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Posts Tagged ‘convictions’

State agencies share data to nab workers’ comp cheat

hopsonA Columbus man who worked two jobs while collecting injured workers’ benefits must pay the Ohio Bureau of Workers’ Compensation $6,000 in restitution and investigative costs and serve five years probation, a judge ruled Tuesday in the Franklin County Court of Common Pleas.

Dion S. Hopson, 43, pleaded guilty Sept. 20 to workers’ compensation fraud, a first-degree misdemeanor. He was sentenced to 180 days in jail, which was suspended in exchange for five years community control. Hopson also was ordered to pay $5,000 in restitution to BWC and $1,000 in investigative costs. He must pay $100 per month to stay in good standing with community control, which will terminate once restitution has been paid.

BWC’s Special Investigations Department started looking at Hopson after a cross-match query with the Ohio Department of Job and Family Services revealed two employers were paying Hopson wages in 2014 and 2015. SID found Hopson was simultaneously receiving Temporary Total Disability benefits from BWC.

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

 

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BWC investigations result in four workers’ comp fraud convictions in January

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer announced today that four individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in January 2016. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

“A recent case in which two individuals stole the identity of a deceased claimant shows that some people will go to great lengths to scam the system,” said Buehrer. “They are a clear reminder why we continue our efforts to protect the dollars employers pay to support Ohio’s injured workers in their time of need.”

 The following are cases that resulted in guilty pleas or convictions during January:

Consuelo “Connie” Griffin and David Lusk (Cincinnati, Hamilton County) both pleaded guilty Jan. 14 in the Hamilton County Court of Common Pleas to counts of theft after they were discovered cashing BWC benefit checks for an injured worker who had died. SID opened an investigation after receiving an allegation from BWC’s claims department, which was unable to contact an injured worker receiving permanent total disability for a workplace injury. The claims department reported that worker’s phone was disconnected. The investigation found that while the injured worker passed away in June 2014, the BWC checks that were mailed to his home continued to be cashed. Griffin and Lusk lived in the same apartment complex as the deceased and when he was hospitalized, Griffin signed a power of attorney document giving her control over his finances. Griffin also had the injured worker’s mail forwarded to her address and the pair moved into his apartment when he was hospitalized. Griffin confessed to signing Harrell’s name on the checks and cashing them. Griffin also took money out of his bank account while he was ill and wrote checks from his account to herself for cash. His account was soon closed because Griffin and Lusk spent all the money and failed to pay any of his nursing home expenses. Lusk pleaded guilty to count of theft and one count of theft from the elderly, both fifth-degree felonies. Griffin also pleaded guilty to two counts of theft, both fifth-degree felonies. The court sentenced them to 10 months in jail, suspended, and ordered them to repay restitution of $5,072.62. They also received three years of probation.

Michelle Green (Columbus, Franklin County) pleaded guilty Jan. 13 in the Franklin County Court of Common Pleas to attempted workers’ compensation fraud, a first degree misdemeanor, for working while receiving benefits. SID’s Intelligence Unit received data from the Ohio Department of Job and Family Services (ODJFS) that indicated Green had received wages while receiving BWC benefits. The investigation confirmed Green was employed with Good Hands Home Health Care Service in Columbus. Evidence obtained during the course of the investigation also showed that she intentionally misrepresented and withheld her employment in order to continue collecting benefits. She was ordered to pay restitution in the amount of $1,899.99 and $100 in court costs.

Randy Gates, dba Gator’s Auto Repair and Towing (Caledonia, Marion County) pleaded no contest on Jan. 21 in the Marion Municipal Court to a second-degree misdemeanor count of failure to comply for operating his business without workers’ compensation insurance coverage. BWC’s Employer Fraud Team (EFT) identified that Gates continued to operate his business, Gator’s Auto Repair and Towing, without valid BWC coverage after two previous investigations for the same issue. He had been previously referred for prosecution in 2005 for failure to comply for operating a business without the required BWC coverage. The EFT attempted to work with this employer to become compliant with state law but Gates refused to submit completed outstanding payroll reports in an effort to calculate accurate premiums owed. The employer also failed to attempt to pay his balance with the BWC. On January 21, 2016, Gates entered a plea of no contest to failure to comply, a second-degree misdemeanor. Gates received a 180-day jail sentence which was suspended, and was ordered to pay fines and court costs. Gates currently has an estimated balance due of approximately $36,000 and is working with the BWC to submit outstanding payroll reports for calculation of exact premium due.

