Archive

Posts Tagged ‘Undercover’

BWC Investigations Result in 13 Workers’ Comp Fraud Convictions in October

 Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Stephen Buehrer today announced 13 individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during October. The court actions are the result of investigations conducted by BWC’s special investigations department (SID). The department works to deter, detect, investigate and prosecute workers’ compensation fraud. The cases bring total convictions in calendar year 2011 to 114.

“Cases like these remind us why detecting and prosecuting fraud must be a very high priority,” said Buehrer. “Whether it’s an injured worker, an employer or provider, it is incredible that anyone would game the system to gain something is not rightfully theirs, at the expense of others who end up paying the bill.”

Below is a sampling of cases that resulted in a guilty plea or conviction during October.

James Landis (Canfield, Mahoning County) pleaded guilty Oct. 24 to a felony count of workers’ compensation fraud for working while receiving benefits. An anonymous tip led to an investigation into whether Landis was working at his business, Mum’s The Word Florist, while receiving workers’ comp benefits. Landis stated on multiple occasions that he was incapable of working in any capacity. However, SID verified Landis was the primary operator of the business while on temporary total disability. He interacted with customers, arranged and delivered flowers, set up floral displays at events, and did all administrative paperwork. Landis is scheduled to be sentenced on Dec. 15. As a condition of his sentencing, he has agreed to repay $8,065.81 in investigative costs. He has repaid 19,000 he received improperly.

Roger Bolin (Nelsonville, Athens County) pleaded guilty Oct. 17 to workers’ compensation fraud and deception to obtain after he filed a false claim to receive narcotic prescriptions. SID received an allegation from an employer indicating Bolin filed a false claim. He indicated he was injured in September 2010, although he not worked for the company since June. Investigators obtained documentation showing Bolin did file a false claim and obtained a narcotic prescription by deception. The Hocking County Common Pleas Court sentenced Bolin to eight months prison to run consecutively on each count. Bolin is currently serving a prison sentence related to a parole violation. The court ordered the new charges to be served consecutively to this sentence.

Donald Johnson (Trenton, Butler County) was sentenced Oct. 17 for deceptively obtaining numerous BWC paid narcotics from multiple physicians and using multiple pharmacies. SID identified Johnson for possible doctor shopping for narcotic drugs and an investigation revealed his deception to obtain narcotics. Johnson agreed in the Butler County Common Pleas Court to pay restitution owed the amount of $2,177.86.

Daniel Engle (Shaker Heights, Cuyahoga County) pleaded guilty to one count of workers’ compensation fraud for working while receiving benefits. SID opened an investigation after a BWC claims service specialist noted that Engle’s employer, the city of Shaker Heights, submitted a letter prepared by Engle. In the letter, Engle informed the city that he was resigning to start his own computer business. SID’s investigation verified Engle owned and operated DNC Computer while receiving BWC temporary total disability benefits. He claimed he was incapable of working in any capacity. Investigators established that Engle repaired computers, sold computers, and sold computer parts. Additionally, Deluxe Transportation/New Valley Taxi employed Engle as a taxi driver. Engle entered a guilty plea in Franklin County Municipal. He was sentenced to 180 days in jail suspended in lieu of three years probation. The court also ordered Engle to pay a $75 fine, court costs and investigative costs in the amount of $4,000. Engle has paid $15,500 in restitution.

Thomas McAllister (Amsterdam, Jefferson County) was sentenced for deception to obtain dangerous drugs. BWC’s intelligence unit began investigating McAllister after suspecting he was receiving narcotic prescriptions from several physicians and pharmacies. The investigation confirmed that McAllister used deception to obtain narcotic medication from various prescribing physicians. On Oct. 12, McAllister entered a plea of guilty to deception to obtain dangerous drugs, a fifth degree felony. The parties agreed to $424 in restitution. McAllister will be sentenced Nov. 30.

