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What do you know about workers’ comp fraud? Our sleuths have questions – and answers!

By Melissa Vince, BWC Public Relations Manager

We’ve had a great time talking workers’ comp fraud this International Fraud Awareness Week. We enjoyed sharing what we do to detect, deter and put a stop to workers’ compensation fraud in Ohio.

Our fraud investigators especially look forward to participating every year because they want to raise awareness and encourage tips from the public, but also because they truly enjoy what they do.

And we appreciate them because they do a great job. So, in honor of them, we let them take a little break to have some fun putting together this quiz challenging your knowledge of workers’ compensation fraud.

So, fire up that brain and let’s get started. Just flip your monitor over for the answers listed at the bottom.

Thanks for following us this week! We’ll be back next year for Fraud Awareness Week, but don’t go away because we’re here all year long on our blog, Twitter and Facebook.

  1. True or false?
    Fraud and abuse are the same.
  2. True or false?
    Proving fraud requires evidence of “knowledge and intent”
  3. True or false?
    Abuse can be criminally prosecuted under the law.
  4. BWC has teams focused on investigating the following types of fraud:
    a) Claimant
    b) Employer
    c) Medical provider
    d) All of the above
  5. Which is an example of fraud?
    a) Billing for services not rendered (a doctor bills for procedures not performed)
    b) Classifying full-time employees as independent contractors/subcontractors.
    c) A claimant performing physical activity outside of his or her restrictions
    d) All of the above
  6. What are the two most common fraud allegations our investigators receive related to medical providers?
    a) Billing for services not rendered (a doctor bills for procedures not performed)
    b) Unlicensed provider (not licensed to practice medicine in the State of Ohio)
    c) Unbundling (charging separately for bundled services)
    d) Upcoding (billing for a more expensive service than the one provided to the claimant)
  7. What is the most common fraud allegation our investigators receive related to employers?
    a) No coverage
    b) Lapsed coverage
    c) Falsified certificate of premium coverage
    d) Underreporting payroll
  8. What is the most common fraud allegation our investigators receive related to claimants?
    a) Physical activity (performing physical activity outside of his or her restrictions; malingering)
    b) Work/Comp (working while receiving lost time benefits)
    c) False claim (staged accidents; false injuries)
    d) Altered documents

 

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It’s not easy being Green: Cleveland florist convicted of work comp fraud

Green Thumb Florists owes BWC $32,000

The owner of a Cleveland flower shop owes the Ohio Bureau of Workers’ Compensation (BWC) nearly $32,000 in restitution after pleading guilty to workers’ compensation fraud in late September.

Mary Green, the owner of Green Thumb Florists, was ordered to pay BWC $31,562, sentenced to five years of community control and fined $315 after pleading guilty Sept. 27 to one fourth-degree felony count of workers compensation fraud in the Cuyahoga County Court of Common Pleas.

Acting on a tip, agents with BWC’s special investigations department (SID) discovered Green had altered a BWC certificate to make it appear her business had proper workers compensation coverage, as required by state law. Agents also discovered her actual policy had been in lapsed status since 2011.

“Our agents made multiple site visits, witnessed multiple employees and put Mary Green on notice to bring her BWC policy into compliance with the law,” said SID Director Jim Wernecke. “But when she wouldn’t cooperate, we brought her case to the county prosecutor and now she has a felony on her record. It didn’t have to go this far. We really need employers to reach out to BWC if they’re struggling to pay their premiums.”

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

Suspect fraud? Call our Fraud Hotline!

By Jeff Baker, Program Administrator, BWC Special Investigations Department

In recognition of International Fraud Awareness Week 2017, we are increasing awareness of fraud and the vigilance of everyday citizens to report suspected fraud committed against the Ohio workers’ compensation system.

A suspicion can be reported online, by email to our secure BWC Allegations@bwc.state.oh.us account, U.S. Postal Service or by calling our Fraud Hotline at 1-800-644-6292. Calling the BWC Fraud Hotline is the most interactive and direct way that you, our partners in fraud prevention and detection, can help.