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

Check out our latest cases at ohiobwcfraud.wordpress.com and view BWC’s workers’ comp fraud awareness video on YouTube.

Tuscarawas County woman ordered to repay $9K for workers’ comp fraud

December 31, 2015 2 comments

Robin Beckett of Dennison (Tuscarawas County) has been ordered to repay more than $9,000 to the Ohio Bureau of Workers’ Compensation after investigators found she knowingly committed fraud by working in violation of the workplace injury benefits she was receiving.

The Special Investigations Department Intelligence Unit noted a database cross-match with the Ohio Department of Job and Family Services showed Beckett earned wages during periods when she was also collecting disability benefits for a workplace injury. The investigation produced evidence proving Beckett knowingly and with fraudulent intent worked for Tender Touch Home Health performing various nursing duties while on temporary total disability.

Robin Beckett pleaded guilty to a fifth-degree felony count of workers’ compensation fraud on Oct. 6 in the Franklin County Court of Common Pleas. Judge McIntosh sentenced Beckett to 10 months in prison, suspended for three years of community control. Conditions of her probation include payment of restitution totaling $9,330.29.

Fairfield County employer admits to faking workers’ comp coverage

newellLANCASTER – The owner of a Fairfield County excavating company has admitted to falsifying his workers’ compensation insurance coverage certificate in order to submit bid proposals to the city of Lancaster. William Newell, of Pleasantville, pleaded guilty to workers’ compensation fraud and must repay more than $5,000 to the Ohio Bureau of Workers’ Compensation (BWC).

“Businesses in Ohio are required to maintain workers’ compensation coverage to protect their employees and care for them if injuries occur,” said BWC Administrator/CEO Steve Buehrer. “Falsifying a coverage certificate is not only against the law, it’s unfair to honest employers that are placed at a competitive disadvantage.”

BWC’s Special Investigations Department opened an investigation into Newell after receiving a tip that he submitted an altered BWC certificate of coverage for his business, Bill Newell Excavating, as part of a bid proposal to the city of Lancaster. After the city notified him he needed to obtain coverage in order to submit bids, Newell submitted all outstanding payroll reports to BWC indicating he did not have any employees or payroll. He also paid past due premiums and fees in order to become compliant and receive a valid certificate of coverage.

Through the investigation, BWC’s employer fraud team obtained three additional false certificates that Newell submitted in bid packets during recent years. When interviewed, Newell initially denied having any knowledge of the false certificates but later admitted creating and submitting them. During the interview Newell stated that he always had employees, but later stated he did not have employees and hired sub-contractors.

The investigation ultimately found that Newell did have employees and that he underreported his payroll in order to avoid paying premiums.

Newell entered a guilty plea to one fifth-degree felony count of workers’ compensation fraud on Nov. 17 in the Fairfield County Court of Common Pleas. He was sentenced to a six month prison term, suspended for three years of community control. The conditions of his community control include a restitution payment of $5,404.90 to BWC, and a continuing obligation to provide the court proof of his premium payments.

To report suspected workers’ compensation fraud, call 1-800-644-6292 or visit bwc.ohio.gov. Check out our latest cases at ohiobwcfraud.wordpress.com, follow Fraud Fridays on Twitter @OhioBWCFraud, or join in the conversation at facebook.com/ohiobwcfraud. View and share BWC’s workers’ comp fraud awareness video on our YouTube channel.

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Massillon woman bets wrong; fraud scheme ends up a bust

Brenda Pumphrey of Massillon (Stark County) claimed a workplace injury caused her to lose use of each hand, one arm and one leg. After surveillance at a West Virginia casino showed no limp and full use of her arms, Pumphrey’s luck ran out and she ended up pleading guilty to workers’ compensation fraud.

An investigation into Pumphrey’s claim started with a speeding ticket. SID received an allegation from a BWC Customer Service Specialist that Pumphrey was issued a speeding ticket in Stark County on a date following her claimed loss of her ability to use her upper extremities.

