Archive

Archive for November, 2014

Fraud investigators learn new tools for preventing and detecting drug diversion

November 26, 2014 1 comment

Four of our fraud analysts and investigators at the Ohio Bureau of Workers’ Compensation’s Special Investigations Department attended the four-day 25th annual conference of the National Association of Drug Diversion Investigators (NADDI) last week in Cincinnati. During the conference, NADDI members exchanged the latest information on preventing and detecting drug diversion.

Ultimately, BWC investigators hope to apply what they learned at this training seminar to their drug-related investigations.

The investigators will also share what they’ve learned with their colleagues, and use those strategies while conducting joint investigations with other law enforcement professionals, some of whom also attended last week’s milestone conference.

Congratulations to NADDI on 25 years of training, collaboration and partnerships! We’re pleased to say that one of our fraud analysts is an officer of this association.

For more articles from our blog, please visit ohiobwcfraud.wordpress.com.

Categories: News Articles

Marion man ordered to pay $6K in workers’ comp restitution

Samuel Jarrell, of Marion (Marion County), pleaded guilty Nov. 12 in Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a first-degree misdemeanor.

BWC received an allegation that Jarrell was working while receiving temporary total disability benefits. Injured workers are not permitted to work while receiving this type of benefit.

Investigators reviewed bank records and conducted both interviews and surveillance to prove that Jarrell was working at his family truck and auto repair business while receiving temporary total disability. Jarrell was ordered to pay $6,136 in restitution, and was also sentenced to 90 days of incarceration, which was suspended for a year of community control. Terms of his community control include paying the restitution.

Columbus man ordered to pay $3K in workers’ comp restitution

Russell Milam of Columbus (Franklin County) pleaded guilty Nov. 12 in Franklin County Court of Common Pleas to workers’ compensation fraud, a fifth-degree felony.Russell Milam booking photo

BWC received two separate allegations that Milam was working while receiving temporary total disability benefits. Injured workers are not permitted to work while receiving this type of benefit. Investigators reviewed payroll records, which showed that Milam worked as a subcontractor for a gutter company in 2010 while receiving temporary total disability.

Milam was ordered to pay $3,288.24 in restitution. He was placed on community control with basic supervision for two years. Milam was also given 12 months at the Ohio Department of Rehabilitation and Correction, which was suspended as long as community control is not violated. He also had 13 days of jail time credit.

What workers’ compensation fraud looks like

In honor of International Fraud Awareness week, we’ve put together a new fraud awareness video. Check it out!

Our most popular workers’ comp fraud cases of the year

November 20, 2014 1 comment

Our most popular workers’ compensation fraud cases this year include claimant, provider and employer subjects:

  • Brooklynn Mieczkowski of Columbus, who inaccurately reported her symptoms and the extent of her injuries to improperly collect workplace injury benefits;
  • Michael Meekins of Akron, who engaged in professional wrestling matches while receiving disability benefits for a back injury;
  • Glenn Jones of Cleveland, whose workplace security camera caught him faking a workplace injury;
  • Nelsonville chiropractor Michael L. Brown, whose patients were not at his office on days that he billed BWC for treating them, including dates his office was closed, and who fabricated the amount of treatment he provided to patients to receive a higher payment for services;
  • Lawanna Porter of Shaker Heights, who operated Palladium Healthcare, a home healthcare agency with more than 100 employees, but failed to report those employees to various state agencies.

These subjects have at least one thing in common. Thanks to the sources who reported their suspicions of fraud, each subject was convicted for their crime.

If you suspect workers’ compensation fraud, call 1-800-644-6292, visit bwc.ohio.gov, or visit facebook.com/ohiobwcfraud.

For more articles from our blog, please visit ohiobwcfraud.wordpress.com.

Throwback Thursday: Investigating workers’ comp fraud is very different from 20 years ago

The world of fraud investigations here at the Ohio Bureau of Workers’ Compensation (BWC) is constantly changing due to technology. Today, we compare the way we used technology in 1994 and how we use it today.

THEN: Here’s a 2002 cover of our magazine, BWC Focus, which is no longer printed.

Data management

  • Then: We used paper files to contain most data.
  • Now: We remotely access data from smart phones and quickly analyze datasets with millions of records using customized data mining software.

Equipment

  • Then: We used pagers to communicate and bulky audio and video recording devices to capture evidence.
  • Now: We use smart phones and Multi-Agency Radio Communication System (MARCS) radios to communicate, conceal covert equipment in everyday items, and deploy advanced surveillance techniques to optimize an undercover agent’s safety and effectiveness.

Training

  • Then: We traveled to training sessions.
  • Now: More effective ways to complete training exist, including computer-based training, webinars and podcasts. Today, via video-conferencing, we inexpensively connect dozens of professionals located throughout the state to exchange demonstrations of best practices.

