BWC SID: Our Journey to Excellence – Part 2 of 3

By Jeff Baker, Program Administrator, BWC Special Investigations Department

In our constant quest for improvement, all members of the Bureau of Workers’ Compensation Special Investigations Department (SID) gathered on October 22, 2015 at our Mansfield service office to successfully complete annual in-service training. The theme of this year’s training event was “Our Journey to Excellence: Past, Present and Future.” Led by SID Director Jim Wernecke, we shared investigative successes, learned how to use new technology recently secured, and committed to operational strategies for even greater effectiveness.

We’ve found that one of the chief ways to find new or alternate methods of fraud detection and investigation is to consult counterpart agencies. Such collaboration allows SID to examine its own methods to see where improvements can be made, how tasks can be accomplished more efficiently, and what new strategies or technologies can be used in the course of an investigation.

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Toby Smith commences his presentation.

This is why Director Wernecke wisely invited Toby Smith, a talented Assistant Director of Security Services with the Industrial Commission of Ohio, to be our keynote speaker. In fewer than 90 minutes, the retired sergeant with the Ohio State Highway Patrol increased our awareness and skills in conducting “Crucial Conversations” to enhance organizational communication and investigative team work.

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Toby Smith holds certificate presented by Jim Wernecke.

To acknowledge our appreciation of his training, Director Wernecke presented Assistant Director Smith with a certificate, noting that it is an honor for us to recognize, praise and thank him. We respect and appreciate all of our law enforcement colleagues for their dedication to serving and protecting the citizens of the state of Ohio. Thanks to their willingness to effectively guide others on their respective journeys, we may be confident in soon reaching our intended destination.

You can read the first article about the October 22 event here and our most recent annual report here.

Who we are, what we do and why we do it…

Combating workers’ comp fraud in Ohio

It’s International Fraud Awareness Week and we’re on board to help educate the public about workers’ comp fraud.

In a nutshell, here’s who we are, what we do and why we do it…

Questions? Don’t hesitate to leave a comment below.

The following statistics are through June 30, 2015.

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I am the subject matter expert

kendraReporting from the National Workers’ Compensation & Disability Conference: Encouraging, empowering and inspiring!

By Kendra DePaul, Special Assistant to the BWC Administrator

On Tuesday, over 500 women, and a few men, gathered in Las Vegas for the 2nd Annual Women in Workers’ Compensation event.

wiwc panelThe mission of the Women in Workers’ Compensation organization is to encourage, empower, inspire and support women in the workers’ compensation industry in their professional development and career growth.

You may or may not be surprised to learn that women do not hold as many leadership roles as men in the insurance industry, and especially in workers’ compensation. The purpose of the event was to encourage women to take leadership roles in the industry, but also to simply understand the difference between men and women in communication.

Margaret Resce Milkint, Managing Partner of The Jacobson Group talked about how
women need to do a better job at taking credit for the work that they do. Women have a tendency to speak in “we” language instead of “I” language. And that we tend to caveat our statements by starting them with “I am not the expert, but…”

Reflecting on this, I think it is great advice for both men and women to be confident in our ability and recognize that for many of the things we work on, we are the subject matter experts and there is nothing wrong with saying as much.

Another topic of conversation was that we have to be willing to take advantage of career opportunities that come our way, even if we don’t think we are ready. Yes, there will always be risk in taking a new role, but if we all waited until we felt we were truly ready, we would never make the move. And many of the speakers spoke about some of best lessons they ever learned, were from times things didn’t go exactly as planned.

Although I have heard many of these things before, the event was a good reminder that  we each have what it takes to move our careers forward, if we so choose. Although there are times when we may doubt our abilities or make mistakes, we have to remain confident and move forward, because we are the leaders of tomorrow.

Fraud Awareness Week begins Nov. 15!

Fraud Week LogoThanks to the Association of Certified Fraud Examiners sponsorship and the power of social media, fraud awareness is spreading. We’re joining forces with more than 150 companies and organizations to educate the public about different types of fraud happening all over the world.

This campaign encourages business leaders and employees to promote anti-fraud awareness and education to help minimize fraud’s impacts.

We’re taking a stand and making it clear to potential fraudsters we’re on the lookout and using sophisticated detection methods to find them. Ultimately, there’s a serious price to pay for committing fraud.

