Northeast Ohio medical clinics at the center of $200,000 workers’ comp fraud indictment

Wooden gavel on library backgroundA Cleveland doctor and the former co-owner of his practice were indicted Oct. 26 on charges related to scamming the workers’ compensation system out of $216,000.

The 170-count indictment returned by a Cuyahoga County grand jury details the findings of an investigation into the actions of Dr. Stephen Bernie, 77, and Dianne Javier, 71, of The Medical Care Group, which has several clinics in Northeast Ohio.

Undercover agents found the pair was defrauding the Ohio Bureau of Workers’ Compensation by billing for procedures never performed and inflating the percentage of disability for injured workers, making them eligible for higher payments from the state. Dr. Bernie also wrote prescriptions for medications without examining or monitoring patients, and signed prescriptions for powerful opioids that were distributed while he was on vacation.

Kim Seltzer, a former employee of The Medical Care Group, already pleaded guilty last year to workers’ compensation fraud, tampering with records and drug trafficking. Seltzer is currently serving a 51-month sentence at the Mansfield Correctional Institution.

Bernie and Javier are scheduled to be arraigned in Cuyahoga County on Nov. 9. Their indictment followed a lengthy investigation by BWC and the Westshore Enforcement Bureau, a multi-jurisdictional specialty police force in Northeast Ohio.

Read more about this case in the Cleveland Plain Dealer.

Working in Workers’ Comp: understanding emerging issues affecting the industry

kendraBy Kendra DePaul, BWC Other States Coverage Manager

Last week, I attended the American Society of Workers Comp Professionals, Inc. (AMCOMP) fall meeting in New York City. AMCOMP is a not-for-profit corporation dedicated to professional excellence in workers’ compensation. Their main goal is to make sure those working in the workers’ compensation industry are well educated in both workers compensation basic concepts and aware of emerging issues affecting the industry.

kendra-mtgThe agenda included a variety of interesting speakers including insurance regulators from Maine and Florida, the New York State Inspector General, and presidents of several insurance companies. They touched on many relevant topics from workers’ comp fraud to how the on-demand economy such as UBER and Air BnB will challenge and change the insurance market. Recently, a new product, Lemonade, was launched in New York that is an indicator of the changes to come. Lemonade is a peer-to-peer insurance company where New Yorkers can buy home owners’ or renters’ insurance from an application, cutting out much of the bureaucracy of traditional insurance. In addition, money that is not spent on paying claims can be donated to a charity of the insured choice. This is definitely an intriguing concept and one that will speak to today’s generation, especially those who buy Toms shoes, or other products which give back for every dollar they take in. This will be a company to watch as they could drive changes in the way people purchase their insurance and what they expect out of companies in terms of being good corporate citizens.

Mark Walls and Kimberly George of the Out Front Ideas webinar series presented a session on issues to watch. They’ve become well known for exploring critical workers’ comp related issues that are not given enough attention in other industry outlets.

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These topics include the use of predictive analytics, how automation may change the workforce, and how we may need to change our claims model to respond to the changes in culture, medical advances and communication preferences of injured workers. Those working in the workers’ comp know that we need to continue to monitor the way of the world and change with it, so that we are not left behind. Mark and Kimberly did an excellent job of discussing the issues we need to take on heads-first to stay relevant and respond to our customers’ needs.

The need to recruit young talent continued to be a theme at this conference. In a previous blog post on the American Association of Compensation Insurance Funds (AASCIF) annual conference, I mention that the state funds across the country, like BWC, worry that they will not be able to replace the employees that are retiring in large numbers.

The keynote speaker was Sean Kevelighan, President  & CEO of the Insurance Information Institute. He spoke about how insurance is a very stable industry providing millions of well-paying jobs, but most people fall into insurance professions by chance and it is still unusual that college graduates specifically plan on entering the industry. I can say that this is true of me, although I was never planning to work in workers’ compensation, I have found it to be interesting, challenging and rewarding. And part of the goal of the Insurance Information Institute is to assist in the promotion of insurance industry professions as often there are great opportunities for young people to work in a variety of interesting roles.

wc-book-kendraWhich brings me to the reason I attended the AMCOMP Fall meeting. AMCOMP has an educational certification program designed to provide those in the industry with a broader view and understanding of the system as a whole. You may have seen me reading a large book on my lunch hour titled Workers’ Compensation –the first one hundred years.

The book covered a variety of topics starting with the history of why workers’ compensation was created and is followed by information on claims handling, medical cost containment, risk management, rate-making, and more. The purpose of the education is to provide a holistic picture of workers’ compensation and gain an understanding how each individual component of the system works together and affects one another.

After successfully completing a mid-term and a final exam, I traveled to the fall meeting to graduate from the program and receive my certification. Not only can I now put a WCP® after my name, more importantly, I have a better understanding of all the pieces and parts of workers’ compensation and can appreciate the importance of looking at workers’ compensation as a system instead of the individual responsibilities of our everyday job.

