Columbus pest control business owner guilty of workers’ comp fraud

wallace photoDavid Wallace of Columbus (Franklin County) appeared in court this week and was ordered to repay the Ohio Bureau of Workers’ Compensation (BWC) $10,000 in restitution for running a pest control company while receiving benefits for a workplace injury.

BWC’s Special Investigations Department initiated an investigation after receiving an allegation that Wallace was running a pest control business while receiving disability benefits. The investigation found evidence proving Wallace was the owner/operator of Discount Pest Control, and was actively working as the sole employee while intentionally concealing his activities from BWC in order to continue receiving benefits.

Wallace appeared in the Franklin County Court of Common Pleas on Feb. 23 and pleaded no contest to a first-degree misdemeanor count of workers’ compensation fraud. Judge Holbrook  found him guilty and in addition to ordering $10,000 in restitution, sentenced Wallace to 180 days in jail, suspended for 60 months of Community Control.

A forged relationship: The victimization of a claimant

By Jeff Baker, Program Administrator, BWC Special Investigations Department

In a September 23, 2011 blog, “Dishonored memories: Deceased claimants with dishonest relatives,” we described how dishonest relatives may express their grief over the death of a loved one quite differently than law-abiding citizens. We noted that criminals may choose to dishonor the memory of deceased relatives by committing workers’ compensation fraud in the personal, confidential records of a deceased claimant.

These criminals falsely report to us that their deceased relatives continue to live. They pretend to be the claimants themselves, sometimes even adopting the voice of an opposite gender’s voice and/or an elderly person in an attempt to deceive us. These charlatans scheme to intercept any check addressed to a deceased claimant, forge their signature, and pretend to be the claimant (aka “uttering”) in order to cash the check to which they know they are not entitled. In situations where lost-time benefits are paid electronically, family members may inappropriately access and use monies to which they are not entitled, by concealing the claimant’s death.

Of course, such deceptive acts, born out of greed, are not limited to the relatives of our claimants. Forgery and uttering crimes are also committed by non-relatives, such as neighbors or other acquaintances. And some claimants are victimized before death, such as when the criminal uses a power of attorney to grab benefits intended for a claimant who has been deceived, often while incapacitated or otherwise dependent.

A Case In Point
blog pic 1Consuelo “Connie” Griffin and David Lusk (Cincinnati, Hamilton County) both pleaded guilty Jan. 14 in the Hamilton County Court of Common Pleas to counts of theft after they were discovered cashing BWC benefit checks for a claimant who had died.

SID opened an investigation after receiving an allegation from BWC’s claims department, which was unable to contact a claimant receiving permanent total disability for a workplace injury. The claims department reported that claimant’s phone was disconnected.

blog pic 2The investigation found that while the claimant passed away in June 2014, the BWC checks that were mailed to his home continued to be cashed. Griffin and Lusk lived in the same apartment complex as the deceased and when he was hospitalized, Griffin signed a power of attorney document giving her control over his finances. Griffin also had the claimant’s mail forwarded to her address and the pair moved into his apartment when he was hospitalized. Griffin confessed to signing Harrell’s name on the checks and cashing them. Griffin also took money out of his bank account while he was ill and wrote checks from his account to herself for cash. His account was soon closed because Griffin and Lusk spent all the money and failed to pay any of his nursing home expenses.

Lusk pleaded guilty to count of theft and one count of theft from the elderly, both fifth-degree felonies. Griffin also pleaded guilty to two counts of theft, both fifth-degree felonies. The court sentenced them to 10 months in jail, suspended, and ordered them to repay restitution of $5,072.62. They also received three years of probation.

For other case examples or more information about the SID, see our Special Investigations Department Fiscal Year 2015 Annual Report.

To report suspected fraud via a fraud referral form click here or call the BWC fraud hotline at 1-800-644-6292.