We realize that such partnerships are necessary to achieve our fraud prevention goals. Since the creation of our Special Investigations Department (SID) in 1993, thousands of our closed, founded cases started with a call to our Fraud Hotline. For example, the conviction of Tim Tokles on August 30, 2017 was the result of just such a call.

You may suspect someone is working while receiving compensation, filed a false claim for an injury that did not happen or is committing another type of workers’ compensation fraud. Calling a fraud hotline may seem rather intimidating. We understand that it can be a nerve-wracking decision to make the call. The person you suspect of fraud could be a friend, a loved-one or even an immediate family member.

Above all, we realize the importance of personal security and safety to each caller.

When you call the SID Fraud Hotline, you will speak with a real person on the other end, one who is ready and willing to listen to your concerns and has years of investigative knowledge, skills and experience securing the essential information from sources like you. Whether your fraud hotline agent is Jake, Taylor, Karen, Connor, Jeff, or any of eight of our most experienced fraud analysts assigned to special investigations unit (SIUs) statewide, you will know within seconds that you have reached a committed, successful professional.

Your fraud hotline agent will know and promptly secure the information needed by our teams of 125 SID employees. Your identity will remain either anonymous or confidential, depending upon your preference. You do not need to have proven any facts; you do not even need to have 100 percent confidence in your suspicion. You need only to suspect that fraud may have occurred or continue to occur. We will conduct the investigation and determine the facts.    

The entire process entails as few as five minutes. Nonetheless, collecting the right information from a caller requires our SID Fraud Hotline professionals to devote as much time as the caller’s unique allegation merits.

When calling, please provide the information you have, including:

  • The name and address (if known) of the subject you’re reporting;
  • A description of the suspect’s behavior; and
  • Any other information that might pertain to the suspected fraudulent activity.

It is through the vigilance of citizens like you, that we are combatting workers’ compensation fraud in Ohio.

 

In pursuit of fairness – #FraudWeek 2017

By Jim Wernecke, Director, BWC Special Investigations Department

I have always appreciated the importance of fairness and integrity. I have used these virtues as a guide throughout my career, from early on when I supervised 15 employees at a small manufacturing company, to my 25 years with the Ohio State Highway Patrol and now as head of the Ohio Bureau of Workers’ Compensation’s Special Investigations Department.

I am privileged to lead 122 professionals who work to deter, detect and investigate workers’ compensation fraud in the state of Ohio. We pursue cases of claimant, medical provider and employer fraud.

What drives a claimant to file a false claim; an employer to purposely misclassify their workers; or a physician to fudge paperwork to secure higher service payments? We can debate the reasons, and they probably vary in each case, but my drive to halt wrongdoing comes from an appreciation for standards, rules and enforcement of the law that are conducted uniformly, fairly and systematically. In short, I want to know that others are following the same rules you and I follow.

It is easy to translate this philosophy into the world of workers’ compensation when you think about employer premiums, medical services and protection of our injured workers. Injured workers deserve a fair system that’s focused on their care and recovery. Employers want their competitors to play by the same rules, and they want assurance that any employee who attempts to gain undeserved benefits will be held accountable. And we all want truthful and professional physicians delivering our medical care.

These are among the many reasons I count fairness and integrity among the most important qualities you’ll find in a person. Treat people fairly, and treat them the way you want to be treated. Our integrity is on the line when we don’t accept the responsibility and tell the truth. Once trust is lost, it’s likely gone forever. I’m sure many of you feel the same.

We take great care to protect the dollars Ohio employers set aside to care for their injured workers. We’re not too shy to say we think we do a pretty good job, but we’re always seeking improvement. That’s why we enjoy taking part in International Fraud Awareness Week each year. We’re not only able to highlight our successes, but also engage and learn from our fraud-fighting peers across the country. This year will be no different.

