Toy safety – make a list and check it twice

By Erik Harden, BWC Public Information Officer

Ralphie’s dream of getting a Red Ryder BB gun for Christmas in the holiday classic “A Christmas Story” has become the stuff of legend. The constant refrain of “you’ll shoot your eye out” torments the young protagonist and gives viewers a good laugh.

But toy safety is a serious matter, especially at this time of year. According to the non-profit toy safety group World Against Toys Causing Harm, Inc. (W.A.T.C.H.), a child is treated in U.S. emergency rooms every three minutes for a toy-related injury.

Statistics from the Consumer Product Safety Commission show there were an estimated 240,000 toy-related injuries in the U.S. in 2016, and a reported 35 children died from toy-related incidents from 2014 to 2016. So, what can we do to keep children safe?

For starters, W.A.T.C.H. releases its Top 10 Worst Toys List before the holiday shopping season to help consumers avoid some of the most dangerous toys on the market. Prevent Blindness America also declares each December Safe Toys and Gifts Month. Although its primary focus is protecting children’s eyesight, Prevent Blindness America has a Safe Toy Checklist that generally applies to toy selection. Prevent Blindness America suggests doing the following before purchasing a toy.

  • Read all warnings and instructions on the box.
  • Ask yourself if the toy is right for your child’s ability and age.
  • Avoid purchasing toys with sharp or rigid points, spikes, rods or dangerous edges.
  • Check the lenses and frames of children’s sunglasses; many can break and cause injuries.
  • Buy toys that will withstand impact and not break into dangerous shards.
  • Look for the letters “ASTM.” This designation means the product meets the national safety standards set by ASTM International.
  • Avoid toys that shoot or include parts that fly off. Remember that BB guns are NOT toys (sorry Ralphie).

W.A.T.C.H. says with online sales expected to surge 17 to 22 percent this 2018 holiday season, parents face the disadvantage of not being able to touch and physically inspect a toy and its packaging for warning signs of obvious hazards at the time of purchase. Also, consumer-to-consumer (i.e. “second-hand”) online sales provide additional opportunities for the purchase of recalled toys and toys with proven defects.

Since there currently is no full-proof safety net in place to prevent dangerous toys from reaching consumers, W.A.T.C.H.  urges parents to think defensively when it comes to toy safety this holiday season. Parents can avoid many toy-related hazards by:

  • Remaining cautious.
  • Identifying safety red flags.
  • Knowing what classic safety traps to look out for.
  • Inspecting new and old toys for defects and poor design.
  • Learning to identify hidden hazards.

W.A.T.C.H. also cautions toy shoppers not to be lulled into a false sense of security that a toy is safe because it has a familiar brand name on the package or it’s available from a well-known retailer.

Using these tips will help keep the kiddos safe and happy this holiday season. Not giving them a “deranged Easter Bunny” suit is also a good plan.

Two Ohio business owners convicted for failing to carry workers’ comp coverage

Second conviction for both employers

A Columbus-area business owner with a criminal history against the Ohio Bureau of Workers’ Compensation pleaded guilty Monday to failing to carry workers’ compensation coverage on his asphalt paving business.

James T. Wilson Jr., 52, of New Albany, pleaded guilty in a Columbus courtroom to a second-degree misdemeanor count of failure to comply after BWC investigators found him operating Performance Companies LLC/Enviro Recycling Group without workers’ compensation coverage. The plea came nine years after Wilson’s first case with BWC, when he pleaded guilty to a fourth-degree felony theft charge and was ordered to pay BWC more than $180,000 in restitution.

“We attempted to work with Mr. Wilson to bring his business into compliance with Ohio law, but ultimately we had to go with this course of action,” said Jim Wernecke, director of BWC’s special investigations department. “I can’t say this enough to employers in our system: If you’re struggling with your BWC premiums, reach out to our agency and work with us. Don’t risk a criminal conviction.”

Wilson’s sentencing will be scheduled for a later date after BWC has finished auditing his business records.

In other news, the owner of a food warehouse and market in Cleveland pleaded guilty Nov. 13 to a first-degree misdemeanor charge of workers’ compensation fraud after he lapsed on a repayment plan related to his 2014 conviction on a similar charge.

Yue Liang, owner of New Sheng Hung, agreed to pay BWC $5,500 toward the balance owed to the agency and an additional $2,000 in restitution. He was sentenced to one year of community control and ordered to bring his policy into compliance.

