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Dayton claims rep is BWC’s Fraud Finder of the Year

A claims service specialist (CSS) in the Dayton service office received the 2016 Fraud Finder of the Year award Jan. 26 from BWC’s Special Investigations Department (SID).

The CSS received the award for alerting SID to a case in which an injured worker claimed to be wheelchair bound and unable to ambulate. Surveillance video in SID’s subsequent investigation, however, showed the claimant shopping, going to the movies and climbing steps at a football game, all without a wheelchair or assistance of any kind.

“Thanks to this CSS’s vigilance and timely referral, we were able to stop fraud in its tracks and save the BWC system tens of thousands of dollars, if not more,” said SID Director Jim Wernecke. “Our success in uncovering fraud protects scarce resources needed to create safe workplaces in Ohio and to take care of those who are legitimately injured on the job.”

The CSS, who handles permanent total disability cases, said she was delighted to receive the award.

“I was surprised,” she said. “It makes you feel good to be recognized.”

SID received 2,700 allegations of fraud in 2016, with about a fourth of those coming from BWC personnel around the state — claims representatives and others who suspect illicit behavior on the part of injured workers, employers, health care providers or others connected to the BWC system.

To show their appreciation, SID leaders conducted a thank-you tour from November through mid-February, presenting Fraud Finder Award certificates to CSSs 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 or visit bwc.ohio.gov.

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Limo driver takes work comp system for a ride, now owes BWC $80,000

robert-willie-jr-booking-photoA former school bus driver caught working as a limousine driver while receiving injured workers’ benefits must pay the Ohio Bureau of Workers’ Compensation $80,000 and serve five years probation.

“Thanks to responsible citizens who report fraud, we were able to stop a workers’ comp cheat and return BWC dollars to their rightful purpose — creating safer workplaces across Ohio and helping workers who are legitimately injured on the job,” said BWC Administrator/CEO Sarah Morrison.

Robert Willie, Jr., 57, of Columbus, pleaded guilty Tuesday in the Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a fifth-degree felony. In addition to restitution and probation, a judge warned Willie that he would serve six months in jail if he violated the terms of his probation.

Willie started collecting BWC benefits in 2010 after getting injured while working as a school bus driver. Acting on an anonymous tip to the BWC Fraud Hotline, BWC’s Special Investigations Department reviewed bank and employment records and found Willie had worked off and on for much of the time between March 2010 and May 2015, all while collecting BWC benefits. Willie worked as a limousine driver and office clerk for a Columbus company.

A photo of Willie can be found here.

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

Fraud funnies: Workers’ comp cheats say the darndest things

By Tony Gottschlich, Public Information Officer, BWC Communications Department

SID Badge and SealMany of us have read funny reports of the ridiculous excuses criminals give police for their illicit behavior, from, “We’re not stealing; we thought it was free,” to Winona Ryder’s, “I shoplifted to prepare for an acting role.”

Our agents in the Special Investigations Department have heard a few whoppers over the years, too. In honor of International Fraud Awareness Week, here’s a sampling. (Note: Each subject was ultimately convicted and sentenced.)

During surveillance, the claimant suspect would appear to drive as if he knew he was under investigation.  He would drive south, north and in circles before going to a job site. During the interview, I asked him if he knew he had been under surveillance. His answer was, “No, I drove that way just in case I was under investigation.”


While wearing boots and standing in wet concrete with a concrete trowel in hand, the claimant suspect stated he was only a “stock holder” in the business.


Upon commencing an interview of the claimant suspect, agents asked him if he was “Joe.” The subject replied, “No.”  He was wearing a shirt with his employer’s name and his own name on it. He confessed to his misdeeds.


A doctor was getting increasingly frustrated during an interview when he was trying to explain to Health Care Provider Team agents why he billed BWC for services not rendered. Each time he gave his “explanation,” the agent replied, “So, you billed services that were not provided.”  The doctor told the agent he was not listening and again launched into his “explanation.”  After the third or fourth round of this conversation, the agent basically restated that the services billed were not provided, but used the same made-up words the doctor had used.  The doctor smacked the table and shouted, “By God, now you’ve got it!”


We were conducting an undercover operation in a small village restaurant in Northwest Ohio to document that our subject was working as a waitress. After our subject took our food order, delivered our food and drink, she gave us our check. We paid it, gave her a tip, and showed her our credentials, asking her if she worked there. She immediately froze, stared at the badge while behind the cash register and said, “No, I ain’t workin’ here.”   Our agent replied, “We want our tip back.”