Those of you who follow workers’ comp fraud in Ohio know we share our fraud news weekly on “Fraud Friday,” but we always take it to another level during IFAW. Please join us this week and all year long as we share new cases, tips for identifying and preventing fraud, insights from our investigators, and much more on our Facebook and Twitter pages.

Happy Fraud Awareness Week!

Cheating BWC proves costly to workers, business owners

A North Canton woman convicted in May of workers’ compensation fraud must reimburse the Ohio Bureau of Workers’ Compensation nearly $22,000 for collecting benefits while working as a home health aide for nearly two years.

A Franklin County judge on Wednesday also sentenced Diana S. Herrick to five years probation in lieu of an eight-month jail sentence for committing the fifth-degree felony. BWC’s Special Investigations Department (SID) found Herrick provided numerous activities for two individuals while claiming to be too injured to work, including household chores, meal preparation, cleaning and shopping.

“I cannot stress this message enough: Cheating BWC will only cost you more in the long run,” said SID director Jim Wernecke. “It could land you a significant financial debt and criminal record, as well as damage to your reputation and potential for future employment.”

Tyrone Bonner

Also this week, the owner of a Columbus security business pleaded guilty to failure to comply with workers’ compensation laws, a second-degree misdemeanor, after investigators found he under-reported his payroll for four years in order to pay less in BWC premiums. A Franklin County judge on Monday ordered Tyrone Bonner of Dayton to pay BWC $9,527 in restitution.

On the same day in a different Franklin County courtroom, Michael Strickland of Sandusky County pleaded guilty to a misdemeanor count of workers’ compensation fraud after BWC found him delivering mail while collecting injured-worker benefits. He paid BWC $5,096 in restitution prior to his court appearance.

Ghandi Faraj

In other news, SID reported closing several criminal cases in June and one in May not previously publicized.

  • Ghandi Faraj of Lorain pleaded guilty June 30 to a first-degree misdemeanor of workers’ compensation fraud after BWC found him operating a Quizno’s restaurant without BWC coverage when one of his employees filed a claim for a workplace injury. A judge sentenced Faraj to two years of non-reporting probation and ordered him to pay BWC $10,487 in restitution and stay compliant with workers’ comp requirements.
  • Darrin Armstrong of Cincinnati pleaded guilty June 15 to a first-degree misdemeanor theft charge after SID found him using his wife’s BWC debit card multiple times after her death. The investigation found 62 transactions between December 2015 and February 2016 totaling over $4,400. A Hamilton County judge placed Armstrong on eleven months probation and ordered him to reimburse BWC $2,715.
  • Latoria Johnson of Columbus pleaded guilty on June 27 to a misdemeanor count of workers’ compensation fraud after BWC found her working at Worldwide Marketing, Hot Topic and Kroger while simultaneously collecting temporary total disability benefits. She reimbursed BWC $5,307.27 prior to sentencing.
  • Cindi Hackney of Columbus pleaded guilty June 13 to one count of failure to comply, a second-degree misdemeanor, after BWC found her operating her pizza restaurant without BWC coverage. She was ordered to pay a fine and court costs totaling $163. She also paid approximately $5,000 toward her BWC debt.
  • Richard Allison of Columbus pleaded guilty to a first-degree misdemeanor of workers’ compensation fraud after investigators found him working for five separate employers over 13 months while collecting BWC benefits. A judge on June 6 sentenced Allison to five years probation in lieu of a six-month jail term and ordered him to pay $5,149 in restitution to BWC.
  • Mohamad Awad of Toledo, doing business as Everlasting LLC, paid almost $1,000 toward his BWC balance before pleading guilty June 5 in a Toledo courtroom to failure to comply, a second-degree misdemeanor. BWC agents had previously made multiple attempts to bring Awad into workers’ compensation compliance but were unsuccessful.
  • Steve Makris of Canton paid BWC $23,943 in restitution after pleading guilty May 26 to a first-degree misdemeanor of workers’ compensation fraud. Investigators found Makris formed a new business, Eagle Industrial Painting, and collected a salary while receiving benefits from BWC.

