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Posts Tagged ‘International Fraud Awareness Week’

Thank you!

November 22, 2019 1 comment

Thanks for following, liking and sharing our International Fraud Awareness Week posts!

It’s great to be part of a large network of individuals and organizations with the same mission – to #StopFraud!

We appreciate the opportunity to share our story and learn what our counterparts are doing in their fight to stop all kinds of fraud.

While we hope you never come across workers’ comp fraud, if you do, we want you to know how to recognize it and where to find us.

 

BWC secures 14 fraud-related convictions in October

Fraudsters owe BWC more than $283,000 in restitution

The Ohio Bureau of Workers’ Compensation (BWC) secured 14 fraud-related convictions in October, with those convicted owing BWC a combined $283,146 in restitution.

Those convicted include injured workers found working while collecting disability benefits, family members collecting their deceased parent’s compensation benefits, and business owners whose coverage had lapsed.

“When people cheat BWC or fail to cover their own employees, they are cheating the injured workers who really need our help and the employers in our system that follow the law,” said BWC Administrator/CEO Stephanie McCloud.

In order of most recent court appearance, those convicted in October include:

Bruce Starkey of Cincinnati, Ohio
Starkey pleaded guilty Oct. 17 and was sentenced in Hamilton County Common Pleas Court Nov. 4 on one count of workers’ compensation fraud, a fifth-degree felony. Starkey received 100 hours of community service and was required to pay BWC full restitution for the $1,459 in permanent total disability benefits he took from his mother’s bank account after she passed. He failed to inform BWC of her passing and wrote 15 checks, forging his mother’s signature.

Cecil Piner of Xenia, Ohio
Piner pleaded guilty Oct. 31 in Franklin County Common Pleas Court on one count of workers’ compensation fraud, a fifth-degree felony, after BWC found him driving a school bus while receiving $17,901 in disability benefits. He was sentenced to five years’ probation in lieu of 12 months in jail and ordered to pay court costs and full restitution.

Kyle Foreman of New Carlisle, Ohio
Foreman pleaded guilty Oct. 30 in Clark County Municipal Court on two counts of failure to comply, both second-degree misdemeanors. His coverage for Kyle S. Foreman Enterprises had lapsed since November 2017, and he failed to pay the premiums before taking his company into bankruptcy. He was ordered to pay a $100 fine and court costs for each count.

Michelle Smith of Cincinnati, Ohio
Smith, 57, pleaded guilty Oct. 23 to one count of workers’ compensation fraud, a fifth-degree felony, after BWC discovered she owned and ran two businesses, Expression Unique LLC and Later in Life Brides, while collecting BWC benefits for workers deemed permanently and totally disabled. A Franklin County judge ordered Smith to pay BWC $40,873 dollars in restitution and serve five years of non-reporting community control (probation). If she violates her probation, she must serve a year in prison.

Louis Tombazzi of Cleveland, Ohio
BWC found Tombazzi owed the agency approximately $75,000 in premiums after letting the policy lapse for his business, Garda Architectural Fabrication. He pleaded guilty Oct. 16 in Cleveland Municipal Court to one count of failure to comply, a second-degree misdemeanor, and was ordered to serve 90 days in jail (suspended), pay a $400 fine, and serve two years’ probation. He also was ordered to report monthly to the court his effort to reduce or pay off his BWC obligation.

Natalia Daniels of Concord Township, Ohio
Daniels pleaded guilty Oct. 16 to one count of workers’ compensation fraud, a first-degree misdemeanor, after receiving $3,600 in BWC disability benefits while working as a bus driver for a senior living facility and as a laborer for an insurance company. A judge ordered her to pay full restitution to BWC and serve 18 months of probation in lieu of a 180-day jail sentence.

Vicki Aloisio of West Chester, Ohio
Aloisio was convicted Oct. 11 on two counts of failure to comply, both second-degree midemeanors, for failing to carry BWC coverage on her business, Richard Aloisio Trucking Inc., despite numerous BWC attempts to assist her. Aloisio owes $28,000 in past-due premiums and penalties. Sentencing in a Butler County courtroom is scheduled for Dec. 6.

Ahmad Al-thamra of Akron, Ohio
Al-thamra pleaded guilty Oct. 10 in Akron Municipal Court to two counts of failure to comply, both second-degree misdemeanors, for failing to maintain workers’ compensation coverage on his business, The Family Corner Store. He was ordered to pay $300 in fines and ordered to pay court costs and obey all laws for one year.

Jason Gaschler of Cheswick, Pennsylvania
Gaschler pleaded guilty Oct. 10 of one count of theft, a first-degree misdemeanor, for operating a construction company, General License Contracting, in Pennsylvania while receiving $6,864 in BWC benefits. He was sentenced to one day in jail (time served) and made full restitution at the time of his hearing.

