Archive

Archive for May, 2018

Case update: Ohio doctor sentenced to 5-year prison term

Dr. Timothy Manuel, a Highland County physician who improperly prescribed opioids to injured workers, was sentenced Thursday to five years in prison and ordered to pay $12,060 in restitution to BWC.

Manuel, 59, was the subject of a joint investigation by BWC and the Ohio Board of Pharmacy that found he prescribed large amounts of medically-unnecessary oxycodone to numerous patients while working as a doctor at Hillsboro Urgent Care in southwestern Ohio. He also billed BWC for medical services that weren’t provided.

Manuel was taken into custody following his sentencing in the Highland County Court of Common Pleas. Read more on the case in this Hillsboro Times Gazette article.

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Youngstown auditor is BWC’s Fraud Finder of the Year

By Jeff Baker, Program Administrator, BWC Special Investigations Department

An external auditor in the Youngstown Claims Office received the 2017 Fraud Finder of the Year award May 22 from BWC’s special investigations department (SID).

The auditor, who does not want to be identified given the sensitive nature of his job, received the award for alerting SID to a case in which an employer failed to report payroll and failed to respond to multiple attempts to schedule a premium audit. An investigation by the SID Employer Fraud Team revealed that most of the employer’s Ohio employees were reported to ODJFS, but not to BWC. The referral resulted in the identification and recovery of $804,352 in savings to the state insurance fund.

“Thanks to this employee’s vigilance and timely referral, we were able to stop fraud and save the BWC system nearly a million dollars,” said SID Director Jim Wernecke. “Our success in uncovering fraud protects resources we need to take care of injured workers, create safe workplaces and provide the best service possible to employers at affordable rates.”

The auditor, who handles employer policy underwriting and premium audits, said he appreciates the recognition and is glad he could help.

“This is why we do what we do,” he said. “After spotting a red flag in this case, I dug a little deeper and found more red flags. Persistence paid off, and it’s a good thing, because this kind of behavior drives up our costs and hurts all the honest players in our system.”

SID received 2,320 allegations of fraud in 2017, with about a fourth of those coming from BWC personnel around the state — claims representatives, employer representatives and others who suspect illicit behavior on the part of injured workers, employers, health care providers or others connected to the BWC system. During 2017, SID closed 311 cases referred by 158 BWC employees. The SID investigations found fraud in 146 of the 311 cases and generated $2,724,426 in identified savings.

To show their appreciation, SID leaders conducted a thank-you tour and red flag training from March through May, presenting Fraud Finder Award certificates to BWC employees in customer service offices across Ohio.

“We encourage all BWC employees to contact us immediately if they suspect fraudulent behavior in our system, even the slightest hint of it,” said Director Wernecke. “We will conduct a thorough investigation, and the sooner we get started, the better.”

To report suspected cases of workers’ compensation fraud, call 1-800-644-6292 (then select option 0, option 4) or visit www.bwc.ohio.gov.

Cleveland bartender’s Facebook post exposes work comp fraud

Restaurant worker owes BWC nearly $7,600

A Cleveland bartender must repay the Ohio Bureau of Workers’ Compensation $7,595 after pleading guilty Tuesday to workers’ compensation fraud.

In addition to restitution, Gabriella Benkovits, 26, of Lakewood, must serve two years of probation for the first-degree misdemeanor, a judge in the Franklin County Court of Common Pleas ruled.

“The company managing Ms. Benkovits’ medical claim for her 2012 work injury alerted us that they found a Facebook post indicating she was working as a bartender in Westlake,” said Jim Wernecke, director of SID’s special investigations department. “Our investigation revealed she worked at three different establishments from July 2015 to February 2016 while collecting disability benefits she wasn’t entitled to.”

Wernecke said Benkovits deliberately concealed her employment from BWC, her physicians and other parties officially involved in her injury case.

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

1,000 Fraud Hotline calls in 6 months!

By Jeff Baker, Program Administrator, BWC Special Investigations Department

We have received 1,000 calls since we launched our new Fraud Hotline system six months ago during International Fraud Awareness Week 2017. That’s 167 calls a month, a little more than seven a day, or one nearly every working hour!

In our November 14, 2017 blog, we noted that calling the BWC Fraud Hotline is the most interactive and direct way for you to report an allegation of fraud. Our hotline puts you in direct contact with an agent in our Special Investigations Department, one ready and willing to listen to your concerns. (Under our old system, you reached a representative in BWC’s Customer Contact Center.)

Our hotline agents have years of investigative knowledge, skills and experience securing the essential information from sources. Whether the fraud hotline agent is Connor, Jake, Jeff, Karen, Karie or Loryn, or any of our 25 fraud analysts assigned to our special investigations unit statewide, callers know within seconds that they have reached a committed, respectful professional.

