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Archive for May, 2014

Prescription Drug Awareness: Stay Informed, Take Control

May 30, 2014 1 comment

Opioid sidebar final 5-30-14Getting hurt shouldn’t lead to physical dependence on medication or death. We’re working to prevent that.

In 2007, unintentional drug poisoning became the leading cause of injury death in Ohio, surpassing motor vehicle crashes, according to the Ohio Department of Health (ODH).  Furthermore, ODH indicates 4 to 5 Ohioans die daily due to drug overdose, which includes both illegal and prescription drugs.

Ohio is not alone as this is a national epidemic.  Dr. Danesh Mazloomdoost, a Johns Hopkins University graduate and medical director of Pain Management Medicine in Lexington, Kentucky, notes in a recent article that over the last decade “opiate overdoses have killed more than 125,000 Americans.”  That’s twice the number of Americans killed during the Vietnam War.  Even more startling is his reference to the fact that “for every opiate overdose, there are 825 recreational opiates users at risk for addiction or overdose.”

Through our investigations, we’ve found that people addicted to prescription medicine may commit crimes. A few weeks ago, we released an investigation summary about a man who was sentenced for receiving opioids from multiple doctors.

Deception to obtain, often called doctor shopping, is a crime where a person attempts to conceal their addiction by seeing multiple doctors to obtain prescriptions for the same or similar drugs.

Addicts may fake injuries and go to an emergency room just to get a few days’ worth of narcotic drugs. To further conceal their doctor shopping, people sometimes use multiple pharmacies in an attempt to avoid any questions about the volume or frequency of filling their prescriptions. These illegal actions result when either the person is abusing the drugs by taking more than prescribed or diverting/trafficking the drugs for money.

BWC initiatives

In response to these trends, BWC made several changes to its pharmacy program over the past several years, including implementation of a medication formulary, standardized drug utilization reviews and a lock-in program to limit doctor and pharmacy shopping.  These efforts have resulted in opiate doses dropping 10.9 million since 2010 and drug cost savings of more than $20 million since 2011.

BWC’s Special Investigations Department (SID) has also amped up its efforts to detect fraudulent activity of drug seekers and of medical providers overprescribing prescription painkillers.

Opioids

Opioids are “remarkable drugs” and “the best way to relieve excruciating pain in the short run after injury or surgery,” according to Webility Corp., which partnered with BWC to develop and test new ways to communicate and provide assistance to injured workers, all with the goal of quicker recovery and return-to-work outcomes.

When taken regularly for months or years, however, they can cause more harm than good.

“With prolonged everyday use, they have actually worsened pain and disability for many people who should have been able to resume a relatively normal life,” according to a Webility Corp. brochure.

Fortunately, most doctors hold the care of their patients as their highest priority. However, there are those who are concerned only with enriching themselves by feeding the drug habits of their patients. Examples of this are all too prevalent and all too recent. Consider this mother’s reaction to her son’s death here and what happened to the responsible doctor, Terry Dragash here.  Like doctor shopping, conspiracy to distribute drugs is another crime SID takes very seriously.

Even as SID seeks out those who improperly use or distribute prescription medications, we understand opioids are often a legitimate part of an injured worker’s treatment and recovery plan.  That’s why BWC strongly encourages injured workers to talk through the pros and cons of starting an opioid treatment program, and ask as many questions of their physicians as possible. When it comes to opioids, asking questions is crucial, and an open and frank conversation with your physician will help you determine the best course of action.

SID’s fraud investigators and analysts see the effects of long-term prescription opioid use, and others do, too. The Ohio Department of Health has launched Prescription for Prevention, a campaign to combat the epidemic of prescription drug overdose and abuse. Learn more about that campaign here.

 

Categories: News Articles

Spotlight: SID college relations program – Where are they now?

May 30, 2014 1 comment

Since 1995, hundreds of our college externs and interns have accrued criminal investigative experience, graduated from the program and commenced meaningful professional careers.

