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Archive for the ‘Fraud Awareness’ Category

Thanks for your allegations, especially 34,634 calls to our Fraud Hotline!

By Jeff Baker, Program Administrator, BWC Special Investigations Department

In observance of Thanksgiving, we are giving thanks for the vigilance of everyday citizens and their willingness to detect and report suspected fraud committed against the Ohio workers’ compensation system.

We realize that such partnerships are necessary to achieve our fraud prevention goals. Since the creation of our Special Investigations Department (SID) in 1993, tens of thousands of our allegations have been furnished by external sources. Each and every reported allegation is entered by an agent into our secure database and reviewed. Effective this week, as a result of calls to our BWC Fraud Hotline, 34,634 allegations have helped us achieve over 1.7 billion in savings.

An investigative professional will promptly answer your call and conduct a brief and effective interview. These agents have years of investigative knowledge, skills and experience securing the essential information from sources like you. Whether your fraud hotline agent is Jake, Taylor, Karen, Connor, Jeff, or any of eight of our most experienced fraud analysts assigned to special investigations units (SIUs) statewide, you will know within seconds that you have reached a committed, successful professional.

Your fraud hotline agent will know and promptly secure the information needed by our teams of 125 SID employees. You do not need to have proven any facts; you do not even need to have 100 percent confidence in your suspicion. You need only to suspect that fraud may have occurred or continue to occur. We will conduct the investigation and determine the facts. Your Fraud Hotline call initiates the process, and in as few as five minutes.

A suspicion can also be reported by means of any of the following: an “after hours” message to our Fraud Hotline voicemail 614.728.2617, online, an email to our secure BWC Allegations@bwc.state.oh.us account, the U.S. Postal Service or in-person at any BWC claims office. Calling the BWC Fraud Hotline is the most interactive and direct way that you, our partners in fraud prevention and detection, can help.

So, thank you for your 34,634 (and counting) calls to our Fraud Hotline! We are indeed thankful for each one.

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What do you know about workers’ comp fraud? Our sleuths have questions – and answers!

By Melissa Vince, BWC Public Relations Manager

We’ve had a great time talking workers’ comp fraud this International Fraud Awareness Week. We enjoyed sharing what we do to detect, deter and put a stop to workers’ compensation fraud in Ohio.

Our fraud investigators especially look forward to participating every year because they want to raise awareness and encourage tips from the public, but also because they truly enjoy what they do.

And we appreciate them because they do a great job. So, in honor of them, we let them take a little break to have some fun putting together this quiz challenging your knowledge of workers’ compensation fraud.

So, fire up that brain and let’s get started. Just flip your monitor over for the answers listed at the bottom.

Thanks for following us this week! We’ll be back next year for Fraud Awareness Week, but don’t go away because we’re here all year long on our blog, Twitter and Facebook.

  1. True or false?
    Fraud and abuse are the same.
  2. True or false?
    Proving fraud requires evidence of “knowledge and intent”
  3. True or false?
    Abuse can be criminally prosecuted under the law.
  4. BWC has teams focused on investigating the following types of fraud:
    a) Claimant
    b) Employer
    c) Medical provider
    d) All of the above
  5. Which is an example of fraud?
    a) Billing for services not rendered (a doctor bills for procedures not performed)
    b) Classifying full-time employees as independent contractors/subcontractors.
    c) A claimant performing physical activity outside of his or her restrictions
    d) All of the above
  6. What are the two most common fraud allegations our investigators receive related to medical providers?
    a) Billing for services not rendered (a doctor bills for procedures not performed)
    b) Unlicensed provider (not licensed to practice medicine in the State of Ohio)
    c) Unbundling (charging separately for bundled services)
    d) Upcoding (billing for a more expensive service than the one provided to the claimant)
  7. What is the most common fraud allegation our investigators receive related to employers?
    a) No coverage
    b) Lapsed coverage
    c) Falsified certificate of premium coverage
    d) Underreporting payroll
  8. What is the most common fraud allegation our investigators receive related to claimants?
    a) Physical activity (performing physical activity outside of his or her restrictions; malingering)
    b) Work/Comp (working while receiving lost time benefits)
    c) False claim (staged accidents; false injuries)
    d) Altered documents

 

Suspect fraud? Call our Fraud Hotline!

By Jeff Baker, Program Administrator, BWC Special Investigations Department

In recognition of International Fraud Awareness Week 2017, we are increasing awareness of fraud and the vigilance of everyday citizens to report suspected fraud committed against the Ohio workers’ compensation system.

