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Archive for January, 2015

Surveillance video shows Trumbull County man committing workers’ comp fraud

January 23, 2015 1 comment

Columbus – A McDonald (Trumbull County) man was sentenced Jan. 8 in Franklin County Court of Common Pleas after investigators with the Ohio Bureau of Workers’ Compensation (BWC) caught him on video working while he was receiving benefits following a workplace injury. Michael Buckner previously pleaded guilty last November to one count of workers’ compensation fraud, a fifth-degree felony.

“We rely upon the eyes and ears of medical providers, employers, claimants and our own employees to report suspected workers’ compensation fraud,” said BWC Administrator/CEO Steve Buehrer. “In this case, a tip is what enabled our investigators to catch Buckner in the act of committing fraud. We encourage anyone who suspects claimant, employer or medical provider fraud to contact us immediately.”

BWC received an allegation that Buckner reported to his BWC medical appointments with heavily callused hands and dirt under his fingernails, and that he may have worked while receiving temporary total disability benefits. Claimants are not permitted to work while receiving this type of benefit.

Using financial records, surveillance operations, undercover operations, field interviews and Buckner’s testimony, investigators found that Buckner was working at his family’s automotive repair business while receiving temporary total disability benefits.

Buckner was sentenced to 11 months of incarceration, which was suspended for three years of community control. He was also ordered to find full-time employment and to repay $21,642.60 in restitution to BWC. Wages will be garnished from his paychecks until the restitution is paid in full.

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, and see what workers’ compensation fraud looks like in our new fraud awareness video on YouTube.

Fraud Finders follow-up: More BWC employees trained and recognized

For two decades, we’ve conducted regular fraud red-flag training for BWC’s claims, medical and employer service specialists. Fraud FindersWe’ve provided them with knowledge in detecting fraud as well as reviewed the various means to most efficiently refer their allegations to our department. This includes a “Report Fraud” icon on every desktop.

Why?

Since the mid-1990s, our internal Fraud Finders program has annually generated hundreds of cases and millions of dollars in savings. BWC employees furnished allegations that resulted in 581 cases closed by the Special Investigations Department (SID) during fiscal year 2014 alone. These cases identified a whopping $7.2 million in savings.

“We’ve found that educating staff about the red flags of fraud really helps them understand the many ways in which someone may attempt to commit workers’ compensation fraud,” said SID Director Jennifer Saunders.  “We’re grateful for the partnership of our staff and the general public who report their suspicions. Our success in uncovering fraud is due largely in part to them for taking action when something just doesn’t seem right.”

SID recently completed its latest round of fraud red-flag presentations and Fraud Finder recognitions at BWC’s 12 service offices around Ohio. Each event was led by a team of three special agents in charge, assistant special agents in charge and investigators. The SID facilitators thanked all fraud allegation sources within BWC for supporting our efforts to deter, detect and prosecute workers’ compensation fraud.

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.

Categories: News Articles

Workers’ compensation fraud: Learn about it and protect yourself

Find out how BWC’s Special Investigations Department successfully investigates worker’s compensation fraud at the 20OSC15fc.15 Ohio Safety Congress & Expo (OSC15), which runs March 31 to April 2 at the Greater Columbus Convention Center.

This annual event hosted by BWC helps Ohio employers prevent workplace injuries and achieve better outcomes for injured workers.

The April 1 session, “BWC Special Investigations Department: Partnering with You to Combat Workers’ Compensation Fraud,” will offer a presentation by representatives from the department. They’ll cover the process for participants to identify and report suspected workers’ compensation fraud, and offer case summaries of recently prosecuted subjects.

These fraud investigators will discuss how workers’ compensation fraud impacts Ohio employers and employees as well as red flag indicators of fraud by subject type – claimant, employer and medical provider – while covering the ways that participants can report suspected fraud to BWC.

An April 2 session, “Safety Violation Investigations,” will explain BWC’s role in investigating potential safety code violations. Other session topics at OSC15 include ergonomics, construction safety, emergency planning and safety program development.

There’s no charge for Ohio employers and their employees to attend OSC15, which is the largest regional safety and health conference in the U.S. A full schedule of sessions is available by clicking here.

Register for OSC15 today!

Categories: News Articles

BWC investigations result in four workers’ comp fraud convictions in December

January 15, 2015 1 comment

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

“Workers’ compensation fraud has a ripple effect on all employers that pay into the State Insurance Fund,” Buehrer said. “We’ve made holding employers, medical providers and injured workers who cheat the system accountable a priority and will continue to do so in 2015 in order to keep employer premiums in Ohio as low as possible.”

