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Posts Tagged ‘Intelligence Unit’

SID Comes of Age: A Retrospective Review at 18

In 1984, the National Crime Prevention Council designated October Crime Prevention Month. Every year since then, government agencies, civic groups, schools, businesses, and youth organizations have reached out to educate the public, showcase their accomplishments, and explore new partnerships during this special month. October has become the official month for recognizing and celebrating the practice of crime prevention, while promoting awareness of important crime prevention strategies. The month-long celebration spotlights successful crime prevention efforts on the local, state, and national levels.

In honor of Crime Prevention Month 2011, we offer the following respective review of the BWC Special Investigations Department.

Our department was formed by statute and commenced operation in 1993. For 18 years we have faithfully fulfilled our mission: effectively and proactively preventing losses to the workers’ compensation system; and deterring, detecting, investigating, and prosecuting workers’ compensation fraud.

During that time, we have achieved significant performance milestones, such as:

  • Completed 55,163 investigations;
  • Closed 22,270 founded cases;
  • Identified more than $1.4 billion in savings;
  • Identified $25,906 per closed case;
  • Referred 3,760 subjects for prosecution; and
  • Secured 1,902 criminal convictions.

Strategic Innovation. To generate these notable outcomes, supported by our agency executives we have consistently identified and implemented innovations.  For example, we created and deployed specialized teams each dedicated to combating a type of workers’ compensation fraud subject; claimants, employers, providers, MCOs, etc. We have identified and implemented new technology to detect fraud, analyze data and secure evidence. For example, the SID Digital Forensics Unit utilizes advanced forensic software and equipment to secure electronic evidence from subjects.

A Common Thread: Detection and Intelligence. The Intelligence Unit program uses various technologies and techniques to detect fraudulent activity and refer allegations to each of our specialized investigative teams. This program includes exchanging data with other agencies and organizations to identify claimants receiving total disability benefits who are gainfully employed, incarcerated, or otherwise not entitled to these benefits. Additionally, the Intelligence Unit identifies fraudulent trends by performing data analyses of BWC indemnity (lost time), medical and employer information.

Most recently, SID has recently increased its staffing to even more effectively combat fraud. In June 2011, BWC Administrator/CEO Stephen Buehrer approved us to post and fill critical vacancies, including those with our Intelligence Unit. The selected professionals will generate significant increases in SID performance results.

Be sure to read more about our fraud investigative strategies and successes in the SID FY 2011 Annual Report.

Look for our next fraud awareness article that will commence a series focused upon health care provider fraud. 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.

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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

BWC Investigations Result in 11 Workers’ Comp Fraud Convictions in June

Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Stephen Buehrer today announced 11 individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during the month of June. 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.

“Our Special Investigations Department continues to do an outstanding job of catching up to these fraudsters and holding them accountable for their actions,” said Buehrer. “Our hope is that by highlighting these actions in the media and through our newly launched Special Investigations Facebook page, we can deter those who would defraud Ohio’s injured workers and businesses.”

Earlier this week, BWC launched a Special Investigations Facebook page that can be found at www.facebook.com/ohiobwcfraud. It includes news on recent investigatory action, a most-wanted section and a link to report fraud.

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

Sharlyn Adams (Cincinnati, Hamilton County) pleaded guilty to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. Investigators found that Adams had returned to work while receiving Temporary Total Disability benefits for performing the same type of work she was performing at the time of her industrial injury. While collecting disability, Adams was working for the Catholic Residential Services Nursing Home. Adams was sentenced to 180 days in jail suspended and she was placed on probation for five years. She was also ordered to pay restitution of $3,661.29 and an additional $1,000 for investigative costs.

William Burchfield (Lancaster, Fairfield County) was sentenced for workers’ compensation fraud for operating without coverage. Burchfield, owner of Elite Sewer and Septic, allowed his policy to lapse in 2007 and failed to have it reinstated even after attempts by BWC agents to assist him in returning to compliance. A judge found Burchfield guilty on June 27 and ordered him to pay restitution to BWC in the amount of $300 per month beginning July 28. The judge also ordered five years probation, a suspended jail sentence of 90 days, and ordered him to pay $100 in fines and $95 in court costs.

James Goloversic (Cincinnati, Hamilton County) pleaded guilty to workers’ compensation fraud and two counts of deception to obtain a dangerous drug for using multiple doctors and multiple pharmacies to obtain narcotics. An investigation found Goloversic was obtaining prescriptions from physicians who were not aware he was seeking narcotics from other physicians. Goloversic utilized multiple pharmacies in order to conceal his deception. Goloversic was sentenced June 28 to three years of community control and ordered to pay court costs. The court further ordered that Goloversic must consult only his treating physician if he wishes to seek any narcotic for pain. If he violates the conditions of his community control, he will serve three and a half years in prison.

James Hale (Kenton, Hardin County), owner of Jimmy’s Pizza, was sentenced for operating his business without a workers’ compensation policy. Hale failed to obtain a policy even after BWC agents advised him of his obligation to do so. On June 2, 2011, Hale pleaded guilty to one count of failure to comply, a second degree misdemeanor. He was ordered to pay restitution in the amount of $1,980.67, in addition to a $200 fine. Hale was also sentenced to 90 days jail suspended, one year probation, and was ordered to remain in compliance with all BWC laws and regulations.

April Hupp (Norwalk, Huron County) pleaded guilty to one count of workers’ compensation fraud for working while receiving benefits. SID received an allegation from an employer who received an anonymous tip that Hupp was operating a cleaning business and was babysitting. Investigators found Hupp was employed as a house cleaner and babysitter while receiving Temporary Total Disability benefits. She was ordered to pay restitution of $5,973.51, sentenced to 11 months in prison, suspended, and placed on three years of probation. She was also ordered to obtain employment and perform 40 hours of community service.

Bradford Pirigyi (Warren, Trumbull County) pleaded guilty to four counts of deception to obtain dangerous drugs, all felonies of the fifth degree. SID opened an investigation when Pirigyi filed a claim against an employer BWC was not able to locate and BWC received a request from a doctor for approval to conduct an MRI for an injury unrelated to a Pirigyi’s allowed claim. The doctor’s office indicated Pirigyi advised them that his claim was for a separate injury he sustained while employed with a construction company. Investigators found Pirigyi sought treatment at several different hospitals and doctor’s offices, and attempted to file workers’ compensation claims against businesses that did not exist in order to obtain prescription narcotics. Pirigyi asked for narcotic pain medication during some of the visits. Each claim and the bills related to those claims were denied by the BWC. Sentencing is not yet scheduled.

Jeffrey D. Volz (Buckeye Lake, Licking County) entered a guilty plea to one count of workers’ compensation fraud for working while receiving benefits. SID opened an investigation into Volz after receiving an allegation from TS Tech, Inc. that Volz was working while receiving Temporary Total Disability benefits. An investigation confirmed that Volz was employed by Teleperformance, Acloche and Work Force Network and knowingly concealed his return to work so that he would continue to receive those benefits. Volz appeared in court with a certified check in the amount of $5,623.98 to cover restitution. The judge sentenced Volz to a term of three months of suspended incarceration and he must pay $700 for investigative costs. The incarceration sentence will be imposed if does not pay within six months.

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/2011/071911.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