Ohio BWC Investigations Nab 5 Individuals on Workers Comp Fraud

Given how workers compensation fraud impacts both employers and the public in general, it behooves those looking into such acts to spend whatever resources necessary to nab defendants.

Such was the case in Ohio recently, as the state’s Bureau of Workers Compensation (BWC) Administrator/CEO Steve Buehrer reported five individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in May. 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.

Following are the cases that resulted in a guilty plea or conviction recently:

Sandy Givens (Dayton, Montgomery County) pleaded guilty May 21 to one felony count of workers comp fraud for working while receiving benefits. SID opened an investigation after receiving an allegation that Givens was working while receiving disability and found that she was operating a pony ride business in the greater Cincinnati area. She was also selling tack equipment at Horsefeathers Tack Shop at Caesar’s Creek Flea Market in Wilmington. The investigation revealed that Givens had $11,119.50 in business deposits from these two businesses over a period of a year. A judge in the Franklin County Court of Common Pleas sentenced Givens to eight months of community control and ordered her to pay court costs. The judge indicated her probation will be terminated once court costs are paid and if Givens does not comply with the terms of community control, she will serve six months in prison. Givens had already settled her BWC claims and the entire overpayment of $32,189.01 has been recouped.

Joshua Gayheart (Shelby, Richland County) pleaded guilty to one misdemeanor count of workers comp fraud for filing a false claim. SID received an allegation that Gayheart had filed a false claim, indicating he was injured when a pallet of books fell on him. The investigation found the alleged injury was inconsistent with the medical conclusions of the examining physician and witness statements. Witnesses indicated that the books fell onto the floor without hitting anyone. The claim was denied by BWC and the case was referred to the Mansfield Municipal Court. Three days after the alleged injury, Gayheart appeared on a segment of the “Steve Wilkos” television show. The video showed Gayheart squatting, bending and jumping, which was inconsistent with his reported restrictions. Gayheart pleaded guilty and was sentenced to 60 days in jail with 60 days suspended and a $100 fine.

Kevin Swanson (Cleveland, Cuyahoga County) pleaded guilty May 28 to one misdemeanor count of workers comp fraud for working while receiving benefits. SID received an allegation through its fraud hotline that Swanson faked an injury with the Cuyahoga Metropolitan Housing Authority and continued to work for a private security agency. The investigation found Swanson worked as a security guard at the Apostolic Faith Tabernacle Church while receiving temporary total disability benefits. The Cuyahoga Metropolitan Housing Authority, which is self-insured, paid the benefits. Investigators obtained employment records, and reviewed medical records and request for benefit forms submitted by Swanson, which contained false and misleading statements regarding his work activity. Swanson was sentenced to six months of community control and a $200 fine. The judge ordered restitution in the amount of $14,190.37 to the Cuyahoga Metropolitan Housing Authority and $2,000 to BWC for investigative costs.

Defendant Pleads Guilty to Submitting False Job Searches

Ruth F. Brock (Coshocton, Coshocton County) pleaded guilty May 14 to one misdemeanor count of workers comp fraud for submitting false job searches to BWC. SID received an allegation from a BWC employee that Brock was misrepresenting her job search activities, enabling her to continue receiving wage loss workers’ compensation benefits. Brock was receiving non-working wage loss, which is payable to injured workers who are unable to find suitable employment. In order to qualify, the injured worker must demonstrate a good faith effort to secure employment within physical restrictions. The investigation showed Brock knowingly misrepresented her job searches to BWC in order to continue receiving these benefits. Investigators reviewed the job searches Brock submitted and did not find a single business that had an application on file for her. She was also submitting the forms with future dates in order to ensure an uninterrupted income stream. Brock was ordered to pay $1,092.76 in restitution, and she paid in full. She was also sentenced to one day in jail, suspended for time served.

Bryan Starcher (Austinburg, Ashtabula County) pleaded guilty May 22 to one misdemeanor count of workers comp fraud for working while receiving benefits. BWC opened an investigation after receiving an allegation that Starcher had been working as a truck driver for a cement company and as a bouncer at a bar while receiving benefits for a prior workplace injury. An analysis of financial records and witness interviews showed that Starcher in fact did return to work as a truck driver at a cement company and as a bouncer at a bar while receiving Temporary Total Disability. Starcher was also interviewed and he admitted that he was not entitled to the benefits. A Franklin County Common Pleas Court judge sentenced Starcher to 30 days of incarceration. He also submitted a $1,500 payment to cover restitution.

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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