Another type of BWC certificate: Showing our appreciation to yet another employer source

By Jeff Baker, Program Administrator, BWC Special Investigations Department

Normally, when our readers think of the words “BWC” and “certificate,” they think of the BWC Certificate of Coverage. This makes sense. The certificate is widely seen and easily recognized. It is the official document employers often frame to display within their business.

Understandably, the law-abiding business owner wants every employee and customer to see that they have secured workers’ compensation coverage from our agency. They know that others see it as proof of the business’s legitimacy and a sign of the owner’s prudence.

That might explain why Vice President of Operations Philip Koster and Human Resources Generalist Lisa Lucas with the Columbus-based business MedCare Ambulance were surprised when we contacted their organization asking to present them with another type of BWC certificate: a Certificate of Appreciation.

Scott Lape, Lisa Lucas, Philip Koster and John Koehl

Scott Lape, Special Agent in Charge of the Southeast Regional Claimant Special Investigations Unit (SIU) within the Special Investigations Department (SID), explained that the certificate acknowledges the business’s referral of a fraud allegation to BWC. The referral, submitted via an online fraud allegation form, had resulted in the successful prosecution of a subject, Lynn D. McCann, II (Knox County) on Sept. 6.

medcare-certificateSigned by SID Director Jim Wernecke, the framed certificate is a simple way to demonstrate our thanks to MedCare Ambulance and others who are our partners in combating fraud.

Significantly, Philip Koster and Lisa Lucas received the Certificate of Appreciation from Scott Lape and Columbus SIU Fraud Analyst John Koehl during International Fraud Awareness Week (IFAW) 2016. Sponsored annually by the Association of Certified Fraud Examiners, IFAW is dedicated to the prevention, identification and investigation of fraud – wherever it might occur throughout the world.

Just like the talented and dedicated professionals with MedCare Ambulance, you are our eyes and ears in Ohio! Thank you for your help in stamping out fraud, and please, keep those tips coming. To report workers’ comp fraud to BWC, click here or call our fraud hotline at 1-800-644-6292.

International Fraud Awareness Week: Spotlight on Doug Fisher

Justice, putting bad providers out of business motivates longtime BWC fraud fighter

By Tony Gottschlich, Public Information Officer, BWC Communications Department

SID Badge and SealAs a special agent in the bureau of diplomatic security for the U.S. State Department in the 1980s and early 1990s, Doug Fisher protected royal families, foreign presidents, Nelson Mandela and U.S. Secretary of State James Baker, among others.

As a police detective earlier in his career, Fisher served on the vice and narcotics unit in High Point, North Carolina, scrubbing the streets of drug dealers, prostitutes, racketeers and other nefarious sorts.

And today at the Ohio Bureau of Workers’ Compensation, as he’s done for the last 23 years, this veteran of the Special Investigations Department (SID) pursues crooks, cheats and others who try to rip off the state’s insurance fund for injured workers.

But contrary to appearances, Fisher’s long career in law enforcement isn’t rooted in “saving the world and all that,” at least in the beginning anyway.

“I was working in a factory, and I said, ‘Hey, that looks like a job where I won’t have to get dirty,’” Fisher recalled with a slight chuckle. “I didn’t want to work in a factory anymore.”

BWC Special Agent in Charge Doug Fisher (right), of SID's Health Care Provider Team, conducts a search warrant with Digital Forensic's Manager Joe Lopez in Northeast Ohio earlier this year.

BWC Special Agent in Charge Doug Fisher (right), of SID’s Health Care Provider Team, conducts a search warrant with Digital Forensic’s Manager Joe Lopez in Northeast Ohio earlier this year.

Fisher is Special Agent in Charge of SID’s largest unit, the health care provider team, which investigates allegations of fraud committed by medical providers, pharmacies and managed care organizations. He usually shuns the spotlight and deflects any credit he’s earned to his team, but after some arm twisting from his boss, he agreed to be featured in this article to promote SID and International Fraud Awareness Week.

“He hates the publicity, every minute of it,” said a smiling Jennifer Cunningham, SID’s assistant director and a 20-year colleague of Fisher’s. “He doesn’t go to work parties and he never wants recognized for anything. That’s just who he is, very humble.”