Ten are current SID employees serving in various roles. To protect their undercover identities, we offer the following list:

  • A criminal investigator with a claimant special investigations unit (SIU);
  • Five field agents in various parts of the state, who conduct claimant and health care investigations;
  • Two digital forensic analysts;
  • Two special agents in charge, one supervising the SID intelligence unit and the other supervising a claimant SIU.

Understandably, the above-listed professionals think highly of their department and our college relations program that introduced them to their careers. But, what do former college interns who now work elsewhere have to say about their experience with us? Here is a sampling of thoughts and insights from recent graduates:

While a college intern:  “The most exciting aspect of my internship with the BWC is the fact that my work has a very real impact on so many individuals and on society as a whole. I actually take part in identifying real cases of potential fraud, many of which go on to be investigated and eventually convicted. It’s a great feeling knowing that even though I’m only a college undergrad, the work I do changes lives.”

Since graduating:  “I would not be where I am today if not for my experience there. Thank you.”

-Allison Whitacre Berberick – Case manager position at North Central Mental Health Services.

“The work that I perform at BWC is quite educational and relevant to what I’m learning in my classes. It is also work that positively impacts and improves citizen’s lives, and that is something that makes me proud, and more eager.”

-Catho Ba – 2012 – 2013 college intern with the SID intelligence unit.

“Working at BWC has given me valuable work experience. I have made important contacts as well. My duties are relevant to my education. My internship this quarter has helped point me in the direction of a future career in detecting fraudulent behavior. I feel that my internship has gone beyond my expectations.”

-Jessica Esmurria – A June 2009 graduate of The Ohio State University.   

Before graduating and accepting a fellowship with the Ohio Legislative Service Commission: “One of many things that I enjoy here at the BWC is practicing self-management and self-directed learning and being treated as any “permanent” member of the agency would be treated. I truly believe working for BWC through the Work Study Program was and still is one of the best decisions I have ever made.” 

-Parvinder Singh– A 2007 graduate of The Ohio State University.

“I’m sure my experience at the BWC will certainly come in handy this summer [interning at a Columbus-based law firm], not only the workers’ comp knowledge I gained, but also the professional skills… Again thank you for the opportunity you gave me.”

-Estevan J. Tobias Molina – A J. D. candidate at the University of Cincinnati College of Law.

We are grateful for the significant contributions of each college intern and humbled by their kind words. Naturally, we know that we cannot rely upon past reputation. Each day, we must improve our college relations program. Stay tuned for part four of this series, in which current college interns describe their work with us, and find out how you can apply for an internship.

Categories: News Articles

Jefferson County man ordered to repay more than $14K in workers’ comp benefits

May 30, 2014 Leave a comment

Columbus – A Wintersville (Jefferson County) man was ordered to repay more than $14,000 in connection with improperly receiving workplace injury benefits. Michael D. Madigan pleaded guilty May 8 in Franklin County Municipal Court to workers’ compensation fraud, a first-degree misdemeanor.

“Workers’ compensation fraud is a crime,” said BWC Administrator/CEO Steve Buehrer. “It affects the bottom line for businesses that pay into the State Insurance Fund, and that’s why we aggressively pursue all cases of suspected fraud.”

The Cambridge Special Investigation Unit (SIU) received an allegation that Madigan was operating a firearms business while receiving multiple types of benefits from the BWC.

Investigators reviewed the bank records of the firearms business. Activity in the account showed sales of firearms and some checks were written directly to Madigan. An audit report of the business indicated that Madigan was the primary person selling the firearms. The investigation conducted by the SIU confirmed that Madigan knowingly owned and operated the business, and earned income while he was receiving benefits from the BWC.

Madigan was ordered to pay $14,801.78 in restitution to the BWC, and court costs.

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

Partnering with other agencies, ‘Fraud costs all of us’

May 23, 2014 Leave a comment

BWC’s Special Investigations Department (SID) routinely conducts data cross-matches with other agencies to detect instances of workers’ comp fraud. We work with law enforcement agencies around the state to investigate allegations. The Ohio Attorney General’s Office handles the prosecution of many of our cases.