You, the general public, are essential in helping us fight fraud, waste, and abuse in workers’ comp. We are celebrating our 25th year since the creation of our Special Investigations Department in 1993 and thousands of our closed, founded cases started with a call to our Fraud Hotline.

Just last month, for example, the convictions of Rodney Alberino, James Harris and Donna Steele were each the result of just such a call.

If you’re concerned about the alleged fraudster discovering your identity, rest assured. Your identity may remain either anonymous or confidential, depending on your preference. In addition, you don’t need to prove any facts or even have 100 percent confidence in your suspicion. You need only to suspect that fraud may have occurred or continues to occur. We’ll take care of the rest.

We look forward to hearing from you, so give us a call at 1-800-644-6292 if you suspect fraud. We will conduct the investigation and determine the facts. Together, we are successfully combatting workers’ compensation fraud in Ohio – one call at a time.

Thank you for your support!

Truck driver guilty of workers’ comp fraud

A truck driver from northeast Ohio must pay more than $12,000 in restitution to the Ohio Bureau of Workers’ Compensation (BWC) after the agency’s investigators found him working again while collecting disability benefits.

Marshall Winn IV of Niles in Trumbull County pleaded guilty Wednesday to a fifth-degree felony count of workers’ compensation fraud in Franklin County Common Pleas Court. A judge sentenced him to five years of probation in lieu of nine months in prison and ordered him to pay BWC $12,450 and court costs.

“Mr. Winn was injured in 2014 and claimed he was disabled from work, but we found evidence that he started working again in January 2015 and that he was running his own trucking business,” said Jim Wernecke, director of BWC’s special investigations department.

In other fraud news, a Dayton office worker pleaded guilty May 9 to a first-degree misdemeanor theft charge after BWC found her working for nearly five months in 2016 while collecting BWC benefits.

A judge fined Brooke Mobley $200 plus court costs in lieu of a 60-day jail sentence. Mobley paid BWC $5,455 in restitution prior to her sentencing.

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

Trucker and 10 others convicted in April for cheating BWC

Agency owed more than $500,000 in restitution

An Ohio truck driver who worked for more than two years while collecting disability benefits could be ordered to pay more than $78,000 in restitution at his sentencing for workers’ compensation fraud June 14.

Walter Lee, of Frazeysburg in Muskingum County, pleaded guilty to the fifth-degree felony April 25 in Franklin County Common Pleas Court. The judge ordered a pre-sentence investigation due to the large amount of restitution — $78,321 — owed to the Ohio Bureau of Workers’ Compensation (BWC).

“Our investigators discovered Mr. Lee knowingly returned to work as a truck driver while collecting disability benefits from our agency,” said Jim Wernecke, director of BWC’s special investigations department. “We’re glad he can work again, but he can’t tell us he’s disabled and collect our benefits while doing it. Those funds are for injured workers who truly need them.”

Lee was injured on the job in 2002. BWC’s investigation found him working from May 3, 2013 to Oct. 2, 2015 while collecting agency benefits.

Lee’s case was one of 11 convictions BWC secured in April along with $515,713 in restitution ordered. Other cases include:

Timothy Manuel, M.D. (Wilmington, Ohio), Drug Trafficking
Manuel pleaded guilty April 27 to four counts of aggravated trafficking in drugs and a fourth-degree felony count of workers’ compensation fraud.

Manuel, who now lives in Missouri, was indicted last year after an investigation by BWC and the Ohio Board of Pharmacy found that he prescribed large amounts of medically-unnecessary oxycodone to numerous patients while working as a doctor at Hillsboro Urgent Care. He also collected $12,068 from BWC for services he did not perform.

His sentencing is scheduled for May 24 in Highland County Common Pleas Court.

Rodney Alberino (Parma Heights, Ohio), Working and Receiving
Alberino was ordered to pay BWC $193,574 in restitution after pleading guilty April 26 to one count of workers’ compensation fraud, a fourth-degree felony. He was also ordered to serve two years of probation. BWC investigators discovered that Alberino had been working a variety of jobs for nearly seven years while collecting disability benefits.

Randall Abel (North Canton, Ohio), Working and Receiving
Abel pleaded guilty to a first-degree misdemeanor theft charge April 25 after BWC found him working as a self-employed automotive repairman while collecting disability benefits. Abel paid $6,475 in restitution to his former employer and was sentenced in the Stark County Common Pleas Court to two years of probation.

