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Archive for October, 2016

Northeast Ohio medical clinics at the center of $200,000 workers’ comp fraud indictment

A Cleveland doctor and the former co-owner of his practice were indicted Oct. 26 on charges related to scamming the workers’ compensation system out of $216,000.

The 170-count indictment returned by a Cuyahoga County grand jury details the findings of an investigation into the actions of Dr. Stephen Bernie, 77, and Dianne Javier, 71, of The Medical Care Group, which has several clinics in Northeast Ohio.

Undercover agents found the pair was defrauding the Ohio Bureau of Workers’ Compensation by billing for procedures never performed and inflating the percentage of disability for injured workers, making them eligible for higher payments from the state. Dr. Bernie also wrote prescriptions for medications without examining or monitoring patients, and signed prescriptions for powerful opioids that were distributed while he was on vacation.

Kim Seltzer, a former employee of The Medical Care Group, already pleaded guilty last year to workers’ compensation fraud, tampering with records and drug trafficking. Seltzer is currently serving a 51-month sentence at the Mansfield Correctional Institution.

Bernie and Javier are scheduled to be arraigned in Cuyahoga County on Nov. 9. Their indictment followed a lengthy investigation by BWC and the Westshore Enforcement Bureau, a multi-jurisdictional specialty police force in Northeast Ohio.

Read more about this case in the Cleveland Plain Dealer.

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Spotlight: Eric Brown – From college extern to special agent in charge of two elite teams

By Jeff Baker, Program Administrator, BWC Special Investigations Department

eric-brown-picMembers of the Special Investigations Department (SID) congratulate Eric Brown. On Oct. 17, 2016, Eric was promoted to special agent in charge (SAC) of the intelligence unit (IU) and the safety violations investigation unit (SVIU).

Eric started his career with BWC in September 2007 as a college extern with SID Administration’s fraud hotline team. Well-deserved promotions soon followed. Since March 2008, Eric has served the department as a college intern with IU, and full time as a criminal investigator and special agent with the health care provider team (HCPT).

intelligence4While working with SID, Eric  completed two degrees. He earned a Bachelor of Arts from The Ohio State University, with a major in Political Science and a minor in Sociology/Criminology, and a Master of Business Administration  from the University of Cincinnati.

Throughout his career, applying insight, initiative and perseverance, Eric  has significantly contributed to the department’s success. For example, he:

  • Initiated and developed the SID Case Management application;
  • Initiated and co-administered the SID Social Media campaign;
  • Co-initiated the SID 2014 Electronic Surveillance Equipment Symposium;
  • Co-initiated, staffed and co-executed the SID Technical Operations Group.

Eric was one of four special agents on Sept. 14 to receive a 2016 Innovator award. He and his co-recipients met criteria including: developed trend-setting initiatives, created an original idea or uniquely adapted an existing program, process or concept, which resulted in a long term benefit to the department; developed new work methods that reduced waste or stretched resources; and provided creative suggestions that saved the department time or money.

safety-violations2Certainly, for all of the above reasons, you can see why we thank and congratulate SAC Brown! We look forward to his continued leadership and success in our department.

For more information about IU, see our Jan.22 article, Spotlight: Intelligence Unit — Predicting even more results, here.

For more information about SVIU, see our 2011 article, SVIU: Investigating suspected violations of specific safety requirements, here, or our 2013 article, Completing the circle of coverage: A look at our Safety Violations Investigation Unit, here.

For more information about the SID see our most recent annual report here.

Spotlight: Dan Fodor – From college intern to assistant director, special investigations central operations

October 14, 2016 1 comment

By Jeff Baker, Program Administrator, BWC Special Investigations Department

fodor-picMembers of the Special Investigations Department (SID) congratulate Dan Fodor. In June 2016, Dan (shown presenting at the 2016 SID in-service meeting on Sept. 14) was promoted to assistant director, central operations.

Assistant director (AD) Fodor started his career with BWC in June 1991 as a college intern with the internal audit department. During this time, Dan completed his degree and became a certified public accountant. He earned a bachelor’s in accounting from The Ohio State University. In December 1991, Dan commenced his initial full-time position with BWC as a  financial/operational auditor and consultant. By the autumn of 1996, he had earned the title of audit senior and commenced his stellar management career.

sid-text-3In November 1999, Dan joined SID as the special agent in charge of the intelligence unit (IU), providing essential support to special investigations unit field agents through fraud detection and data analysis. Given his knowledge, skills and successes with IU, Dan accepted, in June 2014, the additional responsibility of supervising the safety violations investigation unit (SVIU), a team devoted to investigating alleged safety requirement violations that have resulted in a workplace injury, illness or death.

Throughout his career, applying uncanny intuition, uncommon sense and diligence, AD Fodor has energetically prompted our agency’s success and earned the respect of his SID colleagues.

