Ohio Bureau Of Workers Compensation Fraud Convictions

Two Ohio men were dealt their sentences recently for workers compensation fraud.

 

According to information from the Ohio Bureau of Workers Compensation (BWC), the first case involved a West Portsmouth (Scioto County) man, sentenced in Franklin County for going back to work as a truck driver while obtaining workers comp benefits for a previous workplace injury.

 

Christopher Galloway must repay nearly $2,000 he improperly gathered from the Bureau of Workers Compensation.

 

“Mr. Galloway’s work as an independent truck driver was clearly a violation of the law,” commented BWC Administrator/CEO Steve Buehrer. “In addition to putting an end to fraud, it is essential that BWC ensure every employer dollar is used for its intended purpose: injured workers who are truly unable to work.”

 

 

Admission and Cooperation Regarding the Investigation

 

The Portsmouth Special Investigations Unit came across an allegation that Galloway went back to work as a truck driver. Investigators found that Galloway was working as an independent semi truck driver. He admitted to the work activity and cooperated with the investigation.

 

Galloway pleaded guilty in late February and was sentenced the same day in the Franklin County Municipal Court.

 

Judge Tyack ordered Galloway to pay restitution to the tune of $1,812.18, along with $290 in fees and court costs. He also received a sentence of six months in jail, which was suspended for two years of community control.

 

Meantime, a fellow Buckeye State resident also ran afoul of the BWC.

 

A review of court information shows that Richard D. Ketcham was sentenced and must repay more than $26,000 he improperly collected from the BWC.

 

The Lima (Allen County) man was sentenced in Franklin County for operating a photography business from his residence while receiving workers comp benefits.

 

“An investigation revealed that Mr. Ketcham was operating a photography business from his home while collecting disability funds,” noted BWC Administrator/CEO Steve Buehrer. “His actions were a blatant disregard of the law and took funds that are reserved for injured workers unable to work.”

 

Loose Lips Sink Ships

 

BWC’s Special Investigations Department came upon an allegation that Ketcham made comments indicating he might be employed while receiving disability from BWC. Investigators discovered that Ketcham earned profits from his photography business while collecting temporary total and living maintenance benefits.

 

Ketcham pleaded guilty Feb. 27 and was sentenced the same day in the Franklin County Court of Common Pleas.

 

Judge Guy L. Reece II ordered Ketcham to pay restitution to BWC in the amount of $26,716.38. He also was placed on community control for three years.

 

In the event Ketcham violates the terms of community control, he will serve seven months at the Ohio Department of Rehabilitation and Corrections.

 

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: mstack@reduceyourworkerscomp.com.

 

©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


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

Ohio Bureau Of Workers Compensation To Modernize Self-Insured Program

 

 
In an effort to accelerate the service to self-insuring employers, Ohio’s Bureau of Workers Compensation (BWC) Board of Directors recently sat through a presentation on a series of law and rule changes.
 
The presentation included a summary of work within the Bureau of Workers Compensation to modernize the self-insured program and improve service to self-insuring employers.
 
According to BWC Administrator/CEO Steve Buehrer, "Ongoing reform within our self-insured department has improved customer service, and claims and policy management, for self-insuring employers. We have also worked closely with the self-insured community to present this series of rule changes that will provide them with greater flexibility and remove unnecessary burdens that could present a roadblock to success in Ohio."
 
 
Ohio Bureau of Workers Compensation Supports More than 1,200 Businesses
 
BWC's Self-Insured Department provides support to the more than 1,200 self-insured businesses that employ close to two million Ohio employees. These employers administer their own workers comp programs and pay benefits directly to their injured workers.
 
The department presented to the board a number of proposals that will provide more flexibility to self-insured employers.
 
Among them are these rule changes impacting assessments BWC collects to fund administrative costs and the Self-Insured Employer Guaranty Fund (SIEGF), established to pay claims of self-insuring employers that have defaulted.
 
The proposed changes would:
 
      Allow self-insured employers in good standing to submit multiple forms security. All self-insured employers currently must provide a guarantee from a parent company as protection in the event of a default. However, many self-insured employers prefer the option of submitting a letter of credit.
      End a long-standing policy that resulted in multiple assessments on employers with subsidiaries. For it's first three years, a self-insured entity must pay an assessment based on a percentage of the premium paid in the year prior to becoming self-insured. The proposal would remove this assessment that is presently in place with the addition of each new subsidiary to a current self-insured policy.
 
