It’s that recordkeeping time of year

By Renee Peck, Program Administrator, Public Employment Risk Reduction Program

PERRP picturePublic Employers in Ohio have three different recordkeeping requirements and two of these requirements are due on February 1st.

Recordkeeping may seem like just a paperwork task but it is more than that. It’s also the minimum means by which employers can document and track the occurrence and severity of occupational injuries and illnesses.  Employers should review their injuries and illnesses as they occur as well as over time to identify patterns and trends that can be addressed to prevent future injuries and illnesses in their workplaces. Injury and Illness recordkeeping is key to a successful workplace safety and health program.

Under the Ohio Public Employment Risk Reduction Program (PERRP), public employers are required to complete the PERRP Recordkeeping Forms or equivalent for each calendar year:

  • PERRP Form 301P Injury and Illness Incident Form – for each case as it occurs
  • PERRP Form 300P Log of Work-Related Injuries and Illnesses – cases meeting the recordkeeping criteria must be entered on the log within six days of occurrence
  • PERRP Form 300AP Summary of Work-Related Injuries and Illnesses

These forms and instructions for completing them are available at: PERRP Recordkeeping Page

feb 1 due#1: Public Employers must submit their PERRP Form 300AP Summary to PERRP by February 1st of each calendar year. These can be submitted on our  PERRP 300AP On-Line Submission

#2: Public Employers must post the PERRP Form 300AP Summary in visible locations accessible to public employees from February 1st to April 30th

#3: Public Employers must keep the recordkeeping forms for five years following the year to which they pertain.

Public employers are also reminded that they must report any work-related fatality including those from heart attacks and motor vehicle accidents to PERRP within eight hours by calling 1-800-671-6858.

For questions and assistance, please contact PERRP at 1-800-671-6858.

The balance of providing quality care

By Dr. Stephen Woods, BWC Chief Medical Officer

DrStephenWoodsMany of our medical initiatives at BWC focus on musculoskeletal care. Opioid analgesics tend to be a significant part of musculoskeletal care. In addition to my administrative role as BWC’s CMO, I also practice in a musculoskeletal clinic and see a variety of patients with joint and back conditions.

Opioids are now considered to be more aggressive than conservative care. My approach is to begin with conservative treatment. The key is to balance the risk/benefit ratio for each patient individually. The vast majority of sprains and strains can be managed without opioids. However, customized care is important – if a patient is writhing in pain with a major fracture or spinal disc herniation or other major trauma, most would tend to treat those conditions acutely with opioids, and appropriately so. Later in care, when the patient’s symptoms are better controlled, the risk of opioids goes up as far as duration of prescribing and dosing. Longer duration and higher doses tend to be riskier. Again, the risk/benefit analysis is important to strike the right balance.

I know firsthand how tough that balancing act is with addressing short term pain management and the longer term risk of addiction. That risk is very real. Ohio has been active in establishing guidelines to help providers with their awareness of the latest tools in balancing the risk. This all started in 2011 with Governor Kasich’s Cabinet Opiate Action Team (GCOAT), where John Hanna, BWC’s pharmacy director, and I have held seats over the years. GCOAT first focused on emergency room guidelines, and then released guidelines that addressed chronic pain management and most recently released guidelines for acute prescribing.

I encourage my colleagues to review these guidelines as they work through the challenging balancing act of providing the right care at the right time for the right reason.

I also encourage you to learn more about pain management by attending BWC’s Medical & Health Symposium in March, which will cover clinical care, regulatory issues and ethics, among other areas. The symposium offers free educational opportunities for physicians, nurses and chiropractors, and will feature several leading national and state experts in the area of pain management. Bonnie K. Burman, Director of the Ohio Department of Aging and a leader of the GCOAT, will also speak. After hearing the speakers, we expect providers will find that compliance is easier than they think and that there are many tools that make the balancing act much less difficult.

I encourage my colleagues to join BWC in our pursuit of providing world class care to Ohio’s injured workers.