NOW: Our Facebook page, this blog and other social media efforts help us share workers’ comp fraud news.

Lastly (how could we forget?), we use social media and this blog to share our latest news. For more articles from our blog, please visit ohiobwcfraud.wordpress.com.

Social media helps to deter, detect and investigate workers’ comp fraud

November 19, 2014 2 comments

Since 2011, the Ohio Bureau of Workers’ Compensation has used social media to highlight our Special Investigations Department’s efforts to deter, detect and investigate workers’ compensation fraud. And in August 2013, we took it a step further and created Fraud Fridays.

The social media campaign notifies the public of outstanding fugitives, prosecutions, anti-fraud efforts and job postings. SID Facebook content furnishes surveillance video footage, booking photos of convicted subjects and descriptions of their fraud schemes.

That’s right – each week, we share meaningful content on newsworthy fraud topics. Many of the Fraud Friday articles educate our readers on how to detect various types of fraud committed by claimants, employers and providers. We teach our readers how to recognize fraudulent behaviors using real examples of common fraud schemes. We furnish our friends with multiple means to easily report their suspicions to us, including a link to a Report Fraud form. Each article reminds readers that if they suspect workers’ compensation fraud, they may call 1-800-644-6292, visit bwc.ohio.gov, or visit facebook.com/ohiobwcfraud.

We’re certain that all of the above deter would-be criminals from committing fraud against the State Insurance Fund, which pays for injured worker benefits.

In addition to educating the public and deterring future fraud, SID uses social media to conduct our investigations. The SID digital forensics unit uses social media research to support investigations conducted by other SID teams. During fiscal year 2014, the unit also responded to 139 such requests. The unit’s social media analysis assisted SID teams in locating claimants, providers and employers. Through this analysis, the DFU identified the employment information of claimant subjects, as well as potential suspects, witnesses and co-conspirators.

To maximize the impact of our social media campaign, we offer readers a variety of ways they may connect with us and receive news releases, videos, articles and other updates:

And finally, for more articles from our blog, please visit ohiobwcfraud.wordpress.com. Thank you for your support of our efforts!

Does something seem suspicious?

November 18, 2014 1 comment

Does something seem suspicious-

Our sources say the darndest things

Sources say the darndest things

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

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

“BWC is the largest state-fund insurance system in the nation, and we won’t back down when it comes to workers’ compensation fraud,” Buehrer said. “Our Special Investigations Department has identified more than $1.6 billion in savings since it began in 1993, and continually strives to root out fraud and seek prosecution, when necessary, to preserve the State Insurance Fund.”

The following cases resulted in guilty pleas or convictions during October:

Richard Lewis III (Tampa, Florida) pleaded guilty Oct. 27 in Franklin County Municipal Court to one count of workers’ compensation fraud, a first-degree misdemeanor, and was sentenced to 79 days of incarceration and given 79 days of credit for time served. BWC began looking into the matter after receiving a false claim allegation from an employer. Investigators found that Lewis signed a first report of injury form, alleging that he was injured while employed; he received medical treatment and prescription drugs as a result of the claim. The claim was disallowed after investigators learned he was not an employee of the business. In 2013, Lewis filed two additional false claims against another business; those were also disallowed due to a lack of employer/employee relationship.

David Martindale (Warren, Trumbull County) pleaded guilty Oct. 9 in Warren Municipal Court to one count of workers’ compensation fraud, a first-degree misdemeanor, and was ordered to repay $5,679.64 in restitution to BWC, plus a $200 fine and court costs. BWC began investigating after receiving an allegation that Martindale was working while receiving BWC benefits. Financial records and interviews showed that Martindale did return to work while receiving workers’ compensation benefits. In addition to restitution, he was sentenced to serve 180 days in jail, which was suspended for five years of probation. If he violates the terms of his probation, Martindale will serve the jail time.

Russell Woelfel (Miamisburg, Montgomery County) pleaded guilty Oct. 23 in Columbus Municipal Court to workers’ compensation fraud, a first-degree misdemeanor. He appeared in court with a check for $1,015.76 for investigative costs, and had previously repaid his restitution of $2,621.26 to BWC. BWC identified that Woelfel earned wages while simultaneously collecting temporary total disability benefits, and investigators found that Woelfel worked as an engineer for a construction business while collecting BWC disability benefits between May and September 2012. Since he paid for investigative costs and restitution, the judge sentenced Woelfel to pay a $250 fine plus court costs.

Phillip Sexton (Dayton, Montgomery County) pleaded guilty Oct. 20 in Dayton Municipal Court to falsification, a first-degree misdemeanor, and was ordered to pay $1,003.69 in investigative costs along with a $200 fine and $111 in court costs. BWC received an allegation that Sexton may have filed a false claim against The Humane Society of Greater Dayton, and investigators confirmed that Sexton was never employed by the organization.

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.