 
Efforts Include Focus on Collecting Appropriate Securities
 
The department also noted the results of work to improve customer service, productivity and overall business performance. These efforts include ensuring BWC is collecting appropriate securities and more effectively managing defaulted claims, which resulted in a 24% decline in the SIEGF assessment in 2012.
 
The department has also:
 
  • Reduced the average time it takes to renew a policy from 81 days after the employer's scheduled renewal date to 30 days prior to the renewal date;
  • Reduced a backlog of policy renewals from 33 percent of all policies to less than one percent;
  • Improved processing of applications by 44 percent to an average of 67 days; and
  • Expedited response time to injured worker complaints by 33 percent.

 

 
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: mstack@reduceyourworkerscomp.com.
 
©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


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

Ohio Bureau of Workers Compensation Sees Budget Improvements

 
In an effort to offer better results for injured workers, officials with the
Ohio Bureau of Workers Compensation seemed pleased with the announced Fiscal Years 2014-15 budget, H.B. 34, which was presented in the House of Representatives.
 
According to remarks from Administrator/CEO Steve Buehrer, “This budget lets us continue our focus on getting injured workers healthy and safely back on the job sooner, while furthering our efforts to maintain stable, reasonable workers compensation rates for employers.”
 
 
Budget of Nearly $551 Million Seeks Approval
 
As politicians now review the budget language, should it gain approval, the $550.7 million request would be the second consecutive budget decrease under Buehrer. This request represents a close to 5% decrease compared to the original FY 2012 – 2013 appropriation, which sported a 12% decrease compared to the FY 2010 – 2011 appropriation.
 
According to Buehrer, the budget appropriately funds the bureau's mission of protecting Ohio's workers and employers through the prevention, care and management of workplace injuries, while keeping in place reasonable rates for employers.
 
 
Employers Saved Close to $210M in Rate, Budget Reductions
 
Buehrer noted a number of accomplishments during his first two years:
 
     Saved businesses an estimated $210 million through rate and budget reductions;
     Reduced public-employer premiums to their lowest levels in 30 years;
     Created pilot programs to more efficiently manage workers' injuries;
     Enacted numerous changes to prevent prescription abuse, including implementing a drug formulary and pharmacy lock-in program to better manage prescriptions while building a "safety net" plan to allow injured workers to safely transition from narcotics and opiates;
     Implemented Destination: Excellence, a cafeteria-style program that encourages best practices in areas such as accident prevention, cost control, and policy management. In it's first year, more than half of all Ohio employers are taking part in at least one aspect of the program, helping the business community save an estimated $28 – $41 million.
 
Along with close to a dozen minor technical changes, the bill also offers a number of reforms to reportedly increase BWC's ongoing effort to improve medical outcomes for injured workers.
 
"We've made great strides in improving injured worker care while keeping workers compensation costs in check," Buehrer added. "The changes in this bill are consistent with our ongoing reform efforts, and I look forward to working with the General Assembly as well as business and labor stakeholders to continue to make our system better."
 
 
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: mstack@reduceyourworkerscomp.com.
 
©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

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

Ohio Bureau of Workers Compensation Convicted 125 Employers for Fraud in 2012

 

Showing further evidence that crime does not pay, officials with the Ohio Bureau of Workers Compensation (BWC) recently reported 11 individuals were convicted of or pleaded guilty to charges related to defrauding the state’s compensation system in the month of December.

 

The court actions stem from investigations conducted by BWC’s special investigations department (SID). From illegally receiving workers comp payments to running a business without comp coverage or under reporting it, a number of individuals have been arrested and charged within the last year.

 

“Our investigators wrapped up 2012 with 125 convictions of employers, injured workers, providers, and others who committed fraud against the State Insurance Fund,” said BWC Administrator/CEO Steve Buehrer. “Their work helps keep employers from having to cover the cost of fraudulent claims, non-payment of premium, illegal billing, or any other illicit schemes designed to cheat the system.”