Jason Rissner of Rockford, Ohio
Rissner pleaded guilty Oct. 9 in Mercer County Common Pleas Court to one count of petty theft, a first-degree misdemeanor, after he was caught operating his own construction company while receiving $35,261 in temporary total disability benefits from his employer, O’Reilly Auto Parts. He was ordered to spend 180 days in jail, which would be suspended if he committed no more crimes within a year and pay full restitution to O’Reilly.

Brian Franklin of Sharonville, Ohio
Franklin avoided conviction on one charge of workers’ compensation fraud, a fifth-degree felony, after he agreed Oct. 8 in Franklin County to pay BWC $18,081 in restitution. BWC found Franklin working at a community center in 2018 while collecting BWC benefits.

Marshann Kinman of Cedar Grove, Ohio
Kinman pleaded guilty Oct. 8 to one count of workers’ compensation fraud, a fifth-degree felony, in Hamilton County Common Pleas Court. Kinman failed to let BWC know her mother had passed so she could take $6,321 in BWC widow death benefits intended for her mother. Kinman received two years of community service and was ordered to pay BWC full restitution.

Charles Ayler of Cincinnati, Ohio
Ayler pleaded guilty Oct. 3 to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC found him working while receiving BWC benefits. He was sentenced to 180 days in jail, which was suspended for two years of community service, the promise to avoid similar offenses, and to pay BWC full restitution of $6,090 and court costs of $150 by Dec. 31, 2020.

Ronald J. Dorfeld of Brunswick, Ohio
Dorfeld must pay BWC $78,957 in restitution after pleading guilty to a fifth-degree felony charge of workers’ compensation fraud Oct. 1 in a Franklin County courtroom. BWC found Dorfield operating his own business, Xtreme Multimedia Marketing, while receiving disability compensation. A Franklin County judge sentenced Dorfeld to ninth months in jail, which was suspended for five years’ probation and full restitution.

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

Happy Anniversary to Us!

On Nov. 14, 2019, our BWC Special Investigations Department celebrated the second anniversary of its Fraud Hotline system.

We launched this system during Fraud Awareness Week 2017 as an important new customer service tool for external sources to report their suspicions of workers’ compensation fraud. What a successful launch and two years it has been!

We’ve received more than 3,300 calls since then, an average of nearly seven each work day!

If you suspect workers’ compensation fraud in Ohio, call us on it.

We look forward to hearing from you. Give us a call at 1-800-644-6292. We will conduct an investigation and determine the facts. Together, we are successfully combatting workers’ compensation fraud in Ohio – one most important call at a time.

Today, during International Fraud Awareness Week 2019, we thank you for your support!

A letter from Jim Wernecke – Director of BWC Special Investigations

As Director of the BWC Special Investigations Department (SID), I am honored to kick off Fraud Awareness Week. I invite you to view my video message, “Fraud Hurts Us All.

In the video I discuss how workers’ compensation fraud increases premiums for employers, which reduces the money employers can invest in their employees, community and future growth. I explain how BWC employees are improving workplace health and safety, getting injured workers back to work, and keeping premium rates low for employers. I describe how SID employees protect the State Insurance Fund by detecting, investigating, and deterring fraud.

Lastly, I invite viewers to report, via an online form, suspected workers’ compensation fraud.

I also invite you to check back daily as we share success stories in our efforts to combat workers’ comp. fraud. Some stories we will highlight are:

We would not have achieved these successes without the dedicated staff members who serve our department with great skill, resourcefulness, and determination to bring justice to those who cheat our system. Their efforts create safer workplaces and ensure those who attempt to commit fraud in workers’ compensation are held accountable to the fullest extent of the law. Since our inception in 1993, we have identified over $1.9 billion in savings, as well as:

  • Completed over 69,000 investigations
  • Referred 5,420 subjects for prosecution
  • Secured 2,941 criminal convictions

We are honored and eager to join our fraud-fighting colleagues around the country and abroad each November to participate in International Fraud Awareness Week.

The campaign, which runs through Saturday, was established by the Association of Certified Fraud Examiners to highlight the issue of fraud and minimize its impacts.

Most weeks, you’ll find us sharing our fraud news on #FraudFriday. But this week, we’ll have a new fraud feature each day! So keep an eye here on our blog and on our Facebook and Twitter pages!

Happy Fraud Awareness Week!

IFAW: That’s a wrap

It’s time to wrap another impressive International Fraud Awareness Week.

