Archive

Posts Tagged ‘Data Analysis’

Smart phones call for even smarter forensics

Digital forensics unit gravatarEach day, there are at least 10 times more mobile devices being produced in the world than babies being born (Global). Recent research conducted by the Ohio Bureau of Workers’ Compensation Special Investigations Department examined such growth in mobile technology, its uses within the workers’ compensation realm, and its future implications on fraud investigations. Mobile devices are projected to be the most common way Americans access the Internet by 2015, with a compound annual growth rate of 16.6% according to the International Data Corporation (DeGrasse). 

The health information field is leading the growth, with investment in companies that make health information mobile apps rising 78% in 2011 to $766 million (Edney; Bloomberg). In 2012, nearly 420 million smart phones and 44 million tablets will ship worldwide (Canalys). With smart phones and tablets increasingly being used to perform work previously done on a laptop or PC, the workers’ compensation system can expect to see increased use of mobile devices and applications in the daily activities of its healthcare providers, employers, and workers.

Taking advantage of recent trends, the BWC formulary went mobile in April 2012, allowing healthcare professionals immediate access to a formulary at the point of care and helping to ensure prescription safety and accuracy. Epocrates, Inc., available through app stores, can also be utilized by employers and workers. Another app, called PillManager, boasts of “unparalleled connectivity between consumer and pharmacy” where consumers can track their own medications and submit a repeat request for any prescription directly from their handheld device.

Mobile devices can be used outside of the healthcare realm, however, with apps aiding employers and workers during work activities. The U.S. Department of Labor and OSHA teamed up to allow worksite heat index tracking in order to reduce heat-related illnesses for workers outdoors. Using GPS data and information from the U.S. National Oceanic and Atmospheric Administration the app addresses risk levels and advises of rest breaks, fluid consumption, and adjustment of work operations. The NIOSH Lift Calculator app is also within the public domain, utilizing real-time feedback to reduce lower-back injuries; the app uses variables, such as horizontal distance, to calculate stress on the lower back during lifts.

Conversely, workers’ comp officials are concerned that injury exposure may grow as more workers go mobile – 2012 is expected to see nearly 35 million people working from home or other locations (Simpson). Mobile devices, although helpful in many realms, can prove to be a dangerous distraction while walking or driving; if the devices are owned by the employer, injuries while using such devices may present unclear compensability situations.

Mobile phones are being used in virtually all levels of criminal activity, making it easier for investigators to use mobile technology as incriminating evidence in an investigation. Personal surveillance has evolved with social media and mobile technology; as a result, officials can conduct investigations through “open source intelligence”. It has become common for investigators to identify false worker’s comp claims from social media websites like Facebook and Twitter documenting able-bodied activity (Newberry).

In addition, mobile applications create a full electronic audit trail enabling the tracking of people and transactions in both space and time. Within workers’ compensation, claims data can be correlated with information from apps to identify “hotspots” of activity at different pharmacies; problem pharmacies or providers can be identified and investigated more quickly (Savitz; Forbes).

Mobile technology, although helpful in a variety of field investigative aspects, can prove to be a challenge to a digital forensic examiner. The number of operating systems is much greater for mobile devices (>10) than for desktops (3) and each OS differs from the next in the way data is stored and security is provided. DFE’s must have the knowledge and tools to access information from each type of OS. In addition, the move to mobile technology has increased the use of cloud data storage, making it commonplace; Strategy Analytics forecasts U.S. spending on cloud services to grow $50 billion by 2016. Digital evidence has shifted to the cloud, where information may be found in multiple places and on a variety of platforms; also, data processing is decentralized in the Cloud, with a lack of physical access to servers (Grispos, Glisson, & Storer). As a result, traditional approaches to evidence collection are void Investigators must identify that an individual is using the cloud, obtain a search warrant, and overcome the final obstacle that current digital forensics tools are intended for media that is under the investigator’s control. As the transition is made to mobile device storage, investigators must be ready to make the change to better (and more expensive) technology for digital forensics labs.

As technology changes, the BWC Special Investigations Department continues to change its investigative efforts.  While the majority of people use technology to improve business operations or enhance communication, we are prepared to investigate those that use these types of technologies to commit fraud against the Ohio BWC.

To report suspected workers’ compensation fraud, call 1-800-OHIOBWC, visit ohiobwc.com, or visit www.facebook.com/ohiobwcfraud.

