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Posts Tagged ‘workers’ comp fraud’

Ohio carpenter nailed for work comp fraud

Pomeroy man one of two southeastern Ohioans convicted of fraud last week

A southeastern Ohio man must reimburse the Ohio Bureau of Workers’ Compensation (BWC) more than $23,000 after investigators found him working several jobs while collecting injured worker’s benefits.

Ernest Shawn Baker, 45, of Pomeroy in Meigs County, also must serve five years of community control after pleading guilty to a fifth-degree felony count of workers’ compensation fraud Nov. 29 in the Franklin County Court of Common Pleas. His probation could terminate sooner upon full payment of $23,128 in restitution.

“We discovered that Mr. Baker went back to work as a carpenter soon after his injury in 2014, and he deliberately didn’t tell us,” said Jim Wernecke, director of BWC’s special investigations department. “We interviewed union officials and others and found he had worked for a dozen different employers while defrauding our agency.”

In another fraud case, an Athens County man on BWC benefits since 1997 has lost his benefits after investigators found him working again for cash under the table.

Mark McIntosh, 51, of Millfield, pleaded guilty Nov. 28 in a Franklin County courtroom to a first-degree misdemeanor count of workers’ compensation fraud. A judge fined McIntosh $100, then suspended it, and declined to order restitution because of McIntosh’s age and financial situation.

McIntosh worked as a log seller and chain saw operator when he was injured on the job in January 1997. Acting on a tip, BWC investigators found him overseeing a firewood processing plant and hauling firewood while concurrently receiving permanent total disability benefits.

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

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Cleveland convict adds work comp fraud to criminal record

State crimes followed 2015 conviction on several federal charges

A Cleveland garbage hauler and construction worker serving time in a federal prison for fraud, money laundering and violating the Clean Air Act pleaded guilty to workers’ compensation fraud last week.

Christopher Gattarello, 53, pleaded guilty Nov. 22 to a fifth-degree felony count of workers’ compensation fraud for working while receiving temporary disability benefits from the Ohio Bureau of Workers’ Compensation. A judge in the Franklin County Court of Common Pleas sentenced Gattarello to 186 days in jail with credit for time served.

“This was pretty easy detective work on our part, thanks to our customer claims staff,” said Jim Wernecke, director of BWC’s special investigations department. “Every time our claims representatives telephoned Gattarello about his injury claim, they could hear construction noise in the background. We simply followed up from there.”

Wernecke noted that Gattarello’s fraud against BWC started in March 2015, the same month he was convicted on the federal charges. BWC investigators determined Gattarello worked as a driver/heavy equipment operator through Aug. 16 that year and again from November 2015 through June 2016 while concurrently receiving BWC benefits.

Gattarello, the owner of several Cleveland-area garbage-hauling companies, was sentenced in June this year to 57-months in prison for ordering the 2012 demolition of the asbestos-laden National Acme Building in Cleveland’s Glenville neighborhood. Gattarello had been leasing the building and storing garbage there. The demolition released harmful toxins into the air near several homes and a school.

In a related case, Gattarello also was convicted in 2015 for conspiracy to commit wire fraud and money laundering for defrauding a Louisiana company out of nearly $1.2 million. He was accused of submitting false invoices for work his companies never performed, then using more than $12,000 of ill-gotten money to pay off his personal credit card.

Other news
In a separate BWC fraud case last week, another Cleveland-area man pleaded guilty to a fifth-degree felony count of workers’ compensation fraud for working while receiving BWC benefits.

A Franklin County judge on Nov. 22 ordered Timothy S. Lumsden, 50, of Avon Lake, to pay BWC $5,385 in restitution. He also sentenced Lumsden to 11 months in jail (suspended) and community control for three years.

Acting on a tip in 2015, BWC investigators determined Lumsden had returned to work as an independent carpenter at the Federal Knitting Mills Building in Cleveland while collecting temporary total disability benefits.

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

Thanks for your allegations, especially 34,634 calls to our Fraud Hotline!

By Jeff Baker, Program Administrator, BWC Special Investigations Department

In observance of Thanksgiving, we are giving thanks for the vigilance of everyday citizens and their willingness to detect and report suspected fraud committed against the Ohio workers’ compensation system.

We realize that such partnerships are necessary to achieve our fraud prevention goals. Since the creation of our Special Investigations Department (SID) in 1993, tens of thousands of our allegations have been furnished by external sources. Each and every reported allegation is entered by an agent into our secure database and reviewed. Effective this week, as a result of calls to our BWC Fraud Hotline, 34,634 allegations have helped us achieve over 1.7 billion in savings.

An investigative professional will promptly answer your call and conduct a brief and effective interview. These agents have 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 units (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. 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. Your Fraud Hotline call initiates the process, and in as few as five minutes.

A suspicion can also be reported by means of any of the following: an “after hours” message to our Fraud Hotline voicemail 614.728.2617, online, an email to our secure BWC Allegations@bwc.state.oh.us account, the U.S. Postal Service or in-person at any BWC claims office. Calling the BWC Fraud Hotline is the most interactive and direct way that you, our partners in fraud prevention and detection, can help.

So, thank you for your 34,634 (and counting) calls to our Fraud Hotline! We are indeed thankful for each one.

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!

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!