A suspicion can be reported online, by email to our secure BWC Allegations@bwc.state.oh.us account, U.S. Postal Service or by calling our Fraud Hotline at 1-800-644-6292. Calling the BWC Fraud Hotline is the most interactive and direct way that you, our partners in fraud prevention and detection, can help.

We realize that such partnerships are necessary to achieve our fraud prevention goals. Since the creation of our Special Investigations Department (SID) in 1993, thousands of our closed, founded cases started with a call to our Fraud Hotline. For example, the conviction of Tim Tokles on August 30, 2017 was the result of just such a call.

You may suspect someone is working while receiving compensation, filed a false claim for an injury that did not happen or is committing another type of workers’ compensation fraud. Calling a fraud hotline may seem rather intimidating. We understand that it can be a nerve-wracking decision to make the call. The person you suspect of fraud could be a friend, a loved-one or even an immediate family member.

Above all, we realize the importance of personal security and safety to each caller.

When you call the SID Fraud Hotline, you will speak with a real person on the other end, one who is ready and willing to listen to your concerns and has years of investigative knowledge, skills and experience securing the essential information from sources like you. Whether your fraud hotline agent is Jake, Taylor, Karen, Connor, Jeff, or any of eight of our most experienced fraud analysts assigned to special investigations unit (SIUs) statewide, you will know within seconds that you have reached a committed, successful professional.

Your fraud hotline agent will know and promptly secure the information needed by our teams of 125 SID employees. Your identity will remain either anonymous or confidential, depending upon your preference. You do not need to have proven any facts; you do not even need to have 100 percent confidence in your suspicion. You need only to suspect that fraud may have occurred or continue to occur. We will conduct the investigation and determine the facts.    

The entire process entails as few as five minutes. Nonetheless, collecting the right information from a caller requires our SID Fraud Hotline professionals to devote as much time as the caller’s unique allegation merits.

When calling, please provide the information you have, including:

  • The name and address (if known) of the subject you’re reporting;
  • A description of the suspect’s behavior; and
  • Any other information that might pertain to the suspected fraudulent activity.

It is through the vigilance of citizens like you, that we are combatting workers’ compensation fraud in Ohio.

 

In pursuit of fairness – #FraudWeek 2017

By Jim Wernecke, Director, BWC Special Investigations Department

I have always appreciated the importance of fairness and integrity. I have used these virtues as a guide throughout my career, from early on when I supervised 15 employees at a small manufacturing company, to my 25 years with the Ohio State Highway Patrol and now as head of the Ohio Bureau of Workers’ Compensation’s Special Investigations Department.

I am privileged to lead 122 professionals who work to deter, detect and investigate workers’ compensation fraud in the state of Ohio. We pursue cases of claimant, medical provider and employer fraud.

What drives a claimant to file a false claim; an employer to purposely misclassify their workers; or a physician to fudge paperwork to secure higher service payments? We can debate the reasons, and they probably vary in each case, but my drive to halt wrongdoing comes from an appreciation for standards, rules and enforcement of the law that are conducted uniformly, fairly and systematically. In short, I want to know that others are following the same rules you and I follow.

It is easy to translate this philosophy into the world of workers’ compensation when you think about employer premiums, medical services and protection of our injured workers. Injured workers deserve a fair system that’s focused on their care and recovery. Employers want their competitors to play by the same rules, and they want assurance that any employee who attempts to gain undeserved benefits will be held accountable. And we all want truthful and professional physicians delivering our medical care.

These are among the many reasons I count fairness and integrity among the most important qualities you’ll find in a person. Treat people fairly, and treat them the way you want to be treated. Our integrity is on the line when we don’t accept the responsibility and tell the truth. Once trust is lost, it’s likely gone forever. I’m sure many of you feel the same.

We take great care to protect the dollars Ohio employers set aside to care for their injured workers. We’re not too shy to say we think we do a pretty good job, but we’re always seeking improvement. That’s why we enjoy taking part in International Fraud Awareness Week each year. We’re not only able to highlight our successes, but also engage and learn from our fraud-fighting peers across the country. This year will be no different.

Those of you who follow workers’ comp fraud in Ohio know we share our fraud news weekly on “Fraud Friday,” but we always take it to another level during IFAW. Please join us this week and all year long as we share new cases, tips for identifying and preventing fraud, insights from our investigators, and much more on our Facebook and Twitter pages.

Happy Fraud Awareness Week!

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.

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.”