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Posts Tagged ‘Ohio Bureau of Workers’ Compensation’

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.

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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.

Check Smart clerk outsmarts phony owner of BWC rebate check

BWC investigators report 9 convictions in October

An Akron sex offender added forgery to his criminal record last month after a clerk at a Check Smart thwarted his attempt to cash a $5,500 rebate check from the Ohio Bureau of Workers’ Compensation (BWC) that belonged to a church-owned day care center.

“We have to give credit to the clerk, she made our job easy,” said Jim Wernecke, director of BWC’s special investigations department (SID). “She could tell the man added his name to the check and he wasn’t the rightful owner. But instead of simply turning him away, she took his picture, photocopied his driver’s license and had him fill out an application. Then she confiscated the check and refused to cash it.”

A Summit County judge sentenced Keith A. Galloway, 45, to one year in prison Oct. 24 after Galloway pleaded guilty to forgery, a fifth-degree felony. The judge ordered the term be served concurrently with Galloway’s three-year sentence on unrelated drug charges and for failing to register his address with the Summit County Sheriff’s Office.

Galloway attempted to cash the rebate check in July 2017. The check was part of BWC’s $1 billion rebate to Ohio employers that year.

In other news, SID secured eight other workers’ comp fraud or fraud-related convictions in October, bringing calendar year 2018’s total to 72. In order of most recent court case, those convicted include:

Jason Moffitt of Columbus
Moffitt pleaded guilty Oct. 31 to one count of workers compensation fraud, a first-degree misdemeanor, after investigators found he had falsified records to increase his BWC cash benefits. He was sentenced to three months incarceration, which was suspended for two years of community control on the condition he pay BWC $5,325 in restitution.

Philip Ayers, dba Ayers Transportation Services, of Cincinnati
Ayers pleaded guilty Oct. 24 in Hamilton County to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC found him operating his business with lapsed coverage and non-compliant claims filed against his policy. A judge sentenced Ayers to two years of probation and ordered him to maintain full-time employment and cooperate fully with BWC and the Ohio Attorney General’s office on his payment plan to BWC. Ayers owes BWC more than $159,000.

Kurt Ballish, dba Kurt Ballish Construction & Custom Decks, of Chardon
Ballish pleaded guilty Oct. 22 to two misdemeanor counts of failure to comply, the same charges he pleaded guilty to in 2016. A judge in Chardon Municipal Court sentenced Ballish to one year of probation in lieu of 90 days in jail and ordered Ballish to pay fines and court costs totaling $642 by Nov. 30. Ballish owes BWC nearly $19,000.

Frank Krailler, dba Transmission Specialists of Montgomery, of Cincinnati
Krailler pleaded guilty Oct. 22 in Hamilton County to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC discovered him operating his business without workers’ comp coverage. As part of his plea deal, Krailler paid $4,000 in restitution.

Gyorgy Benedek of Columbus
Benedek, owner of Maintenance Free Building Services Inc., pleaded guilty Oct. 18 in Franklin County to a reduced charge of failure to comply after submitting a check to BWC for $43,069 in restitution.

Penny Sibila of Canton
Sibila must pay BWC $26,719 in restitution after pleading guilty to a fifth-degree felony charge of workers’ compensation fraud Oct. 18 in a Franklin County courtroom. Acting on a tip, BWC investigators found Sibila working as a property manager for an apartment complex while collecting BWC benefits for an injury she suffered in 2014. In addition to restitution, a judge sentenced Sibila to two years of non-reporting probation in lieu of a seven-month jail sentence.

Thomas Banig of Cleveland
Banig pleaded guilty Oct. 17 to one count of workers’ compensation fraud, a first-degree misdemeanor, after he filed a false claim in 2014 against an employer he had not worked for since 2003. A judge sentenced Banig to 180 days incarceration, suspended for one year of community control.

Rami Khayat, dba Triple Auto Sales, of Cleveland
Khayat pleaded guilty Oct. 1 to one count of failure to comply, a second-degree misdemeanor, after BWC found he was operating his business without BWC coverage. A judge ordered Khayat to pay BWC $965 in restitution.

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

Foregoing workers’ comp coverage costs Ohio businesses

The Ohio Bureau of Workers’ Compensation (BWC) secured court convictions in October against three Ohio business owners — including a Cleveland-area man for the second time since 2016 — who failed to protect their workers with proper BWC coverage.