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

Former police officer indicted on work comp fraud and other charges related to shooting incident

A former Ohio police officer is facing multiple charges, including inducing panic, forgery and workers’ compensation fraud, after claiming and later recanting that he was shot in the arm during a traffic stop, Ohio Attorney General Mike DeWine announced this week.

A Tuscarawas County grand jury indicted Bryan Eubanks, 37, of Cumberland, Ohio, on June 29. It charged the fired 14-year veteran of the Newcomerstown Police Department with the following:

  • One count of inducing panic, a felony of the fifth degree;
  • One count of making false alarms, a felony of the fifth degree;
  • Two counts of tampering with evidence, felonies of the third degree;
  • One count of forgery, a felony of the fifth degree, and
  • One count of workers’ compensation fraud, a misdemeanor of the first degree.

The charges of inducing panic and making false alarms each carry two firearm specifications.

An investigation conducted by the Tuscarawas County Sheriff’s Office found that on April 11, 2017, then-Officer Eubanks shot himself while on duty, but claimed he was shot by a man in a vehicle after stopping the car for a traffic violation.

“The fictional story that this defendant is accused of concocting led to a response involving local, state, and federal authorities, and an Ohio Blue Alert was issued to put the entire state on alert,” said Attorney General DeWine. “Considerable resources were used to investigate the claims, and there must be consequences for needlessly causing such serious alarm.”

Additionally, an investigation by the Ohio Bureau of Workers’ Compensation found that Eubanks forged workers’ compensation documents to apply for benefits related to his injury.

According to the TimesReporter.com, Eubanks told investigators he made up the story to cover up a failed suicide attempt. He said he had been struggling emotionally following a murder investigation last year.

Eubanks’ arraignment is scheduled for July 17.

Spotlight on SID’s college relations program

Developing tomorrow’s leaders in criminal justice, law enforcement

By Jeff Baker, Program Administrator, BWC Special Investigations Department

Interested in getting coffee? Making photocopies?

You won’t find that at the Ohio Bureau of Workers’ Compensation’s (BWC) Special Investigations Department (SID). SID interns are real employees who do real work as part of our college relations program, now in its 23rd year.

“We’re treated like coworkers,” says Ohio State University student Gabby Master, an intern in SID’s intelligence unit. “We do all the projects everyone else does.”

On top of all that, she adds, “It’s really fun!”

(You can catch Gabby sharing more about her intern experience in this YouTube video.)

Established in 1995, SID’s college relations program promotes the study and practice of criminology, criminal justice, law enforcement and public administration. Since its inception, SID has recruited, selected, oriented and trained more than 300 paid college interns.

Gabby Master, Kelsey Wilson, Loryn Competti and Brianna Belmonte

Many have humbled us with favorable feedback over the years, but we know the credit and accolades go to them. Their careers are testament to their professionalism.

Many have gone on to become officers, criminal investigators, special agents, fraud analysts, digital forensic analysts, assistant special agents in charge, special agents in charge and assistant director.

We’re pleased that for more than 20 years our college relations program has attracted students from a variety of backgrounds, schools and experiences.

Today we have seven talented interns working with our special investigations units (SIUs) statewide. Four college interns (pictured above) are based in our Columbus headquarters: Gabby Master, Kelsey Wilson, Loryn Competti and Brianna Belmonte. Our other SID interns (not pictured) are Allison Castle (Lima), Stephen Kersey (Toledo) and Connor Yuellig (Governor’s Hill).

These interns are here for the same reasons that our past interns have worked with SID. They want a challenge, and that’s what they get.

“Our interns have helped us tremendously over the years,” says SID Director Jim Wernecke. “Their work has helped us convict hundreds of fraudsters and saved the BWC system tens of millions of dollars.”

Are you enrolled at a college or university and interested in joining our team as an intern? If so, I invite you to contact me at Jeffrey.B.1@bwc.state.oh.us.