It’s essential that we all work together. Fraud costs all of us.

That’s the tagline of a new website recently launched by the Ohio Department of Jobs & Family Services (ODJFS), since May is “Public Assistance Fraud Awareness Month.” Their new website allows tipsters to report public assistance fraud of all types.

We work with ODJFS to find instances of injured workers who are off of work and receiving workers’ comp benefits. Data cross-matches with the agency allow us to detect wages for injured workers who are believed to be off of work while recovering from a workplace injury and receiving BWC benefits.

Congratulations to our friends at ODJFS on launching such an important site. Don’t forget to report suspected workers’ compensation fraud by calling us at 1-800-644-6292 or visiting bwc.ohio.gov.

Categories: News Articles

Spotlight: SID college relations program — 20 years of working with higher education

May 23, 2014 1 comment

In 1995, BWC’s Special Investigations Department (SID) created its college relations program to promote the study and practice of criminology, criminal justice, law enforcement and public administration.

First, we created BWC-paid internships. These successfully permitted SID supervisors to furnish practical work experience to qualified students. Next, we created unpaid college externships for OSU students; several of these internships allowed students to earn course credit based upon the number of hours worked with us. Today, we offer similar course-credit externships with other colleges and universities. Most recently, we began offering college externships to Columbus State Community College students studying criminal justice. Some students join us as college externs and then are deemed the most qualified candidates for BWC paid internships.

For the past 12 years, we’ve offered federal work-study program internships to OSU students who were awarded federal grants based on need. As an off-campus community service employer, we’ve worked with dozens of these talented college interns.

No matter which type of position best meets the needs of the student, our job is to furnish the mentoring and work experience that graduates tell us have served as a stepping stone to future opportunities in their careers. That’s why we continue to offer all four types of college relations positions.

Stay tuned for part three of this series, in which graduates describe their professional career experiences.

Categories: News Articles

Upper Sandusky man ordered to repay more than $22K in workers’ comp benefits

May 23, 2014 Leave a comment

??????????????????????Columbus – An Upper Sandusky (Wyandot County) man was ordered to repay more than $22,000 in connection with improperly receiving workplace injury benefits. Gerald Whitacre pleaded guilty May 15 in Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a fifth-degree felony.

“An attentive employer services specialist was able to identify Mr. Whitacre’s falsified wage statements,” said BWC Administrator/CEO Steve Buehrer. “Staff members in many departments within BWC work to detect fraud at every level and put a stop to it.”

After conducting an employer audit, a BWC employer service specialist reported a suspicion that Whitacre may have falsified wage statements from a trucking company in Upper Sandusky to obtain increased workers’ compensation benefits. Investigators found that Whitacre altered his pay stubs to lower dollar amounts and submitted them to BWC to qualify for working wage loss disability benefits. He underreported his payroll to BWC on 41 wage statements, and if he had accurately reported his earnings, he would not have been entitled to the benefits he received.

Whitacre was sentenced to 12 months of incarceration, which was suspended for five years of community control. Conditions of Whitacre’s community control include paying $22,468.81 in restitution to BWC, obtaining viable employment, paying court costs and not having any new convictions. If he violates the terms of community control, Whitacre will serve 12 months of incarceration.

A photo of Whitacre is available here.

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

Spotlight: SID college relations program

May 16, 2014 1 comment

In 1995, BWC’s Special Investigations Department (SID) created its college relations program to promote the study and practice of criminology, criminal justice, law enforcement and public administration. On college and university campuses throughout Ohio (and beyond), SID staff members have shared with students, faculty and staff members our department’s results and exchanged insights on how to further combat crime. SID supervisors have also offered to furnish practical work experience to the most qualified students.

Since the inception of the program nearly 20 years ago, SID has recruited, selected, oriented and trained more than 300 paid interns and unpaid externs. Most of the externs elected to earn course credit for their practicums with our special investigations units (SIUs). Whether they have been interns or externs, the dedicated graduates of our college relations program have humbled us with favorable feedback. However, we know that the credit and the accolades go to them. Their careers are testament to their professionalism. Many have gone on to become officers, criminal investigators, special agents, analysts, digital forensic analysts, assistant special agents in charge and special agents in charge.