 

Among those who ran afoul of the law for a variety of offenses:

 

Eric Renzhofer, dba ARS Construction Inc., (Bowling Green, Wood County) was found guilty Dec. 3 of workers comp fraud for altering his coverage certificate. SID received an allegation from a premium auditor that Renzhofer may be altering a certificate of coverage. While conducting an audit on an unrelated case, the auditor noticed the policy number listed did not match ARS Construction, Inc. The Employer Fraud team investigation found that Renzhofer altered a certificate belonging to another business to make it appear that his business (ARS Construction) had active coverage. Renzhofer confessed to altering the certificate and cooperated by providing business records to determine the premiums he owed. Renzhofer was ordered to pay fines of $250 and restitution.

 

Eugene Vaughn (Spencer, Medina County) was found guilty Dec. 28 on five felony counts of deception to obtain a dangerous drug after he was discovered doctor shopping. A pharmacy contacted SID and advised that Vaughn was receiving prescriptions from multiple insurers, including BWC. SID worked with the Medina County Drug Task Force on the investigation, which found Vaughn obtained narcotics from different doctors during the same prescription cycle, including prescription drugs paid by BWC. Vaughn also used multiple pharmacies to fill these prescriptions. Vaughn was sentenced in the Medina County Common Pleas Court to three years general supervision by the Adult Parole Authority, drug screening, and continued drug treatment. Vaughn’s driver’s license was suspended for six months with work privileges upon request. He must have only one prescribing doctor with those prescriptions verified by Adult Parole Authority.

 

Victor Figueroa (Columbus, Franklin County) pleaded guilty Dec. 13 to one count of workers comp fraud for working while receiving benefits. SID’s Intelligence Unit detected that Figueroa was earning wages from multiple employers during periods he was collecting Temporary Total disability benefits from BWC. The investigation found Figueroa worked for Fairfield Insulation and Qualiteck, Inc. while collecting these benefits. Figueroa was ordered to pay restitution of $9,653.70 and he paid in full at the sentencing. He was also sentenced to one day in jail, suspended for time served.

 

Danny Albert (Columbus, Franklin County) pleaded guilty Dec. 17 to one misdemeanor count of workers comp fraud for working while receiving benefits. SID received an allegation that Albert was working for Southeast Mental Health as a Resident Specialist while he was receiving benefits and was prohibited from working. The investigation found Albert was in fact employed with Southeast, Inc, and Stevens Building Services while receiving Living Maintenance and Temporary Total benefits. Evidence obtained during the investigation also showed that Albert intentionally misrepresented and withheld employment activity in order to continue collecting these benefits. Albert was sentenced to 180 days in jail, suspended for 12 months of community control, and ordered to pay $7,051.75 in restitution.

 

Sheldon Greene (Middletown, Butler County) pleaded guilty Dec. 6 to one felony count of workers comp fraud for working while receiving benefits. SID received an allegation that Greene had returned to work at Michael’s Dining and Jazz restaurant in Dayton. The investigation found Greene was working at Michael’s Dining and Jazz restaurant as a chef and was operating his own catering company, Liberty City BBQ, in the Cincinnati and Dayton areas while receiving BWC disability benefits. Greene appeared in the Franklin County Court of Common Pleas and the judge terminated the case after he repaid BWC $9,992.28.

 

Jerry Adams, dba Quaker Pool & Spa, (Calcutta, Columbiana) was found guilty Dec. 13 of one felony count of fraud for allowing his workers comp insurance coverage to lapse. BWC’s Employer Compliance Department attempted to work with Adams, owner of Quaker Pool & Spa, after he allowed his coverage to lapse. After multiple attempts, Adams still failed to submit outstanding payroll reports and the case was turned over to SID for a fraud investigation. Employer fraud team agents met with Adams and his accountant on multiple occasions and facilitated the receipt of all but one of the outstanding payroll reports. Adams was given instructions on how to request a payment plan in order to get the policy reinstated. However, Adams again failed to follow through. Adams paid $4,226.34 as a down payment and signed a Payment Plan with the Attorney General’s Special Counsel agreeing to pay the remaining balance of $11,495.50 over the course of the next year. His sentencing is scheduled for February 21, 2013.