Since 1993, our Special Investigations Department has researched and reviewed 115,474 allegations of workers’ compensation fraud, completed 62,985 investigations resulting in 2,485 criminal convictions and identified nearly $1.7 billion in savings.

Workers’ compensation fraud can be committed by an employer who isn’t truthful about the amount of payroll reported for workers’ compensation premiums, a claimant faking an injury to get some time (and money) away from work, or a medical provider who is overbilling. These are just a few examples.

Read more about International Fraud Awareness Week here and stay tuned throughout the next week for tips, articles and new cases here on our blog, ohiobwcfraud.wordpress.com, and also on Twitter, Facebook and YouTube.

BWC investigations result in six workers’ comp fraud convictions in October

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer announced today that six individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in October 2015. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

“Employers pay premium to BWC with the expectation that those dollars go toward the care and recovery of their workers who are injured on the job, not to dishonest claimants, employers or medical providers,” said BWC Administrator/CEO Steve Buehrer. “I am pleased our investigators were able to put an end to these attempts to defraud the workers’ compensation system.”

The following is a sampling of cases that resulted in guilty pleas or convictions during October:

Krystal Knight (Toledo, Lucas County) pleaded guilty Oct. 6 in the Lucas County Court of Common Pleas to one misdemeanor count of attempted theft for forgery. An investigation by BWC’s special investigations department revealed that Knight cashed two checks from Catholic Healthcare Partners, which were self-insured disability payments issued to another claimant, Judith Burris, in July 2014. The checks, totaling $1,062, were cashed after Burris, her mother, passed away on June 29, 2014. The investigation proved that Knight signed Burris’ name on the checks and presented Burris’ license to Huntington Bank in order to cash the checks. As part of a plea agreement, Knight was sentenced to pay restitution to Catholic Healthcare Partners in the amount of $1,062, but Knight failed to make the payment. She is scheduled for sentencing on November 17, 2015.

James Orr (Bethel, Clermont County) pleaded guilty Oct. 6 in the Hamilton County Municipal Court to a fourth-degree misdemeanor count of disorderly conduct for filing a false claim. Orr filed a claim with the BWC alleging he was injured in 2010 while working at Solutions Plus in Amelia.  Investigators interviewed co-workers and found that Orr had told them he hurt his back landscaping and working on his personal vehicle.  A medical report noted that Orr told the doctor that he was hurt at work two days prior to the alleged injury date on the first report of injury, and had sought treatment the next day at Clermont Mercy Hospital. Investigators found that Orr had not been treated by Clermont Mercy Hospital and time cards from the employer indicated that Orr did not work on the date of the alleged injury. Orr was sentenced to three days credit in the Hamilton County Jail, court costs, and ordered to stay employed.

Ralph Dollison (Circleville, Pickaway County) pleaded guilty Oct. 28 in the Franklin County Court of Common Pleas to one first-degree misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID received an allegation that Dollison was working while receiving compensation for a workplace injury. The investigation proved Dollison worked for a concrete company as a laborer and performed duties such as digging, building forms, pouring concrete and finishing concrete. Evidence also revealed he intentionally misrepresented and withheld his employment in order to continue collecting the disability benefits. Dollison was ordered to pay $4,081.47 in restitution and placed on community control for five years. He was also sentenced to 180 days in jail, suspended as long as he complies with the community control.

Timothy Morrow (Delaware, Delaware County) pleaded guilty to one first-degree misdemeanor count of workers’ compensation fraud on Oct. 20 in the Franklin County Court of Common Pleas for working while receiving benefits. SID opened an investigation after receiving an allegation that Morrow was operating his own HVAC business while receiving disability benefits from the BWC.  The investigation, which included a review of bank records and multiple interviews, confirmed Morrow did own and operate a business, TTM Mechanical, and conducted HVAC installations and repairs during the time he was receiving benefits. The evidence obtained during the course of the investigation also revealed that he intentionally misrepresented and withheld his employment from BWC. Morrow was sentenced to 30 days in the Franklin County Jail, suspended, and was placed on six months of probation.  He was also ordered to pay court costs along with $8,399.74 in restitution to BWC.  The restitution was paid at the clerk’s office after the hearing.