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

Get to your Thanksgiving feast safe and sound

Buckle Up – Every Trip. Every Time.

By Erik Harden, BWC Public Information Officer

For many of us Thanksgiving includes piling into a car and travelling to visit family and friends. In fact, Thanksgiving weekend is the year’s busiest travel weekend.

Whether you’re driving across the street or across the country to reach your Thanksgiving feast, you should always wear your seat belt.

With increased traffic brings the increased possibility of traffic crashes. That’s why we’re partnering with the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) to share this important lifesaving reminder: Buckle Up – Every Trip. Every Time.

During the 2016 Thanksgiving weekend*, 341 people died in motor vehicle crashes nationwide. Tragically, 49 percent of those killed had not buckled up. Nighttime proved even more deadly, with 55 percent of Thanksgiving weekend crashes occurring at night.

Much like drunk driving, these deaths represent needless tragedies for families across America. The simple click of a seat belt could have prevented these fatalities. Research shows that wearing a seat belt is one of the simplest things you can do to stay safe when you’re traveling in a vehicle, especially during busy travel periods like Thanksgiving.

The NHTSA estimates that proper seat belt use reduces the risk of fatal injury to front seat passengers by 45 percent, and the risk of moderate to serious injury by 50 percent. In 2016, approximately 14,668 people survived crashes because they were buckled up. If everyone had worn their seat belts that year, an additional 2,456 lives could have been saved. NHTSA’s research also shows:

  • Males are more likely to be unbuckled than females in fatal crashes. In 2016, 52 percent of males who died in crashes were not buckled up at the time of the crash, compared to 40 percent of females.
  • Younger drivers are also at greater risk of being unbuckled. In fact, the 13- to 15-year-old and 18- to 34-year-old age groups had the highest percentages (62 percent and 59 percent, respectively) of occupants killed who were not wearing their seat belts at the time of the crash.

Seat belt use should be a no-brainer. We know that regular seat belt use vastly reduces fatalities. In the spirit of Thanksgiving, let’s be grateful for the most basic vehicle technology that has – without a doubt –  saved the most lives.

We all want to see our friends and family arrive safe and sound to the Thanksgiving table. So, remember to Buckle Up – Every Trip. Every Time.

For additional tips to make your holiday road trip safer, visit our BeSafeOhio site.

*6 p.m. Wednesday, Nov. 23, to 5:59 a.m. Monday, Nov. 28

 

 

IFAW: That’s a wrap

It’s time to wrap another impressive International Fraud Awareness Week.

We specialize in workers’ comp fraud but enjoy hearing about what our counterparts are doing in their fight to stop all kinds of fraud. We also appreciate the opportunity to share our story with you.

We’ve shared a lot about ourselves, including what we do, why we do it, a little about how we do it, how Ohioans can help and much more.

Thanks for connecting with us this week. While we hope you never come across workers’ comp fraud, if you do, we want you to know how recognize it and where to find us.

If you do still have questions, don’t worry, we’re here all year long.

Our fraud hotline is, well, hot! Thanks for making us aware of fraud all year long!

By Jeff Baker, Program Administrator, BWC Special Investigations Department

We have received more than 2,300 calls since we launched our new Fraud Hotline system on November 14, 2017, during International Fraud Awareness Week 2017.

The nearly 200 calls a month, means we have received 9 each work day, or more than one every working hour!

In our November 14, 2017 blog, we noted that calling the BWC Fraud Hotline is the most interactive and direct way for you to report an allegation of fraud. Our hotline puts you in direct contact with an agent in our Special Investigations Department, one ready and willing to listen to, document, and promptly act upon, your concerns.

We look forward to hearing from you, so give us a call at 1-800-644-6292 if you suspect fraud. We will conduct the investigation and determine the facts. Together, we are successfully combatting workers’ compensation fraud in Ohio – one most important call at a time.

Today, during International Fraud Awareness Week 2018, we thank you for your support!

‘Records told the story’ in fraud case: Northeast Ohio business overbills agency; owner found guilty of workers’ comp fraud

By Jennifer Cunningham, Assistant Director, BWC Special Investigations Department

The bills coming from a Northeast Ohio health care facility to the Ohio Bureau of Workers’ Compensation (BWC) looked suspicious.

