Ohio Bureau of Workers Compensation Prosecutes 10 in Work Comp Fraud

10 Individuals Caught Defrauding Ohio’s Workers Comp System

Ohio Bureau of Workers Compensation (BWC) Administrator/CEO Steve Buehrer recently announced 10 individuals were convicted or pleaded guilty to charges related to defrauding Ohio’s workers comp system during August.

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.

Workers That Break Law Will Be Pursued With Criminal Charges

“While Ohio workers injured on the job will receive the care they need regardless of whether employers have paid their premiums, employers must make it a priority to maintain a policy in accordance with the law,” said Buehrer. “Likewise, workers filing false claims, exaggerating injury or working while receiving benefits are breaking the law and BWC will pursue criminal charges accordingly.”

A summary of the cases that resulted in a guilty plea or conviction during August follows.

Allowed Coverage to Lapse

Keesh Edwards, dba Keesh Inc., (Cincinnati, Hamilton County) – Pleaded guilty to a felony count of workers comp fraud for allowing his businesses’ workers comp coverage to lapse. BWC’s employer fraud team received a referral from the finance department after banks refused to honor the checks he submitted to pay his premium. The investigation found that the employer had not submitted the required semi annual payroll reports since July 1, 2009. The owner, Keesh Edwards, was notified of the check denials and missing payroll reports. Edwards subsequently submitted some of the missing reports, but failed to make any payments for the lapsed coverage periods or the denied check. The employer continued to operate the business with employees without the required BWC coverage. A jury trial began Aug. 8 but Edwards changed his plea to guilty prior to the start of the second day of trial. Sentencing will be scheduled for this month. The total premium and penalty amount owed was $43,235.99.

Filed a False Claim

Travis Ametrano (Findlay, Hancock County) – Pleaded guilty to a misdemeanor count of workers comp fraud for filing a false claim. Ametrano alleged he was injured when he slipped on ice while walking into work. SID opened an investigation in February after receiving an allegation that Ametrano was actually injured during an indoor soccer game hours before reporting to work and allegedly falling. Agents interviewed referees and the scorekeeper from the game prior to his alleged injury. The interviews positively identified Ametrano by photograph as a player that injured his leg during a game on Sunday, the day before the reported injury. He initially denied having sustained any type of injury or having any physical issues during the soccer game. He later admitted that what the witnesses had reported was accurate but stated that he had suffered an injury not identified in his claim. BWC denied Ametrano’s claim based on the investigative findings. Ametrano pleaded guilty Aug. 8 in the Findlay Municipal Court and was sentenced to a 30 day suspended jail sentence. He must also pay fines of $250.

Working While Receiving Benefits

Chester Fusco (Ashtabula, Ashtabula County) – Pleaded guilty Aug. 7 to working while receiving benefits. SID received an allegation through BWC’s website indicating Fusco operates a snowplow in the winter and is paid in cash for his services. Surveillance, witness interviews and business and bank records revealed he worked independently as a subcontractor, for Cooper Contracting and Bauer Construction between November 2008 and February 2011. Fusco plowed commercial properties for these companies while receiving temporary total disability benefits. Fusco had previously completed a settlement agreement for his BWC claim with the Ohio Attorney General’s Office representing the BWC; however, this did not preclude a criminal referral based on the investigation. Fusco pleaded guilty Aug. 7 in a Franklin County Common Pleas courtroom. He was sentenced to six months in jail, suspended for five years of community control. He must also pay restitution of $10,588.14.

Anthony Perry (Cleveland, Cuyahoga County) – Pleaded guilty Aug. 27 to one felony count of workers’ compensation fraud for working while receiving benefits. BWC investigators acted on a tip that Perry was employed while receiving temporary total and living maintenance disability benefits. The investigation found that Perry had returned to work as a self employed landscaper and snowplow operator. He used his own landscaping equipment to do yard work and mow grass for residential and commercial customers, and hired staff to assist. Perry was ordered to pay $41,644.28 in restitution and serve three years of community control.

Faked Injury to Receive Benefits

Robin Hammond and Randy Hammond (Galion, Crawford County) – Each pleaded guilty to fraud for their roles in a scheme to collect hundreds of thousands of dollars in benefits Robin claimed she needed following a workplace injury. Robin Hammond was a nurse’s aide and claimed a workplace injury left her unable to use her arms and legs and without fine motor skills in her hands and feet. Based on her diagnosis, she was granted permanent total disability and BWC paid for special medical equipment. SID opened an investigation into Hammond after receiving allegation that she was not as injured as she claimed to be, and was engaged in physical activity. Surveillance video showed she visited her doctors in a wheelchair but demonstrated full use of all four limbs, walking without assistance after leaving her appointments. The couple fled the state after being interviewed by investigators. Attorney General Mike DeWine’s office issued a nationwide warrant for their arrest and they were located in Hurricane, Utah. Robin Hammond pleaded guilty to one felony count of workers comp fraud and was and sentenced to one year in prison with judicial release possible after six months. Randy Hammond pleaded guilty to one felony count of complicity and received five years of community control. The couple was ordered to repay BWC $173,332.09.

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: [email protected].

WORKERS COMP MANAGEMENT MANUAL: www.WCManual.com

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.