In the coming weeks, we will be featuring a four-part series that highlights SID’s college relations program. We will describe the four types of college internships and externships we offer, profile graduates of our program, recognize current SID college interns and externs and list current vacancies. Stay tuned for part one of the series, which outlines the four types.

Categories: SID Information

BWC investigations result in 12 workers’ comp fraud convictions in April

May 16, 2014 Leave a comment

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer today announced that 12 individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in April 2014. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID), which works to deter, detect, investigate and prosecute workers’ compensation fraud.

“Since the beginning of the year, 36 convictions have been obtained,” Buehrer said. “We’re pleased with our agents’ success in tracking down fraud among employers, claimants and medical providers, and will continue to routinely share information about their cases to deter others from committing workers’ compensation fraud. We want to prevent fraud from happening in the first place.”

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

David Delvecchio (Mooresville, Indiana) pleaded guilty April 29 in Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a fifth-degree felony. SID received an allegation from a BWC claims specialist that Delvecchio may have returned to work because he was never home during the day. Investigators found that he returned to work in 2011 and in 2013 for multiple employers in Indiana while collecting BWC disability benefits. A restitution hearing is scheduled for June 19, and Delvecchio is scheduled to be sentenced on June 27.

Robert Hill (St. Paris, Champaign County) pleaded guilty April 9 to a Bill of Information filed in Champaign County Court of Common Pleas to one count of workers’ compensation fraud, a fourth-degree felony. SID received an allegation that Hill was operating a tractor part business from his home. Investigators found that Hill and his wife operated the business online and from his home while he collected temporary total disability benefits from a self-insured employer between 2011 and 2013. Sentencing is scheduled for May 19.

Charles Hepner (Strongsville, Cuyahoga County) pleaded guilty April 9 in Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a first-degree misdemeanor. SID identified Hepner as possibly working through a cross-match with the Ohio Department of Jobs and Family Services; he had wages reported in 2012. Investigators found he worked for multiple employers while receiving BWC benefits. Hepner was sentenced to 180 days of incarceration, which was suspended for two years of community control and $6,235.52 in restitution.

Kenny McSwain Jr. (Akron, Summit County) pleaded guilty to workers’ compensation fraud, a first-degree misdemeanor. SID received an anonymous tip through BWC’s fraud hotline that McSwain worked at a local hotel while receiving temporary total disability benefits from BWC. Investigators reviewed employment and payroll records, and interviewed McSwain, who acknowledged that he collected BWC disability benefits he wasn’t legally entitled to receive. He paid $1,216.32 in restitution at his sentencing. He was sentenced to serve 30 days in jail, which was suspended.

David Morinello (Parma, Cuyahoga County) pleaded guilty April 2 in Franklin County Court of Common Pleas to workers’ compensation fraud, a fifth-degree felony. A confidential source contacted BWC’s Northeast Regional Special Investigations Unit to report Morinello was working while receiving temporary total disability benefits. Investigators determined that he worked for an outdoor lighting business as well as his own outdoor lighting and design business while receiving BWC benefits. Morinello provided the court with a cashier’s check for $8,898.09 in restitution. He was fined $100 and ordered to pay court costs by June 20. He will be placed on probation, if he does not pay.

George Walter (Columbus, Franklin County) was sentenced April 15 in Franklin County Court of Common Pleas after pleading guilty to forgery, a fifth-degree felony. SID’s Intelligence Unit identified that Walter had filed multiple claims, which had all been disallowed due to no employee-employer relationship. Walters filed six claims, but the listed employer denied Walter was ever employed by them, or had not been employed on the date of the alleged accident. Using business records and statements from business owners and management staff, investigators determined that Walter was not an employee. He was sentenced to five years of community control, but if he violates terms of community control, he will serve six months in prison.

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

Clark County man sentenced for working while collecting benefits

May 9, 2014 1 comment

Steven Pernell, of Springfield (Clark County), pleaded guilty April 22 in Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a first-degree misdemeanor.

