Investigative unit nets 9 fraud convictions in October

One worker falls off tractor he took to bar, claims work injury

A nurse who stole a dead patient’s electronic benefits card and a Southwest Ohio man who injured himself after using his employer’s tractor to go to a bar are among nine Ohioans convicted of workers’ compensation fraud in October, the Ohio Bureau of Workers’ Compensation (BWC) reported Wednesday.

“As guardians of the State Insurance Fund, we won’t tolerate the theft or misuse of injured workers’ benefits,” said BWC Administrator/CEO Sarah Morrison. “The misappropriation of those funds raises the costs of workers’ compensation coverage for everyone.”

Toledo nurse Damita Frazier pleaded guilty Oct. 4 to petty theft, forgery and workers’ compensation fraud, all fifth-degree felonies, after BWC’s Special Investigations Department (SID)  found she had taken a deceased patient’s BWC benefits card and used it to purchase household items and food. She also gave the card to her son, Shaquille Malone, who used it to purchase food, jewelry, auto parts and gas.

Under a diversion agreement with the Lucas County Court of Common Pleas, Frazier must serve two years probation, provide 50 hours of community service and pay $2,122 in restitution to BWC.

Malone pleaded guilty to a first-degree misdemeanor count of petty theft and agreed to pay $647 in restitution to BWC. He is scheduled to be sentenced on Dec. 13.

In Brown County in Southwest Ohio, worker Chris Owen of Georgetown filed a claim for workers’ compensation after slipping and falling from a company tractor. Owen’s employer was suspicious and reported him to BWC. Investigators determined Owen used the tractor after work hours without the owner’s permission to travel to a local bar owned by his sister. The injury occurred when he returned the tractor to his employer.

Owen pleaded no contest in Brown County Municipal Court and was found guilty of workers’ compensation fraud, a first-degree misdemeanor. A judge sentenced Owen to 180 days in jail, suspended, and one year of probation. He ordered Owen to pay BWC $2,366 in restitution.

As of Oct. 31, SID had landed 91 fraud convictions for the calendar year. Other convictions in October, starting with the most recent, include:

Tsige Kahsai, dba Boss Market, Columbus, Ohio (Franklin County) – Failure to Comply
Kahsai pleaded no contest Oct. 17 and was found guilty of one count of failure to comply, a second-degree misdemeanor, after SID found she was operating her business with at least one employee and no workers’ compensation coverage. During the prosecution process, Kahsai submitted a BWC application for coverage and obtained valid coverage. A municipal court  judge fined her $100.

Anthony Crenshaw, Columbus, Ohio (Franklin County) – Working and Receiving
SID found a database cross match with the Ohio Department of Job & Family Services indicating Crenshaw earned wages while concurrently receiving BWC benefits. Agents found Crenshaw working as a home health aide while receiving temporary total disability benefits.

Crenshaw pleaded guilty Oct. 6 to one count of workers’ compensation fraud, a first-degree misdemeanor. A county common pleas judge ordered Crenshaw to pay $10,000 restitution to BWC. That money was already on deposit with the clerk of courts at the time of sentencing. The defendant was sentenced to two days in jail, with two days of
jail-time credit. Costs and fines were waived.

Ray George, dba Spectrum Painting, Bellefontaine, Ohio (Logan County) – Lapsed Coverage
George pleaded no contest Oct. 6 to one count of failure to comply, a second-degree misdemeanor, for operating his business without workers’ compensation coverage. George was ordered to pay $336 in restitution to BWC and $100 in court costs.

O.W. White, Cincinnati, Ohio (Hamilton County) – False Wages
White pleaded guilty Oct. 5 in Franklin County Common Pleas Court to one count of workers’ compensation fraud, a fifth-degree felony. Agents discovered White’s employer closed for business in 2013, but White filed false wage statements for nearly two years after that so he could qualify for more than $27,000 in wage-loss disability benefits.

A judge found White guilty and sentenced him to community control for five years and ordered him to pay restitution of $25,000 to BWC. If White violates the terms of his community control, he must serve 12 months in prison.

Kelly Smith, Piketon, Ohio (Pike County) – False Claim
Smith pleaded guilty Oct. 4 to one count of workers’ compensation fraud, a first-degree misdemeanor, for claiming he had been injured on a job he had actually been fired from one day earlier. Smith received no benefits from the claim.