Cincinnati home health aide repays $12K for workers’ comp fraud

Talesha picA Cincinnati (Hamilton County) woman has repaid more than $12,000 in workers’ comp benefits she received fraudulently. Talesha Sherman was sentenced in the Franklin County Court of Common Pleas on Feb. 11.

The BWC Special Investigations Department began investigating after identifying that Sherman may have been earning wages while simultaneously collecting disability for a workplace injury.  The investigation revealed that Sherman had returned to work as a home health aide while on temporary total disability.

Sherman pleaded guilty to one first-degree misdemeanor count of workers’ compensation fraud and paid restitution totaling $12,981.40 prior to her plea. The judge also sentenced her to 90 days in jail, suspended for one year of community control.

The value of tracking safety in the workplace

By Samson Agboola, Research Administrator 1

The face of today’s workplace is rapidly changing. These changes present employers and occupational safety professionals alike with opportunities to align safety programs with current needs of the workplace. An example is the significant influx of young workers into the workplace. This shift is reflected in the changing workforce cultures to align with attitudes, beliefs and goals of young workers. Simply put, there are more young workers in the workforce today than ever before and statistics show that this trend is likely to continue. This change, as well as other significant changes, requires that employers stay current with safety needs in the workplace by investing in efforts to track and identify trends in workplace injuries and illness.

What do the stats say?
A good way to illustrate the value of tracking workplace safety is to take a quick look at currently available statistics. Did you know that workers between ages 16 and 19 have the highest rate by age group of severe injuries requiring one or more days away from work (DAFW) in Ohio’s private industries in 2014? The reported rate of 129.8 cases per 10,000 full time workers was almost double that of three years earlier. Another millennial age group (20-24) had the third highest rate in Ohio private industry. National statistics also indicates that this age group (16-19) had the second highest rate at 104.8. Did you also know that workers with less than three months on the job accounted for a higher proportion of cases requiring days away from work in 2014 than in previous years? These statistics are according to the Bureau of Labor Statistics (BLS) through the Survey of Occupational Injuries and Illnesses (SOII) program. This information emphasizes the importance of tracking safety in our individual workplaces and how aggregation of such information can be useful in identifying trends in workplace injuries and illnesses at both state and national level.

Simple ways to invest in prevention
A good first step towards staying informed of the types of hazards that exist in our workplaces is to ensure good recordkeeping of workplace injuries. This is the basis for a reliable injury and illness surveillance system. To stay current with workplace safety for all workers, young and old, there is a need to track safety through diligent recordkeeping and reporting; and regular review of safety measures. Information obtained from these processes is useful in ensuring that prevention and safety interventions continue to be responsive to current safety needs of the workplace. It is essential to keep in mind that measures designed to prevent (and reduce) injuries in the workplace are only as good as the information from which they are developed.

BWC commitment to tracking workplace safety
As part of efforts to prevent workplace injuries in Ohio to our millennials and to all employees, the Ohio Bureau of Workers’ Compensation (BWC) has committed to a cooperative agreement with the BLS to gather information on workplace injuries and illnesses through the SOII program. The program provides annual rates, numbers and case characteristics information of workplace injuries and illnesses at both state and national levels. This information is gathered through confidential data collection from a random sample of employers. Establishments included in the survey are required to provide data from the Occupational Safety and Health Administration (OSHA) recordkeeping logs and summaries (OSHA 300A or equivalent documents) and detailed case characteristics information on cases with one or more days away from work (OSHA 301 or its equivalent). This information is useful in identifying both general workplace hazards and ones that are specific to several criteria including industry and occupation. It also serves as a tool with which establishments can compare their injury rates with others in the same industry at both state and national level.

Conclusion
Safety needs in the workplace continue to evolve due to the nature of today’s changing work environments. One such change is the increasing population of young workers in the workplace. A simple way employers can stay current in efforts to ensure safety in the workplace is to practice good recordkeeping and reporting. One of the ways BWC continues to demonstrate its commitment to workplace safety is through administration of SOII in Ohio. The SOII program serves as the most robust source of information on non-fatal workplace injuries and illness in the nation. Through good recordkeeping and participation in this program employers contribute to identifying trends in injuries and illnesses in workplaces both in the state and the nation.

