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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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The numbers are in: SID identified $60.1 million in savings last year

SID annual report FY 2014We are pleased to report that SID identified $60.1 million in savings over the past year, according to statistics outlined in BWC’s Special Investigations Department (SID) fiscal year (FY) 2014 annual report. The report, which was published today, reflects upon and reviews recent performance statistics, trends, and strategies for preventing and detecting fraud.

Since our department’s inception in 1993, we have closed nearly 61,000 cases and identified more than $1.5 billion in savings to the Ohio workers’ compensation system.

Among the more than 2,055 cases that were closed in FY 2014, 924 were closed-founded, meaning the original allegation was proven. The average savings identified among the 924 cases was more than $65,000. More than 250 of these cases were referred for prosecution, resulting in 149 indictments and 132 convictions. These 149 indictments were an 11 percent increase over last year.

During the last 12 months, SID staff continued their focus on technological advancements as well as emerging trends pertaining to fraud and abuse. Additionally, SID continued to use effective digital forensics and social media to root out otherwise undetected fraudulent activity, and to bring public attention to workers’ compensation fraud.

Comparatively, SID achieved the following in FY 2014:

  • Lowest number of cases open at year end in the last 15 years;
  • Lowest number of investigative lag days per closed case in the last seven years;
  • Highest savings identified in the last four years;
  • Highest savings identified per closed and per founded case in the last seven years;
  • Highest number of terabytes of data processed by our digital forensics unit;
  • Highest number of referrals in the last six years;
  • Third highest number of indictments in the last 15 years;
  • Highest percentage of founded cases referred for criminal prosecution in the last seven years.

Looking forward, FY 2014 marks the beginning of SID’s fourth strategic plan, which will serve as an operational guide for the next five years. The results of this level of planning are responsible for the success SID experienced in this past fiscal year.

Thank you for supporting our efforts to deter, detect and prosecute workers’ compensation fraud. Keep those tips coming!

Coming Soon…SID FY 2014 Annual Report

Like a good movie trailer that entices you to go to the movie theater, we would like to make you aware of our soon-to-be released SID fiscal year 2014 Annual Report.  Each year, we furnish an annual report of our performance, strategic initiatives and fraud trends we have identified.  In the coming weeks, we will be hard at work reviewing operations, assessing performance outcomes and tallying the results achieved during fiscal year 2014, which concludes on June 30. Since fiscal year 2001, this year-end process has culminated in the publication (during late July) of our SID annual report.

Like in the movie, The Wizard of Oz, we are like the man behind the curtain.  Our investigative staff works diligently to ensure those with legitimate work-related injuries receive benefits and medical care…and those who are not answer for their actions to the fullest extent of the law.  In the coming report, we will highlight some of our successes in the past year, profile some interesting fraud cases and provide a sneak peak of our new strategic initiatives.

Since SID performance results are generated by effective collaborations with our governmental and public law enforcement colleagues, the report will acknowledge those agencies with which we conducted joint investigations during fiscal year 2014.

The document will also offer achievements of respective teams and task forces, as well as shine a spotlight upon operational trends and strategies. Debuting in this year’s report will be a summary of presentations facilitated by SID employees. These include our sponsorship of an inaugural Electronic Surveillance Equipment Symposium, conducted for 300 members of governmental and public law enforcement agencies on April 17.

Most importantly, we’re pleased that the current level of performance suggests we will surpass our outstanding results from fiscal year 2013. View the entire 2013 annual report here.

Of course, criminals do not take sabbaticals. Neither do we. Even as we create and finalize the fiscal year 2014 report, we continue to detect, investigate, prosecute and deter fraud. On July 1, we commence the work that will warrant review in our fiscal year 2015 Annual Report.

Meanwhile, stay tuned for the late July release of the SID fiscal year 2014 Annual Report.

Annual report highlights SID activities in the last year

SID FY 2013 Annual ReportSID recently published its annual report for fiscal year (FY) 2013. The report reflects and reviews recent performance statistics, ongoing trends, as well as future strategies for preventing and detecting fraud.

