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Posts Tagged ‘Claimant Fraud’

Two Geauga County men owe a combined $200,000 for workers’ comp fraud

McElroy and Hill sentenced in separate cases 

Two Geauga County men have been sentenced after they were convicted of fraud for working while collecting workers’ compensation benefits.  Kenneth McElroy was self-employed performing equipment repair and snow plowing services and owes $80,000 to the Ohio Bureau of Workers’ Compensation (BWC).  William Hill was discovered operating his own business, Hill’s Contracting Company, and must repay more than $133,000.

“Disability benefits are not a way to boost your salary when you are perfectly capable of working,” said BWC Administrator/CEO Stephen Buehrer. “These men may have been feeling comfortable that they could continue their scams but both cases prove that cheaters can never assume they can continue undiscovered.”

BWC’s Special Investigations Division (SID) opened an investigation into Kenneth McElroy after learning he was self-employed snow plowing and repairing lawn mower/landscape and construction equipment while receiving temporary total disability benefits.  SID conducted numerous interviews confirming that the Chardon man was performing these services at his home and at customer’s residences.

The Ohio Industrial Commission issued an order in October finding all benefits McElroy received for the period of more than five years had been overpaid.  Additionally, his benefits were terminated due to a finding of fraud.  McElroy pleaded guilty to a felony count of theft on Dec. 14 in a Franklin County courtroom and was ordered to pay $80,000 in restitution.  The judge also sentenced McElroy to five years of community control and a suspended a six month prison sentence.

William Hill became the subject of an investigation after a BWC claims service specialist suspected he may be working for his own company while receiving temporary total disability benefits. An investigation verified the Chesterland man was operating Hill’s Contracting Company for three years in direct conflict with his disability benefits.

Hill pleaded guilty Dec. 6 to one felony count of workers’ compensation fraud in Franklin County Municipal Court. He was ordered to pay $131,919.43 in restitution and an additional $2,000 for investigative costs.  He was also sentenced to five years of community control.  As part of the agreement, Hill is ordered to pay $100 per month. If Hill does not comply with probation or make the required monthly payments, he will serve six months in prison.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/122111.asp

BWC Investigations Result in Five Workers’ Comp Fraud Convictions in November

December 21, 2011 1 comment

Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Stephen Buehrer announced five individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during the month of November. The court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID), which works to deter, detect, investigate, and prosecute workers’ compensation fraud. The cases bring the total number of convictions this year to 119.

“With another month comes five more fraud convictions, the result of our investigators’ outstanding work following up on leads and proactively identifying fraud,” said Buehrer. “What many perpetrators often do not understand is that if their activity does not generate tips from suspicious neighbors, co-workers or others surrounding them, their activity will raise red flags among BWC staff trained to detect suspected fraud.”

Following are four of the cases that resulted in a guilty plea or conviction during the month of November.

Michael Roe Booking PhotoMichael Roe (Middletown, Butler County) was sentenced November 28 for working while receiving benefits. SID received an allegation through BWC’s fraud hotline indicating Roe was working for a friend while collecting temporary total disability benefits. Investigators found Roe was working as a part-time tow truck driver for Lightening Towing and Recovery in Middletown. Roe pleaded guilty in the Franklin County Common Pleas Court to a felony count of workers’ compensation fraud. Roe was ordered to pay restitution of $5,163.91, and another $2,000 for investigative costs. He was also placed on community control for two years. Roe must pay full restitution by June 15, 2012 and obtain no further felony convictions or he will serve six months in jail.

James Mann (Toledo, Lucas County) was sentenced November 30 for fraud after he was found treating injured workers without a medical license. BWC’s Health Care Provider team investigated Mann after an employer reported inconsistencies with the treatment provided to an injured worker by Mann, owner of Toledo Medical Evaluators, LLC. The team found Mann was performing disability exams and file reviews in both Ohio and federal workers’ compensation cases although he lost his license to practice medicine in 1991 after he was convicted of illegal processing of drug documents. Mann was attempting to conceal the fact that he was personally conducting exams by erroneously reporting that one of the licensed physicians in his practice conducted the exam. Mann then submitted the fraudulent exam reports to the Ohio Industrial Commission. Mann pleaded no contest to a bill of information in Lucas County Common Pleas Court to one count of workers’ compensation fraud. He was sentenced to serve five years of probation and pay $90,278 in restitution, in addition to $10,530 for investigative costs. Mann previously pleaded guilty in the United States District Court, Northern District of Ohio, to three counts of Mail Fraud.