BWC remains a committed and reliable ally for all employers in Ohio towards preventing workplace injuries and improving safety in Ohio’s workplaces. For more information on our safety services please visit www.bwc.ohio.gov.

You can also find more information and statistics on workplace injuries and illnesses in Ohio from the Survey of Occupational Injuries and Illnesses –on our website.

Have you heard about the Ohio Safety Congress? Are you attending? If you don’t currently have plans to, I strongly encourage you to consider attending. Ohio Safety Congress & Expo is the largest and longest-running occupational safety, health and workers’ compensation event in Ohio. The educational sessions offer useful information on techniques for injury and illness prevention, rehabilitation, return-to-work and cost savings. The Expo Marketplace is represented by numerous vendors with the latest services, industrial supplies, safety equipment and gear.

If you found value in this blog post, then you should plan to attend the two sessions I am co-presenting. One offers general information on the SOII program and the second session offers information on statistics of injuries in healthcare industry in Ohio. Click here for more information on Safety Congress.

Cleveland man repays $42K, pleads guilty to workers’ comp fraud

A Cleveland (Cuyahoga County) man repaid more than $42,000 to the Ohio Bureau of Workers’ Compensation (BWC) before entering a guilty plea to workers’ compensation fraud earlier this month.

BWC’s Special Investigations Department (SID) opened an investigation into David Milcinovic after a cross-match with Ohio Department of Job and Family Services indicated the Polish National Alliance reported wages for him during a period of time he was receiving workers’ compensation benefits. The investigation confirmed Milcinovic continued employment as the Vice President of Union of Poles and Board Member of the Polish National Association while he was receiving temporary total disability benefits for a workplace injury.

Milcinovic pleaded guilty to a first-degree misdemeanor count of workers’ compensation fraud on Feb. 9 in the Franklin County Municipal Court. Milcinovic had already prepaid the entire restitution in the amount of $42,911.73 to the Bureau of Workers’ Compensation. He was ordered to pay a fine of $250, plus court costs.

Columbus woman ran cleaning business while on workers’ comp

booking photo OliviaOlivia Robinson of Columbus (Franklin County) has been ordered to repay the Ohio Bureau of Workers’ Compensation (BWC) more than $26,000 in workers’ compensation benefits. She received the benefits fraudulently while working at a banquet center and concurrently operating her own cleaning business.

BWC’s Special Investigations Department (SID) received an allegation that Robinson owned a cleaning company and was cleaning offices and residential homes while she was receiving workers’ comp for a workplace injury. The investigation confirmed she was owner of All Points Cleaning and had been cleaning offices for regular and repeat customers over a period of several years. Investigators also found Robinson was concurrently employed with Bridgewater Banquet Center, and that she intentionally misrepresented and withheld her employment with both companies in order to continue collecting BWC benefits.

Robinson pleaded guilty to a first-degree felony count of attempted workers’ compensation fraud on Feb. 16 in the Franklin County Municipal Court. She was ordered to pay $26,737.47 in restitution to BWC. She was also sentenced to eight months in the Ohio Department of Rehabilitation and Correction, suspended on the condition that she successfully completes five years of community control.

INDUSTRY SPECIFIC SAFETY PROGRAM – A great return on investment

By Bruce Loughner, BWC Safety Technical Advisor

As the BWC safety subject matter expert for the Industry Specific Safety Program (ISSP), I have seen employers continuously improve the safety culture of their organization by developing strategies to prevent injuries and illness by working with BWC safety staff. Public and private employers that successfully completed the program requirements realized that continuing to improve the safety culture of their organization can yield great returns on investments.  Since the program began in 2012 until 2014, BWC awarded $10.4 million in rebates to participants.

