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Archive for August, 2016

Special Investigations Department identified $56.6 million in savings last year

We’re pleased to announce that SID identified $56.6 million in savings for the State Insurance Fund over the past year due to workers’ compensation fraud committed by claimants, employers and medical providers.

cvr4Recovered funds will go back to the State Insurance Fund to care for workers injured in Ohio. The Spe cial Investigations Department Fiscal Year 2016 Annual Report was released today, and includes an overview of statistics and strategies for preventing and detecting fraud.

Since its inception in 1993, SID has completed nearly 64,000 investigations and identified $1.7 billion in savings to the Ohio workers’ compensation system.

Among the more than 1,500 cases that were closed during FY 2016, 668 were closed founded, meaning the original allegation was proven. The average savings identified among the 668 cases was more than $84,000. This average savings identified per closed case was the second highest annual average generated by SID. Nearly 200 of these cases were referred for prosecution, or 29.6 percent of the founded cases. SID obtained 119 indictments and 127 convictions.

SID employees are able to generate these results because of their effective and efficient day-to-day investigative techniques and tactics, including collaboration within the law enforcement community. SID employees maintain effective partnerships with our colleagues within local, state and federal investigative bodies. These benchmarking partners recognize that SID embraces technology, such as electronic surveillance equipment and data analysis, including predictive modeling, to proactively detect fraud. During FY 2016, the total savings identified from allegations detected by our intelligence unit and referred to field teams for investigation exceeded $36 million.

However, enforcement is not the only method used by SID to achieve its departmental mission. SID employees promote fraud prevention strategies to internal and external stakeholders by means of articles in periodicals, presentations, and social media, such as this article. These efforts educate, inform and build understanding of BWC’s overall mission “to protect Ohio’s workers and employers through the prevention, care and management of workplace injuries and illnesses at fair rates.”

sid mission
Thank you for supporting our agency’s mission and efforts. Please keep those tips coming!

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Richland County man ran home maintenance business while receiving workers’ comp

Ambrose Adams, Jr.A home repair man who purposely concealed his employment while receiving injured workers’ benefits pleaded guilty Aug. 16 to workers’ compensation fraud and had to pay BWC nearly $12,000 in restitution.

BWC’s Special Investigations Department (SID) started looking at Ambrose Adams, of Lexington, Ohio, near Mansfield, after receiving an internal tip from a customer service specialist. The CSS had become suspicious after calling Adams and reaching a voice mail message for ‘Milt’ with Double A Home Maintenance and Repair. Adams’ middle initial is M. The CSS also advised that Adams had a history of “no-showing” for exams or appointments scheduled with BWC or his own providers.

SID confirmed Adams returned to work as a self-employed home improvement contractor for his business, Double A Home Maintenance and Repair, while concurrently receiving workplace injury benefits from BWC.

Adams, 59, pleaded guilty to a misdemeanor count of workers’ compensation fraud in the Franklin County Court of Common Pleas after paying BWC $11,965 in restitution. A judge sentenced Adams to 60 days in jail, suspended, and one year of probation.

Special Investigations Dept nets 6 convictions in July

The BWC Special Investigations Department netted six convictions in July in criminal cases related to workers’ compensation fraud.

“Workers’ comp fraud is not only illegal, it impacts the entire workers’ comp system designed to protect Ohio workers and employers in the event of a workplace injury,” said BWC Administrator/CEO Sarah Morrison. “Putting an end to fraud safeguards employer premiums that should be going toward helping injured workers return to health and back on the job as soon as possible.”

As of July 31, BWC’s Special Investigations Department had secured 61 convictions for the calendar year. July convictions include:

Mike G. Abro (Cuyahoga County)
Investigators found Abro was operating several Happy’s Pizza franchise locations in Northeast Ohio with multiple BWC policies in which coverage was lapsed.  Abro worked with BWC to bring several policies back into compliance, but failed to become compliant at his East Cleveland location.

Abro pleaded guilty July 6 in Cuyahoga County Common Pleas Court to one count of failure to comply, a second-degree misdemeanor. He was sentenced to 90 days incarceration, suspended, and ordered to serve one year of non-reporting probation. As a condition of his probation, Abro was ordered to bring the lapsed policy into compliance. He made a $15,000 payment in June, and must enter into a payment plan on his remaining balance of approximately $18,000 in order to become compliant with the law.

Shannon Graham (Lorain County)
Investigators found Graham had returned to employment as a medical records and scheduling coordinator with a retirement community while receiving temporary total disability benefits by a self-insured employer.

Graham pleaded guilty July 26 in Cuyahoga County Common Pleas Court to one count of falsification, a first-degree misdemeanor. She made an initial restitution payment of $2,500. She was sentenced to a 180 days jail, suspended for one year of community control, and ordered to pay restitution in the amount of $3,200.

