Trying to get away with breaking the law left 10 Ohio individuals behind the eight ball recently.
According to recent information from Ohio Bureau of Workers Compensation (BWC) Administrator/CEO Steve Buehrer, 5 individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers comp system recently.
A sampling of the cases that resulted in a guilty plea or conviction:
Claimed Home Injury Happened At Work
John Burgin (Toledo, Lucas County) was found guilty March 5 in the Toledo Municipal Court of attempting to commit an offense, a second degree misdemeanor, for filing a false claim. SID received an allegation that Burgin filed a false claim against the Grand Rapids Club. Investigators found the injury he claimed happened at work actually occurred when he fell through a glass door at home. Additionally, he punched a wall at a hospital two weeks prior to his alleged work injury. Burgin did not immediately seek treatment because he did not have personal medical insurance. Burgin’s case was set for trial in January 2013; however, Burgin left court before the case was called and a bench warrant was issued. Burgin was sentenced to 30 days, suspended, and placed on probation for one year.
Did Not Report All Work Activity & Wages to Receive Higher Benefits
Clareta Fisher (Cleveland, Cuyahoga County) pleaded no contest to one count of workers comp fraud for inappropriately receiving wage loss benefits. SID received a fraud referral from a BWC employee indicating Fisher was not reporting all of her work activity and wages in order to receive a higher weekly wage loss benefit. Investigators confirmed that Fisher did fail to properly report all earnings for her work as a licensed practical nurse. Fisher appeared in the Franklin County Municipal Court and sentencing is set for May 29. If she pays restitution of $3,082.03 and $890.90 investigative costs, the judge indicated he would fine her and that would conclude her obligations. However, she will be placed on probation if payment is not made in full.
Doctor Inappropriately Utilizing Health Insurance Forms
Dr. Eric Barker (Dayton, Greene County) pleaded guilty to a felony count of workers comp fraud in Franklin County for using the information of another physician in order to receive reimbursement from BWC. SID opened an investigation into the chiropractor after receiving an allegation that Barker was inappropriately utilizing Health Insurance Claim Forms for the treatment of injured workers. Investigators learned the business, located at 1353 Woodman Drive, had been sold to Barker, who was decertified as a BWC provider in 2009 due to a felony conviction. An analysis revealed BWC reimbursed approximately $8,000 to Teeters Chiropractic after that sale for chiropractic manipulation, evaluation and management and consultation services that were in fact rendered by Barker. The bills were submitted using another assigned BWC provider number as a way of circumventing Barker’s exclusion from the workers’ compensation system. Barker was ordered to pay $8,587.57 in restitution, in addition to and $8,000 for investigative costs. He was also sentenced to five years of community control, which will cease once he pays full restitution. He will serve a 12 month prison term if he violates these conditions.
Submitted Work Comp Premium Payments Returned for Non-Sufficient Funds
Patsy Krise, dba Sandusky Torching (Holland, Lucas County) pleaded guilty to workers comp fraud March 20 for submitting premium payment checks that were returned due to non-sufficient funds. SID received a referral from BWC Collections after receiving a non-sufficient funds check from Krise, owner of Sandusky Torching. Investigators met with Krise in an attempt to work with her to pay back the more than $1,300 owed, as well as close the policy as the business had been shut down. However, Krise again failed to remit appropriate payment. Krise was ordered to a period of rehabilitation under control and supervision of the Lucas County Adult Probation Department for two years. She was ordered to immediately pay all financial obligations.
Working While Receiving Work Comp Benefits
Carolann Humberston (Howard, Knox County) pleaded guilty March 12 to one count of workers’ comp fraud for working while receiving benefits. BWC’s Intelligence Unit reported that an Ohio Department of Job and Family Services wage crossmatch indicated that Humberston earned wages from a Columbus business during the same time period she received the BWC funds. The investigation produced evidence that Humberston knowingly worked as a nurse while receiving temporary total disability benefits. Humberston was sentenced to six months in prison, suspended for a year of community control. She was ordered to pay restitution to BWC in the amount of $11,157.03, plus court costs. Humberston presented a check for the entire amount. Community control will end upon payment of court costs.
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].
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