The flexibility of the program is an effective way to tailor your safety prevention to your company’s specific industry. It focuses on doing safety assessments, providing employers with year-round training and education opportunities and provides tailored on-site consultations.

Sometimes we cannot see the forest for the trees, and having someone outside of the organization provide a fresh look at safety systems and work processes may be a refreshing opportunity to see things differently. Imagine the benefits of having a safety professional help you identify potential hazards to prevent injuries and save the company money. That’s exactly what thousands of companies in Ohio have achieved since 2012 when ISSP started. I have seen companies’ cultures really improve when they have one of our consultants help them set up a safety team with the emphasis of looking at behaviors rather than physical hazards.

We have three different disciplines of consultants available, a benefit to any employer that pays workers’ compensation premiums.

  • Industry and construction safety consultants look at your operation as a whole and help you access safety needs.
  • An ergonomic team looks at cumulative trauma disorders that could cause musculoskeletal injuries and assists in developing risk controls.
  • Our industrial hygienists look for the unseen hazards within the work area by evaluating noise, air contaminates, chemical exposures, and other environmental hazards.

You can schedule one of these consultants on our website.

Training is another important aspect in the ISSP. BWC has more than 80 educational classes that are industry specific.  Loss prevention activities for program credit by our staff can include most types of safety training like hazard communication, confined space, and OSHA 10 hour and accident analysis, just to name a few.  Employers can enhance their current safety training by attending one of our professional safety classes.

Another way employers can get training for their employees is to send them to the Ohio Safety Congress. This multi-day safety event is the largest in the state usually drawing more than 6,000 participants. Networking, attending exciting seminars and workshops make this a perfect opportunity to get current safety information in your specific industry.

Register now

Participating in ISSP will give an employer a better understanding of the various hazards in the work environment; our consultants can make recommendations for prevention efforts that drive self-sufficient safety systems and resolve the root of the issues. Focusing on preventing injuries and illness is the key to safety. The ISSP focuses employers to look for opportunities to continuously improve on the safety and health of the company’s most valuable resource, its employees.

BWC investigations result in four workers’ comp fraud convictions in January

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer announced today that four individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in January 2016. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

“A recent case in which two individuals stole the identity of a deceased claimant shows that some people will go to great lengths to scam the system,” said Buehrer. “They are a clear reminder why we continue our efforts to protect the dollars employers pay to support Ohio’s injured workers in their time of need.”

 The following are cases that resulted in guilty pleas or convictions during January:

Consuelo “Connie” Griffin and David Lusk (Cincinnati, Hamilton County) both pleaded guilty Jan. 14 in the Hamilton County Court of Common Pleas to counts of theft after they were discovered cashing BWC benefit checks for an injured worker who had died. SID opened an investigation after receiving an allegation from BWC’s claims department, which was unable to contact an injured worker receiving permanent total disability for a workplace injury. The claims department reported that worker’s phone was disconnected. The investigation found that while the injured worker passed away in June 2014, the BWC checks that were mailed to his home continued to be cashed. Griffin and Lusk lived in the same apartment complex as the deceased and when he was hospitalized, Griffin signed a power of attorney document giving her control over his finances. Griffin also had the injured worker’s mail forwarded to her address and the pair moved into his apartment when he was hospitalized. Griffin confessed to signing Harrell’s name on the checks and cashing them. Griffin also took money out of his bank account while he was ill and wrote checks from his account to herself for cash. His account was soon closed because Griffin and Lusk spent all the money and failed to pay any of his nursing home expenses. Lusk pleaded guilty to count of theft and one count of theft from the elderly, both fifth-degree felonies. Griffin also pleaded guilty to two counts of theft, both fifth-degree felonies. The court sentenced them to 10 months in jail, suspended, and ordered them to repay restitution of $5,072.62. They also received three years of probation.