An internal cross-match of state data revealed that Pernell may have been employed while receiving disability benefits from the BWC. Investigators found that he returned to work while receiving benefits during 2010 and 2011. He collected a total of $3,839.52 in disability while employed at two different jobs.

Pernell was sentenced to serve six months in jail, which was suspended on the condition that he pay $4,755.74 in restitution and investigative costs to the BWC. He was given credit for four days of jail time he had served. Also, Pernell was placed on non-reporting probation for 2.5 years and was ordered to pay $160 per month to the BWC.

Mahoning County man sentenced for working while collecting benefits

May 9, 2014 2 comments

William McieWilliam Mcie, of Lake Milton (Mahoning County), was sentenced April 18 in connection with working while receiving workers’ compensation benefits. He previously pleaded guilty Feb. 11 to one count of workers’ compensation fraud, a fifth-degree felony.

A confidential source contacted BWC and said that Mcie was working as a self-employed carpenter. Surveillance was conducted and Mcie’s customers and suppliers were interviewed. It was determined that he worked between 2008 and 2012 while receiving temporary total disability benefits.

Injured workers are not permitted to work while receiving this type of benefit.

Mcie was sentenced to serve one year in prison, which was suspended for three years of community control. As a condition of community control, he was ordered to repay $7,500 in restitution and investigative costs to the BWC.

That’s a wrap: Electronic surveillance symposium captured the very image of success!

May 2, 2014 Leave a comment

Hundreds of law enforcement professionals from around Ohio and the U.S. gathered on April 17 in Columbus for the Electronic Surveillance and Equipment Symposium (ESES14). Investigators, special agents, officers and deputies discussed the latest electronic surveillance tools and trends.eses14

Subsequently, dozens of the attendees furnished useful feedback pertaining to this first-ever event, co-sponsored by BWC’s Special Investigations Department (SID) and the Ohio State Highway Patrol.

Attendees specified the following as their favorite part of the event:

  • An aviation surveillance seminar presented by Sgt. Justin Cromer, Ohio State Highway Patrol, Aviation Unit;
  • A seminar about concealing cameras in everyday items presented by Jonathan Banks, special agent supervisor, Ohio Attorney General’s Medicaid Fraud Control Unit;
  • Legal issues regarding electronic surveillance presented by Mary Beth Young, assistant U.S. attorney in the Southern District of Ohio;
  • A drone surveillance seminar and demonstration presented by five SIERRA Project team members from the University of Cincinnati and University of Toledo;
  • Equipment exhibits and demonstrations by more than two dozen vendors during the afternoon’s trade fair.

Most importantly, more than 90 percent of attendees who completed a post-event survey indicated they would attend a similar symposium again. In fact, several respondents proposed topics for us to consider for a potential ESES15.

All agreed that effective surveillance plays an important role in law enforcement and criminal investigations. Accordingly, they appreciate a secure environment in which law enforcement professionals share best practices and advice in hopes of strengthening our efforts to contribute to safer communities.

Thank you to all who participated in and made ESES14 a success!

Follow BWC’s SID on Twitter @OhioBWCFraud and on Facebook at facebook.com/ohiobwcfraud to stay up-to-date on our continuing efforts to detect, deter, investigate and prosecute all types of workers’ compensation fraud in Ohio.

Categories: News Articles

Toledo man sentenced for receiving narcotics from multiple doctors

May 2, 2014 1 comment

Raymond Hutchison, of Toledo (Lucas County), was sentenced April 24 after pleading guilty in Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a first-degree misdemeanor.

BWC’s Special Investigations Department identified that Hutchison received multiple narcotics from several physicians and multiple pharmacies in his claim. Investigators found that Hutchison obtained several overlapping prescriptions of Oxycodone from multiple physicians between July and November 2012 after signing a pain management agreement with his physician.

Hutchison was sentenced to serve one year of community control with conditions that he not obtain any new convictions and pay court costs, as well as pay $2,100.01 in restitution and investigative costs to BWC.