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Posts Tagged ‘SID’

Lake County landscaper pleads guilty to workers’ comp fraud, repays $22,000

Charles Bentley booking photoCharles D. Bentley of Mentor-on-the-Lake was sentenced March 10 in a Franklin County Courtroom after pleading guilty to workers’ compensation fraud.

BWC’s Special Investigations Department (SID) began investigating after receiving an anonymous allegation stating Bentley had been working “under the table” for a landscaping company for three years. Bentley should not have been working at all as he was receiving workers’ compensation benefits for a workplace injury.

The investigation confirmed that Bentley returned to employment during the winter season as a snowplow truck driver while receiving temporary total disability benefits.

Bentley pleaded guilty plea to one misdemeanor count of workers’ compensation fraud in the Franklin County Court of Common Pleas. He had already paid the entire restitution in the amount of $22,125.60 to BWC.  He was sentenced to 90 days in jail, suspended for 90 days of community control.

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BWC investigations result in five workers’ comp fraud convictions in November

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer announced today that five individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in November 2015. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

“Identifying and weeding out fraud is an essential part of not only maintaining fairness, but keeping workers’ comp costs manageable for Ohio employers,” said Buehrer.

The following is a summary of the cases that resulted in guilty pleas or convictions in November:

Latonia Almon (Columbus, Franklin County) pleaded guilty Nov. 16 to a fifth-degree felony count of workers’ compensation fraud in the Franklin County Court of Common Pleas for working while receiving benefits. A cross match with the Ohio Department of Job and Family Service conducted by BWC’s Intelligence Unit identified Almon as possibly working while receiving temporary total disability benefits. SID obtained employment records that revealed Almon she continued to work as a home health aide during the entire period she was collecting benefits for a workplace injury. During an interview, Almon admitted to “kinda” working and receiving payment for the services she provided. Almon admitted she did not inform the BWC of this employment. A pre-sentence investigation has been ordered and sentencing is scheduled for January 15, 2016.

Robert Aleshire (Delta, Fulton County) pleaded guilty Nov. 3 in the Franklin County Court of Common Pleas to a fifth-degree felony count of theft for working while receiving benefits. SID’s Intelligence Unit identified that Alshire was involved in a Public Utilities Commission of Ohio (PUCO) motor vehicle inspection as a commercial truck driver while he was collecting permanent total disability benefits from BWC. The investigation found that Aleshire was driving as an independent contractor under the name MoMo Trucking. The judge ordered a pre-sentence investigation and Aleshire is scheduled to be sentenced on January 13, 2016.

Sandra Houshel (Dayton, Montgomery County) pleaded guilty Nov. 19 in the Franklin County Municipal Court to one first-degree misdemeanor count of workers’ compensation fraud for working while receiving benefits. The judge ordered her to pay a fine of $100 plus court costs. SID began investigating after receiving an allegation that Houshel was working at a restaurant in downtown Dayton while collecting temporary total disability benefits for a workplace injury. The investigation found that Houshel was working at the restaurant most the week, opening the restaurant and working as a waitress. Houshel immediately paid the full restitution of $3,369.24 to the court.

Mike Crawley (Shelbyville, Indiana) pleaded guilty Nov. 16 in the Darke County Court of Common Pleas to one fifth-degree felony count of workers’ compensation fraud for working while receiving benefits. SID began investigating after receiving an allegation that Crawley may be working for a local trailer park. The investigation found that Crawley performed various maintenance work at the mobile home park while collecting temporary total disability benefits from BWC. Crawley is scheduled to be sentenced on January 16, 2016.

Rachel Madison (Bedford, Cuyahoga County) pleaded guilty Nov. 23 in the Franklin County Court of Common Pleas to a fifth-degree felony count of workers’ compensation fraud for improperly receiving dependent death benefits. Madison was eligible to receive death benefits up to age 25 if enrolled at an accredited educational institution. SID received an allegation that she was submitting proof of college enrollment to the BWC in order to receive the benefits but was not attending the classes. Madison’s course schedule from the University of Akron showed that either she failed to attend classes or did not remain in full-time status. She failed to report to BWC that she did not attend classes and was not enrolled as a full-time student but submitted paperwork to BWC in order to continue receiving the benefits. Madison was sentenced to six months in prison, suspended for five years of community control. As a condition of her probation, she is required to pay $12,319.98 in restitution.