A case was opened and a review of the claim showed that Pumphrey’s physician of record had continuously advised that she was unable to use her extremities but was reluctant to obtain some treatment that was advised. Pumphrey’s roommate, Robin Hopton, was also noted in several physician visits assisting Pumphrey. Hopton told the doctor she had to assist Pumphrey with her daily activities at their residence.

Agents conducted surveillance of Pumphrey and Hopton visiting her doctor’s office. Additionally, Pumphrey’s bank records showed a high volume of ATM and debit card activity at the Mountaineer Casino, located in Chester, West Virginia. Video from the casino showed Pumphrey walking with no noticeable limp and with full use and range of motion of both arms. Hopton was also with Pumphrey at the casino.

The physician concluded after seeing the casino video that it appeared Pumphrey had intentionally deceived him. The Ohio Industrial Commission terminated her Permanent Total Disability benefits.

On Friday, Oct. 16, Brenda Pumphrey was sentenced on her previously entered guilty plea to a felony count of workers’ compensation fraud. She was placed on community control for three years and ordered to pay restitution of $9,192.75. Pumphrey will serve six months in jail if she violates the terms of community control.

Hopton was also convicted of a misdemeanor count of workers’ compensation fraud in August.  She was sentenced 30 days jail, suspended, and ordered to pay court costs.

The big business of health care provider fraud

As you can see from reading this blog, we take all types of fraud seriously and fraud committed by health care providers is no different.

In fact, in 1994 we created the Health Care Provider Team (HCPT) to exclusively investigate this type of fraud.

This past fiscal year HCPT closed 64 cases, identified $19M in savings, made 11 criminal prosecution referrals, and obtained 3 convictions.

Just to give you an idea of the types of fraud committed by health care providers, here are a few of our most notable, recent cases.

Lawanna Porter, of Shaker Heights, who operated Palladium Healthcare, a home healthcare agency with more than 100 employees, failed to report having employees to various state agencies or to secure workers’ compensation, and failed to report her payroll to BWC. SID conducted this joint investigation with the Ohio Attorney General’s Office, Medicaid Fraud Control Unit. In addition to restitution, Porter was ordered to pay BWC $15,000 in investigative costs, for a total of $139,573. She was also sentenced to five years of community control. If she violates the terms of her sentencing, Porter could be sent to prison for 11.5 years.

Nelsonville chiropractor Michael L. Brown, D.C., whose patients were not at his office on days that he billed BWC for treating them, including dates his office was closed, and who fabricated the amount of treatment he provided to patients to receive a higher payment for services. Brown was ordered to pay $394,021 in restitution, which includes approximately $60,000 in investigative costs. He was sentenced to five years of probation. If he fails to comply with the terms of his probation, Brown could be sentenced to serve nine months in jail. Brown voluntarily decertified himself as a BWC health care provider.

Jeffrey Stychno, D.C., an Ohio chiropractor was sentenced to pay $89,000 in combined restitution to Medicaid and the Bureau of Workers’ Compensation (BWC). Stychno was ordered to pay $69,781 to BWC and $19,715 to Medicaid after he was convicted of fraudulent billing practices during his time as co-owner of Integrated Health in Warren, Ohio.

Joseph J. Yurigan, D.C., a chiropractor who formerly practiced in Weirton and Wheeling West Virginia was sentenced for health care fraud and tax evasion. Our investigation revealed Yurigan was routinely and consistently billing for services that he never provided to undercover operatives. The Federal Bureau of Investigations, the West Virginia Department of Insurance Commission, United States Treasury Department and the United States Attorney’s Office became involved in the investigation and executed a search warrant. Yurigan pleaded guilty and yesterday was ordered to make restitution totaling $836,066.

After reading these cases you have most likely come to the same conclusion…this big business is just not worth it!

BWC investigations result in six workers’ comp fraud convictions in October

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer announced today that six individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in October 2015. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

“Employers pay premium to BWC with the expectation that those dollars go toward the care and recovery of their workers who are injured on the job, not to dishonest claimants, employers or medical providers,” said BWC Administrator/CEO Steve Buehrer. “I am pleased our investigators were able to put an end to these attempts to defraud the workers’ compensation system.”

