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Posts Tagged ‘Employer Compliance’

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 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

Make ‘em pay: BWC Employer Compliance Unit

By John Sledd, Manager, Employer Compliance Department

BWC’s Employer Compliance Department works closely with the Special Investigations Department. The Employer Compliance Department’s role is to identify employers who are operating their business without participating in the Ohio’s Workers’ Compensation System. Additionally, the department attempts to determine the causes of non-compliance and assist employers in obtaining or reinstating their coverage.  In some instances, employers who attempt to avoid or evade their worker’s compensation obligations commit criminal acts such as failing to pay their premiums, improperly reporting their employees or forging or altering documents to obtain lower premiums.

When the Employer Compliance Department suspects that a criminal act has been committed, the employer is referred to the Special Investigations Department for a criminal investigation.  In some instances, the Employer Compliance Department may pursue civil remedies, such as an Injunction, to prevent an employer from operating until they have paid their outstanding premium and have obtained proper coverage. Our overarching goal is to help employers identify and use the proper tools to insure coverage for their employees to maintain a safe and financially sound business operation.  

A Case In Point
The Special Investigations Department received a referral from the Employer Compliance Department that a Columbus health services company was currently operating with lapsed coverage. The Employer Compliance Department attempted to bring the subject into compliance but the employer failed to make payments to become compliant. During an interview with investigators, the owner of the company admitted to having five part-time employees. Later, the owner told investigators that she made contact with the Ohio Attorney General’s Office’s Collection Division to pay her past due BWC premiums. Investigators determined that the Collections Division made numerous phone calls to the owner, which were never returned. The owner of the company was convicted of one second degree misdemeanor count of failure to comply.

If you suspect that an employer is operating without workers’ compensation coverage, 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.