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

Check out our latest cases at ohiobwcfraud.wordpress.comand view BWC’s workers’ comp fraud awareness video on YouTube.

A form of referral

By Jeff Baker, Program Administrator, BWC Special Investigations Department

Every day members of our BWC Special Investigations Department are reminded why we created our on-line fraud referral form. It works. Effective December 1, we had received more than 8,000 allegations from external sources via the referral form. And, since fiscal year 2002, the percentage of new allegations we have received from external sources via referral forms has steadily increased from one percent to 17 percent.

allegations

Here is how the form works: simply select the type of subject you suspect – injured worker, employer, provider, or other – and the interactive form will prompt you for pertinent information. To “complete” the form, just post whatever information you have to a few screens. No field is required. You decide how much or little information you care to furnish us. You may advance past any screen at your discretion. Many sources have furnished their allegations in a matter of a minute or two.
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The form will display a confirmation that we have received your allegation. All members of our SID intake team immediately receive an e-mail containing all information from the form. They promptly enter the allegation into our secure database, the Fraud Management System, and commence their review and research of the subject. If you elect to furnish us with a contact phone number or e-mail address, a SID professional will contact you with an investigative update within 14 days. They will also re-contact you when we have a known outcome, such as a criminal conviction and/or sentencing.

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For example, as recently as December 11, we reported on the conviction of Rachel Madison, a Bedford woman who pleaded guilty to workers’ compensation fraud. She was ordered by the Franklin County Court of Common Pleas to pay $12,319 in restitution to the BWC. SID commenced its investigation of Madison after an acquaintance confidentially reported his/her suspicions via a fraud referral form.

To report suspected fraud via the fraud referral form click here. You may also report suspected fraud by calling either the BWC fraud hotline at 1-800-644-6292 or Jeff in SID Administration at 1-614-466-7837.

Smart phones call for even smarter forensics

Digital forensics unit gravatarEach day, there are at least 10 times more mobile devices being produced in the world than babies being born (Global). Recent research conducted by the Ohio Bureau of Workers’ Compensation Special Investigations Department examined such growth in mobile technology, its uses within the workers’ compensation realm, and its future implications on fraud investigations. Mobile devices are projected to be the most common way Americans access the Internet by 2015, with a compound annual growth rate of 16.6% according to the International Data Corporation (DeGrasse). 

The health information field is leading the growth, with investment in companies that make health information mobile apps rising 78% in 2011 to $766 million (Edney; Bloomberg). In 2012, nearly 420 million smart phones and 44 million tablets will ship worldwide (Canalys). With smart phones and tablets increasingly being used to perform work previously done on a laptop or PC, the workers’ compensation system can expect to see increased use of mobile devices and applications in the daily activities of its healthcare providers, employers, and workers.

Taking advantage of recent trends, the BWC formulary went mobile in April 2012, allowing healthcare professionals immediate access to a formulary at the point of care and helping to ensure prescription safety and accuracy. Epocrates, Inc., available through app stores, can also be utilized by employers and workers. Another app, called PillManager, boasts of “unparalleled connectivity between consumer and pharmacy” where consumers can track their own medications and submit a repeat request for any prescription directly from their handheld device.

Mobile devices can be used outside of the healthcare realm, however, with apps aiding employers and workers during work activities. The U.S. Department of Labor and OSHA teamed up to allow worksite heat index tracking in order to reduce heat-related illnesses for workers outdoors. Using GPS data and information from the U.S. National Oceanic and Atmospheric Administration the app addresses risk levels and advises of rest breaks, fluid consumption, and adjustment of work operations. The NIOSH Lift Calculator app is also within the public domain, utilizing real-time feedback to reduce lower-back injuries; the app uses variables, such as horizontal distance, to calculate stress on the lower back during lifts.