Michelle Green (Columbus, Franklin County) pleaded guilty Jan. 13 in the Franklin County Court of Common Pleas to attempted workers’ compensation fraud, a first degree misdemeanor, for working while receiving benefits. SID’s Intelligence Unit received data from the Ohio Department of Job and Family Services (ODJFS) that indicated Green had received wages while receiving BWC benefits. 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. She was ordered to pay restitution in the amount of $1,899.99 and $100 in court costs.

Randy Gates, dba Gator’s Auto Repair and Towing (Caledonia, Marion County) pleaded no contest on Jan. 21 in the Marion Municipal Court to a second-degree misdemeanor count of failure to comply for operating his business without workers’ compensation insurance coverage. BWC’s Employer Fraud Team (EFT) identified that Gates continued to operate his business, Gator’s Auto Repair and Towing, without valid BWC coverage after two previous investigations for the same issue. He had been previously referred for prosecution in 2005 for failure to comply for operating a business without the required BWC coverage. The EFT attempted to work with this employer to become compliant with state law but Gates refused to submit completed outstanding payroll reports in an effort to calculate accurate premiums owed. The employer also failed to attempt to pay his balance with the BWC. On January 21, 2016, Gates entered a plea of no contest to failure to comply, a second-degree misdemeanor. Gates received a 180-day jail sentence which was suspended, and was ordered to pay fines and court costs. Gates currently has an estimated balance due of approximately $36,000 and is working with the BWC to submit outstanding payroll reports for calculation of exact premium due.

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.

BWC safety consultant’s career inspired by family

By Michelle Gatchell, External Communications

SC pic for blogMeet Ohio BWC Industrial Safety Consultant Specialist, Colleen Bolha from our Youngstown Service Office. She assists employers in Southern Mahoning County and Columbiana County with all their safety needs. Ohio employers receive safety consultation services from BWC free of charge as a benefit of their workers’ compensation insurance coverage. Last year Colleen consulted with 189 employers on a variety of safety issues. I had an opportunity to talk to Colleen, and find out a little about what she does and why.

What type of training or education do you have for this job?

I have my Associate Safety Professional (ASP) certification from the Board of Certified Safety Professionals, Bachelor of Science degree from Youngstown State University and I’m currently pursuing a Master’s degree in Occupational Safety & Health from Columbia Southern University.

Why did you want to be an Industrial Safety Consultant Specialist?

Through prior experience working as a claims specialist here at the bureau, I saw the devastating impact workplace injuries can have on injured workers as well as employers. I thought it was a great opportunity to work at the other end of the spectrum with employers to help provide a safe workplace, hopefully avoiding having to work with a claims specialist by preventing injuries.

Also, my father, a retired Youngstown firefighter, was seriously injured years ago when he fell through a staircase while fighting a fire and I had an uncle who lost an arm in an industrial accident.

Firefighter pic for blog

 

 

 

 

 

Seeing them go through healing and just wanting to be back at work added into my motivation for this position to do it to the best of my ability.

Working as a claims specialist, we came across people whom because of their injury could never go back to work, and hearing what it was doing to them and their families, I know how important my job is to families and employees.

Do you remember doing your first consult with a company? What advice did you end up giving them?

I do remember when I first began as a safety consultant. It was in the midst of the Globally Harmonized System (GHS) update to the Hazard Communication Standard and many employers requested assistance with training in this area. Whether they just needed training material or requested on-site training with their employees, I ensured they were ready to meet the changes to the standards by the OSHA deadlines.

What do you find most companies need consulting on?

I don’t think there is any one thing as this varies so much depending on the current needs of the employer.  Consulting with the employers opens up opportunities to see what’s happening at their facility and assisting in areas that might be in need they didn’t even consider.  It’s always a good thing to have another set of eyes conducting safety assessments of the workplace or to review written programs.  It’s also great to have the opportunity to consult with employers and make them aware, if they weren’t already, of all the services that are available to them.  Maybe they were aware of the industrial hygiene services but unaware of the safety grant money or the Safety and Hygiene Library resources.  Just being in contact with our customers is important.