A judge sentenced Smith to 17 days in jail and ordered him to pay $672 to BWC for its investigation. Smith had 17 days of jail-time credit and had already paid the $672 at the time of sentencing. Smith had previously been prosecuted for filing a false claim in 2010.

Keith Speed, dba Speed’s Electrical Service, Columbus, Ohio (Franklin County) – False Application for Coverage
Investigators found Speed had been operating his business under lapsed status since March 2003, with several injury claims filed during the lapsed period. Agents also found his wife, Anetta Speed, had opened another BWC policy for the business without disclosing the company had a previous policy. This was an attempt to avoid past experience and debt accrued by the business. Keith Speed was convicted Oct. 4 of one count of attempted workers’ compensation fraud, a first-degree misdemeanor. A judge sentenced him to one day in jail, with credit for time served.

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

International Fraud Awareness Week: Spotlight on Doug Fisher

Justice, putting bad providers out of business motivates longtime BWC fraud fighter

By Tony Gottschlich, Public Information Officer, BWC Communications Department

a-sid-badge-and-sealAs a special agent in the bureau of diplomatic security for the U.S. State Department in the 1980s and early 1990s, Doug Fisher protected royal families, foreign presidents, Nelson Mandela and U.S. Secretary of State James Baker, among others.

As a police detective earlier in his career, Fisher served on the vice and narcotics unit in High Point, North Carolina, scrubbing the streets of drug dealers, prostitutes, racketeers and other nefarious sorts.

And today at the Ohio Bureau of Workers’ Compensation, as he’s done for the last 23 years, this veteran of the Special Investigations Department (SID) pursues crooks, cheats and others who try to rip off the state’s insurance fund for injured workers.

But contrary to appearances, Fisher’s long career in law enforcement isn’t rooted in “saving the world and all that,” at least in the beginning anyway.

“I was working in a factory, and I said, ‘Hey, that looks like a job where I won’t have to get dirty,’” Fisher recalled with a slight chuckle. “I didn’t want to work in a factory anymore.”

BWC Special Agent in Charge Doug Fisher (right), of SID’s Health Care Provider Team, conducts a search warrant with Digital Forensic’s Manager Joe Lopez in Northeast Ohio earlier this year.

Fisher is Special Agent in Charge of SID’s largest unit, the health care provider team, which investigates allegations of fraud committed by medical providers, pharmacies and managed care organizations. He usually shuns the spotlight and deflects any credit he’s earned to his team, but after some arm twisting from his boss, he agreed to be featured in this article to promote SID and International Fraud Awareness Week.

“He hates the publicity, every minute of it,” said a smiling Jennifer Cunningham, SID’s assistant director and a 20-year colleague of Fisher’s. “He doesn’t go to work parties and he never wants recognized for anything. That’s just who he is, very humble.”

A Wisconsin native, Fisher joined BWC in 1993 and was one of SID’s founding members that year. The department has grown since then into a 118-member force that investigates hundreds of fraud cases a year involving workers, employers, medical professionals and others in the BWC system. In fiscal year 2016, the department’s work led to 127 convictions and $56.6 million in savings. Fisher’s team closed 51 cases, landed five convictions and identified $15 million in savings.

He said the job, though, is about more than prosecutions and protecting the State Insurance Fund.

“We knock a lot of bad providers out of the system,” Fisher said from his Mansfield office. “These are people who practice crappy medicine or no medicine at all – they’re just prescribing painkillers to people and it’s a shame.”

One recent case he’s proud of involves a chain of Cleveland-area medical clinics that was indicted Oct. 26 on racketeering and other charges related to scamming BWC out of $216,000.

A 170-count indictment returned by a Cuyahoga County grand jury accuses Dr. Stephen Bernie and an associate of 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 is also accused of writing prescriptions for medications without examining or monitoring patients, and signing prescriptions for powerful opioids that were distributed while he was on vacation.

BWC Special Agent in Charge Doug Fisher, of SID’s Health Care Provider Team, spends much of his time in the field, but works out of the Mansfield Service Office.

Said Fisher, “Cases like that are some of the most satisfying – agents working a hard, long case that takes several years and lots of frustration and they drive it to a conclusion.”

Cunningham calls Fisher a “visionary” who looks at the big picture, studies the latest trends and enjoys outfoxing the fraudsters he’s after.

“He’s always thinking, trying to be one step ahead of the bad guys,” she said.

Fisher, 56, and his wife, Debbie, live in Northeast Ohio and are the parents of two adult children. An avid reader and long-distance runner, he also teaches criminal science part time at Stark State College in North Canton.