Conversely, workers’ comp officials are concerned that injury exposure may grow as more workers go mobile – 2012 is expected to see nearly 35 million people working from home or other locations (Simpson). Mobile devices, although helpful in many realms, can prove to be a dangerous distraction while walking or driving; if the devices are owned by the employer, injuries while using such devices may present unclear compensability situations.

Mobile phones are being used in virtually all levels of criminal activity, making it easier for investigators to use mobile technology as incriminating evidence in an investigation. Personal surveillance has evolved with social media and mobile technology; as a result, officials can conduct investigations through “open source intelligence”. It has become common for investigators to identify false worker’s comp claims from social media websites like Facebook and Twitter documenting able-bodied activity (Newberry).

In addition, mobile applications create a full electronic audit trail enabling the tracking of people and transactions in both space and time. Within workers’ compensation, claims data can be correlated with information from apps to identify “hotspots” of activity at different pharmacies; problem pharmacies or providers can be identified and investigated more quickly (Savitz; Forbes).

Mobile technology, although helpful in a variety of field investigative aspects, can prove to be a challenge to a digital forensic examiner. The number of operating systems is much greater for mobile devices (>10) than for desktops (3) and each OS differs from the next in the way data is stored and security is provided. DFE’s must have the knowledge and tools to access information from each type of OS. In addition, the move to mobile technology has increased the use of cloud data storage, making it commonplace; Strategy Analytics forecasts U.S. spending on cloud services to grow $50 billion by 2016. Digital evidence has shifted to the cloud, where information may be found in multiple places and on a variety of platforms; also, data processing is decentralized in the Cloud, with a lack of physical access to servers (Grispos, Glisson, & Storer). As a result, traditional approaches to evidence collection are void Investigators must identify that an individual is using the cloud, obtain a search warrant, and overcome the final obstacle that current digital forensics tools are intended for media that is under the investigator’s control. As the transition is made to mobile device storage, investigators must be ready to make the change to better (and more expensive) technology for digital forensics labs.

As technology changes, the BWC Special Investigations Department continues to change its investigative efforts.  While the majority of people use technology to improve business operations or enhance communication, we are prepared to investigate those that use these types of technologies to commit fraud against the Ohio BWC.

To report suspected workers’ compensation fraud, call 1-800-OHIOBWC, visit ohiobwc.com, or visit www.facebook.com/ohiobwcfraud.

Sources:

Apple App Stores. Available from: http://www.apple.com/iphone/from-the-app-store or http://www.apple.com/ipad/from-the-app-store; 2012 [accessed 06.26.12]

“App stores; direct revenue to exceed $14 billion next year and reach close to $37 billion by 2015.” Canalys. Available from: http://www.canalys.com /newsroom/app-stores-direct-revenue-exceed-14-billion-next-year-and-reach-close-37-billion-2015; 2012 [accessed 06.26.12]

DeGrasse, M. “Mobile devices projected to overtake PCs as connections to Internet.” RCR Wireless. Available from: http://www.rcrwireless.com /blog/20110912/devices/mobile-devices-projected-to-overtake-pcs-as-connections-to-internet/; 2012 [accessed 06.26.12]

Edney, A. “iPad-toting doctors spur venture funding in medical apps.” Bloomberg Report. Available from: http://www.bloomberg.com/news/2012-06-18/oprah-aids-doctors-as-app-investments-soar-health.html; 2012 [accessed 6.26.12]

Grispos, G., Glisson, W., & Storer, T. “Calm before the storm: the emerging challenges of cloud computing in digital forensics.” 2009. [accessed 06.26.12]

Hobson, E. “Securing the cloud: digital investigations for the cloud.” Qinetiq. 2010. [accessed 06.26.12]