Fulton County man who claimed permanent disability sentenced for fraud

Robert Aleshire photoRobert Aleshire of Delta (Fulton County) was sentenced in Franklin County Common Pleas Court on Jan. 13 following an investigation by BWC that found he was working while receiving workers’ compensation benefits.

BWC’s Special Investigations Intelligence Unit identified that Aleshire was involved in a Public Utilities Commission of Ohio motor vehicle inspection as a commercial truck driver while he was collecting benefits. The investigation revealed that Aleshire was driving for Whitacre Logistics as an independent contractor under the name MoMo Trucking during the same time he was receiving permanent total disability for an injury that allegedly left him permanently unable to work.

The judge placed Aleshire on community control and basic supervision for five years.  As a condition of his community control, Aleshire was ordered to pay restitution of $8,903.44 and $2,000 for investigative costs, for a total of $10,903.44.  The judge also ordered him to have no new convictions. If Aleshire violates the terms of his community control, he will receive a prison term of 12 months.

Spotlight: Intelligence Unit – Predicting even more results

By Jeff Baker, Program Administrator, BWC Special Investigations Department

Fraud magnifiedOne of the many integral parts of the Special Investigations Department’s (SID) success is the heard-but-not-seen work done by our Intelligence Unit (IU). Its key functions are to provide support to BWC SID field agents through fraud detection and data analysis. For decades, the unit has generated significant results. In FY 2015, the IU detected 720 fraud allegations, resulting in the identification of $37,087,770 in savings. More recently, during the first six months of FY 2016, the unit detected 323 fraud allegations, resulting in the identification of $23,983,867 in savings.

Here is how the IU generates these results. The unit reviews BWC data about claimants, medical providers and employers. All data tells a story and some stories, unfortunately, include red flags that identify possible fraudulent activities. The knowledge, skills and experience of IU professionals enable them to detect possible fraud, even in massive data sets containing millions of data elements. Here, the unit employs data analysis, including predictive modeling, to proactively detect fraud.

The daily efforts of the IU uncover filed claims that are potentially false, benefit compensation to which claimants are not entitled, diversion of prescription drugs, medical billing fraud and failure of employers to pay workers’ compensation premiums.

The IU is made available to SID special agents who depend on the unit to deliver accurate information that supports ongoing field investigations conducted by Special Investigations Units (SIUs). During the first six months of FY 2016, the IU completed 1,499 data requests from the SIUs and assisted with analyses of case information.

These data analysis and detection efforts examine not only information provided to BWC, but also our external partners. The IU exchanges data with other state agencies to further detect fraud. For example, the unit was the source of the allegations that resulted in the recent criminal convictions of Latonia Almon and Michelle Green, the subjects of a Jan. 22, 2016 SID social media article, “Columbus home health aides sentenced for workers’ comp fraud.”In those cases, a crossmatch of data with the Ohio Department of Job and Family Services tipped the IU off to possible fraud.

Any law enforcement or other criminal investigative agency interested in partnering with the IU should contact Becky Donchess at (614) 466-8090 or Rebecca.D.1@bwc.state.oh.us.

For more information about the SID or its IU, see our Special Investigations Department Fiscal Year 2015 Annual Report.

Columbus home health aides sentenced for workers’ comp fraud

State agency information sharing program tips off investigators

COLUMBUS – Two Columbus women who were working as home health aides were sentenced for two separate cases of workers’ compensation fraud in Franklin County courtrooms last week. Latonia Almon and Michelle Green became the subjects of separate investigations after the Ohio Bureau of Workers’ Compensation (BWC) Special Investigations Department (SID) received data from the Ohio Department of Job and Family Services (ODJFS) indicating they were receiving wages while collecting workers’ comp benefits.

“While many cases come to our attention after we receive tips through our hotline and website, our Intelligence Unit utilizes analytical intelligence to root out otherwise undetected fraudulent activity,” said BWC Administrator/CEO Steve Buehrer. “Data sharing with ODJFS and other state agencies is another tool that helps proactively detect fraud among claimants, medical providers and employers.”