 

Anil Nalluri, MD (Youngstown, Mahoning County) pleaded guilty Dec. 13 to one misdemeanor count of workers comp fraud for billing for services not rendered. SID began investigating Nalluri in 2003 after receiving a complaint from an injured worker that he was providing only 10 minutes of psychotherapy services during what was supposed to be a 45 minute session. The injured worker confronted Nalluri about the lack of care and Nalluri informed the patient that he would receive payment from BWC regardless of the treatment provided. Nalluri later removed the injured worker from treatment at the office and failed to provide the patient his medical records when requested. Agents conducted an undercover operation and observed several patients exiting the office very soon after arriving. An agent also posed as a patient, visiting Nalluri 12 times and capturing video supporting the allegation, including an appointment that lasted one minute. In another instance, BWC was billed for a 20 – 30 minute psychotherapy session that video showed lasted three and a half minutes and consisted primarily of discussions about the economy. After the undercover operation concluded, investigators conducted interviews with Nalluria’s employees and patients. A number of patients reported the services they received were less than adequate and often lasted just enough time for Nalluri to write a prescription. Nalluri was paid $71,669.62 in restitution and investigative costs. He was also voluntarily decertified as a BWC provider.

 

 

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: mstack@reduceyourworkerscomp.com.

 

©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


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

Ohio Bureau of Workers Compensation Award $153,000 in Safety Grants

 

Ohio BWC Awards Safety Intervention Grants to State Businesses
 
The Ohio Bureau of Workers Compensation (BWC) recently awarded safety intervention grants to five Ohio businesses totaling more than $153,000.
 
BWC designed the Safety Intervention Grant Program to assist Ohio employers in reducing illnesses and injuries and to create a partnership with them to establish best practices for accident and injury prevention.
 
 
Safety Grants Available to Protect Wellbeing of Workers
 
"Safety grants are available to businesses in any industry looking to protect the health and wellbeing of their workers," said BWC Administrator/CEO Steve Buehrer. "Many employers find their purchase allows for sometimes the simplest of adjustments that can make a tremendous difference in the number of injuries and corresponding costs associated with claims."
 
Ohio private and public employers are eligible for safety intervention grants, which include a 2-to-1 matching amount up to a maximum of $40,000 for a total of $60,000 – $20,000 from the employer and $40,000 from BWC. Quarterly data reports and follow-up case studies help BWC determine the effectiveness of employers" safety interventions and establish best practices.
 
 
The following are a list of businesses that received grants from BWC:.
 
City of Girard Fire Dept. (Trumbull County)
BWC awarded $38,570 to purchase an exhaust removal system to reduce carcinogens from diesel exhaust. The City of Girard Fire Department is a public employer that provides fire suppression and emergency medical services to the city's 10,000 residents and thousands of workers.
 
Bowlin Energy LLC (Hamilton County)
BWC awarded $40,000 to purchase battery powered crimping tools and hydraulic tampers to reduce the risk of strains, sprains and carpal tunnel syndrome resulting from forceful exertions and awkward postures. Bowlin Energy is a private utility employer that repairs and replaces overhead power lines and supporting power poles.
 
Peerless Saw Company (Franklin County)
BWC awarded $40,000 to purchase a precision leveling machine to perform saw blade flattening. The purchase will reduce ergonomic risk factors associated with manual hammering, including injury to the hand, wrist, elbow and shoulder. Peerless Saw Company manufactures custom circular saws.
 
SMI Crankshaft LLC (Seneca County)
BWC awarded $22,078 to purchase a vibratory finishing machine to reduce the risk of injury from vibration, repetitive motion, and awkward postures. The machine will also reduce eye injuries resulting from metal particles. SMI Crankshaft is a finishing operation that produces precision crankshafts from raw forgings and castings.
 
Buckeye Power Sales (Franklin County)
BWC awarded $12, 754 to purchase 30 hoist systems to reduce the risk of sprains and strains resulting from manual material handling. Buckeye Power Sales sells, delivers and services power generation systems. This grant was awarded through a partnership between BWC and the National Institute for Occupational Safety and Health to research how to create safer work environments for employees working in the wholesale/retail trade, and other sectors that perform delivery, installation, receiving or material handling tasks.
 
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: mstack@reduceyourworkerscomp.com.
 