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I am thankful for the opportunity to complete this education as I believe we owe it to the employers we insure and the injured workers we care for to stay educated on the ever changing world of workers’ comp.

Eye protection: Are you in the 35-percent group?

By Greg Collins, Industrial Safety Administrator for the OSHA On-Site Consultation Program

Eye Injury Prevention Month is here, and the American Academy of Ophthalmology (AAO) has some information that you may find surprising.

Each year, about 2.4 million people suffer an eye injury. Many people think these injuries mostly happen in the workplace. However, about half of all eye injuries occur in the home.

The reason for this becomes clearer when you look at the statistics. According to the AAO, only about 35 percent of people working on projects at home wear protective eyewear. Luckily, this eyewear is readily available from safety suppliers, hardware stores and home-improvement stores. When choosing safety eyewear, remember to look for a marking required by the American National Standards Institute (ANSI). You should see a marking on the earpiece or lens that says ANSI Z87.1 or just Z87.1.

When you think about it, there are many hazardous exposures in the home, for example cleaning chemicals or flying particles. The AAO believes every home should have at least one pair of protective eyewear. However, when working around the house, it’s best to just keep other family members, especially children, away from these hazards.

Another good rule of thumb is if you are using a power tool, use eye protection. Make it a habit to wear safety glasses when working on your car, driving nails and doing most other physical work.

In the workplace, employers should also determine the type of protective eyewear their employees should be wearing. Employers seeking help in making this determination can contact one of our safety consultants for expert advice.

The loss of eyesight is a terrible tragedy for anyone. It’s even more tragic when you realize these losses are so easily preventable by simply wearing protective eyewear. Whether you’re at home or work, always remember to protect this precious asset.

Additional resources
AAO – Preventing eye injuries
Indiana University – Eye safety reminders

Spotlight: Eric Brown – From college extern to special agent in charge of two elite teams

By Jeff Baker, Program Administrator, BWC Special Investigations Department

eric-brown-picMembers of the Special Investigations Department (SID) congratulate Eric Brown. On Oct. 17, 2016, Eric was promoted to special agent in charge (SAC) of the intelligence unit (IU) and the safety violations investigation unit (SVIU).

Eric started his career with BWC in September 2007 as a college extern with SID Administration’s fraud hotline team. Well-deserved promotions soon followed. Since March 2008, Eric has served the department as a college intern with IU, and full time as a criminal investigator and special agent with the health care provider team (HCPT).

intelligence-unit-textWhile working with SID, Eric  completed two degrees. He earned a Bachelor of Arts from The Ohio State University, with a major in Political Science and a minor in Sociology/Criminology, and a Master of Business Administration  from the University of Cincinnati.

Throughout his career, applying insight, initiative and perseverance, Eric  has significantly contributed to the department’s success. For example, he:

  • Initiated and developed the SID Case Management application;
  • Initiated and co-administered the SID Social Media campaign;
  • Co-initiated the SID 2014 Electronic Surveillance Equipment Symposium;
  • Co-initiated, staffed and co-executed the SID Technical Operations Group.

safety-violationsEric was one of four special agents on Sept. 14 to receive a 2016 Innovator award. He and his co-recipients met criteria including: developed trend-setting initiatives, created an original idea or uniquely adapted an existing program, process or concept, which resulted in a long term benefit to the department; developed new work methods that reduced waste or stretched resources; and provided creative suggestions that saved the department time or money.

Certainly, for all of the above reasons, you can see why we thank and congratulate SAC Brown! We look forward to his continued leadership and success in our department.

For more information about IU, see our Jan.22 article, Spotlight: Intelligence Unit — Predicting even more results, here. For more information about SVIU, see our 2011 article, SVIU: Investigating suspected violations of specific safety requirements, here, or our 2013 article, Completing the circle of coverage: A look at our Safety Violations Investigation Unit, here. For more information about the SID see our most recent annual report here.

Ergonomics Month spotlight: Lima company not just going through the (repetitive) motions

By Melissa Vince, BWC Public Relations Manager

Here’s a recipe for workplace injury. Just start with a 17-step manufacturing process that produces 50 parts per hour. Mix in at least 7,200 hand motions per employee over each eight-hour shift. Repeat the process day in and day out and the end result is quite unappetizing: an elevated risk of Carpal Tunnel Syndrome and Tendonitis.

That was the dilemma Randall Bearings, Inc. faced as the company went about its work to manufacture precision machined products, primarily bronze material, for its clients in a number of industries around the world. So the Lima company introduced a new ingredient that protects its employees from injury by reducing repetitive motion.

The company purchased this robotic arm that grasps parts and maneuvers them throughout the 17-step process involved in the manufacturing process.

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The new addition is reducing the risk of injury to employees.

“We are excited about the possibilities this provides for a safer work environment for our associates,” said Mary Dupes, Human Resources Director for Randall Bearings.

Hear from Dupes and BWC Administrator/CEO Sarah Morrison in this WLIO–TV Lima story.