SID opened an investigation into Almon after receiving information from its Intelligence Unit that an ODJFS crossmatch of data indicated she was employed while receiving workers’ comp benefits. Investigators found Almon was working as a home health aide for Columbus Global Home Health during the entire period she was collecting disability for a workplace injury that occurred when she was working at the Scioto Juvenile Correctional Facility. During an interview, Almon admitted to “kinda” working and receiving payment for the services she provided. She also admitted she did not inform the BWC of this employment.

Latonia Almon was sentenced Jan. 15 after pleading guilty to one fifth-degree felony count of workers’ compensation fraud. Judge McIntosh sentenced her to 12 months of incarceration, suspended for three years of community control, and ordered her to pay $70,610.55 in restitution to BWC.

Michelle Green also became the subject of an investigation following an ODJFS data crossmatch that indicated she was earning wages while collecting benefits for a workplace injury. The investigation confirmed Green was employed with Good Hands Home Health Care Service in Columbus. Evidence obtained during the course of the investigation also showed that she intentionally misrepresented and withheld her employment in order to continue collecting benefits.

Green pleaded guilty to attempted workers’ compensation fraud, a first-degree misdemeanor, on Jan. 13. She was ordered to pay restitution in the amount of $1,899.99 and $100 in court costs.

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.

Safety Ingenuity

By Bernie Silkowski, Director of Technical Services and Support, Division of Safety & Hygiene

A couple of articles about innovation crossed my computer screen recently.  The first was a listing of the most innovative states based on R&D intensity, productivity, high-tech density, STEM concentration, science & engineering degree holders, and patent activity. Three days later was a story naming IBM as the most innovative company in America based solely on the number of patents it was granted last year.

In occupational safety we measure innovation differently—by the ingenuity that reduces the risk of injury and illness.  Most often this is done by applying the top tier of the hierarchy of controls: engineering the hazard out of the operation.  By redesigning the activity, operation, or equipment to completely eliminate the hazard—or reduce exposure or potential consequences—employees have less risk of injury.  Employers win, too, not only because their employees remain safe and healthy, but because these improvements often lead to increased productivity, better employee morale, and long-term cost savings.

safety innovations smallerOur Safety Innovations Competition is designed to recognize and reward employer ingenuity that results in these types of improvements.  We don’t consider patents, educational degrees, or whether the improvement is high-tech, low-tech, or no-tech.  What matters is risk reduction, cost savings, and potential application to other workplaces, industries, or operations.  The innovation itself could be something brand new or an off-the-shelf item or established process used in a new or creative way.

The Technical Advisor Unit of the Division of Safety and Hygiene recently made on-site visits to evaluate the semifinalist entries in this year’s competition.  As a result, we selected the following five finalists:

  • Ashland, Inc., of Dublin – “Ergonomics ‘Kaizen’ Events Significantly Reduce Risk” — In this innovation, Ashland applied the Kaizen process in a concentrated effort to identify ergonomic hazards and reduce the associated risks.
  • AWP, Inc., of Kent – “Contractor Grade Bedslide” – AWP established a program to install and manage use of bed slides on its pickup trucks to reduce the hazards associated with loading and unloading equipment for work zone traffic control.
  • City of Cuyahoga Falls – “Underground Cable Puller” – The city purchased specialized cable-pulling equipment that reduces employee hazard exposure when pulling cable through buried conduit.
  • Cooper Farms Feed and Animal of Fort Recovery – “Hog Loader” – This innovation reduces the safety and ergonomic risks to employees when loading hogs into trailers.
  • Midmark Corporation of Versailles – “Automated Guided Carts” – These automated carts replaced the manual movement of supplies and materials around a manufacturing facility.

These employers will be displaying information about their innovations at the Ohio Safety Congress & Expo on March 9 and 10.  Stop by the Safety Innovations Competition booth to speak with these innovators and learn more about what they did and how they did it.  Final judging will also take place at this time with the winners announced (and the checks handed out) on March 10.