He said he plans to retire from BWC within the next year.

BWC investigators nab Central Ohio workers’ comp fugitive, land fraud conviction

michael-mitchell-booking-photoA Columbus-area man was sentenced for workers’ compensation fraud last week during a court appearance that was delayed after he failed to appear for his 2013 arraignment.

Michael M. Mitchell, 49, pleaded guilty to a fifth-degree felony count of workers’ compensation fraud in the Franklin County Court of Common Pleas. He was sentenced to 11 months of incarceration, suspended for five years of community control, and ordered to pay BWC $5,000 in restitution.

BWC’s Special Investigations Department (SID) received an allegation from the Claims Service Specialist managing Mitchell’s claim after she became suspicious that he may be working while receiving workplace injury benefits.  The investigation revealed Mitchell was self-employed as a painter and sub-contracted multiple jobs from various painting companies while also collecting benefits from BWC.  Investigators also determined Mitchell did not have current workers’ compensation coverage and altered his BWC certificate of coverage in order to secure painting jobs.

Mitchell was indicted by a Franklin County Grand Jury in 2013 but he failed to appear for his arraignment and a warrant was issued for his arrest.  SID’s Fugitive Task Force partnered with the Franklin County Sheriff’s office to locate Mitchell, who was taken into custody in March 2016.

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

Cincinnati woman who stole from mother guilty of workers’ comp fraud

With mother in nursing home, daughter used benefits card to buy drugs

shawna-j-photoA Cincinnati woman who stole her disabled mother’s workers’ compensation benefits to support her drug habit must pay $26,170 in restitution to her mother and the Ohio Bureau of Workers’ Compensation (BWC), a Hamilton County Common Pleas judge ruled Sept. 21.

Shawna R.  Jessee, 48, also must serve 180 days in the Hamilton County Justice Center’s extended drug treatment program for women, minus 72 days credit for time already served. She must serve five years probation, submit to random drug screenings and serve 18 months in prison if she fails a drug screening or terms of her probation.

“We know drug addiction is a serious health issue tearing at the fabric of our society, but we can’t tolerate the theft or misuse of funds that belong to our injured workers,” said BWC Administrator/CEO Sarah Morrison.

BWC’s Special Investigations Department started looking at Jessee after a BWC claims specialist couldn’t reach Jessee’s mother. Investigators found the mother living at a local nursing home and discovered Jessee had been using her mother’s benefits card to withdraw money without her mother’s consent.

Jessee pleaded guilty Aug. 17 to a fourth-degree felony count of workers’ compensation fraud. She must pay $18,724 in restitution to her mother and $7,446 to BWC.

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

Raising awareness during Fraud Awareness Week, combating fraud every day

By Melissa Vince, BWC Public Relations Manager

a-sid-badge-and-sealWhen the Ohio Bureau of Workers’ Compensation created its Special Investigations Department (SID) in 1993, the new department boasted a staff of a dozen people and offices in just three cities to combat fraud across Ohio’s 88 counties. Data was stored in paper files and agents relied on such state-of-the-art equipment as pagers, payphones and binoculars, not to mention video cameras the size of small SUVs.

SID looks vastly different today. Staffed with 118 agents, supervisors and support personnel, the department works out of 11 offices across the state and investigates hundreds of fraud cases a year, from workers who fake injuries to physicians running pill mills. Agents are armed with smart phones and sophisticated investigatory devices they don’t talk about publicly.

In 23 years, SID has identified more than $1.7 billion in savings, as well as:

  • Researched 117,820 allegations;
  • Completed 64,255 investigations;
  • Referred 4,897 subjects for prosecution; and
  • Secured 2,595 criminal convictions.

Says SID Director Jim Wernecke: “Even after all these successes, we know fraud still persists, and our goal remains the same after more than two decades: to detect and deter workers’ compensation fraud in Ohio and return misappropriated funds to caring for injured workers and improving workplace safety.”

While tried and true techniques remain important to a successful case, we’re also committed to keeping pace with the most up-to-date resources, such as digital forensics and analytical intelligence, including predictive modeling, to root out otherwise undetected fraudulent activity. We also use social media and specialized presentations to educate and build awareness.

fraud-week-logo2016One of many ways we build awareness is by eagerly joining our fraud-fighting colleagues around the country and abroad each November to participate in International Fraud Awareness Week. The campaign, which runs until Saturday, was established by the Association of Certified Fraud Examiners to highlight the issue of fraud and help minimize its impacts.