James Harris (Cleveland, Ohio), Working and Receiving
Harris pleaded guilty April 25 in Franklin County Common Pleas Court to one count of workers compensation fraud, a fifth-degree felony, after investigators found him working for a property management company while receiving BWC benefits. He was sentenced to three years of probation and ordered to pay BWC $10,498 in restitution.

Tina Valley (Akron, Ohio), False Claim
Valley pleaded guilty April 16 in Akron Municipal Court to workers’ compensation fraud, a first-degree misdemeanor, after filing a false injury claim. She claimed she was injured from a slip and a fall while working at a local fast food restaurant. Surveillance video from the business showed she never actually slipped and fell.

A judge gave Valley a six-month suspended jail sentence and ordered her to perform three days of community service and pay court costs and fines totaling $527.

Thomas Cannell (Northfield, Ohio), Working and Receiving
Cannell pleaded guilty April 11 in United States District Court to one count of theft of government property and one count of wire fraud after BWC and
federal investigators discovered he had been working for decades while collecting disability income from BWC and the Social Security Administration.

Cannell was ordered to pay restitution of $684,048 ($479,288 to Social Security and $204,761 to Ohio BWC).  A sentencing date has not yet been set.

Vincent Dombrow (Findlay, Ohio), Working and Receiving
Dombrow pleaded guilty April 9 in Franklin County Common Pleas Court to obstructing official business, a second-degree misdemeanor, after investigators found he had returned to work while collecting BWC benefits. A judge sentenced him to 90 days in jail, which was suspended after Dombrow paid restitution of $3,941.

Kenneth Gilmore (Cleveland, Ohio), False Claim
Gilmore pleaded guilty April 2 in Lorain County Common Pleas Court to multiple felony counts related to his attempts to fraudulently obtain prescription pain killers. A judge sentenced him to 30 months in jail and ordered he pay $6,075 in restitution BWC.

Investigators found Gilmore had submitted three false claims of work injuries at Cleveland-area hospitals between December 2013 and June 2014. He admitted to BWC that he filed the claims to obtain narcotics. 

Donna Steele (New Lebanon, Ohio), Working and Receiving
Steele pleaded guilty April 4 in Franklin Municipal Court to workers’ compensation fraud, a first-degree misdemeanor, after BWC found her running a babysitting business in her home while collecting disability benefits. She paid BWC $10,611 in restitution, plus a fine of $250 and court costs.

Kalyan Ravula, dba United Car Lot (Columbus, Ohio), No Coverage
Ravula pleaded guilty April 3 to one count of failure to comply, a second-degree misdemeanor, and was fined $100 after BWC found him operating a business without workers’ compensation coverage.

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

Cleveland fraudster owes BWC nearly $200,000

Former trucker worked variety of jobs while collecting disability benefits

 

A Cleveland-area man owes the Ohio Bureau of Workers’ Compensation (BWC) nearly $200,000 after the agency found him working for nearly seven years while collecting disability benefits.

Rodney W. Alberino, 44, of Parma Heights, pleaded guilty to a fourth-degree felony count of workers’ compensation fraud April 26 in the Cuyahoga County Common Pleas Court. He must pay BWC $193,574 in restitution and serve two years of probation.

“We got a tip that Mr. Alberino had been operating a lawn care business and working with his neighbor rehabbing houses while collecting disability benefits,” said Jim Wernecke, director of BWC’s special investigations department. “Our investigators talked to witnesses, gathered records and shot surveillance video. They found Mr. Alberino performing a number of work activities, including snow removal, landscaping, property maintenance, painting, and siding installation.”

Alberino was working as a truck driver when he was injured on the job in January 2010. He collected BWC benefits until Dec. 28, 2016.

In other fraud news:

A southwest Ohio physician who pleaded guilty April 27 to four counts of aggravated trafficking in drugs also collected $12,068 from BWC for services he did not perform.

In addition to the drug charges, Dr. Timothy Manuel, 59, pleaded guilty in Highland County Common Pleas Court to a fourth-degree felony count of workers’ compensation fraud. Sentencing is scheduled for May 24.

Manuel, who now lives in Missouri, was indicted last year after an investigation by BWC and the Ohio Board of Pharmacy found that he prescribed large amounts of medically-unnecessary oxycodone to numerous patients while working as a doctor at Hillsboro Urgent Care.

Randall Abel, 33, of North Canton, pleaded guilty to a first-degree misdemeanor theft charge April 25 after BWC found him working as a self-employed automotive repairman while collecting disability benefits.

Acting on a tip, investigators found Abel owning and operating RJ’s Performance Diesel while receiving disability benefits from his former employer, a local construction company.

Abel paid $6,475 in restitution to his former employer and was sentenced in the Stark County Common Pleas Court to two years of probation.

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