Too many, it seemed, were for treatment to a company co-owner and others closely connected to the business. Our agency had paid more than $110,000 for claims on one of those cases alone and $27,000 for treatment provided to co-owner Jeffrey L. Guerin. So, in late winter of 2013, our special investigations department decided to take a closer look at PT Plus LLC of Willoughby Hills, a provider of physical therapy and massage therapy about 20 miles northeast of Cleveland.

After a preliminary investigation by our Health Care Provider Team, we used an undercover agent posing as an injured worker to get an inside look at the practice. In roughly 23 visits over three months our agent observed — and records later proved — PT Plus billed BWC for services that weren’t rendered to patients. In one case, our agent witnessed an injured worker refuse treatment, but PT Plus billed BWC anyhow, using spurious treatment notes to support the claim.

Our agents subsequently interviewed three former PT Plus employees, all of whom alleged co-owner Guerin committed health care fraud out of the business. Specifically, they claimed Guerin billed BWC and other third-party payers for treatment not rendered to patients. They said Guerin managed the day-to-day operations of the business and had total control over the billing process. They said he altered the units of service recorded on fee sheets and the patient’s in/out time recorded on treatment notes to correspond with the amount of treatment billed to BWC.

As we were investigating, PT Plus went out of business around July 2014. Our agents learned the business records and patient charts were stored at Guerin’s business partner’s residence. We conducted a search warrant and interviewed the co-owner, who denied any involvement in the company’s day-to-day operations and billing responsibilities. That was Guerin’s role, he said.

Our agents interviewed Guerin, who admitted sole responsibility for billing and overseeing his company’s daily operations. He told our agents that beginning in 2009 he had auditors review his businesses records to look for discrepancies. He said they found that he had actually under-billed BWC about 60 percent of the time, thus shorting his business money. For the audits that revealed overbilling, it didn’t amount to much money, he said. Taken collectively, it was all a wash and that’s why he didn’t inform BWC or any other third-party payer, he explained. But that’s not what our agents found.

During the interview, Guerin retrieved the audit worksheets from his basement and surrendered them to the agents. The agents conducted a cursory review and discovered the majority of the 2014 audit worksheets recorded overbilling. “He offered bizarre justifications and excuses for the records,” one agent told me. “He was cooperative, but we could tell he wasn’t truthful. I think he felt he could explain his way out of it, but the records told the story.

Back at the office, the health care provider team conducted its own audit. The methodology entailed comparing the type, amount (Units of Service) and length (In/Out Times) of treatment that the therapists recorded on the billing and treatment records with the bills Guerin sent to BWC. The audit revealed more than 170 instances where Guerin altered data so he could bill and receive reimbursement for more treatment than was rendered.

On May 18, 2018, Guerin pleaded guilty to one count of workers’ compensation fraud, a first- degree misdemeanor, in Franklin County Municipal Court. He paid BWC restitution in the amount of $7,154 on the same day.

Let’s talk workers’ comp fraud

By Melissa Vince, BWC Public Relations Manager

Fraud (/frôd/), noun
Definition: Wrongful or criminal deception intended to result in financial or personal gain.

In other words, cheating to get one over on others. There are countless ways people try to commit fraud. Check fraud, identify theft, pyramid schemes, credit card fraud and so on.

What do we do in the Ohio Bureau of Workers’ Compensation Special Investigations Department? We pursue workers’ compensation fraud.

BWC insures Ohio employers for workplace injuries and cares for employees who are hurt on the job. The vast majority of Ohio workers, employers, medical providers and others are interested in nothing other than getting injured workers healed and back on the job. There are a few though who have other ideas.

We define workers’ compensation fraud as knowingly making a false representation of a material fact to obtain or to deny workers’ compensation benefits or to avoid responsibility under the law. Workers’ compensation fraud increases premiums for employers, which reduces the money employers can invest in their employees, community and future growth.

There are a number of ways fraudsters can seek to manipulate the system, for example:

  • When an employer misrepresents the amount of payroll or classification of its employees.
  • When a medical provider intentionally receives payments to which he or she is not entitled.
  • When a worker fakes an injury, or returns to work while receiving benefits.

And there are many more detailed on our website, bwc.ohio.gov.

What’s our goal? #StopFraud in Ohio’s workers’ compensation system. You’ll see in this infographic highlighting a few stats from the last year that we work hard every day to achieve that goal.

 

 

 

 

 

 

 

Anyone committing fraud, or thinking of trying to get one over on us should remember this word:

ex·pose (/ikˈspōz/), verb
Definition: make (something) visible, typically by uncovering it.