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Also, National Ergonomics Month is a great time to consider how you can improve ergonomics in your workplace. Mike Lampl, BWC’s Ergonomics Technical Advisor, offers some insight into ergonomics and tips for avoiding injuries in his latest blog here.

Making ergonomic improvements helps prevent or eliminate injuries

By Mike Lampl, Ergonomics Technical Advisor

Did you know each October is National Ergonomics Month? The Human Factors and Ergonomics Society launched it in 2003 to help raise awareness about this important workplace safety topic each year.

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So, what exactly is ergonomics?

According to the International Ergonomics Association, ergonomics (or human factors) is a scientific discipline concerned with understanding interactions among humans and other elements of a system.

Ergonomics professionals apply theory, principles, data and other methods to workplace design to optimize the well-being of workers and overall system performance.

In the workplace, ergonomics is balancing job demands with the capabilities of our greatest assets – our workers.

Why is it important?

 The statistics below from Ohio in 2014* re-enforce the need for ergonomics in the workplace.

In that year:

  • The most-frequent nature of injury was sprains, strains, tears (41.9 percent);
  • The most-frequently injured body part was the back (17.3 percent);
  • The most-frequent cause of injury was overexertion (33.5 percent).

Making ergonomic improvements helps prevent or eliminate injuries. This includes positioning work optimally or using appropriate tools or equipment to assist employees.

Ergonomics can also positively impact quality, productivity, workforce turnover, absenteeism and morale.

How to identify areas for improvement

Here are some tips to help identify areas for ergonomic improvement in your workplace. Observe your work areas and write down your observations.

Pay attention to:

  • Homemade adaptations to accommodate personal preferences and needs;
  • Job tasks that require forceful exertions (e.g., heavy lifting, pushing and pulling);
  • Job tasks that require awkward postures (e.g., bent wrists, bent backs, etc.);
  • Job tasks that require repetitive motions (e.g., working at a fast pace);
  • Information on injuries that may relate to ergonomic conditions.

Ergonomics is not an overnight proposition. It is a continuous improvement process that minimizes or eliminates workplace risk factors.

What are workplace risk factors?

They are:

  • Forceful exertions;
  • Repetitive motions;
  • Awkward postures;
  • Mechanical pressure on soft tissue;
  • Inadequate rest.

Many great organizations in Ohio are working with their employees to implement ergonomic improvements. Visit our ergonomics consulting page to find out how we can assist your business’ ergonomics efforts.

*Source: BWC Division of Safety & Hygiene research and statistics department and the Bureau of Labor Statistics

Spotlight: Dan Fodor – From college intern to assistant director, special investigations central operations

By Jeff Baker, Program Administrator, BWC Special Investigations Department

fodor-picMembers of the Special Investigations Department (SID) congratulate Dan Fodor. In June 2016, Dan (shown presenting at the 2016 SID in-service meetig on Sept. 14) was promoted to assistant director, central operations.

Assistant director (AD) Fodor started his career with BWC in June 1991 as a college intern with the internal audit department. During this time, Dan completed his degree and became a certified public accountant. He earned a bachelor’s in accounting from The Ohio State University. In December 1991, Dan commenced his initial full-time position with BWC as a  financial/operational auditor and consultant. By the autumn of 1996, he had earned the title of audit senior and commenced his stellar management career.

sid-text-1-1In November 1999, Dan joined SID as the special agent in charge of the intelligence unit (IU), providing essential support to special investigations unit field agents through fraud detection and data analysis. Given his knowledge, skills and successes with IU, Dan accepted, in June 2014, the additional responsibility of supervising the safety violations investigation unit (SVIU), a team devoted to investigating alleged safety requirement violations that have resulted in a workplace injury, illness or death.

Throughout his career, applying uncanny intuition, uncommon sense and diligence, AD Fodor has energetically prompted our agency’s success and earned the respect of his SID colleagues. A few examples from his 25-year career, include:

  • Guided and directed the department’s effective use of the agency’s data warehouse;
  • Developed and executed SID performance measurements and management reporting;
  • Effectively partnered with other BWC operational areas and external entities;
  • Co-administered the SID strategic planning process for several five-year plans;
  • Since 2000, IU has detected 18,950 fraud allegations, resulting in the identification of $473 million in savings; and
  • Between 2000 and June 30, 2016, IU’s fraud allegations resulted in 948 criminal referrals and 480 convictions.

These performance results demonstrate, in part, why Dan is highly qualified to direct our SID central operations. Certainly, for all of the above reasons, you can see why we thank and congratulate AD Fodor! We look forward to his continued guidance, direction, leadership and success in our department.

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For more information about IU, see our Jan.22 article, Spotlight: Intelligence unit — Predicting even more results, here. For more information about SVIU, see our 2011 article, SVIU: Investigating suspected violations of specific safety requirements, here, or our 2013 article, Completing the circle of coverage: A look at our safety violations investigation unit, here. For more information about the SID, see our most recent annual report here.