Thomas McallisterThomas McAllister (Steubenville, Jefferson County) pleaded guilty to deception to obtain narcotics. BWC’s Intelligence Unit identified Thomas McAllister as potentially receiving prescriptions from several physicians and pharmacies. SID’s investigation confirmed that he used deception to obtain 11 prescriptions from three prescribing physicians. McAllister entered a guilty plea in October to a felony count of deception to obtain dangerous drugs. A Franklin County judge sentenced McAllister November 30 to 30 days in jail. He was also ordered to pay $424 in restitution, and his driver’s license will be suspended for six months.

Gary Metz (Sharonville, Hamilton County) was sentenced November 22 for working while receiving benefits. BWC’s Special Investigations Department investigated Metz after receiving a tip and found he was working as a cable technician for his brother’s company Comteam, Inc., while receiving Living Maintenance and Non-Working Wage Loss benefits. Metz pleaded guilty in the Franklin County Common Pleas court to one felony count of workers’ compensation fraud. He was ordered to pay restitution of $6,165 and investigative costs of $1,000. He was also sentenced to six months in Ohio Department of Rehabilitation and Correction, suspended if he pays restitution and court costs by Dec. 30.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/121511.asp

We are hiring!

We are hiring various investigative positions throughout the state. Apply to each position below or visit http://careers.ohio.gov/.

Canton

Position

Team

Closing Date

Fraud Investigator

Region 1

12/14/2011

Cincinnati

Position

Team

Closing Date

Fraud Investigator

Health Care Provider Team

12/14/2011

Cleveland

Position

Team

Closing Date

Fraud Investigator

Region 1

12/14/2011

 Fraud Investigator 

Employer Fraud

12/14/2011

 

Columbus

Position

Team

Closing Date

Criminal Investigator

Region 2

12/14/2011

Lima

Position

Team

Closing Date

Criminal Investigator

Region 3

12/14/2011

Fraud Investigator

Employer Fraud

12/14/2011

Mansfield

Position

Team

Closing Date

Fraud Investigator

Region 1

12/14/2011

Regional Locations TBD (Canton, Cleveland, Mansfield and Youngstown)

Position

Team

Closing Date

Assistant Special Agent In Charge

Region 1

12/08/2011

Sharonville man on workers’ comp caught working for brother’s company

December 1, 2011 1 comment

Gary Metz was installing cable for Comteam, Inc.

A Sharonville (Hamilton County) man was sentenced in court last week after the Ohio Bureau of Workers’ Compensation (BWC) discovered he was working as a cable installer for his brother’s Milford company. Gary Metz must repay BWC $7,165 by Dec. 30 or risk jail time.

“The majority of injured workers are conscientious of the rules and would never purposely break them,” said BWC Administrator/CEO Stephen Buehrer. “Regrettably, BWC’s investigators must remain alert for others like Mr. Metz who knowingly commit fraud hoping it will go unnoticed while they pocket checks they are not eligible to receive.”

BWC’s Special Investigations Department investigated Metz and found he was working as a cable technician for Comteam, Inc., owned by his brother. Metz was working full time for the company while receiving Living Maintenance and Non-Working Wage Loss benefits. Non-Working Wage Loss is payable to injured workers who are unable to find suitable employment, and Living Maintenance is paid to an injured worker while they are participating in a vocational rehabilitation plan.

Metz pleaded guilty November 22 in the Franklin County Common Pleas court to one felony count of workers’ compensation fraud. He was ordered to pay restitution of $6,165 and investigative costs of $1,000. He was also sentenced to six months in Ohio Department of Rehabilitation and Correction, suspended if he pays restitution and court costs by December 30.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/120111.asp

The long arm of the law: The SID Fugitive Task Force in action

November 21, 2011 3 comments

Handcuffed

The scenario is all too common in the criminal justice system. By means of a grand jury indictment, a defendant is charged with a crime. Yet – although presumed innocent until proven guilty – the defendant fails to show up in court for a scheduled arraignment hearing. Without even entering a plea to the criminal charge, the defendant has fled. The court promptly issues a bench warrant for the defendant’s arrest. The defendant has become a fugitive from the law.

Many fugitives go into hiding, apparently hoping the court will somehow forget about them. Some leave our state, or even our country, seemingly believing the best bet is to put distance between themselves and their crime. However, little do they understand that they can indeed run, but they certainly cannot hide.