We are pleased to report that SID identified $55 million in savings during FY 2013. Among the more than 2,000 cases that were closed, 915 were founded, meaning the original allegation was proven. The average savings identified among the 915 cases was more than $60,000. 236 of these cases were referred for prosecution, resulting in 134 indictments and 140 convictions to date. These 140 convictions were a 14 percent increase over last year. Additionally, SID received more than 3,300 allegations and teams are currently investigating approximately 1,000 open cases.

During the last twelve months, SID staff members remained tuned to emerging trends that affect their work, such as the rise in prescription fraud. The department also creatively utilized available resources such as social media and data digital forensics to root out otherwise undetected fraudulent activity and bring public attention to combating wrongdoing. This resourcefulness and persistence is prevalent in the work of each SID team and reflects the department’s commitment to protecting the Ohio State Insurance Fund. The FY 2013 fraud report includes information about these efforts and the condition of workers’ compensation fraud in Ohio.

Furthermore, the conclusion of FY 2013 also brings to a conclusion the third five-year SID strategic plan. The results of this level of planning are responsible for the success SID experienced in this past fiscal year. Comparatively, SID achieved:

  • The lowest number of cases open at year end;
  • The highest number of terabytes of data processed by Digital Forensics Unit;
  • Second lowest number of investigative lag days per closed case in the past five years;
  • Second highest number of convictions in the past eight years;
  • Second highest percentage of founded cases referred for criminal prosecution in the past six years; and
  • Second highest savings identified per closed and per founded case in the past six years.

Lastly, the report reviews results since our department’s inception in 1993 – including that we have closed nearly 59,000 cases and identified more than $1.5 billion in savings to the Ohio workers’ compensation system.

FY 2012 Annual Report

We published our fiscal year (FY) 2012 fraud results, ongoing trends and future strategies. View our  SID FY 2012 Annual Report.

The report highlights our achievements during the fiscal year, including performance against goals measured via key indicators. During FY 2012, SID identified $59,373,483 in savings. SID closed 2,046 cases and 976 – or 47.7 percent – were closed founded (the original allegation was proven). Of these founded 976 cases, 251 – or 25.7 percent – were referred for prosecution. SID obtained 152 indictments and 123 convictions. These 152 indictments were a 9 percent increase over last year. SID received 4,198 allegations and teams are currently investigating 1,106 open cases. The average founded closed case in FY 2012 identified $60,833 in savings to the Ohio workers’ compensation system. These results contribute to the agency’s priorities — improving operations and providing better service and care for customers.

The report reviews results since our department’s inception in 1993 – including that we have closed more than 56,000 cases and identified nearly $1.5 billion in savings to the Ohio workers’ compensation system. The report also identifies fraud trends and highlights strategies as specified in our department’s five-year strategic plan.

To report fraud online, please visit: http://bit.ly/reportfraud.
To speak with a fraud hotline agent, please call: 1-800-OHIOBWC.

Categories: Annual Reports

SVIU FY 2011 Annual Report

September 1, 2011 1 comment

SID is releasing its Safety Violations Investigation Unit (SVIU) fiscal year (FY) 2011 results: SVIU FY 2011 Annual Report.

During FY 2011, we increased our effectiveness and exceeded operational goals. We increased the percentage of all cases closed founded from 22 percent in FY 2009 to 45 percent in FY 2011. We increased the percentage of violations of specific safety requirements (VSSR) adjudications that resulted in the granting of an award by the Industrial Commission (IC) from 20 percent in FY 2010 to 27 percent in FY 2011. We decreased the average duration of an investigation to just 82 days. Thus, we increased the percentage of cases closed within 90 days from 76 percent in FY 2010 to 82 percent in FY 2011. These results contribute to the agency’s priorities — improving operations and providing better service and care for customers.

During the last 12 months, we focused on combating VSSRs while encouraging workplace safety and employer compliance. The FY 2011 SVIU report includes information about these efforts and the conditions regarding worker and workplace safety in Ohio, citing a couple of noteworthy cases. The report also identifies trends and highlights future strategies as specified in our department’s five-year strategic plan.

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