We specialize in workers’ comp fraud but enjoy hearing about what our counterparts are doing in their fight to stop all kinds of fraud. We also appreciate the opportunity to share our story with you.

We’ve shared a lot about ourselves, including what we do, why we do it, a little about how we do it, how Ohioans can help and much more.

Thanks for connecting with us this week. While we hope you never come across workers’ comp fraud, if you do, we want you to know how recognize it and where to find us.

If you do still have questions, don’t worry, we’re here all year long.

Our fraud hotline is, well, hot! Thanks for making us aware of fraud all year long!

November 16, 2018 1 comment

By Jeff Baker, Program Administrator, BWC Special Investigations Department

We have received more than 2,300 calls since we launched our new Fraud Hotline system on November 14, 2017, during International Fraud Awareness Week 2017.

The nearly 200 calls a month, means we have received 9 each work day, or more than one every working hour!

In our November 14, 2017 blog, we noted that calling the BWC Fraud Hotline is the most interactive and direct way for you to report an allegation of fraud. Our hotline puts you in direct contact with an agent in our Special Investigations Department, one ready and willing to listen to, document, and promptly act upon, your concerns.

We look forward to hearing from you, so give us a call at 1-800-644-6292 if you suspect fraud. We will conduct the investigation and determine the facts. Together, we are successfully combatting workers’ compensation fraud in Ohio – one most important call at a time.

Today, during International Fraud Awareness Week 2018, we thank you for your support!

‘Records told the story’ in fraud case: Northeast Ohio business overbills agency; owner found guilty of workers’ comp fraud

November 15, 2018 1 comment

By Jennifer Cunningham, Assistant Director, BWC Special Investigations Department

The bills coming from a Northeast Ohio health care facility to the Ohio Bureau of Workers’ Compensation (BWC) looked suspicious.

Too many, it seemed, were for treatment to a company co-owner and others closely connected to the business. Our agency had paid more than $110,000 for claims on one of those cases alone and $27,000 for treatment provided to co-owner Jeffrey L. Guerin. So, in late winter of 2013, our special investigations department decided to take a closer look at PT Plus LLC of Willoughby Hills, a provider of physical therapy and massage therapy about 20 miles northeast of Cleveland.

After a preliminary investigation by our Health Care Provider Team, we used an undercover agent posing as an injured worker to get an inside look at the practice. In roughly 23 visits over three months our agent observed — and records later proved — PT Plus billed BWC for services that weren’t rendered to patients. In one case, our agent witnessed an injured worker refuse treatment, but PT Plus billed BWC anyhow, using spurious treatment notes to support the claim.

Our agents subsequently interviewed three former PT Plus employees, all of whom alleged co-owner Guerin committed health care fraud out of the business. Specifically, they claimed Guerin billed BWC and other third-party payers for treatment not rendered to patients. They said Guerin managed the day-to-day operations of the business and had total control over the billing process. They said he altered the units of service recorded on fee sheets and the patient’s in/out time recorded on treatment notes to correspond with the amount of treatment billed to BWC.

As we were investigating, PT Plus went out of business around July 2014. Our agents learned the business records and patient charts were stored at Guerin’s business partner’s residence. We conducted a search warrant and interviewed the co-owner, who denied any involvement in the company’s day-to-day operations and billing responsibilities. That was Guerin’s role, he said.

Our agents interviewed Guerin, who admitted sole responsibility for billing and overseeing his company’s daily operations. He told our agents that beginning in 2009 he had auditors review his businesses records to look for discrepancies. He said they found that he had actually under-billed BWC about 60 percent of the time, thus shorting his business money. For the audits that revealed overbilling, it didn’t amount to much money, he said. Taken collectively, it was all a wash and that’s why he didn’t inform BWC or any other third-party payer, he explained. But that’s not what our agents found.

During the interview, Guerin retrieved the audit worksheets from his basement and surrendered them to the agents. The agents conducted a cursory review and discovered the majority of the 2014 audit worksheets recorded overbilling. “He offered bizarre justifications and excuses for the records,” one agent told me. “He was cooperative, but we could tell he wasn’t truthful. I think he felt he could explain his way out of it, but the records told the story.

Back at the office, the health care provider team conducted its own audit. The methodology entailed comparing the type, amount (Units of Service) and length (In/Out Times) of treatment that the therapists recorded on the billing and treatment records with the bills Guerin sent to BWC. The audit revealed more than 170 instances where Guerin altered data so he could bill and receive reimbursement for more treatment than was rendered.

On May 18, 2018, Guerin pleaded guilty to one count of workers’ compensation fraud, a first- degree misdemeanor, in Franklin County Municipal Court. He paid BWC restitution in the amount of $7,154 on the same day.