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

Check out our latest cases at ohiobwcfraud.wordpress.com and view BWC’s workers’ comp fraud awareness video on YouTube.

Researching Our Way to a Safer Ohio

Call for research grant proposals due Nov. 23
by Bernard J. Silkowski, BWC Director of Technical Services & Support

Most of us pass by hundreds of road signs every day, rarely giving them a second thought. And if we do, I’ll wager it’s not about the thought that went into designing them.

Isign began thinking about this as a teen, after I was hired to paint a sign for my church.  How big should the lettering be?  How wide and long should I make the shaft of the directional arrow?  What’s the best size and shape for the arrowhead so it could be easily discerned by a passing motorist?  While making “parking in the rear” too small was unlikely to have dire consequences, the process made me wonder why highway signs are the way they are.

Now I know that human factors research has answered these types of questions, and, that the findings of that research have been incorporated into standards for highway signage.  These standards are effective because they allow passing motorists to quickly and clearly recognize the guidance the signs are conveying.  This improves highway safety and is a good example of turning research into practice.

This is what we hope to achieve with the BWC research grant program. We believe through research, experts can learn things that can be used to make Ohio’s workplaces safer. At this very minute, nine safety research studies funded by $2 million in grants from the BWC are underway at six Ohio universities.  These projects, due for completion in 2017, were chosen for their potential to positively affect the overall safety, health, productivity, and competitiveness of Ohio’s workforce.

cover smallOur current research grant projects
Three of these projects are targeting the health care industry, which had the third highest rate of injury in the state in 2014.  Another is studying how pushing and pulling activities cause low back and shoulder injuries, and another, the dynamic assessment of torque tools, both areas for which there has been surprisingly little research.  Other researchers are looking at certain aspects of the safety and health risks of stored grain facilities, preventing injuries using wearable computer technology, Total Worker Health, and integrating safety and ergonomics with lean and six sigma processes in manufacturing.

Call for research proposals
The second round of grants, which will total $1 million, is open to any college, university, or not-for-profit research institution located within Ohio.  Research proposals are welcome until 5:00 p.m. on Nov. 23 for any occupational safety and health (OS&H) topical area.  We are, however, particularly interested in the following areas:

  • Assessing the occupational exposure of firefighters to agents that lead to the development of occupational disease
  • Prevention of injuries
    • In the wholesale and retail sector
    • Among firefighters working for small firefighting divisions
    • Among construction workers (especially injuries caused by falls)
  • Prevention of musculoskeletal disorders
    • In the automotive service sector
    • Especially those disorders associated with back, shoulder, and knee
  • Studying treatment outcomes for back, knee, and shoulder injuries
  • Development of innovative solutions/methods/tools
    • To quantify the effectiveness and return on investment (ROI) for implementing OS&H or ergonomics interventions in the workplace
    • To improve OS&H management
    • To improve employees’ perceptions, participation, and commitment to safety in the workplace.

Other benefitsOhio Occupational Safety and Health Research Program cover-page-001
Putting the safety aspect aside for a moment, there are other benefits to this grant program.  It keeps employer premium dollars in the Buckeye State by investing them at our educational institutions and providing educational and employment opportunities for students and researchers.  Our industries become more competitive because improvements in safety, quality, and productivity go hand-in-hand.  The program fosters collaboration between academia and industry and helps make Ohio a center of safety proactivity, improvement and innovation—a name for which Ohio is becoming known nationally.

Can research be exciting? It certainly can when it leads to safer and more healthful workplaces.  That’s why we created the research program in the first place and always welcome ideas for future research projects.

For details about the Ohio Occupational Safety and Health Research Program and this year’s call for proposals, click here.

Seated at the summit: Benchmarking for peak performance

By Jeff Baker, Program Administrator, BWC Special Investigations Department

To meet our ongoing commitment for improvement, BWC’s
Special Investigations Department (SID) works to foster an ongoing exchange with our counterparts both in Ohio and nationally to keep on top of the best fraud prevention strategies.  Last week, we participated in an Ohio Insurance Fraud Summit, sponsored by our colleagues in the Ohio Department of Insurance.