Are there certain things all companies could improve that are simple to fix?

The most important thing I think is to include everyone. To develop a true safety culture, it’s very important for everyone from top to bottom to be involved in the safety process, not just a few people. Simply having everyone take responsibility for safety encourages participation and buy-in to the safety program. Doing this creates a great foundation for any safety program.

What do you find rewarding about your job?

Honestly, there are many rewarding things about this job.  It’s most rewarding to me, when after working with an employer, to perhaps assist in identifying and correcting an issue or to do some type of training, that I’m asked to return.  We work closely with employers and are treated like a welcomed part of that company.

It’s also rewarding to be a part of BWC, where we have a spectacular group of professionals that not only support our customer’s needs, but each other’s needs as well.  I’m really proud to be a part of the Youngstown team.

Do you find that you take the things you know as a safety consultant to your friends and family, and what advice do you usually share with them?

kids picThis is hard not to do, as it’s natural for everyone to want to protect the people you care about and to keep them safe.  I think the most I do is with my young nieces, and that’s probably in fire prevention.

We review our fire emergency plan and meeting place often.  I do stress to them why it’s so important to account for their safety in the case of an emergency. They are interested in what I’m doing and ask questions about what I’ve done each day. There probably aren’t many girls their ages (11 & 12) that are as familiar with OSHA standards as they are!

Is there a consult job that sticks with you because you really made a difference? What was it? And how did you improve safety in their world?

There is not one consult job that sticks with me; however, there is a group of them.  This group would be the group of employers that I have been fortunate enough to have worked with helping them to prepare to apply for safety intervention grants.  Working toward this goal with the employer involves some time and effort from both sides so it’s a good feeling of accomplishment when this comes to fruition.  Being involved in the entire process from start to finish of obtaining safety grant money for an employer is a memorable one because everybody benefits. The employer gets money to help pay for the safety intervention, and the employees get a safer work process when it is put into place.

I hope you enjoyed meeting one of our safety specialists here at BWC. Colleen is just one of more than 100 consultants around Ohio ready to help employers make their workplaces safer. You can request a consultant in your area by calling 1-866-569-7805 or visiting bwc.ohio.gov.

Register now: Free continuing education opportunities!

Dr. Brian Wilson, SE Regional Director, Provider Engagement

Among being involved in many initiatives here at BWC, I am honored to be assisting as a committee member on our 2016 Ohio Workers Compensation Medical and Health Symposium, March 10 -11. This year’s slate of speakers offers a wide array of topics from various experts in the field of pain management and neuromusculoskeletal care.

Free continuing education
As a fellow health-care professional, I am excited BWC is offering these sessions to my colleagues which will help inform them about the latest trends/treatments relative to practice and patient care, not to mention the fact that these sessions qualify for free continuing education credit for physicians, chiropractors, nurses and vocational rehabilitation providers. For your review, here is the symposium brochure.

Some of the topics I have a particular interest in are Concussion/Post-Concussion Syndrome, Knee Injuries, Multi-Disciplinary Approach to Pain Management, and Non-Opioid Treatment Options – just to name a few.  In today’s health-care paradigm, providers are collaborating more and more and utilizing a team approach toward patient care.  This proves most important when dealing with concussions and the myriad of approaches to manage those who suffer with this type of injury.

Also, the session dealing with knee injuries particularly resonates well here in Ohio since BWC unveiled its new pilot study, the Enhanced Care Program, in northeastern Ohio.  This program is designed to provide better coordinated care among our provider community for the injured worker. Finally, our intent is to give our attendees options in treatment of certain cases where they can utilize less opiate usage and more alternative methods with potentially the same outcome, just less invasive.

Case-by-case
We hope this symposium will help assist providers in addressing their patients’ needs by understanding various approaches from least invasive to most invasive measures while striving to provide the utmost evidence-based healthcare on a case-by-case basis.

Invitation
I hope you will consider joining us this year, so we can continue to build and expand this symposium in the future.