Archive

Posts Tagged ‘ohio bwc fraud’

1,000 Fraud Hotline calls in 6 months!

By Jeff Baker, Program Administrator, BWC Special Investigations Department

We have received 1,000 calls since we launched our new Fraud Hotline system six months ago during International Fraud Awareness Week 2017. That’s 167 calls a month, a little more than seven a day, or one nearly 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 your concerns. (Under our old system, you reached a representative in BWC’s Customer Contact Center.)

Our hotline agents have years of investigative knowledge, skills and experience securing the essential information from sources. Whether the fraud hotline agent is Connor, Jake, Jeff, Karen, Karie or Loryn, or any of our 25 fraud analysts assigned to our special investigations unit statewide, callers know within seconds that they have reached a committed, respectful professional.

You, the general public, are essential in helping us fight fraud, waste, and abuse in workers’ comp. We are celebrating our 25th year since the creation of our Special Investigations Department in 1993 and thousands of our closed, founded cases started with a call to our Fraud Hotline.

Just last month, for example, the convictions of Rodney Alberino, James Harris and Donna Steele were each the result of just such a call.

If you’re concerned about the alleged fraudster discovering your identity, rest assured. Your identity may remain either anonymous or confidential, depending on your preference. In addition, you don’t need to prove any facts or even have 100 percent confidence in your suspicion. You need only to suspect that fraud may have occurred or continues to occur. We’ll take care of the rest.

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 call at a time.

Thank you for your support!

Advertisements

Cleveland fraudster owes BWC nearly $200,000

Former trucker worked variety of jobs while collecting disability benefits

 

A Cleveland-area man owes the Ohio Bureau of Workers’ Compensation (BWC) nearly $200,000 after the agency found him working for nearly seven years while collecting disability benefits.

Rodney W. Alberino, 44, of Parma Heights, pleaded guilty to a fourth-degree felony count of workers’ compensation fraud April 26 in the Cuyahoga County Common Pleas Court. He must pay BWC $193,574 in restitution and serve two years of probation.

“We got a tip that Mr. Alberino had been operating a lawn care business and working with his neighbor rehabbing houses while collecting disability benefits,” said Jim Wernecke, director of BWC’s special investigations department. “Our investigators talked to witnesses, gathered records and shot surveillance video. They found Mr. Alberino performing a number of work activities, including snow removal, landscaping, property maintenance, painting, and siding installation.”

Alberino was working as a truck driver when he was injured on the job in January 2010. He collected BWC benefits until Dec. 28, 2016.

In other fraud news:

A southwest Ohio physician who pleaded guilty April 27 to four counts of aggravated trafficking in drugs also collected $12,068 from BWC for services he did not perform.

In addition to the drug charges, Dr. Timothy Manuel, 59, pleaded guilty in Highland County Common Pleas Court to a fourth-degree felony count of workers’ compensation fraud. Sentencing is scheduled for May 24.

Manuel, who now lives in Missouri, was indicted last year after an investigation by BWC and the Ohio Board of Pharmacy found that he prescribed large amounts of medically-unnecessary oxycodone to numerous patients while working as a doctor at Hillsboro Urgent Care.

Randall Abel, 33, of North Canton, pleaded guilty to a first-degree misdemeanor theft charge April 25 after BWC found him working as a self-employed automotive repairman while collecting disability benefits.

Acting on a tip, investigators found Abel owning and operating RJ’s Performance Diesel while receiving disability benefits from his former employer, a local construction company.

Abel paid $6,475 in restitution to his former employer and was sentenced in the Stark County Common Pleas Court to two years of probation.

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

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

 

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!

November 14, 2017 2 comments

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.