It’s one thing to come up with an idea about how to reduce risk, but another to develop it thoroughly, implement it effectively, and make it work in the long run.  These employers have done all this and are reaping the benefits.

BWC investigations result in nine workers’ comp fraud convictions in December

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

“Several employers are featured in this month’s list of cases,” said Buehrer. “Protecting the wellbeing of their employees must be among an employer’s highest priorities. Ohio law does allow employees of businesses with lapsed policies to receive care if they are injured, however, BWC must recover these costs, meaning honest employers end up paying more in the long run.”

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

Robert Stauffer, dba Initial Designs/Seaway Enterprises, Toledo (Lucas County), appeared in a Lucas County courtroom on Dec. 30 after he failed to maintain workers’ compensation insurance coverage. A case was opened after SID’s Intelligence Unit detected Initial Designs, Inc. as operating without coverage. The Employer Fraud Team’s investigation found Stauffer’s business had been operating without workers’ compensation coverage since 2005.  Stauffer failed to report payroll and bring his business into compliance with the law during a time his business was operating. By concealing employee payroll, Stauffer was successful in concealing from the BWC the amount of his premiums due at the time he was operating the screen printing business. Stauffer was interviewed numerous times and given multiple opportunities to comply with Ohio Law and become compliant, which he failed to do. Stauffer was found eligible for the pre-trial diversion program.  All criminal proceedings were stayed and he was placed on supervision under the control of the Pre-Trial/Pre-Sentence department for a term of five years and to comply with all the provisions of the agreement.

John Flood, dba Walter Allen Corp., Grill and Skillet Restaurant, Columbus (Franklin County), pleaded guilty Dec. 30 to one first-degree misdemeanor count of workers’ compensation fraud for operating without coverage. BWC’s Employer Compliance Department referred Flood to SID due to his failure to maintain workers’ compensation coverage.  Flood’s coverage had been lapsed since 1994 and Flood failed to comply with attempts by the compliance department to bring the policy back into compliance with state law. Agents interviewed Flood and advised him to complete the payroll reports and file them with BWC.  He was also advised he could enter into a payment plan toward the past due premiums. When Flood failed to take these steps, agents subpoenaed payroll records and used them to bill the outstanding premiums. Flood’s plea is contingent on his continuing cooperation with the BWC to complete his repayment plan for unpaid premiums and non-compliant claims associated with his accounts. To date, Flood has filed all outstanding payroll reports but has not made any payments or payment arrangements. Sentencing is scheduled for February 25, 2016.

Lakhvir Sidhu, dba Liverpool Express Inc., Marion (Marion County) was convicted of a second-degree misdemeanor count of failure to comply with the law on Dec. 7 for allowing his workers’ compensation coverage to lapse. BWC’s Employer Compliance Department first attempted to work with Sidhu, owner of Liverpool Express, to bring his policy into compliance but investigators with the agency’s Special Investigations Department opened a fraud investigation after Sidhu did not cooperate. An audit on the business showed Sidhu was paying wages to employees he claimed were subcontractors. Investigators interviewed Sidhu on several occasions regarding the lapsed policy and the requirement to report wages for his employees. After meeting with agents, Sidhu paid his past due premiums, although he still claimed the workers were subcontractors. The investigation later revealed that Sidhu reported employee wages to the Ohio Department of Job and Family Services that totaled $266,000 more than the wages he reported to BWC for the same time period. The matter was then reviewed by the Marion City Law Directors office after Sidhu failed to enter into a payment plan and/or file the additional payroll information as requested by agents. Sidhu was ordered to pay restitution in amount of $3,724.77, and comply with BWC regulations and Ohio laws. Sidhu must also pay fines totaling $400 and serve 90 days of incarceration, suspended for two years community control.