SID Dan Fodor 2Dan Fodor, the special agent in charge of the SID Intelligence Unit, participated as a subject matter expert on two panel discussions: “Emerging Fraud Trends” and “Data Mining as Part of a Fraud Prevention Plan”. He is uniquely qualified to speak on these topics. The Intelligence Unit he has successfully supervised since 1999, identified $37 million in savings during the last fiscal year alone.

Of course, the specific content of the panel discussions is confidential. Otherwise, would-be fraudsters might think themselves capable of using the “inside information” to avoid detection. Access to the summit was restricted by invitation only to those with a demonstrated need to know. Nonetheless, we can report that the effective benchmarking that occurred at the summit will generate even greater performance results for each participating law enforcement agency. As Dan noted, following the summit:

“It was a great opportunity to share some of our successes and experience in detecting insurance fraud. Bottom line, you have to think like a criminal to catch one.”

Thanks to effective collaborations, such as this summit, SID and its allies are increasingly realizing their mission to deter, detect, investigate and prosecute insurance fraud.

You can read the past posts about our SID Director here and our most recent annual report here.

Circleville laborer sentenced for workers’ comp fraud

Ralph Dollison booking photoRalph Dollison of Circleville (Pickaway County) was ordered to repay more than $4,000 for committing workers’ compensation fraud.

SID received an allegation that Ralph Dollison was working while receiving compensation for a workplace injury. The investigation proved Dollison worked for a concrete company as a laborer and performed duties such as digging, building forms, pouring concrete and finishing concrete.  Evidence also revealed he intentionally misrepresented and withheld his employment in order to continue collecting the disability benefits.

Dollison pleaded guilty Oct. 28 in the Franklin County Court of Common Pleas to one first-degree misdemeanor count of workers’ compensation fraud. He was ordered to pay $4,081.47 in restitution and placed on community control for five years. He was also sentenced to 180 days in jail, suspended as long as he complies with the community control.

 

Ohio hub of safety innovations

By Michael Rienerth, BWC Ergonomics Technical Advisor

Innovation is happening all around us!  Take for example this article about the Cleveland Clinic summarizing the top 10 medical innovations for 2016. Innovation can take many forms – including new equipment, processes, methods or technology and can involve anything from an incremental change to a revolutionary new way of doing things. It’s constantly changing our lives in many exciting ways – especially in our workplaces. Ohio’s business leaders know that innovation is essential for remaining competitive in the world today – and that includes keeping employees safe and healthy.

One way BWC is helping to foster innovativeness in the area of occupational injury/illness prevention is by sponsoring an annual Safety Innovations Competition.  The competition encourages employers to share innovations that have reduced safety, ergonomic and occupational health risks for employees.

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A panel of safety, ergonomics and industrial hygiene specialists from the BWC Division of Safety & Hygiene recently reviewed applications for the 2016 competition. The applications were scored on the following criteria: risk reduction, innovativeness, cost savings and potential impact.

We’re  pleased to announce the semi-finalists for the 2016 Safety Innovations Competition.

Ashland Inc. Dublin, Ohio Ergonomics Kaizen Process
AWP, Inc. Kent, Ohio Contractor Grade Bedslide
City of Cuyahoga Falls Cuyahoga Falls, Ohio Underground Cable Puller
Cooper Farms Feed & Animal Fort Recovery, Ohio Hog Loader
Midmark Corp Versailles, Ohio Automatic Guided Carts
Northcoast Recycling Specialist Wickliffe, Ohio Hydraulic Core Stripper
Nucor Steel Marion, Inc. Marion, Ohio R-Factor Rolling Process
Tri America Contractors, Inc. Wheelersburg, Ohio Pipe Fabrication Transporter Safety
Whitacre Greer Co. Alliance, Ohio Bin Area Material Feed Air Cannons

Congratulations to the semi-finalists! We’ll pay each of them a visit to further evaluate the innovations and then we’ll select five finalists that will attend the BWC Safety Congress and Expo March 9-11, 2016 at the Columbus Convention Center.

They’ll present their innovations to a panel of independent judges and awards will be presented during a ceremony on March 10.  Good luck to all the semi-finalists!

We want to hear about your innovations! Comment below and let us know how your business is being innovative to reduce risks.