Mark Robinson (Fairfield, Butler County), pleaded guilty Oct. 2 to one count workers’ compensation fraud for working while receiving benefits. Robinson worked as a general contractor for Bed and Breakfast properties in Hamilton while collecting temporary total disability. He performed maintenance and contractor work at various rental properties. Robinson paid back the full criminal overpayment of $6,463.25 and investigative costs of $1,207.38 for a total of $7,670.63 restitution paid to the BWC.

Daren Snyder (Chillicothe, Ross County) pleaded guilty Oct. 3 in a Franklin County courtroom to fraud for working while receiving benefits. SID opened an investigation after receiving an allegation indicating Snyder was working while receiving temporary total disability and living maintenance. Investigators found Snyder did return to work as a self-employed plumber during the period he received benefits. Sentencing is scheduled for Dec. 2.

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.

https://www.ohiobwc.com/home/current/releases/2011/111511a.asp

Toledo Man Caught on Camera Roofing While on Workers’ Comp

October 18, 2011 1 comment

Daniel Uribes sentenced in fraud case

A Toledo (Lucas County) man has been sentenced in a fraud case after investigators from the Ohio Bureau of Workers’ Compensation (BWC) captured video not only showing him working a roofing job while receiving benefits, but also leaving the worksite to attend a hearing on his workers’ comp case, and later returning to finish the job. The investigation, conducted by BWC’s Special Investigations Department (SID) resulted in a guilty plea by Daniel Uribes, who was sentenced the Toledo Municipal Court last week.

“It is ironic that our investigators were able to catch Uribes on tape taking a break from his illegal work activity to attend a hearing related to his workers’ compensation case,” said BWC Administrator/CEO Stephen Buehrer.  “It is also telling of the lengths some will go when committing fraud, and a reminder to us of the importance of our work to put an end to it.”

Uribes became the subject of an investigation after SID obtained evidence that he engaged in roofing work with his father while receiving Temporary Total Disability benefits for a workplace injury.  A surveillance operation showed Uribes was performing roofing work at a residence in Toledo.  During the surveillance, Uribes left the job site to travel to downtown Toledo and attend his Industrial Commission hearing on a separate issue related to his incarceration while collecting disability.  After the hearing, the investigators followed Uribes back to the work site, where he returned to work on the roof and more video was obtained. 

Uribes originally pleaded not guilty but withdrew and entered a no contest plea to a misdemeanor charge of workers’ compensation fraud.  The judge sentenced Mr. Uribes to ten days in the Corrections Center of Northwest Ohio, with credit for time served.  Mr. Uribes had already paid his full restitution of $3,254.30. 

If you suspect that a subject 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.

https://www.ohiobwc.com/home/current/releases/2011/101811.asp

Linchpin in Healthcare Fraud Scheme to Repay More

‘Operation Backbreaker’ culminates in felony conviction for chiropractor

Bruce Holaday Booking Photo

The sentencing today of Fairfield (Hamilton County) chiropractor Bruce E. Holaday in a Franklin County courtroom is the culmination of a sweeping health care fraud investigation conducted by the Ohio Bureau of Workers’ Compensation (BWC) and Attorney General Mike DeWine’s office.  Holaday, owner of the Back and Spine Center, pleaded guilty in July to felony workers’ compensation fraud and was ordered to repay BWC more than $200,000.  The investigation, dubbed ‘Operation Backbreaker,’ has already resulted in the conviction of four of Holaday’s associates for their role in the scheme to defraud the state’s workers’ compensation system.

“Operation Backbreaker was an elaborate scam and an unfortunate reminder that some providers are concerned more with how much they can bill BWC than with ensuring injured workers receive appropriate care,” said Administrator/CEO Stephen Buehrer.  “Employers expect BWC to ensure care for their workers by ethical providers that are authorized to treat them so their premium dollars are not lost to fraud by deceptive providers.”

The investigation began after BWC’s Special Investigations Department (SID) received an allegation that Holaday was unlawfully using the names and provider identification numbers of the chiropractors with whom he practiced to conceal from BWC his direct involvement in rendering or managing treatment for injured workers.  Holaday had been decertified as a BWC health care provider and was prohibited from seeking and receiving reimbursement from BWC.