The following is a sampling of cases that resulted in guilty pleas or convictions during October:

Krystal Knight (Toledo, Lucas County) pleaded guilty Oct. 6 in the Lucas County Court of Common Pleas to one misdemeanor count of attempted theft for forgery. An investigation by BWC’s special investigations department revealed that Knight cashed two checks from Catholic Healthcare Partners, which were self-insured disability payments issued to another claimant, Judith Burris, in July 2014. The checks, totaling $1,062, were cashed after Burris, her mother, passed away on June 29, 2014. The investigation proved that Knight signed Burris’ name on the checks and presented Burris’ license to Huntington Bank in order to cash the checks. As part of a plea agreement, Knight was sentenced to pay restitution to Catholic Healthcare Partners in the amount of $1,062, but Knight failed to make the payment. She is scheduled for sentencing on November 17, 2015.

James Orr (Bethel, Clermont County) pleaded guilty Oct. 6 in the Hamilton County Municipal Court to a fourth-degree misdemeanor count of disorderly conduct for filing a false claim. Orr filed a claim with the BWC alleging he was injured in 2010 while working at Solutions Plus in Amelia.  Investigators interviewed co-workers and found that Orr had told them he hurt his back landscaping and working on his personal vehicle.  A medical report noted that Orr told the doctor that he was hurt at work two days prior to the alleged injury date on the first report of injury, and had sought treatment the next day at Clermont Mercy Hospital. Investigators found that Orr had not been treated by Clermont Mercy Hospital and time cards from the employer indicated that Orr did not work on the date of the alleged injury. Orr was sentenced to three days credit in the Hamilton County Jail, court costs, and ordered to stay employed.
Ralph Dollison (Circleville, Pickaway County) pleaded guilty Oct. 28 in the Franklin County Court of Common Pleas to one first-degree misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID received an allegation that Dollison was working while receiving compensation for a workplace injury. The investigation proved Dollison worked for a concrete company as a laborer and performed duties such as digging, building forms, pouring concrete and finishing concrete. Evidence also revealed he intentionally misrepresented and withheld his employment in order to continue collecting the disability benefits. Dollison was ordered to pay $4,081.47 in restitution and placed on community control for five years. He was also sentenced to 180 days in jail, suspended as long as he complies with the community control.

Donald Detrick (West Mansfield, Logan County) pleaded guilty Oct. 27 in the Franklin County Court of Common Pleas to a misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID opened an investigation after receiving an allegation that Detrick may be working while receiving benefits for a workplace injury. The investigation revealed that Detrick worked as the fire chief for Bokecreek Township in Logan County, fire safety coordinator for York Township in Logan County and as a certified water inspector for Midwest Express while collecting temporary total disability benefits.  Prior to the plea, Detrick paid $25,586.40 to the Clerk of Courts in order to pay in full his restitution of $22,155.04 and investigative costs of $3,431.36. A judge sentenced him to community control for six months under the condition that he pay the restitution and investigative costs, have no new convictions, and pay all court costs. He will serve six months in jail if he does not meet these terms.
Timothy Morrow (Delaware, Delaware County) pleaded guilty to one first-degree misdemeanor count of workers’ compensation fraud on Oct. 20 in the Franklin County Court of Common Pleas for working while receiving benefits. SID opened an investigation after receiving an allegation that Morrow was operating his own HVAC business while receiving disability benefits from the BWC.  The investigation, which included a review of bank records and multiple interviews, confirmed Morrow did own and operate a business, TTM Mechanical, and conducted HVAC installations and repairs during the time he was receiving benefits. The evidence obtained during the course of the investigation also revealed that he intentionally misrepresented and withheld his employment from BWC. Morrow was sentenced to 30 days in the Franklin County Jail, suspended, and was placed on six months of probation.  He was also ordered to pay court costs along with $8,399.74 in restitution to BWC.  The restitution was paid at the clerk’s office after the hearing.

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

Check out our latest cases at ohiobwcfraud.wordpress.com and view BWC’s workers’ comp fraud awareness video on YouTube.