A Wisconsin native, Fisher joined BWC in 1993 and was one of SID’s founding members that year. The department has grown since then into a 118-member force that investigates hundreds of fraud cases a year involving workers, employers, medical professionals and others in the BWC system. In fiscal year 2016, the department’s work led to 127 convictions and $56.6 million in savings. Fisher’s team closed 51 cases, landed five convictions and identified $15 million in savings.

He said the job, though, is about more than prosecutions and protecting the State Insurance Fund.

“We knock a lot of bad providers out of the system,” Fisher said from his Mansfield office. “These are people who practice crappy medicine or no medicine at all – they’re just prescribing painkillers to people and it’s a shame.”

One recent case he’s proud of involves a chain of Cleveland-area medical clinics that was indicted Oct. 26 on racketeering and other charges related to scamming BWC out of $216,000.

A 170-count indictment returned by a Cuyahoga County grand jury accuses Dr. Stephen Bernie and an associate of 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 is also accused of writing prescriptions for medications without examining or monitoring patients, and signing prescriptions for powerful opioids that were distributed while he was on vacation.

BWC Special Agent in Charge Doug Fisher, of SID's Health Care Provider Team, spends much of his time in the field, but works out of the Mansfield Service Office.

BWC Special Agent in Charge Doug Fisher, of SID’s Health Care Provider Team, spends much of his time in the field, but works out of the Mansfield Service Office.

Said Fisher, “Cases like that are some of the most satisfying – agents working a hard, long case that takes several years and lots of frustration and they drive it to a conclusion.”

Cunningham calls Fisher a “visionary” who looks at the big picture, studies the latest trends and enjoys outfoxing the fraudsters he’s after.

“He’s always thinking, trying to be one step ahead of the bad guys,” she said.

Fisher, 56, and his wife, Debbie, live in Northeast Ohio and are the parents of two adult children. An avid reader and long-distance runner, he also teaches criminal science part time at Stark State College in North Canton.

He said he plans to retire from BWC within the next year.

Raising awareness during Fraud Awareness Week, combating fraud every day

BSID Badge and Sealy Melissa Vince, BWC Public Relations Manager

When the Ohio Bureau of Workers’ Compensation created its Special Investigations Department (SID) in 1993, the new department boasted a staff of a dozen people and offices in just three cities to combat fraud across Ohio’s 88 counties. Data was stored in paper files and agents relied on such state-of-the-art equipment as pagers, payphones and binoculars, not to mention video cameras the size of small SUVs.

SID looks vastly different today. Staffed with 118 agents, supervisors and support personnel, the department works out of 11 offices across the state and investigates hundreds of fraud cases a year, from workers who fake injuries to physicians running pill mills. Agents are armed with smart phones and sophisticated investigatory devices they don’t talk about publicly.

In 23 years, SID has identified more than $1.7 billion in savings, as well as:

  • Researched 117,820 allegations;
  • Completed 64,255 investigations;
  • Referred 4,897 subjects for prosecution; and
  • Secured 2,595 criminal convictions.

Says SID Director Jim Wernecke: “Even after all these successes, we know fraud still persists, and our goal remains the same after more than two decades: to detect and deter workers’ compensation fraud in Ohio and return misappropriated funds to caring for injured workers and improving workplace safety.”

While tried and true techniques remain important to a successful case, we’re also committed to keeping pace with the most up-to-date resources, such as digital forensics and analytical intelligence, including predictive modeling, to root out otherwise undetected fraudulent activity. We also use social media and specialized presentations to educate and build awareness.

fraud-week-logo2016One of many ways we build awareness is by eagerly joining our fraud-fighting colleagues around the country and abroad each November to participate in International Fraud Awareness Week. The campaign, which runs until Saturday, was established by the Association of Certified Fraud Examiners to highlight the issue of fraud and help minimize its impacts.

Most weeks, you’ll find us sharing our fraud news on #Fraud Friday. But this week we’ll have a new fraud feature each day, including tips for identifying and preventing fraud, new cases, and insights from our investigators on what they do here every day to stop workers’ comp fraud in Ohio.  So keep an eye here on our blog and on our Facebook and Twitter pages for fresh content.

Happy Fraud Awareness Week!

And don’t forget to keep those tips coming. To report workers’ comp fraud in Ohio, click here or call our fraud hotline at 1-800-644-6292.

 

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.