“We made every attempt to bring these employers into compliance with Ohio law, but they wouldn’t cooperate and we were forced to bring charges against them,” said Jim Wernecke, director of BWC’s special investigations department (SID). “I can’t stress this to employers enough: If you’re struggling with your BWC premiums, work with us. Avoiding us will only make your situation worse.”

Among those convicted were Kurt A. Ballish of Chardon, Ohio, owner of Kurt Ballish Construction & Custom Decks. He pleaded guilty Oct. 22 to two misdemeanor counts of Failure to Comply, the same charges he pleaded guilty to in 2016.

A judge in Chardon Municipal Court ordered Ballish, who owes BWC nearly $19,000, to become compliant with Ohio’s workers’ compensation law or go to jail. He sentenced Ballish to one year of probation in lieu of 90 days in jail and ordered Ballish to pay fines and court costs totaling $642 by Nov. 30.

In Cincinnati, the owner of a now-closed transportation services company must pay BWC more than $159,000 in restitution following his guilty plea to a reduced charge of workers’ compensation fraud.

Philip Ayers, owner of Ayers Transportation Services, pleaded guilty Oct. 24 in a Hamilton County courtroom to the first-degree misdemeanor charge. A judge sentenced Ayers to two years of probation and ordered him to maintain full-time employment and cooperate fully with BWC and the Ohio Attorney General’s office on his payment plan to BWC.

In another employer case, the owner of Triple R Auto Sales in Cleveland pleaded guilty to one count of Failure to Comply Oct. 1 after BWC discovered the business had been in operation for 11 years without workers’ comp coverage.

A judge in Cleveland Municipal Court ordered Rami Khayat to pay BWC $965 in restitution. An injured-worker claim filed against Khayat’s business triggered BWC’s investigation.

In other news, a Columbus tow-truck driver who falsified records to increase his BWC cash benefits pleaded guilty Wednesday to a first-degree misdemeanor count of workers’ compensation fraud.

A Franklin County judge sentenced Jason E. Moffitt to two years of community control in lieu of a three-month jail sentence. The judge also ordered Moffitt to pay BWC $5,325 in restitution.

BWC investigators say Moffit intentionally inflated his income on an earnings statement and signed another person’s name to it. The letter was used to establish Moffitt’s BWC compensation payments.

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

Lapsed policy costs Columbus cleaner $43,000

BWC wraps three fraud-related cases over the last week

The owner of a Columbus cleaning company who continued to run his business after his workers’ compensation insurance lapsed in 2010 paid more than $43,000 in restitution to the Ohio Bureau of Workers’ Compensation (BWC) at his court hearing Oct. 18.

Gyorgy Benedek, owner of Maintenance Free Building Services Inc., pleaded guilty to a reduced charge of Failure to Comply after submitting a check to BWC for $43,069 in the Franklin County Court of Common Pleas. The plea followed a BWC investigation that revealed Benedek provided falsified BWC certificates of coverage to land a cleaning contract with another company.

“We got a tip from a company doing business with Mr. Benedek that his BWC certificates looked suspicious, so we checked it out,” said Jim Wernecke, director of BWC’s special investigations department. “We found multiple problems with the certificates indicating Mr. Benedek was attempting to skirt his legal obligation to protect his employees and carry proper insurance.”

Among BWC’s findings:

  • Benedek provided three BWC certificates showing the signature of former BWC Administrator/CEO Marsha P. Ryan when it should have been the signature of her successor, Stephen Buehrer.
  • The certificates were dated during a period Benedek’s policy was lapsed.
  • Benedek reported zero payroll between 2009 and 2015, but a BWC audit found he had more than 30 employees during that time and unreported payroll of more than $650,000.

In two other recent cases, a Canton woman must pay BWC $26,719 in restitution after pleading guilty to a fifth-degree felony charge of workers’ compensation on Oct. 18, and a Cincinnati-area business owner avoided a felony fraud conviction by paying $4,000 in restitution to BWC at his court hearing Oct. 22.

Acting on a tip, BWC investigators found Penny L. Sibila of Canton working as a property manager for an apartment complex from May 11, 2015 to July 27, 2016, while collecting BWC benefits for an injury she suffered in 2014.