Most weeks, you’ll find us sharing our fraud news on #Fraud Friday. But this week we’ll have a new fraud feature each day, including tips for identifying and preventing fraud, new cases, and insights from our investigators on what they do here every day to stop workers’ comp fraud in Ohio.  So keep an eye here on our blog and on our Facebook and Twitter pages for fresh content.

Happy Fraud Awareness Week!

And don’t forget to keep those tips coming. To report workers’ comp fraud in Ohio, click here or call our fraud hotline at 1-800-644-6292.

Safety rocks and rolls at Cleveland-area safety council’s CEO event

By Michelle Francisco, BWC Safety Council Program Manager

rocknrollGiven the recent success of the Cavaliers and the Indians, Cleveland is suddenly known for its professional sports teams. But at the recent Cleveland Southwest Safety Council (CSSC) CEO event, Harley-Davidson motorcycles – and rock music – took center stage.

More than 180 CSSC members and their highest-ranking local officials gathered at the Rock-N-Roll City Harley-Davidson dealership, which opened just a year ago in Brook Park, to hear owner Mike Davis discuss his company philosophy and the importance it places on safety. Mike is the owner of four dealerships in Ohio, but he started his career in aeronautics, an industry equally dedicated to safety.

rocks-2The CSSC often selects a local business to host its CEO networking event, believing that members enjoy a non-traditional setting that provides a behind-the-scenes perspective of a company’s operation. Previous hosts have included the NASA Safety Center and Kaufman Container.

Many of the dealership’s 50+ employees mingled with guests, speaking proudly of their visibility in the community and popularity with travelers passing through Cleveland at nearby Hopkins airport.

rock4On the day of the event, visitors in town from Chicago for game two of the World Series stopped by the dealership to shop at one of Harley-Davidson’s newest state-of-the art dealerships.

Safety staff Gayle Luker and Nicole Lorenzo, from BWC’s Garfield Heights customer service office, mingled with attendees, touching base with existing customers and developing new leadership contacts.

Meanwhile, I took the opportunity to say a few words on behalf of the agency, reinforcing BWC’s commitment to creating a forum for safety education, reducing accidents and making Ohio a safer place to work.

Following the meeting, representatives from several employers approached me to express their appreciation for BWC’s safety efforts. Steve Hilton, the Health Safety & Environmental Manager of self-insuring ThyssenKrupp Materials NA (Ken-Mac Metals Division), is responsible for the company’s workers’ compensation in several states. He said he is most impressed with the no-added cost “pre-paid” services unique to Ohio. He lauded the recent air monitoring provided by local industrial hygienist Ron Kruchan and acknowledged the significant cost-savings it provides his company. Each year, ThyssenKrupp also invites safety managers from eight plants across the country to BWC’s annual Ohio Safety Congress & Expo in Columbus to capitalize on the education and certification credits it offers.

These are just some of the many benefits Ohio employers enjoy as part of their BWC workers’ compensation insurance coverage.

BWC sponsors 82 safety councils across the state to provide a forum for accident prevention, workers’ compensation and health & wellness information in local communities. The Berea, Brook Park and Middleburg Heights chambers of commerce co-sponsor the CSSC. They work together to provide valuable monthly occupational safety and health educational opportunities to more than 130 members.

For more information about the Cleveland Southwest Safety Council, visit their website.

Groveport woman cheated BWC out of $51,000

 Health care worker sentenced on workers’ comp fraud charges Thursday

danielle-cheeks-booking-photoA Central Ohio woman must pay more than $51,000 in restitution to the Ohio Bureau of Workers’ Compensation after pleading guilty Thursday to a fifth-degree felony count of workers’ compensation fraud.

Danielle Cheeks, 41, of Groveport, must repay BWC $51,590 and serve five years probation in lieu of a six-month jail sentence for fraudulent behavior dating back to 2010, according to her Nov. 3 sentence in the Franklin County Court of Common Pleas.

BWC’s Special Investigations Department started looking at Cheeks after a BWC claims service specialist (CSS) suspected Cheeks was under-reporting her work wages in order to receive higher living maintenance wage-loss benefits from BWC. The CSS told investigators he had requested Cheeks on multiple occasions to submit her paystubs but she never complied.

Investigators determined Cheeks was working as a home health aide for three private companies, as well as for herself as an independent provider for Medicaid recipients, as early as August 2010.  This employment conflicted consistently with BWC benefits she received from August 2010 through November 2014.

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