It was for this very reason that, back in 1999, SID assembled an elite team comprised of a fraud analyst and several special agents. This BWC Fugitive Task Force (FTF) – as it was soon to be known – immediately commenced coordinating action with law enforcement agencies to bring our BWC fugitives to justice. The FTF accomplishes its mission by identifying the location of each fugitive, guiding law enforcement to execute the fugitive’s arrest and, where needed, ensuring the fugitive’s extradition to the respective jurisdiction where s/he faces a criminal charge. Of course, the key action step is the first action step – namely, locating the fugitive. To do this, the FTF uses many sources of information, including the databases of other governmental and law enforcement agencies. Often FTF members conduct surveillance. Sometimes they execute undercover operations. Always, these investigative strategies are carefully planned and coordinated to secure otherwise hidden information.

A Case In Point

We received an allegation that a claimant was receiving lost time benefits for a falsified assault and that he routinely engaged in several, strenuous physical activities without any apparent physical restriction. Our investigation revealed the subject had furnished no fewer than 17 versions of how he had sustained his injuries in an attempted robbery reported to, and investigated by, local law enforcement. The evidence we secured included statements from multiple witnesses to whom the subject had admitted he had sustained no injury. Additionally, we secured a security guard’s statement that he observed the claimant put on back and leg braces and a sling in a parking lot prior to attending an Industrial Commission hearing. After viewing our surveillance video, a provider concluded the claimant’s “presentation was not true and it was a conscious and deliberate feigning of an illness or disability.” In fact, our investigation proved that while receiving benefits the claimant had continued to work as a self-employed auto mechanic.

When indicted, the subject fled prosecution. However, our Fugitive Task Force located him in Las Vegas, Nevada and secured his extradition back to Ohio. The subject pled guilty to one fifth-degree felony count of workers’ compensation fraud. The court sentenced the subject to serve five years of probation. The court ordered the subject to pay BWC $33,635 in restitution.

A Case In Point

We received an allegation that a claimant owned and operated a business in Arizona while receiving lost time benefits from BWC. Our investigation revealed the subject owned and operated a home restoration business in Sierra Vista, Arizona. The evidence we secured included reports documenting the subject was found guilty in Arizona on three occasions of operating his business without a contractor’s license. Our evidence also included 149 checks written by customers to the subject. In all, we identified $419,357 in cash and checks the subject received for his active work as a contractor.

The BWC SID Fugitive Task Force coordinated the subject’s arrest at work by the Cochise County (Arizona) Sheriff’s Department. The U.S. Marshalls Service extradited the subject back to the State of Ohio. The subject pled guilty to one fifth-degree felony count of workers’ compensation fraud. The court sentenced the subject to serve 12 months of incarceration (suspended) and five years of probation. The court ordered the subject to pay BWC $64,273 in restitution and $2,727 investigative costs.

Be on the Lookout

You may see the identities and photos of current BWC “Wanted Fugitives” on our SID Facebook page: ohiobwcfraud.

Look for our next fraud awareness article that will discuss our Safety Violations Investigation Unit (SVIU). Meanwhile, be sure to read more about fraud investigations in our SID FY 2011 Annual Report.

If you suspect anyone is committing workers’ compensation fraud, or if you suspect you know the location of a BWC fugitive, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

BWC Investigations Result in 13 Workers’ Comp Fraud Convictions in October

 Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Stephen Buehrer today announced 13 individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during October. The court actions are the result of investigations conducted by BWC’s special investigations department (SID). The department works to deter, detect, investigate and prosecute workers’ compensation fraud. The cases bring total convictions in calendar year 2011 to 114.

“Cases like these remind us why detecting and prosecuting fraud must be a very high priority,” said Buehrer. “Whether it’s an injured worker, an employer or provider, it is incredible that anyone would game the system to gain something is not rightfully theirs, at the expense of others who end up paying the bill.”

Below is a sampling of cases that resulted in a guilty plea or conviction during October.

James Landis (Canfield, Mahoning County) pleaded guilty Oct. 24 to a felony count of workers’ compensation fraud for working while receiving benefits. An anonymous tip led to an investigation into whether Landis was working at his business, Mum’s The Word Florist, while receiving workers’ comp benefits. Landis stated on multiple occasions that he was incapable of working in any capacity. However, SID verified Landis was the primary operator of the business while on temporary total disability. He interacted with customers, arranged and delivered flowers, set up floral displays at events, and did all administrative paperwork. Landis is scheduled to be sentenced on Dec. 15. As a condition of his sentencing, he has agreed to repay $8,065.81 in investigative costs. He has repaid 19,000 he received improperly.

Roger Bolin (Nelsonville, Athens County) pleaded guilty Oct. 17 to workers’ compensation fraud and deception to obtain after he filed a false claim to receive narcotic prescriptions. SID received an allegation from an employer indicating Bolin filed a false claim. He indicated he was injured in September 2010, although he not worked for the company since June. Investigators obtained documentation showing Bolin did file a false claim and obtained a narcotic prescription by deception. The Hocking County Common Pleas Court sentenced Bolin to eight months prison to run consecutively on each count. Bolin is currently serving a prison sentence related to a parole violation. The court ordered the new charges to be served consecutively to this sentence.