A few examples from his 25-year career, include:

  • Guided and directed the department’s effective use of the agency’s data warehouse;
  • Developed and executed SID performance measurements and management reporting;
  • Effectively partnered with other BWC operational areas and external entities;
  • Co-administered the SID strategic planning process for several five-year plans;
  • Since 2000, IU has detected 18,950 fraud allegations, resulting in the identification of $473 million in savings; and
  • Between 2000 and June 30, 2016, IU’s fraud allegations resulted in 948 criminal referrals and 480 convictions.

These performance results demonstrate, in part, why Dan is highly qualified to direct our SID central operations. Certainly, for all of the above reasons, you can see why we thank and congratulate AD Fodor! We look forward to his continued guidance, direction, leadership and success in our department.

dan-fodor-quote2
For more information about IU, see our Jan.22 article, Spotlight: Intelligence unit — Predicting even more results, here. For more information about SVIU, see our 2011 article, SVIU: Investigating suspected violations of specific safety requirements, here, or our 2013 article, Completing the circle of coverage: A look at our safety violations investigation unit, here. For more information about the SID, see our most recent annual report here.

BWC’s Special Investigations lands 9 fraud convictions in September

The Ohio Bureau of Workers’ Compensation (BWC) netted nine convictions in September in criminal cases related to workers’ compensation fraud.

Those convicted included workers who found other work while collecting BWC benefits, employers with lapsed coverage who racked up outstanding premiums and fines totaling tens of thousands of dollars, and a dependent of a deceased worker who lied about her college attendance to collect nearly $54,000 in BWC benefits over four years.

“Those who cheat the workers’ compensation system divert resources we need to serve employers and injured workers in the most efficient, cost-effective manner possible,” said BWC Administrator/CEO Sarah Morrison. “Congratulations to our investigators for bringing these cases to justice and returning funds to their rightful purpose – making Ohio workplaces safer and caring for injured workers.”

As of Sept. 30, BWC’s Special Investigations Department (SID) had secured 80 convictions for the calendar year. September convictions include:

William Tootle, Columbus, Ohio (Franklin County) – Falsified Wages
Acting on a tip, investigators found Tootle was submitting false wages in order to receive higher wage benefits than he was actually entitled to receive. Tootle pleaded guilty Sept. 29 in the Franklin County Court of Common Pleas to one count of workers compensation fraud, a first-degree misdemeanor. Tootle paid $7,478 in restitution to BWC.

Steve Petrick Jr., Sandusky, Ohio (Erie County) – Lapsed Coverage
Investigators found Petrick, owner of Steve Petrick Roofing, had been in continuous operation with employees without appropriate workers’ compensation insurance coverage. Petrick pleaded guilty Sept. 28 to a fourth-degree felony count of attempted workers’ compensation fraud in the Erie County Court of Common Pleas. Petrick owes outstanding premiums/penalties of approximately $54,000.

Sentencing is set for Nov. 9.

Lisa M. Manley, Brewster, Ohio (Stark County) – Working and Receiving
Manley pleaded guilty Sept. 27 to a first-degree misdemeanor count of workers’ compensation fraud for working while receiving BWC injured worker benefits. She paid BWC $1,078 in restitution prior to her plea. A judge in the Franklin County Court of Common Pleas sentenced Graham to a 30-day suspended jail sentence and waived fines and cost.

Ronnie Tolliver, Greenville, Ohio (Darke County) – Working and Receiving
Acting on a tip, investigators found Tolliver operated and actively worked at T&T Total Remodeling while collecting more than $18,000 in temporary total disability benefits between April and November of 2013.

Tolliver pleaded guilty Sept. 22 to one count of workers’ compensation fraud, a fifth-degree felony. A judge in the Franklin County Court of Common Pleas sentenced Tolliver to non-reporting community control for five years and ordered him to pay $18,510 in restitution to BWC. The judge warned Tolliver that if he violates the terms of his community control, he will serve 12 months in prison.

Dion Hopson, Columbus, Ohio (Franklin County) – Working and Receiving
Investigators found Hopson working for two employers in 2014 and 2015 while collecting injured workers’ benefits. Hopson pleaded guilty Sept. 20 in the Franklin County Court of Common Pleas to workers’ compensation fraud, a first-degree misdemeanor. He was sentenced to 180 days in jail, which was suspended in exchange for five years community control. He also was ordered to pay $5,000 in restitution to BWC and $1,000 in investigative costs.

Kori White, Cleveland, Ohio (Cuyahoga County) – Death Benefits
White pleaded guilty Sept. 19 to a misdemeanor count of workers’ compensation fraud after investigators found she deceived BWC about her student status to collect nearly $54,000 in dependent death benefits over four years.

A judge in the Franklin County Court of Common Pleas sentenced White to community control for five years, under the conditions she obtain a job or undergo job training and make regular payments toward her BWC balance. White paid $10,000 toward her restitution to BWC prior to her plea, leaving her with a balance owed of $43,782.