Investigators observed Sibila performing several office functions and learned she collected commissions for landing new tenants. They also found she used the alias “Linda” to conceal her return to work from BWC.

In addition to restitution, a Franklin County judge sentenced Sibila to two years of non-reporting probation in lieu of a seven-month jail sentence.

 

In Hamilton County on Monday (Oct. 22), Frank Krailler of Loveland pleaded guilty to a first-degree misdemeanor count of workers’ compensation fraud after BWC found him operating his business, Transmission Specialists of Montgomery, without BWC coverage.

Krailler paid BWC $4,000 in restitution at his hearing in a Hamilton County court room, but an outstanding balance remains.

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

BWC reports 7 fraud-related convictions in September

Six Ohioans and a Florida resident owing the Ohio Bureau of Workers’ Compensation (BWC) more than $450,000 in back premiums and restitution were convicted on fraud or fraud-related charges in September.

Those convicted include a Jackson Twp. business owner who misclassified his employees and underreported his payroll to shave $350,000 off his BWC premiums. Others include a basketball coach, a taxi service owner and a valet attendant.

“Whether it’s employers trying to avoid paying their fair share or claimants trying to hide their work activity, cheating the system is not tolerated,” said Jennifer Cunningham, assistant director of BWC’s special investigations department. “We exist to find and prosecute these cheaters to reduce costs to employers and ensure honest claimants receive the benefits they need.”

September’s cases bring total convictions since January to 61, as of Sept. 30. Those convicted, in order of most recent court case, include:

Christine Estrict, Working and Receiving, Cleveland, Ohio
Estrict, aka Christina Estrict, pleaded guilty to a first-degree misdemeanor count of workers’ compensation fraud on Sept. 26 in the Franklin County Court of Common Pleas after BWC found her working as a youth basketball coach and referee while collecting BWC benefits. A judge sentenced her to 180 days in jail, then suspended the sentence for five years of probation. He ordered her to pay BWC $4,156 in restitution.

Glenn J. Miller III, Working and Receiving, Augustine, Florida
Miller pleaded guilty Sept. 26 to one count of workers’ compensation fraud, a fifth-degree felony, after BWC found him working as a truck driver while collecting BWC benefits. A judge sentenced him to six months incarceration, suspended for three years of community control with the condition to pay restitution of $16,000 to BWC.

James M Horton, dba All Around Transportation, Lapsed Coverage, Hamilton, Ohio
Horton, of Clarksville, pleaded guilty to a second-degree misdemeanor count of Failure to Comply Sept. 25 in Hamilton Municipal Court after BWC discovered his policy lapsed in July 2016. Horton, who owes BWC more than $55,000 in back premiums, faces up to 90 days in jail and a $750 fine at his sentencing Dec. 5 if he fails to enter a repayment plan by then.

Anthony Caputo, Working and Receiving, Strongsville, Ohio
Caputo pleaded guilty Sept. 17 in Franklin County to a first-degree misdemeanor count of workers’ comp fraud after investigators found him working as a valet attendant at a Cleveland-area hospital while collecting BWC benefits. A judge fined him $500 in lieu of a 10-day jail sentence. Caputo paid BWC $4,021 in restitution prior to his plea.

Linda Cline, Working and Receiving, Springfield, Ohio
Cline pleaded guilty in a Franklin County courtroom to one count of workers’ compensation fraud, a first-degree misdemeanor, after investigators found her working while collecting BWC benefits. A judge ordered Cline to serve six months of community control and to pay $1,500 in investigative costs. Cline paid BWC $6,759 in restitution prior to her plea.

Craig Snee, dba Earth ‘n Wood, Underreporting and Misclassification of Payroll, North Canton, Ohio
A Stark County jury found Snee guilty Sept. 12 of a fourth-degree felony count of workers’ compensation fraud after BWC found he had misclassified his employees and underreported his payroll to save $350,000 in BWC premiums. Sentencing is scheduled for Oct. 17.

Clarice Ward, Working and Receiving, Euclid, Ohio
Ward pleaded guilty Sept. 4 to a fifth-degree felony count of workers’ compensation fraud after investigators found her working while collecting BWC benefits. A Cuyahoga County judge sentenced her to six months in prison, suspended for five years of community control, and ordered her to pay BWC $26,578 in restitution.

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