Newberry, L. “Social media footprint helps Pa. investigators.” Officer.com. Available from: http://www.officer.com/news/10731208/social-media-footprint-helps-pa-investigators; 2012 [accessed 06.26.12]

Ohio BWC Web. [accessed 06.26.12]

Savitz, E. “5 ways mobile apps will transform healthcare.” Forbes. Available from: http://www.forbes.com/sites/ciocentral/2012/06/04/5-ways-mobile-apps-will-transform-healthcare/; 2012 [accessed 06.26.12]

Simpson, A. “As more workers go mobile, workers’ compensation exposure grows.” Insurance Journal. Available from: http://www.insurancejournal.com /news/national/2011/06/01/200720.htm; 2012 [accessed 06.26.12]

Pharmacist Sentenced to Two Years in Prison for Illegal Distribution of Oxycodone, Structuring and Filing False Income Tax Return

On January 9, 2012, the United States Attorney’s Office, Southern District of Ohio, issued the following press release:

‘Harold Eugene Fletcher, 43, owner of the East Main Street Pharmacy in Columbus, was sentenced in U.S. District Court to 24 months in prison for illegally distributing the painkiller oxycodone, structuring financial transactions to avoid reporting requirements, and filing false income tax returns for five years.

Carter M. Stewart, United States Attorney for the Southern District of Ohio, Robert L. Corso, Special Agent in Charge, U.S. Drug Enforcement Administration (DEA), and Darryl Williams, Special Agent in Charge, Internal Revenue Service (IRS), announced the sentence handed down today by U.S. District Judge Algenon L. Marbley.

Fletcher was also sentenced to spend five years under court supervision after he completes his prison term. He will spend the first year of supervised release on home confinement and perform 208 hours of community service during the second year.

The sentence includes a $75,000 fine and restitution of $275,000 to the IRS. He is also required to cooperate with the IRS to file any corrected income tax returns for 2005 through 2009. His sentence includes a lifetime ban on practicing as a pharmacist or having any connection with a pharmacy or the distribution of drugs.

Fletcher owned and operated the East Main Street Pharmacy at 1336 East Main Street in Columbus. He pleaded guilty on January 11, 2011.

Fletcher is the first pharmacist convicted and sentenced to prison in the Southern District of Ohio for the illegal distribution of drugs.

According to a statement of facts read during the plea hearing, Fletcher distributed oxycodone outside the usual course of professional practice and without any legitimate medical purpose in February 2006. Fletcher also structured bank deposits of more than $100,000 by breaking the cash amounts into deposits of less than $10,000 each in an attempt to evade federal reporting requirements regarding cash deposits. Fletcher also admitted to filing false federal income tax returns for five years.

“We will continue to prosecute those involved in the illegal distribution of prescription drugs,” Stewart said. “This should send a message of deterrence to any licensed medical professional or others involved in such actions.”

Stewart commended the cooperative investigation by IRS and DEA agents and diversion investigators, along with Assistant U.S. Attorneys Michael Marous and David J. Bosley, and Special Assistant U.S. Attorney Brad Tammaro with the Ohio Attorney General’s Office and former Special Assistant U.S. Attorney Segev Phillips, who prosecuted the case.’

For more information about the United States Attorney’s Office, Southern District of Ohio, see http://www.justice.gov/usao/ohs/.

For information about the BWC Special Investigations Department be sure to read our SID FY 2011 Annual Report.

If you suspect anyone is committing workers’ compensation fraud in Ohio, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

Hannah News reported: “State Secures First Pill Mill Conviction of 2012”

On January 6, 2012, Hannah News reported as follows:

‘Another Ohio pill mill has fallen to a multi-agency initiative launched by the Ohio Attorney General’s Office, the Ohio Pharmacy Board and State Medical Board, the Ohio Bureau of Workers’ Compensation, the Regional Agencies Narcotics & Gun Enforcement Task Force (R.A.N.G.E.), as well as local and federal authorities. Dr. Han M. Yang is the latest conviction, pleading guilty Thursday to eight felony counts.