Robert D Matusiak, Brunswick, Ohio (Medina County) – No Coverage, False ApplicationMatusiak, owner of Rob’s Tree Service, pleaded guilty Sept. 19 to one count of workers’ compensation fraud, a fourth-degree felony, after investigators found he had been operating his business with employees even though he dropped his BWC policy in 2004.

Investigators also found Matusiak filed falsified applications for BWC coverage during their investigation in an attempt to cover up his history and avoid paying $22,000 in outstanding premiums. Sentencing in the Medina County Court of Common Pleas is set for Nov. 3.

Cheryl McCleary, Columbus,Ohio (Franklin County) – Obstructing Official Business
Investigators found McCleary working as a home health aide while receiving BWC benefits.

McCleary pleaded guilty Sept. 13 in the Franklin County Court of Common Pleas to a reduced charge of attempted obstruction of official business, a first-degree misdemeanor. McCleary was sentenced to one day in jail, time served, and ordered to pay $12,985 in restitution to BWC. McCleary has paid the full amount.

Lynn D. McCann II, Mount Vernon, Ohio (Knox County) – Working and Receiving
McCann pleaded guilty Sept. 6 to a first-degree misdemeanor charge of workers’ compensation fraud after his employer reported him to BWC last year on suspicion of the crime. Investigators found McCann working as a paramedic for five months in 2015 while collecting BWC benefits for an injury he suffered doing a similar job.

McCann repaid more than $14,000 to BWC prior to his sentencing in the Franklin County Court of Common Pleas. A judge sentenced him to one day in jail, time served.

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

Sandusky employer refused to maintain workers’ comp coverage, owes $54,000

petrickThe owner of a Sandusky roofing company pleaded guilty to fraud Sept. 28 for failing to maintain appropriate workers’ compensation insurance coverage.

Steve Petrick, Jr., Owner/Operator of Steve Petrick Roofing, caught the attention of BWC’s Special Investigations Department after an anonymous tipster alleged he was operating his business without the required coverage.

BWC’s Employer Compliance Department attempted to assist Petrick with bringing his policy into compliance, but he claimed he had no employees and continued operating his business without coverage.

The case was forwarded to BWC fraud investigators after an injury claim was filed against the policy while the policy was lapsed. The investigation and surveillance proved Petrick Roofing had been in continuous operation with employees. Petrick again failed to come into compliance following an interview with agents.

Petrick pleaded guilty to a felony count of attempted workers’ compensation fraud in the Erie County Court of Common Pleas. Sentencing is set for Nov. 9, 2016.

Petrick owes outstanding premiums/penalties of approximately $54,000.

SID Annual in-service training – An opportunity to recognize our own – Part 3 of 3

By Jeff Baker, Program Administrator, BWC Special Investigations Department

In our constant quest for improvement, all members of the Bureau of Workers’ Compensation Special Investigations Department (SID) annually complete in-service training. On Sept. 14, led by SID Director James Wernecke, we shared investigative successes, acknowledged team results, and presented individual awards.

Preparations: In August, all 126 SID employees had been invited to nominate a peer to receive an individual award. A management committee furnished behavioral characteristics for use by SID employees when submitting written justifications for any peer nomination. These characteristics varied according to the type of award: Innovator; Excellence; and Leadership. In reviewing all nominations, the committee members found that imminently qualified professionals were nominated by their colleagues. Ultimately, the committee selected the six most-worthy SID employees.

Presentations: These talented and dedicated professionals received their awards at the culmination of the Sept. 14 event.

Four special agents with the SID Health Care Provider Team (HCPT) received Innovator awards. They met criteria including: developed trend-setting initiatives, created an original idea or uniquely adapted an existing program, process or concept, which resulted in a long term benefit to the department; developed new work methods that reduced waste or stretched resources; and provided creative suggestions that saved the department time or money.

josh-g-1A special agent with considerable field training officer experience from the southeast regional claimant special investigations unit (SIU) earned the Excellence award. The special agent met four standards including: performing duties or providing services to others that are beyond the professional’s assigned responsibilities; working on special projects within the department; volunteering or contributing to organizations outside the department; and demonstrating an ability and willingness to work positively, respectfully and effectively with people inside or outside of the department.

Josh Grappy, a forensic computer specialist with the SID digital forensics unit (DFU), received the Leadership award fromDirector Wernecke and SID Assistant Directors Jennifer Cunningham and Dan Fodor. Here are just some of the reasons he was nominated:

josh-g-2“Josh does not sit back and watch the world go by, he is making things happen within our organization. Josh has a high level of perseverance, stick-to-itiveness and drive. He can be counted on to get things done. Josh not only meets the customers’ expectations, he regularly exceeds them.”

Please, join us in thanking and congratulating each of the SID award nominees and recipients. They are the reason we are able to meet our mission: To effectively and proactively prevent losses to the workers’ compensation system and to deter, detect, investigate and prosecute workers’ compensation fraud.

You can read the first article about our Sept. 14 event here, the second article about the event here, and our most recent annual report here.