working while collecting BWC disability. The investigation revealed records and surveillance video that confirmed Neeley returned to self-employed work performing several different concrete installation jobs for several customers between July and October 2012.  Neeley fled to Florida once he was aware of the investigation and a warrant was issued in Ohio for his arrest. Neeley was arrested in Florida on unrelated charges and extradited back to Ohio. Terms of his community control include basic supervision with telephone reporting allowed provided Neeley make a good faith effort to obtain/maintain employment, and payment of restitution totaling  $6,878.14, including $2,000 for investigative costs. Neeley must pay $250 a month and at least $2,250 by Dec. 31, or he will be sent to jail for the remainder of his sentence.

To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov. Check out our latest cases on our fraud blog, ohiobwcfraud.wordpress.com, follow Fraud Fridays on Twitter @OhioBWCFraud, or join in the conversation at www.facebook.com/ohiobwcfraud. View and share BWC’s workers’ comp fraud awareness video on our YouTube channel.

Workers’ comp fraud supervisors to speak at Ohio Safety Congress

OSC14logoclrBecome more aware of workers’ comp fraud, learn how to recognize it at your workplace and stop it from happening to you by attending the Ohio Safety Congress & Expo 2014 (OSC14) later this month.

Supervisors from BWC’s Special Investigations Department will present “Workers’ Compensation Fraud: Do You Know If It’s Happening to You?” twice, Session 614, March 26 from 1:15-2:15 p.m. and Session 634, March 27 from 1:15-2:15 p.m.

During these sessions, attendees will learn how and when to report suspected workers’ comp fraud, signs of possible injured worker, employer and provider fraud, the differences between civil and criminal workers’ comp fraud cases, actions to deter and prevent workers’ comp fraud in the workplace, and how workers’ comp fraud increases the costs of medical services, premiums and doing business.

Admission to OSC14 is free to all Ohio employers and employees.

OSC14 will be held March 25 to 27 in Columbus, at the Greater Columbus Convention Center. The three-day event will include 175 expert-led educational sessions. In addition to fraud, other topics being covered include ergonomics, construction safety, emergency planning and safety program development. OSC14’s two-day Expo marketplace will offer workplace solutions and ideas.

A full schedule of sessions is available by clicking here.

Register for OSC14 today!

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