Yang, 69, could get 17 years in jail and $80,000 in fines for his trouble. That would add to $100,000 in drug profits he has already surrendered.

State, local and federal officers raided his Dayton and Bethel Township offices in Montgomery and neighboring Clark counties in October as part of a year-long investigation into prescription drug abuse, medical fraud, and money laundering. (See The Hannah Report, 10/3/11.) Authorities found would-be customers lined up outside for quick prescriptions, though facilities were largely bereft of exam tables and other equipment needed for legitimate medical services. Undercover agents previously witnessed Yang writing prescriptions within minutes of a patient’s arrival, and with no examination.

Formerly affiliated with Good Samaritan Hospital and Miami Valley Hospital in Dayton, Yang was since charged with six counts of trafficking in prescription drugs, including five fourth-degree felonies and one fifth-degree felony; one second degree count of engaging in a pattern of corrupt activity; and one fourth-degree count of theft by deception involving health care fraud. Clark County Common Pleas Court Judge Richard O’Neill accepted Yang’s guilty plea Thursday.

“We are committed to driving pill mills, and their trail of suffering and death, out of Ohio,” Attorney General Mike DeWine said in a statement. “More work remains, but rest assured we will continue the fight.”

In addition to state and federal officials, the investigation involved Clark County Sheriff Gene Kelly, Montgomery County Sheriff Phil Plummer, Clark County Prosecutor Andrew Wilson, and Montgomery County Prosecutor Mat Heck. A local pharmacist had alerted authorities in October 2010 after a woman nine months pregnant showed up with a prescription written by Yang for powerful painkillers.

DeWine said sentencing will be announced later, but indicated Yang faces penalties ranging up to 18 years in prison and fines up to $77,500.

The arrest and conviction follows at least four convictions, investigations and/or license revocations involving Ohio physicians in 2011, including Dr. James Lundeen, Dr. Victor Georgescu, Dr. George D.J. Griffin, and a fourth doctor who colluded in a prescription drug scheme with former Cincinnati attorney Kenneth Lawson, who was stripped of his law license in September. (See The Hannah Report, 4/5/11, 9/20/11, 12/15/11, 12/20/11.)

The governor, state Legislature and DeWine launched the coordinated offensive against pill mills and over-prescribing doctors in early 2011. (See The Hannah Report, 2/8/11, 2/9/11, 2/21/11.)’

For more information about the BWC Special Investigations Department be sure to read our SID FY 2011 Annual Report.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

SID digital forensics unit: Ensuring justice for even the smartest criminals

Digital forensics unit gravatar

In our digital age almost all data elements are stored electronically – whether on computers, laptops, servers, digital recorders, iPads or smartphones. Even criminals who think they are too smart to be detected, investigated and prosecuted, routinely use one or more of these electronic devices in the course of their crimes.

To bring these criminals to justice, the SID digital forensics unit (DFU) provides a full range of technical support for special agents conducting workers’ compensation fraud investigations. In fact, the unit’s primary duties include the forensic imaging and analysis of digital data from electronic devices. For example, when executing search warrants, the forensic analysts make exact copies of the storage from these devices. Then, employing specialized training, these uniquely talented professionals use specialized forensic software to filter through a vast amount of information.

During just the last year, the unit has processed 12.88 terabytes of data. This quantity is equivalent to 6,282,923,587 printed pages. These pages, if stacked, would be stretch 397 miles high – or the length of 6,981 football fields.

A Case In Point

Forensic analysts are often required to gain access to proprietary software, such as office billing and point-of-sale software, in order to provide data to investigators. In a recent case, the unit worked with a software developer to successfully gain back-door access to the sales and time keeping software of a long-defunct business. The data provided essential information to SID special agents. The evidence proved to be a very important component of the case, which identified almost $350,000 in savings to the BWC State Fund.

Be on the Lookout

Look for our next fraud awareness article that will discuss our SID Fugitive Task Force. Meanwhile, be sure to read more about fraud investigations in our SID FY 2011 Annual Report.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.