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Ducking workers’ comp coverage costs Mansfield freight hauler $144K

The owner of a Mansfield freight hauling and trucking company must pay $144,400 in restitution to the Ohio Bureau of Workers’ Compensation (BWC) following his sentence Monday for his conviction on four felony charges related to workers’ compensation fraud.

A Richland County judge also ordered Robert Tate, owner of Elite TNT Enterprises, to serve two years of probation for his conviction Feb. 20 on two counts of workers’ comp fraud, fourth-degree felonies, and two counts of tampering with records, third-degree felonies. Tate must bring his BWC policy into compliance with state law and pay the agency $137,447 in unpaid policy premiums and $6,953 for the costs of its investigation.

“We reached out to Mr. Tate several times to follow the law and protect his employees with workers’ compensation coverage, but he chose to ignore us and it cost him,” said BWC Administrator/CEO Stephanie McCloud.

BWC’s special investigations department discovered in 2017 that Tate was operating his business without BWC coverage. After several attempts to work with Tate, agents subpoenaed bank records and audited his business, finding Tate under-reported his payroll over several payroll periods in an attempt to lower the amount he owed the agency. They also found he falsified new applications for BWC coverage by failing to list previous policies with the agency and he under-reported the number of workers he employed.

In other news:

  • A Reynoldsburg woman must pay BWC $5,010 in restitution after pleading guilty April 4 to a misdemeanor count of workers’ compensation fraud. BWC investigators discovered Amanda Treadway working as a swimming pool attendant at a condominium complex in 2017 and also as a phlebotomist while collecting BWC disability benefits.
  • A Cincinnati man found working as a truck driver while collecting BWC disability benefits was convicted of a fifth-degree felony charge of workers’ compensation fraud April 3. Antoine Harris paid BWC $7,963 in restitution prior to his guilty plea. A judge subsequently terminated Harris’s sentence of one month of probation.
  • A Cleveland Heights woman found working as a restaurant hostess while collecting BWC disability benefits pleaded guilty to a misdemeanor count of workers’ compensation fraud March 28 in Franklin County Municipal Court. A judge ordered Morgan Hines to pay BWC $4,089 in restitution, $88 in court costs and a $250 fine. The judge also sentenced her to two years of probation.
  • BWC has reinstated the policy of a Columbus day care center after the owner paid the $9,442 he owed the agency in back premiums. Ali Ismail, owner of Helpful Hands Children’s Centers, pleaded guilty March 20 to a misdemeanor count of failure to comply.

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

Employer compliance supervisor is BWC’s Fraud Finder of the Year

By Jeff Baker, Program Administrator, BWC Special Investigations Department

An employer compliance supervisor in the Cincinnati Service Office received the 2018 Fraud Finder of the Year award Feb. 21 from BWC’s special investigations department (SID).

The supervisor received the award for alerting SID to a case in which an employer failed to report payroll and failed to respond to multiple attempts to schedule a premium audit. An investigation by the SID employer fraud team revealed the employer was operating without coverage. The referral resulted in the identification and recovery of $316,103 in savings to the state insurance fund.

“Thanks to this employee’s vigilance and timely referral, we were able to stop fraud in its tracks and save the BWC system hundreds of thousands of dollars,” said SID Director Jim Wernecke. “Our success in uncovering fraud protects resources needed to create safe workplaces in Ohio and to care for those who are legitimately injured on the job.”

The BWC employee, who supervises field staff members assigned to the BWC employer compliance department, said he was honored to receive the award.

“I am truly honored to be recognized for simply doing my job and trying to do my part, while seemingly small, to safeguard the State Insurance Fund,” the employee said. He offered the following advice to any BWC employee who suspects fraud: “Trust your gut.”

SID received 3,150 allegations of fraud in 2018. About a fifth of those came from BWC personnel around the state. These included claims representatives, employer representatives and others who suspected illicit behavior on the part of injured workers, employers, health care providers or others connected to the BWC system. During 2018, SID closed 381 cases referred by 169 BWC employees. The investigations resulted in 192 “founded cases” (the original allegation was proven true) and identified $3.1 million in savings to the BWC system

To show their appreciation, SID leaders conducted a thank-you tour and red-flag training from November through February, presenting Fraud Finder Award certificates to BWC employees in service offices across Ohio.

“We encourage all BWC employees and the general public to contact us immediately if they suspect fraudulent behavior in our system, even the slightest hint of it,” said Director Wernecke. “We will conduct a thorough investigation, and the sooner we get started, the better.”

To report suspected cases of workers’ compensation fraud, call 1-800-644-6292 (then select option 0, option 4, option 1) or visit www.bwc.ohio.gov.

Trucker kept truckin’ while collecting injured-worker benefits

Zanesville man convicted of workers’ comp fraud

A Zanesville truck driver must pay nearly $8,000 in restitution to the Ohio Bureau of Workers’ Compensation (BWC) after agency investigators found him working for a living while collecting BWC disability benefits.