Mike Watkins, New Lebanon (Montgomery County), pleaded guilty to one count workers’ compensation fraud, a first-degree misdemeanor on Dec. 16 for working while receiving benefits and falsifying earnings.   SID received an allegation that Mike Watkins may have returned to work for his business, Mike Watkins Sterling Homes, while he was collecting temporary total disability benefits and was supposed to be off work recovering from a workplace injury. The investigation found that Watkins did work for his business for two years while receiving compensation in violation of the program’s rules regarding returning to work. The investigation also uncovered false payroll checks were being written to Watkins by his wife Terri so that he could qualify for living maintenance wage loss benefits. Mike Watkins was sentenced to 30 days in jail, which was suspended for five years of community control. The restitution owed to BWC is $77,339.43 and $7,234.90 in investigative costs for a total of $84,574.33. Prior to the plea, Watkins’ attorney gave a check totaling $30,000 to the Attorney General to be paid toward the amount he owed. The conditions of community control are that he pay the remaining balance of $54,574.33, maintain employment and have no new arrests or convictions. Terri Watkins earlier pleaded guilty to one count complicity to commit workers’ compensation fraud, a first-degree misdemeanor, on June 15, 2015. The judge found her guilty and ordered her to repay restitution of $16,192.00 and $7,234.90 in investigative costs, for a total of $23,426.90. She provided a check to the court. As her restitution was paid in full, the judge ordered her to pay $30 in court costs and sentenced her to time served.

Mark Walker, Painesville (Lake County) entered a guilty plea on Dec. 17 to one count of workers’ Compensation fraud, a fifth-degree felony, for working while receiving benefits. SID began investigating after receiving an allegation from an anonymous source indicating Walker was running his own business called Mark’s Handyman Service, while receiving temporary total benefits. The investigation found that Walker did return to work at Mark’s Handyman Service, while concurrently collecting the benefits for a period of five years. The Industrial Commission of Ohio issued an order finding an overpayment of compensation in the amount of $74,954.16. Sentencing is scheduled for March 18, 2016.

Cindi Brown, dba Brown/Walter Commercial Cleaning, Kent (Portage County), pleaded no contest to one second-degree misdemeanor count of failure to comply on Dec. 7 for operating her business without workers’ compensation insurance coverage. Brown, owner of Brown/Walter Commercial Cleaning, became the subject of an investigation after SID received an allegation from a competing business that she was operating with employees without coverage. The complainant stated Brown was recently awarded a cleaning contract by Rubbermaid that was previously awarded to the source’s company.  Investigators conducted an interview and obtained documentation that confirmed a contract was awarded to Brown’s company to clean a Rubbermaid facility located in Mogadore. During interviews, Brown advised she cleaned houses by herself until she obtained the contract with Rubbermaid and required workers to assist with the job. She stated she was providing the workers 1099’s and considered them contractors. Investigators explained to Brown that the workers should be classified as employees and she would need to report the wages and pay the associated premiums. Brown committed to doing so, but failed to submit any outstanding payroll reports or pay any premiums. The case was referred to the Portage County Prosecutor’s office following Brown’s failure to submit outstanding payroll and pay premium. She was ordered to pay restitution and was also sentenced to 90 days of incarceration, which was suspended as long as she remains compliant with the law.

Ramzes Madison, Bedford (Cuyahoga County) was convicted of one fifth-degree felony count of workers’ compensation fraud on Dec. 10 for misleading BWC about his status as a college student. Ramzes Madison was eligible to receive benefits up to age 25 if enrolled at an accredited educational institution. SID began investigating after receiving an allegation that he was submitting proof of college enrollment to BWC in order to receive benefits but was not attending the classes.  SID obtained enrollment records from the University of Akron and Cuyahoga Community College and found that he had not attended classes he was registered for after submitting his schedule to the BWC.  Madison was sentenced to 20 days in jail in the Franklin County Correctional Center and five years of community control. Should sanctions of his community control be violated, Madison will face an additional 12 months in prison.  As a condition of his probation, Madison is required to pay $19,611.42 in restitution to BWC. His sister pleaded guilty to similar charges three weeks earlier.

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.