©2013 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

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

Prison Doors Slamming Shut Is Strong Reminder Workers Comp Fraud Does Not Pay

 

To Repay More Than $30,000
 
Keith Miller of Grove City (Franklin County), Ohio was recently ordered to pay restitution to the Ohio Bureau of Workers Compensation (BWC) after he admitted to altering paperwork he submitted to request injured worker benefits. Miller pleaded guilty in a Franklin County courtroom and must repay more than $30,000.
 
According to BWC officials, Miller was receiving Living Maintenance Wage Loss, which is available to an injured worker who has completed a rehabilitation plan but continues to have physical restrictions and experiences a wage loss upon return to work.
 
 
Statements Had Conflicting Work Dates
 
BWC's Special Investigations Department received an allegation in 2010 that the wage statements Miller submitted to request compensation appeared to be suspicious. The statements had conflicting work dates and appeared to have been altered.
 
Investigators interviewed Miller and his employer, and he ultimately admitted to altering the statement forms and submitting false payroll records in order to receive benefits.
 
"It can be frustrating for someone who can work following an injury but faces employment at a lower wage," said BWC Administrator/CEO Steve Buehrer. "Living Maintenance can help close that gap, but is clearly not justified if submitting false information is the only way to gain approval."
 
 
7 Months in Prison, 5 Year Community Control, $30K Fine
 
Miller pleaded guilty to one felony count of workers comp fraud was sentenced to seven months in prison, suspended for a five-year period of community control. He was also ordered to pay $30,240.31 in 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: mstack@reduceyourworkerscomp.com.
 
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

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

Ohio BWC Reports Convictions for Workers Comp Fraud

8 Individuals Convicted of Charges

 

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

 

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 comp fraud.

 

“These cases represent two common types of fraud cases we see: employers that don’t maintain the proper workers comp coverage and injured workers obtaining employment in conflict with their benefits,” said Buehrer. “Regardless, Ohio employers and their workers should know that cases that involve any apparent fraud will be taken very seriously by our investigators – and perpetrators will be punished.”

 

 

Summary of Cases:

 

 

Lisa Hart, dba Emergency Pet Clinic, (Bedford Heights, Cuyahoga County) pleaded guilty to three felony counts of fraud for failing to obtain workers compensation insurance coverage. Hart is the owner and operator of the Emergency Pet Clinic. She purchased the business in December 1996 but never completed the BWC paperwork indicating she had made the purchase. The BWC policy lapsed in September 2003 when Hart failed to file the BWC payroll report for the first half of 2003 and pay the associated premium. BWC’s employer compliance department made multiple unsuccessful attempts to bring the business back into compliance. The department referred the case to SID’s employer fraud team. Agents attempted to interview Hart, but she either canceled meetings or did not respond. Interviews with current and former employees of the business confirmed Hart did hire employees, and some of those employees had filed injury claims during the time period the policy was lapsed. Hart was sentenced Sept. 24 to one year incarceration suspended for five years of probation. Terms of her probation include making restitution in the amount of $21,023.27, including $2,000 for investigative costs and cooperating with a BWC audit.

 

Mark Knose (Cincinnati, Hamilton County) pleaded guilty to one felony count of workers compensation fraud for working while receiving benefits. SID received an allegation from a third-party administrator indicating Knose may be coaching baseball. The investigation found that Ross Local Schools employed Knose as a varsity pitching coach and that the Champions of Baseball Academy in Milford employed him as a coach and scout. Both organizations employed Knose while he received temporary total compensation. Knose entered his guilty plea Sept. 19. He is scheduled for sentencing in this month in the Hamilton County Court of Common Pleas.

 

Michael Myers (Goshen, Clermont County) pleaded guilty in the Clermont County Court of Common Pleas to one felony count of workers compensation fraud for drug trafficking. The Clermont County narcotics task force contacted SID and informed it that Myers may be selling narcotics that BWC paid for as a result of his workplace injury claim. SID worked with the drug task force and had an informant purchase several pills, later identified as prescribed to Myers and paid for by BWC. Myers pleaded guilty Sept. 7 and was placed on probation. He must also pay court costs.

 

December Combs (Bellefontaine, Logan County) pleaded no contest in Bellefontaine Municipal Court Sept. 11 to charges related to fraudulently creating an online account to access her ex-husband’s claim information. SID received an allegation that Combs assumed her ex-husband’s identity to obtain information for use at child custody hearings. SID found that accusation to be true. Combs must pay a $150 fine.

