By Jeff Baker, Program Administrator, BWC Special Investigations Department
One 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.
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