BWC special agents posed as injured workers and sought treatment at two clinics.  Investigators found that in addition to concealing his direct involvement in treating injured workers to circumvent his exclusion, Holaday also billed and received payment from BWC for treatment never provided to injured workers.  In carrying out the scheme, Holaday created bogus treatment records to substantiate the fraudulent bills submitted to BWC.

In addition to repaying $106,566.13 in restitution, which he paid in full today, Holaday is jointly liable with co-defendant Dr. Gary Berner for repaying an additional $104,350.53.  The judge also sentenced Holaday to 30 days in jail, placed him on five years of community control, and ordered him to pay $12,500 in investigation costs and an unknown amount for court costs.

SID’s investigation already resulted in the conviction of four associates at Holaday’s chiropractic clinic. Dr. Gary T. Berner pleaded guilty to felony workers’ compensation fraud for his active involvement in the scheme.  He was sentenced to 5 years community control and ordered to pay over $110,000 in restitution and investigative and court costs.  As part of his community control, Dr. Berner was also handed a conditional sentence of 180 days in Franklin County jail.

Additionally, Dr. Dennis M. Mulcahy; Charles E. Hoskins, Jr.; and Debra A. Ramge have all pleaded guilty to felony workers’ compensation fraud.

To report fraud online, please visit: http://bit.ly/reportfraud.
To speak with a fraud hotline agent, please call: 1-800-OHIOBWC.

Zannoni Sentenced for Fraud Related to Improper Prescribing and Billing

Zannoni UC Screenshot

Dr. Jean Zannoni

Dr. Jean Zannoni of Parma (Cuyahoga County) has been sentenced to two years probation and ordered to pay more than $7,500 in fines and restitution after pleading guilty to theft, attempted workers’ compensation fraud and telecommunications fraud. The action occurred following an undercover investigation of an alleged “pill mill” by the Ohio Bureau of Workers’ Compensation.

“Through our investigation, we were able to determine Dr. Zannoni was not only fraudulently billing BWC, but providing narcotics without proper medical examination,” said BWC Administrator/CEO Stephen Buehrer. “This action should serve as a warning to those physicians who put money before the proper treatment of injured workers.”

BWC’s Special Investigations Division teamed up with the Strongsville Police Department and Westshore Enforcement Bureau in 2007 to investigate an alleged pill mill at Cleveland Family Practice, 4732 Pearl Road in Cleveland. BWC supplied two undercover agents for the investigation and both were provided narcotic medications without proper medical examinations and BWC was billed improperly for the office visit. Search warrants later executed at her office and residence turned up a copy of orders Zannoni provided to her staff that instructed them to bill all injured workers under the same code and charge BWC $75 no matter the circumstances of their visit.

The team also obtained copies of patient files, including those of BWC’s undercover agents.

Undercover video above shows Parma doctor prescribing narcotics to BWC agents who reported no pain

Zannoni’s records falsely indicated she delivered services to the agents that she never provided, and that she elevated pain levels and fabricated tests to justify her continual prescribing of pain medication. When an agent conveyed that she had no pain, Zannoni advised her she had to have pain in order to receive a prescription; however, she wrote the prescription anyway. After the same agent had an MRI that returned normal, Zannoni continued to write the narcotic prescriptions without a physical examination and bill improperly for the visit.

Investigators also found that Zannoni continued to prescribe narcotics to patients who were known doctor shoppers even after receiving warnings from pharmacies, parents, spouses, social service agencies and police departments. In at least one circumstance, Zannoni confronted one of these patients about receiving narcotics from another physician but continued to prescribe on the condition that he promise he would only receive his pain medications from her.

Zannoni originally entered a no contest plea to these charges in September, 2010, but withdrew her plea in October. She pleaded again in June and was given probation, and ordered to pay restitution to BWC in the amount of $5,067.34 and a fine of $2,500.

To report fraud online, please visit: http://bit.ly/reportfraud.
To speak with a fraud hotline agent, please call: 1-800-OHIOBWC.

http://www.ohiobwc.com/home/current/releases/2011/070711.asp