Sources:

Apple App Stores. Available from: http://www.apple.com/iphone/from-the-app-store or http://www.apple.com/ipad/from-the-app-store; 2012 [accessed 06.26.12]

“App stores; direct revenue to exceed $14 billion next year and reach close to $37 billion by 2015.” Canalys. Available from: http://www.canalys.com /newsroom/app-stores-direct-revenue-exceed-14-billion-next-year-and-reach-close-37-billion-2015; 2012 [accessed 06.26.12]

DeGrasse, M. “Mobile devices projected to overtake PCs as connections to Internet.” RCR Wireless. Available from: http://www.rcrwireless.com /blog/20110912/devices/mobile-devices-projected-to-overtake-pcs-as-connections-to-internet/; 2012 [accessed 06.26.12]

Edney, A. “iPad-toting doctors spur venture funding in medical apps.” Bloomberg Report. Available from: http://www.bloomberg.com/news/2012-06-18/oprah-aids-doctors-as-app-investments-soar-health.html; 2012 [accessed 6.26.12]

Grispos, G., Glisson, W., & Storer, T. “Calm before the storm: the emerging challenges of cloud computing in digital forensics.” 2009. [accessed 06.26.12]

Hobson, E. “Securing the cloud: digital investigations for the cloud.” Qinetiq. 2010. [accessed 06.26.12]

Newberry, L. “Social media footprint helps Pa. investigators.” Officer.com. Available from: http://www.officer.com/news/10731208/social-media-footprint-helps-pa-investigators; 2012 [accessed 06.26.12]

Ohio BWC Web. [accessed 06.26.12]

Savitz, E. “5 ways mobile apps will transform healthcare.” Forbes. Available from: http://www.forbes.com/sites/ciocentral/2012/06/04/5-ways-mobile-apps-will-transform-healthcare/; 2012 [accessed 06.26.12]

Simpson, A. “As more workers go mobile, workers’ compensation exposure grows.” Insurance Journal. Available from: http://www.insurancejournal.com /news/national/2011/06/01/200720.htm; 2012 [accessed 06.26.12]

BWC Investigations Result in Nine Workers’ Comp Fraud Convictions in July

Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Stephen Buehrer today announced nine individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during the month of July. 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.

“Several of these individuals went to great lengths in their attempts to cheat the system so they could receive undue compensation and access to prescription drugs,” said Buehrer.  “They likely did not anticipate the expertise and dedication our investigators have when it comes to finding and eliminating fraud.”

Following is a sampling of cases that resulted in a guilty plea or conviction during the month of July.

 Charles Watson (Toledo, Lucas County) pleaded guilty to one count of deception to obtain dangerous drugs for fraudulently receiving BWC paid narcotic prescriptions from two different physicians.  Watson was traveling from one physician in Toledo to another physician in Dover (Tuscarawas County) to obtain similar narcotics.  Neither physician knew Watson received narcotics from prescriptions written by the other physician.  Watson was sentenced nine months suspended incarceration and was placed on community control for two years.  As a condition of community control, Watson was ordered to pay restitution of $930.24 and court costs.  The court also suspended his driver’s license for six months. 

Misti Marshall (Elyria, Lorain County) entered a plea of guilty to one count of workers’ compensation fraud for working while receiving benefits. BWC’s Automated Detection and Intelligence unit noted a cross match with the Ohio Department of Job and Family Services (ODJFS) indicating potential fraud.  Investigators found Marshall was receiving wages from Assured Home Health, Rono Investments, Industrial Plastics and Kelly Services while she was collecting Temporary Total Disability and Living Maintenance benefits. Marshall must pay restitution of $18,177.15 and an additional $3,000 for investigative costs. Her sentencing is scheduled for September 22.

Benton Crist (Delphos, Allen County) pleaded guilty to one count of workers’ compensation fraud for working while receiving benefits.  Crist failed to inform BWC that he was working as a truck driver for Martin Transportation Systems, in Byron Center, Michigan (formerly Topline Express out of Lima, Ohio) during the time he was applying for and collecting Non-Working Wage Loss benefits.  The investigation began after a BWC claims service specialist recognized signs of possible fraud in his claim documents. Crist was sentenced to five years of community control and ordered to pay court costs and restitution of $ 42,876.34.  He was also sentenced to 12 months suspended incarceration.

Donald Fisher (Clermont County) pleaded guilty in Clermont County to one count of deception to obtain a dangerous drug, a fourth degree felony. Investigators found that Fisher was having his granddaughter use and sell narcotics prescribed by his BWC physician.  Between May 2010 to March 2011, Fisher gave his adult granddaughter 10 Opana and 10 Percocet pills each week to traffic on the street in exchange for sexual favors. Rebecca Fisher sold the Opana for $50 per pill and the Percocet for $12 per pill and split her profits with Fisher.  Both confessed to selling the BWC prescribed narcotics during the same period Fisher received Permanent Total Disability benefits. Fisher’s sentencing is pending.

http://www.ohiobwc.com/home/current/releases/2011/081211.asp

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

Morrow School Bus Driver Sentenced for Workers’ Comp Fraud

Pamela Meyers Booking Photo

Pamela Meyers

A Warren County woman must repay more than $13,000 following an investigation by the Ohio Bureau of Workers’ Compensation (BWC) that revealed she was working while collecting workers’ compensation benefits.  Pamela Meyers pleaded guilty to a felony count of workers’ compensation fraud related to her work as a bus driver while receiving disability payments for a workplace injury she sustained while working as a driving instructor.

