By Jeff Baker, Program Administrator, BWC Special Investigations Department
The auditor, who does not want to be identified given the sensitive nature of his job, received the award for alerting SID to a case in which an employer failed to report payroll and failed to respond to multiple attempts to schedule a premium audit. An investigation by the SID Employer Fraud Team revealed that most of the employer’s Ohio employees were reported to ODJFS, but not to BWC. The referral resulted in the identification and recovery of $804,352 in savings to the state insurance fund.
“Thanks to this employee’s vigilance and timely referral, we were able to stop fraud and save the BWC system nearly a million dollars,” said SID Director Jim Wernecke. “Our success in uncovering fraud protects resources we need to take care of injured workers, create safe workplaces and provide the best service possible to employers at affordable rates.”
The auditor, who handles employer policy underwriting and premium audits, said he appreciates the recognition and is glad he could help.
“This is why we do what we do,” he said. “After spotting a red flag in this case, I dug a little deeper and found more red flags. Persistence paid off, and it’s a good thing, because this kind of behavior drives up our costs and hurts all the honest players in our system.”
SID received 2,320 allegations of fraud in 2017, with about a fourth of those coming from BWC personnel around the state — claims representatives, employer representatives and others who suspect illicit behavior on the part of injured workers, employers, health care providers or others connected to the BWC system. During 2017, SID closed 311 cases referred by 158 BWC employees. The SID investigations found fraud in 146 of the 311 cases and generated $2,724,426 in identified savings.
To show their appreciation, SID leaders conducted a thank-you tour and red flag training from March through May, presenting Fraud Finder Award certificates to BWC employees in customer service offices across Ohio.
“We encourage all BWC employees to contact us immediately if they suspect fraudulent behavior in our system, even the slightest hint of it,” said Director Wernecke. “We will conduct a thorough investigation, and the sooner we get started, the better.”
To report suspected cases of workers’ compensation fraud, call 1-800-644-6292 (then select option 0, option 4) or visit www.bwc.ohio.gov.