Donald Johnson (Trenton, Butler County) was sentenced Oct. 17 for deceptively obtaining numerous BWC paid narcotics from multiple physicians and using multiple pharmacies. SID identified Johnson for possible doctor shopping for narcotic drugs and an investigation revealed his deception to obtain narcotics. Johnson agreed in the Butler County Common Pleas Court to pay restitution owed the amount of $2,177.86.

Daniel Engle (Shaker Heights, Cuyahoga County) pleaded guilty to one count of workers’ compensation fraud for working while receiving benefits. SID opened an investigation after a BWC claims service specialist noted that Engle’s employer, the city of Shaker Heights, submitted a letter prepared by Engle. In the letter, Engle informed the city that he was resigning to start his own computer business. SID’s investigation verified Engle owned and operated DNC Computer while receiving BWC temporary total disability benefits. He claimed he was incapable of working in any capacity. Investigators established that Engle repaired computers, sold computers, and sold computer parts. Additionally, Deluxe Transportation/New Valley Taxi employed Engle as a taxi driver. Engle entered a guilty plea in Franklin County Municipal. He was sentenced to 180 days in jail suspended in lieu of three years probation. The court also ordered Engle to pay a $75 fine, court costs and investigative costs in the amount of $4,000. Engle has paid $15,500 in restitution.

Thomas McAllister (Amsterdam, Jefferson County) was sentenced for deception to obtain dangerous drugs. BWC’s intelligence unit began investigating McAllister after suspecting he was receiving narcotic prescriptions from several physicians and pharmacies. The investigation confirmed that McAllister used deception to obtain narcotic medication from various prescribing physicians. On Oct. 12, McAllister entered a plea of guilty to deception to obtain dangerous drugs, a fifth degree felony. The parties agreed to $424 in restitution. McAllister will be sentenced Nov. 30.

Mark Robinson (Fairfield, Butler County), pleaded guilty Oct. 2 to one count workers’ compensation fraud for working while receiving benefits. Robinson worked as a general contractor for Bed and Breakfast properties in Hamilton while collecting temporary total disability. He performed maintenance and contractor work at various rental properties. Robinson paid back the full criminal overpayment of $6,463.25 and investigative costs of $1,207.38 for a total of $7,670.63 restitution paid to the BWC.

Daren Snyder (Chillicothe, Ross County) pleaded guilty Oct. 3 in a Franklin County courtroom to fraud for working while receiving benefits. SID opened an investigation after receiving an allegation indicating Snyder was working while receiving temporary total disability and living maintenance. Investigators found Snyder did return to work as a self-employed plumber during the period he received benefits. Sentencing is scheduled for Dec. 2.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/111511a.asp

Cuyahoga Falls Man Finds Two Ways to Violate Workers’ Comp Laws

Verhelle worked and was incarcerated while receiving disability payments

COLUMBUS – A Cuyahoga Falls (Summit County) man who worked for three employers and served time in the Akron Oriana House while on workers’ comp was sentenced for fraud last week in a Franklin County courtroom.  Stacy Verhelle entered a guilty plea after an investigation by the Ohio Bureau of Workers’ Compensation (BWC) revealed he continued to cash disability checks while working and during his stint in jail.

“As if defrauding the system by illegally working while collecting benefits wasn’t enough, Mr. Verhelle also chose to collect benefits while behind bars,” said BWC Administrator/CEO Stephen Buehrer.  “The prospect of a few extra dollars in his pocket apparently kept him from doing the right thing because he perpetuated his charade by stating on multiple occasions that he was incapable of working in any capacity.”

BWC’s Special Investigations Department received an allegation that Verhelle was working periodically for different employers while on temporary total disability.  Agents established that Verhelle was employed by Davis Family Roofing, Biltmore Exteriors and Equity One Exteriors. Verhelle was sub-contracted by these companies to be a sales representative and estimator, securing jobs for the companies and receiving a percentage of the total value of each job. 

It was also determined that he was incarcerated in the Akron Oriana House while receiving benefits, also a conflict with BWC disability benefits.

Stacy Verhelle entered a guilty plea to workers’ compensation fraud on Oct. 25.  Judge Sheward sentenced him to three days in jail with credit for time served, and ordered him to pay $10,815.16 in restitution in addition to $1,000 to cover investigative costs. 

If you suspect that a subject is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.