“BWC investigators’ careful monitoring of claims again proved successful in identifying abuse of the system,” said BWC Administrator/CEO Stephen Buehrer.  “Employers are overwhelmingly supportive of their injured workers and work hard to maintain safe workplaces, and we will not allow fraudulent activity to unfairly raise their premiums.”

BWC’s Special Investigations Department opened an investigation after detecting that Meyers was collecting wages while on Temporary Total Disability.  Investigators found she worked as a driver the Little Miami School District in Morrow from July 20, 2006 to September 4, 2006, and from March 12, 2007 to September 16, 2007, in violation of the rules associated with receiving those benefits. 

Meyers was sentenced in a Franklin County courtroom to five years of community control, ordered to pay restitution in the amount of $11,396.10, court costs and investigative costs totaling $2,000.  Meyers will serve 12 months in prison if she violates community control.  She made a payment of $7,000 toward restitution on the day of sentencing.

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

http://www.ohiobwc.com/home/current/releases/2011/080211.asp

Columbus Woman Caught Working Four Jobs While On Workers’ Comp

Annette McDaniel must repay more than $19,000 after the Ohio Bureau of Workers’ Compensation (BWC) found she was working four jobs at Columbus area businesses while receiving workers’ compensation benefits for a prior workplace injury.  McDaniel, also known as Annette Fair and Ronette Fair, pleaded guilty to workers’ compensation fraud and was sentenced in a Franklin County courtroom earlier this week.

“McDaniel thought she could get away with working several jobs and also collecting several types of benefits under a number of aliases,” said BWC Administrator/CEO Stephen Buehrer.  “Our Special Investigations Department is a step ahead of her and other fraudsters with access to automated detection tools that bring attention to irregularities they hope will go unnoticed.”

In August 2007, BWC’s Special Investigations Department opened an investigation after a database cross-match conducted with the Ohio Department of Job and Family Services raised red flags.  The database reported McDaniel worked for KC Men’s Clothing while she was collecting Temporary Total Disability and Living Maintenance Wage Loss benefits from BWC.   The investigation confirmed McDaniel not only worked for KC Men’s Clothing, but also for AmeriCoat, Value City Department Stores and Adecco USA during the periods she collected these benefits.

On July 18, McDaniel pleaded guilty to a felony count of workers’ compensation fraud and was sentenced to a suspended sentence of eight months incarceration suspended and five years of community control. As a condition of the community control, McDaniel was ordered to pay restitution in the amount of $17,064.25 as well as investigative costs in the amount of $2,500 and court costs.

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

http://www.ohiobwc.com/home/current/releases/2011/072211.asp

Illinois Brothers’ Workers’ Comp Fraud Scheme Falls Apart

Data analysis exposes fraud; Psychiatrists and brothers now owe BWC a combined $100,000

COLUMBUS – A pair of Illinois brothers who traveled to Columbus to practice psychiatry were sentenced for workers’ compensation fraud after an investigation showed they were conducting inadequate examinations of injured workers and submitting false bills to the Ohio Bureau of Workers’ Compensation (BWC). Muhammed S. Choudhry, M.D., owner and practitioner at Nehal Psychiatric Group, located at 1100 Morse Rd. in Columbus, pleaded no contest to a felony charge in a Franklin County courtroom. His brother, Naseem M. Chaudhry, M.D, pleaded no contest to a misdemeanor.

“Using some very innovative tools and techniques, analysts in our Automated Detection and Intelligence Unit are able to identify instances of potential fraud,” said BWC Administrator/CEO Stephen Buehrer. “In this case, data analysis exposed the brothers’ wrongdoing and allowed us to bring their fraudulent activity to a halt.”

Dr. Muhammed Choudhry, who traveled from his home in Bolingbrook, Illinois to practice in Columbus three days a month, caught the attention of BWC’s Special Investigations Department (SID) after analysis revealed he billed BWC for more than twenty hours of individual psychotherapy on a single day. A subsequent investigation revealed he was significantly over reporting time spent with his patients, in some cases spending less than five minutes with a patient, while billing BWC in excess of 45 minutes of individual psychotherapy. Agents also found that both he and his brother, Dr. Nassem Chaudhry, who occasionally traveled to Columbus to fill in for him, billed BWC for services when patients did not even make it into the office. During their visits, patients were prescribed a wide variety of narcotics.

Ohio Attorney General Mike DeWine added, “The partnership between BWC and our Health Care Fraud section enables us to effectively expose and prosecute wrongdoing by those providers who try to defraud the workers’ compensation system. We will aggressively pursue this conduct wherever we see it and send the message that cheating the system does not pay.”

Muhammad Saleem Choudhry pleaded no contest and was ordered to pay $78,573.16 in restitution and investigative costs. He also received an eight month prison sentence suspended on the condition that he pay restitution and successfully complete community control. Naseem Chaudhry also pleaded no contest and was ordered to pay restitution and investigative costs totaling $27,422.60, a $250 fine and court costs. He will serve ninety days in jail if he does not pay the full restitution within ninety days.

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

http://www.ohiobwc.com/home/current/releases/2011/062211.asp