Douglas J. Krouskoupf, 53, pleaded guilty Jan. 9 to a first-degree misdemeanor count of workers’ compensation fraud in the Franklin County Court of Common Pleas. A judge sentenced Krouskoupf to 180 days in jail, which he suspended on the condition Krouskoupf pay BWC $7,924 in restitution.

“We found Mr. Krouskoupf working for his brother’s sandblasting business on multiple occasions and that he was also driving a semi-truck while collecting BWC benefits,” said Jim Wernecke, director of BWC’s special investigations department. “Our benefits are for people who suffer a workplace injury and can’t do their job. Mr. Krouskoupf clearly doesn’t fit into that category.”

In other news, BWC netted seven fraud or fraud-related convictions in December, bringing calendar year 2018’s total to 94. In order of most recent case, December convictions include:

Jason Dudas, Mentor, Ohio
Dudas pleaded guilty Dec. 13 to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC found him working as a handyman while receiving BWC benefits. A judge ordered Dudas to pay $5,073 in restitution and serve three years of non-reporting probation.

Gabriel Seda, Grafton, Ohio
Seda pleaded guilty Dec. 6 through a Bill of Information to a fifth-degree felony count of workers’ compensation fraud after BWC found him working as a landscaper while receiving BWC benefits. A Franklin County judge ordered Seda to reimburse BWC $33,960 and sentenced him to five years of probation in lieu of a year in prison.

John House, Chris Kraft and Lynn Howard, dba Old Crow Bar, Middletown, Ohio
House, Kraft and Howard, owners of the Old Crow Bar, each pleaded guilty Dec. 3 to disorderly conduct, a fourth-degree misdemeanor, after BWC discovered they weren’t carrying workers’ compensation coverage on their business. A judge sentenced House to 10 days in jail (suspended) and fined him $200 and $90 in court costs. Kraft and Howard were both sentenced to one day in jail (suspended) and fined $100 and $90 in court costs.

Brian Lang, dba Outdoor Inspirations, Holland, Ohio
Lang pleaded guilty to a third-degree misdemeanor charge of attempted failure to comply with the law Dec. 3 after BWC discovered him running a business without workers’ compensation coverage to protect his employees. A judge scheduled sentencing for Jan. 28 after Lang paid $5,304 toward the balance he owes BWC.

Beth Turner, dba Flashions Ltd, Springfield, Ohio
Turner pleaded guilty Dec. 3 to failure to comply, a minor misdemeanor, after BWC found her operating her business without workers’ compensation coverage. Turner was fined $100 and court costs.

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

 

Auld Lang Syne…

Standout fraud cases in 2018

By Melissa Vince, BWC Public Relations Manager

Soon we’ll all be counting down and singing that classic New Year’s song to say farewell to 2018 and hello to 2019. Or maybe you’re like me and you’ll wake up at 12:05 a.m. to realize you missed another countdown.

In the spirit of Auld Lang Syne, which roughly translates as “for old times’ sake,” we thought we’d look back at some of our more notable cases in 2018. Since January, we shared 48 blogs covering claimant, provider and employer workers’ compensation fraud cases. The following cases stand out in our memory:

Thanks for your support this year. We were proud to celebrate our 25th year of investigating, detecting and deterring fraud in Ohio. Now it’s on to 26!

And thanks for following the BWC Fraud Blog. We hope you’ll stay tuned here in 2019 for more on the latest news and information on workers’ comp fraud in Ohio. Don’t forget to also follow our Facebook page.

Cheers! Okay, everyone now: Should auld acquaintance be forgot….

Home Depot shopping trip blows fraudster’s cover

Mentor man caught working as handyman while collecting BWC benefits

 

A northeast Ohio landscaper must pay the Ohio Bureau of Workers’ Compensation (BWC) a little more than $5,000 in restitution after the agency’s investigators found him working while collecting injured-worker benefits.

Jason Dudas, 39, of Mentor, pleaded guilty Dec. 13 to one count of workers’ compensation fraud, a first-degree misdemeanor, in the Franklin County Court of Common Pleas. A judge ordered Dudas to pay BWC $5,073 in restitution and serve three years of non-reporting probation.

“We got a tip that Mr. Dudas might be working after someone spotted him getting into a truck loaded with construction supplies at a Home Depot store,” said Jim Wernecke, director of BWC’s special investigations department. “We checked it out and found Mr. Dudas working as a handyman while collecting BWC benefits. This behavior isn’t just illegal, it’s expensive and unfair because it drives up the costs of our workers’ comp system for everyone.”

In other business, a Toledo-area business owner pleaded guilty to attempted failure to comply with the law Dec. 3 after BWC discovered him running a business without workers’ compensation coverage to protect his employees.