Diane Kaiser (Franklin County)
Investigators found Kaiser working for an insurance company while also receiving temporary total disability benefits from BWC. Kaiser pleaded guilty July 11 in Franklin County Common Pleas Court to one count of attempted workers’ compensation fraud, a first-degree misdemeanor. She was ordered to pay $1,734 in restitution and $500 in investigative costs to BWC.

Donald Rasmussen (Lucas County)
Investigators found Rasmussen was working as a truck driver while receiving temporary total disability payments from BWC. Rasmussen pleaded guilty July 26 in Franklin County Common Pleas Court to one count of workers’ compensation fraud, a first-degree misdemeanor. The judge sentenced Rasmussen to 60 days in jail, suspended for one year if he has no other convictions. Rasmussen paid $29,720 in restitution to BWC prior to his plea.

De’Ericka Vason (Cuyahoga County)
Investigators found Vason working as a day care worker while collecting temporary total disability payments from BWC. Vason pleaded guilty July 5 in Franklin County Common Pleas Court to one count of workers’ compensation fraud, a first-degree misdemeanor. Vason was sentenced to 180 days in jail, suspended for three years of community control, and ordered to pay restitution in the amount of $2,235 to the BWC.

Ryan Somnitz (Sherrills Ford, North Carolina)
Acting on an anonymous tip, investigators found Somnitz was not fulfilling the educational requirements he needed to receive dependent death benefits. He was required to be pursuing a full-time educational program while enrolled in an accredited educational institution. Investigators, however, found Somnitz consistently and knowingly remained in part-time student status and withheld from BWC that he was not a full-time student. Somnitz pleaded guilty July 11 to one count of workers’ compensation fraud, a fifth-degree felony. He is scheduled for sentencing Aug. 24.

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

Under the table: summertime fraud

We’re already well into the heat of the summer, a time of year when we all enjoy barbeques, gardening, vacations and freshly cut grass. But on those outdoor chores on the hottest of August days, some of us would rather pay the young person down the street to weed the flowerbeds and clear the gutters.

It’s a pretty simple transaction, really. The neighbor isn’t an “employee” in the official sense, and you hand him the cash when the job is done.

A problem arises, however, if instead of a high school sophomore trimming your trees and bushes, the work is done by an injured worker receiving workers’ compensation benefits.

If that’s the case, there’s a big problem. There are two acts of fraud taking place. The first lies with the worker who is working while receiving compensation benefits. If you’re on comp, you can’t work.

The second would apply to you, the person who hired the injured worker. If you knowingly employ a worker who is simultaneously receiving workers’ compensation benefits, you are also liable and you could also face charges of fraud and conspiracy to conceal wages. This is precisely why attorney Otha Jackson was convicted in federal district court of one felony count of mail fraud and one felony count of conspiracy to commit an offense against the United States. Our investigation proved that Jackson had knowingly hired an injured worker, Renee Jefferson, and conspired to conceal her wages. Jefferson was sentenced to serve 18 months in federal prison. Jackson was sentenced to serve 21 months in federal prison.

BWC’s Special Investigations Department (SID) is constantly on the lookout, especially during the summer months, for fraudulent companies operating in the great outdoors with claimants receiving workers’ comp and trying to hide their earnings by taking cash under the table. SID is able to track official wage reports, and we’re also aware of ways those who commit fraud try to work around them. Our investigators are also out in full force. We know the extended daylight hours that draw injured workers into public view act as a spotlight to shine attention upon their activities. Cameras capture evidence of their crimes.

Don’t let fraud get in the way of a summer that should be about sunshine, family and fun.

Lucas County man pleads guilty to workers’ comp fraud

A Lucas County truck driver was sentenced in the Franklin County Court of Common Pleas July 26 following an investigation by the Ohio Bureau of Workers’ Compensation that found he worked for three trucking companies while receiving workplace injury benefits.

Donald Rasmussen, of Holland, raised suspicion with a BWC claims service specialist in 2011 when he requested two years of retroactive temporary total disability benefits. The CSS reported that Rasmussen was a truck driver at the time of his injury and questioned whether he worked during the new period of benefits that he requested.

Rasmussen claimed he had not worked since 2009, however, BWC’s Special Investigations Department obtained evidence showing he did in fact work as a truck driver for three different truck owners. He was able to obtain benefits he was not entitled to receive by failing to to notify BWC, his treating physicians or managed care organization that he returned to work.

Rasmussen pleaded guilty to a misdemeanor count of workers’ compensation fraud and was sentenced to sixty days in jail, suspended provided he has no convictions for one year.  Rasmussen repaid $29,720.39 in restitution to BWC prior to his plea.

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