International Fraud Awareness Week: BWC and workers’ comp fraud

November 17, 2014 1 comment

We’re the Ohio Bureau of Workers’ Compensation and we’re tough on fraud.Fraud Awareness Week 2014

BWC is partnering with the Association of Certified Fraud Examiners for International Fraud Awareness Week to educate the public and prevent future occurrences of fraud.

Since 1993, BWC’s Special Investigations Department has researched and reviewed more than 112,405 allegations of workers’ compensation fraud, and completed 61,359 investigations and identified $1,621,856,667 in savings.

Workers’ compensation fraud can be committed by an injured worker faking an injury to get some time (and money) away from work, a medical provider who is overbilling, or an employer isn’t truthful about the amount of payroll reported for workers’ compensation premiums. These are merely a few examples.

For Fraud Week, we’re expanding our usual Fraud Friday coverage into a week’s worth of tips, articles and new cases here on our blog, ohiobwcfraud.wordpress.com, and also on Twitter, Facebook and YouTube. Stay tuned!

Columbus health aide ordered to pay $14K in workers’ comp restitution

November 13, 2014 1 comment

Dianne Smoot, of Columbus, was sentenced Nov. 6 to pay $14,598.24 in restitution to the Ohio Bureau of Workers’ Compensation (BWC) after pleading guilty the same day in Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a fifth-degree felony.

A data cross-match with the Ohio Department of Job and Family Services revealed that Smoot received wages during the time she received disability benefits from BWC. Investigators found that Smoot worked as a home health aide for a program sponsored by the Central Ohio Area Agency on Aging while receiving the benefits.

In addition to restitution, Smoot was sentenced to six months of incarceration, which was suspended for five years of community control. Terms of community control include paying the restitution and maintaining employment.

Fraud, integrity the focus of recent conference

Two of our investigators at the Ohio Bureau of Workers’ Compensation’s Special Investigations Department attended the two-day Targeting Fraud: Safeguarding Integrity conference in Columbus. During the conference, they gleaned ideas from the latest information on specialized investigative topics, such as deception, organizing complex cases into electronic files, examining dangers and repercussions of counterfeit products and the increasing use of virtual currencies in illegal and fraudulent activities.

“My favorite speaker spoke about exploring the scientific truths and lies about telling truths and lies,” one fraud analyst said afterward. “He gave us the opportunity to test our skills at spotting lies, and he also taught us clues to look for that may be related to deception.”

The investigators will share what they’ve learned with their colleagues, and use those strategies while conducting joint investigations with other law enforcement professionals, some of whom also attended last week’s conference.

Ultimately, using what they learned at this and other training seminars, the BWC investigators seek to secure even more results than the $60.1 million in savings they identified last year, as outlined in our FY 2014 annual report.

For more articles from our blog, please visit ohiobwcfraud.wordpress.com.

Categories: News Articles

Home healthcare agency owner sent to jail, ordered to pay $124K

Columbus – A Shaker Heights (Cuyahoga County) woman was sentenced Oct. 16 in Franklin County Court of Common Pleas to 30 days in jail and ordered to pay $124,573.07 in restitution to the Ohio Bureau of Workers’ CoLawanna Porter Franklin County booking photompensation (BWC) after operating a home healthcare agency with more than 100 employees, but failing to report those employees to various state agencies. Lawanna Porter previously pleaded guilty Aug. 21 to one count of aggravated theft, a third-degree felony, one count of tampering with evidence, a third-degree felony, one count of workers’ compensation fraud, a fourth-degree felony, and four counts of forgery, fifth-degree felonies.

“Employer payroll information and employee totals are used to calculate workers’ compensation premiums,” said BWC Administrator/CEO Steve Buehrer. “It’s critical that we receive the correct information to ensure that our calculations are accurate. We’re pleased the numbers are corrected and this employer has been ordered to pay the proper amount.”

BWC received an allegation from the Ohio Attorney General’s Office Medicaid Fraud Control Unit that Porter operated Palladium Healthcare, a home healthcare agency with locations in Ashtabula and Bedford Heights, but failed to report employees to state agencies. Investigators with BWC’s Special Investigations Department Employer Fraud Team worked with the Attorney General’s Office to investigate the matter; they found that Porter denied having any employees to BWC. Using bank records and policy information, BWC investigators found that Porter should have paid an additional $124,573.07 in workers’ compensation premiums between 2010 and 2012.

Palladium Healthcare LLC, of which Porter was a co-defendant, pleaded guilty to one count of aggravated theft, a third-degree felony. Porter’s sentencing included that charge as well.

Both of the Palladium Healthcare locations are closed.

In addition to restitution, Porter was ordered to pay BWC $15,000 in investigative costs, for a total of $139,573.07. She was also sentenced to five years of community control. If she violates the terms of her sentencing, Porter could be sent to prison for 11.5 years.

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.