Brian Lang, owner of Outdoor Inspirations of Holland, Ohio, pleaded guilty to the third-degree misdemeanor charge in Sylvania Municipal Court after paying $5,304 toward the balance he owes BWC. A judge scheduled sentencing for Jan. 28.

“Our investigation revealed Mr. Lang had several employees and therefore he absolutely should be carrying workers’ compensation insurance,” said Wernecke. “We put him on notice to become compliant with the law, but he failed to do that and that’s why he found himself in court Dec. 3.”

Outdoor Inspirations is a specialty landscaping and tree service company, according to its website. The company’s workers’ comp policy remains lapsed.

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

Let’s talk workers’ comp fraud

November 13, 2018 2 comments

By Melissa Vince, BWC Public Relations Manager

Fraud (/frôd/), noun
Definition: Wrongful or criminal deception intended to result in financial or personal gain.

In other words, cheating to get one over on others. There are countless ways people try to commit fraud. Check fraud, identify theft, pyramid schemes, credit card fraud and so on.

What do we do in the Ohio Bureau of Workers’ Compensation Special Investigations Department? We pursue workers’ compensation fraud.

BWC insures Ohio employers for workplace injuries and cares for employees who are hurt on the job. The vast majority of Ohio workers, employers, medical providers and others are interested in nothing other than getting injured workers healed and back on the job. There are a few though who have other ideas.

We define workers’ compensation fraud as knowingly making a false representation of a material fact to obtain or to deny workers’ compensation benefits or to avoid responsibility under the law. Workers’ compensation fraud increases premiums for employers, which reduces the money employers can invest in their employees, community and future growth.

There are a number of ways fraudsters can seek to manipulate the system, for example:

  • When an employer misrepresents the amount of payroll or classification of its employees.
  • When a medical provider intentionally receives payments to which he or she is not entitled.
  • When a worker fakes an injury, or returns to work while receiving benefits.

And there are many more detailed on our website, bwc.ohio.gov.

What’s our goal? #StopFraud in Ohio’s workers’ compensation system. You’ll see in this infographic highlighting a few stats from the last year that we work hard every day to achieve that goal.

Anyone committing fraud, or thinking of trying to get one over on us should remember this word:

ex·pose (/ikˈspōz/), verb
Definition: make (something) visible, typically by uncovering it.

Special investigations department finishes FY2018 with impressive results

By Jim Wernecke, Director, BWC Special Investigations Department

It’s getting harder and harder for the criminally minded to rip off BWC and the State Insurance Fund and get away with it.

That was the message I took to BWC’s board of directors Thursday afternoon when I presented the board with the Special Investigations Department’s annual report for FY2018, which closed June 30. The report details another impressive year of our department’s efforts to deter, detect, investigate and prosecute workers’ compensation fraud.

Here are some highlights in what was our 25th year as a department:

  • We closed 1,622 fraud cases, 448 more than in 2017.
  • We secured 101 convictions of claimants, employers and health care providers who defrauded our agency.
  • For every dollar we spent on our efforts, we saved the state fund nearly five ($4.81), or $1.33 more than last year.
  • We reduced our investigation time per case by 23 days on average, our lowest number on this measure since 2005.
  • All told, we saved the state fund $60.1 million in 2018, a 44 percent jump over 2017’s numbers.

We couldn’t have achieved this success without the 121 dedicated staff members who serve our department with great skill, resourcefulness and determination to bring justice to those who cheat our system. We also owe a great deal of credit to advances in technology and a key operational change we made last year to increase our efficiency and productivity.

Drones and Workplace Safety
The drone program we implemented in 2017 for our safety investigators proved itself a worthy investment in 2018. Our safety investigators relied on the tool at 10 workplace safety violation sites last year, including two that would have been especially difficult and dangerous, if not impossible, to properly investigate without it. The most challenging case involved flying the drone into an elevator shaft. Another involved an old factory site where the factory was being torn down. Thanks to our drones, our safety investigators could remain at a safe distance while navigating the drones to survey the sites and take accident scene pictures.

We have three drone pilots certified with the Federal Aviation Administration and three more waiting in the wings, so to speak. And while they find the drones fun and exciting, their enthusiasm is tempered in knowing that each operation is tied to tragedy and unfortunate events. Their drive is to ensure they gather accurate data and conduct unbiased investigations.

Hotline
In November we rolled out a new method for collecting fraud allegations. Until then, outside callers would report allegations to BWC personnel that staffed our customer contact centers. Now the callers reach our investigators directly, which allows our team to ask follow-up questions and obtain more precise information to jumpstart the investigation. It also reduced or eliminated the wait times for callers, which led to fewer dropped calls. The bottom line is the new hotline system led to a more comprehensive and detailed fraud allegation packet that we could send to our field teams.

Looking ahead
As we commence our 26th year in FY 2019, we remain united in our commitment to protecting the state insurance fund and the Ohio workers and employers it serves. We join our colleagues throughout this agency in delivering the people of this state the world-class workers’ compensation system they deserve.