 

Albert Harr (Tallmadge, Summit County) pleaded guilty to one count of attempted theft and one count of attempted workers compensation fraud, both misdemeanors, for failing to report wages. Harr, a highway contractor for the United States Postal Service (USPS), came under investigation by a special task force to address a trend among contractors of failing to maintain workers’ compensation coverage despite receiving funds from the USPS to purchase coverage. Investigators found that Harr hired an employee to help him operate the route driver but failed to report the employee to BWC. However, he did request and receive reimbursement from the USPS for the additional workers’ compensation costs associated with the new employee. Simply put, Harr pocketed the money instead of using it to purchase coverage with BWC. Harr was sentenced Sept. 20 to one year of probation and ordered to repay restitution in the amount of $2,237.65.

 

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: mstack@reduceyourworkerscomp.com.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

 


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

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 mstack@reduceyourworkerscomp.com

 

 


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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.

 

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Ohio Pharmacy Management Initiatives Save 2.6 Million in Prescription Costs

 

Pharmacy Management Initiatives Positive for Injured Workers
 
A recent report to the Ohio Bureau of Workers Compensation (BWC) Board of Directors outlined how the bureau's first ever formulary and a number of other pharmacy management initiatives are helping in efforts to increase positive outcomes for injured workers.
 
 
Narcotics Prescribed Down 1.1 million doses
 
The report includes early data showing a newly enacted formulary has driven down the number of narcotics prescribed to injured workers by 12 percent, or 1.1 million doses, supporting Governor John Kasich's efforts to address the Ohio's opiate epidemic.
 
"Ohio's new formulary is proving an effective way to help manage care and ensure we are getting injured workers the right prescriptions for the right conditions at the right time," said BWC Administrator/CEO Steve Buehrer. "While narcotics can be a legitimate part of the treatment process, we owe it to Ohio's workers to ensure their road to recovery doesn't descend down the dark path of addiction." [WCx]
 
 
$2.6 million Saved in Prescription Costs
 
A review of prescriptions written from February to April 2012, compared to the same period in 2011 showed 1.1 million fewer prescribed doses of narcotics. This equals a 12-percent reduction in the number of doses and a 15-percent, or $2.1 million, reduction in costs. The same review showed the number of skeletal muscle relaxants (SMR) prescriptions dropped by 59 percent, resulting in a 58 percent, or $532,000, decrease in cost. SMRs are among the most commonly overused drug classes and are often prescribed in conjunction with narcotics.
 
BWC began implementing its first ever formulary in September, however, BWC chose to start its study on Feb. 1, the first day that new restrictions on opiates were implemented.
 
The formulary is helping improve the efficiency and effectiveness of treatment, limit the inappropriate use of medications and lower prescription costs. The formulary provides a concise list of medications that can be utilized for treatment of approved conditions related to an injured worker's claim and may include guidelines related to their use.
 
Additional Controls on Pharmacy Program
 
In addition to the formulary, the presentation by BWC Pharmacy Director John Hanna to the Medical Services & Safety Committee late yesterday covered several other controls BWC is placing on its pharmacy program, including:
 
      Point of service edits that allow BWC's pharmacy benefits manager, SXC Solutions, to screen out prescriptions that aren't related to an injured worker's condition to ensure they are receiving medications relevant to their injury;
      The standardization of drug utilization reviews, a process that allows for a timely, objective evaluation of prescriptions an injured worker receives to ensure they are appropriate. Drug utilization reviews evaluate the necessity and appropriateness of prescription drug treatment and can identify overuse or dangers mixing of prescriptions;
      A pharmacy lock-in program that was established to limit the practice of doctor and pharmacy shopping, and the dangers that can arise when medications are prescribed by multiple physicians and are processed in different pharmacies. The program allows BWC, under certain circumstances, to require an injured worker to use a single pharmacy for non-emergent prescriptions. BWC can also restrict an injured worker convicted of a drug offense to the use of a single prescribing physician in order to receive reimbursement for non-emergent prescriptions;
      Requiring generic medications when available.
 