The following is a sampling of cases that resulted in guilty pleas or convictions during December:

Keith Hullinger (Canton, Stark County) pleaded guilty and was sentenced Dec. 2 in the Franklin County Court of Common Pleas on one count of workers’ compensation fraud, a first-degree misdemeanor. BWC received an allegation that Hullinger was working while receiving temporary total disability benefits from BWC. Injured workers are not permitted to work while receiving this type of benefit. Investigators found that Hullinger worked as a dump truck driver while receiving disability benefits he was not entitled to receive. He was ordered to pay $2,248.55 in restitution to BWC and sentenced to one year of community control.

Jerry Jennings (Glenford, Perry County) pleaded guilty and was sentenced Dec. 3 in the Franklin County Court of Common Pleas on one count of workers’ compensation fraud, a first-degree misdemeanor. BWC received an allegation that Jennings was receiving cash for working while collecting permanent total disability benefits. Investigators confirmed the allegation by interviewing witnesses, reviewing bank records and conducting surveillance. The evidence was presented to his treating physicians for review. Both of them indicated that Jennings deceived them and is capable of working. He was sentenced to six months of incarceration, which was suspended for four years of community control. A condition of his community control is that he must pay $4,726.22 in restitution to BWC.

Dean Moffo (Austintown, Mahoning County) was sentenced Dec. 9 in Trumbull County Court of Common Pleas after pleading guilty in September 2014 to one count of workers’ compensation fraud, one count of theft and one count of tampering with records, all first-degree misdemeanors. BWC received an allegation that Moffo was working while receiving temporary total disability benefits. Injured workers are not permitted to work while receiving this type of benefit. Investigators conducted interviews and analyzed financial records, and found that Moffo returned to work as a self-employed mechanic while receiving benefits. He was sentenced to two years of community control and ordered to pay a total of $11,000 in restitution to BWC along with court costs of $330.  If Moffo violates any condition of his probation, he is subject to either six months of incarceration, or 40 hours per week of community service until he has satisfied his debt.

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 and view BWC’s workers’ comp fraud awareness video on YouTube.

The reason we collaborate with law enforcement agencies

As a criminal justice agency, we regularly consult and partner with law enforcement and criminal justice agencies for our investigations. Municipal police departments, county sheriff’s offices, state agencies and federal offices, prosecutors at the city, county, state and federal level – BWC’s Special Investigations Department works with all types of agencies to investigate workers’ compensation fraud.

The reason is simple: 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 learn ways to accomplish tasks more efficiently and glean new strategies and technologies for conducting investigations.

Most frequently, our fraud investigators collaborate with other agencies to conduct joint criminal investigations of fraud suspects. They often execute search warrants with local, state and federal law enforcement agencies as well.

Here are just three examples of cases in which we received assistance from other law enforcement agencies:

  • Joseph Curto, of Conway, South Carolina, who had worked for seven employers since 1999 and used his wife’s Social Security number to report his earnings in an effort to conceal his income to continue receiving workers’ comp benefits. The Social Security Administration, Office of Inspector General assisted in the out-of-state investigation;
  • Lawanna Porter, of Shaker Heights, who operated Palladium Healthcare, a home healthcare agency with more than 100 employees, failed to report having employees to various state agencies or to secure workers’ compensation, and failed to report her payroll to BWC. SID conducted this joint investigation with the Ohio Attorney General’s Office, Medicaid Fraud Control Unit;
  • Daren L. Snyder, of Chillicothe, who was convicted of workers’ compensation fraud in 2011. However, when Snyder failed to meet the conditions of his probation, a warrant was issued for his arrest. On Nov. 25, 2014, the Franklin County Sheriff’s Office arrested Snyder.

We are honored 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.

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

Belmont County man pleads guilty to falsifying job search forms for workers’ comp benefits

Chalmers Barnes III, of Belmont (Belmont County), pleaded guilty Jan. 5 in Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a first-degree misdemeanor.

BWC fraud investigators received an allegation from a BWC claims service specialist that Barnes submitted falsified job search forms to receive non-working wage loss benefits. In order to receive this type of benefit, claimants must submit job search forms to show that they are searching for a job.

Investigators checked job searches Barnes submitted to BWC, and found that Barnes was not performing in-person job searches or completing job applications at those businesses. As a result, BWC paid benefits to Barnes that he was not entitled to receive.

Barnes was sentenced to one day in jail and given credit for time served. He also paid $749.47 in restitution prior to his sentencing.