"By better understanding and managing the role of pharmaceuticals in recovery, we are helping injured workers heal and get back on the job sooner," said Buehrer. "The added benefit is the cost savings that help us keep premiums affordable for Ohio's businesses." [WCx]
 
 

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 mstack@reduceyourworkerscomp.com

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Ohio BWC Awards More Than $265K in Employer Workplace Safety Grants

 

The Ohio Bureau of Workers Compensation (BWC) recently awarded safety intervention grants totaling more than $265,000 to Ohio employer. BWC designed the Safety Intervention Grant Program to assist Ohio employers in reducing illnesses and injuries and to create a partnership with them to establish best practices for accident and injury prevention.
 
"The biggest impact of these grants will be in helping the recipients' employees avoid injuries resulting from the manual handling of material," said BWC Administrator/CEO Steve Buehrer. "Repetitive motion while handling materials can cause long-term health issues, and I applaud these companies for taking ergonomics into consideration and making the changes necessary to protect their workers."
 
Ohio private and public employers are eligible for safety intervention grants, which include a 2-to-1 matching amount up to a maximum of $40,000 for a total of $60,000 – $20,000 from the employer and $40,000 from BWC. Quarterly data reports and follow-up case studies help BWC determine the effectiveness of employers’ safety interventions and establish best practices.
 
The following are a list of businesses that received grants from BWC:
 
Auto Gate Inc. (Erie County)
 
BWC awarded $40,000 to purchase an enclosed paint booth to reduce the risk of injury related to chemical exposure from spray painting. Auto Gate manufactures security gates and fencing for business and residential.
 
Cheeseman LLC (Mercer County)
 
BWC awarded $40,000 to purchase dock plates and repair damaged dock positions to reduce the risk of injury from slips, trips and falls; cuts and lacerations; and manual material handling while loading and unloading product from trucks. Cheeseman LLC is a leading provider in less-than-truckload and truckload services.
 
 
Cincinnati Preserving Company, dba Clearbrook Farms (Hamilton County)
 
BWC awarded $7,344.67 to purchase a vacuum lift system and freestanding workstation jib crane to reduce the risk of injury related to manual material handling, forceful exertions and deficient postures. Cincinnati Preserving has produced fruit preserves and pie fillings since 1924.
 
 
Frost Roofing Inc. (Auglaize County)
 
BWC awarded $17,640.05 to purchase Accutrac, Accuseam and Rhinotrac tools to reduce the ergonomic risk factors related to repetitive motion and awkward postures as insulation and roofing membrane are installed with screws and plates. Frost Roofing is a full service-roofing contractor for both residential and commercial fields.
 
 
Leonard Williams Masonry Inc. (Licking County)
 
BWC awarded $39,995.66 to purchase a hydraulic scaffolding to reduce the risk of injury such as sprains and strains, which are related to manual material handling that occurs while workers erect scaffolding by hand. Leonard Williams Masonry provides residential and commercial masonry work.
 
 
Oxford Township (Tuscarawas County)
 
BWC awarded $36,633.60 to purchase a pothole-patching machine to reduce the ergonomic risk factors, such as strains and sprains, associated with manual material handling while repairing streets and roadways. Oxford Township is a public employer providing street repair and maintenance services to the township.
 
 
SCS Construction Services Inc. (Hamilton County)
 
BWC awarded $39,795.13 to purchase a self-propelled scraper, electric scaffold, wall/floor scanner, drywall screw guns, reciprocating saws, rotary hammer kits, Cutquik Cart for cutoff saw, dual disc floor grinder and powered carpet puller. These items will help reduce the risk of injury related to manual material handling. SCS provides commercial construction, demolition and remodeling services.
 
 
Spring Meadows Extended Care Facility (Lucas County)
 
BWC awarded $3,996.66 to purchase a pivot assist to reduce the risk of injury such as sprains and strains related to manual patient handling. Spring Meadows is a 100 bed skilled nursing, longer-term care and rehabilitation facility.
 
 
Troy Innovative Instruments Inc. (Geauga County)
 
BWC awarded $40,000 to purchase an automated passivation and cleaning unit to reduce the risk of injury related to repetitive motion and awkward postures, in addition to citric or nitric acid exposure. Troy Innovative is a manufacturer of medical implants and instruments.

 

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 mstack@reduceyourworkerscomp.com

 

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

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.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

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