By Jeff Baker, Program Administrator, BWC Special Investigations Department
The supervisor 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 the employer was operating without coverage. The referral resulted in the identification and recovery of $316,103 in savings to the state insurance fund.
“Thanks to this employee’s vigilance and timely referral, we were able to stop fraud in its tracks and save the BWC system hundreds of thousands of dollars,” said SID Director Jim Wernecke. “Our success in uncovering fraud protects resources needed to create safe workplaces in Ohio and to care for those who are legitimately injured on the job.”
The BWC employee, who supervises field staff members assigned to the BWC employer compliance department, said he was honored to receive the award.
“I am truly honored to be recognized for simply doing my job and trying to do my part, while seemingly small, to safeguard the State Insurance Fund,” the employee said. He offered the following advice to any BWC employee who suspects fraud: “Trust your gut.”
SID received 3,150 allegations of fraud in 2018. About a fifth of those came from BWC personnel around the state. These included claims representatives, employer representatives and others who suspected illicit behavior on the part of injured workers, employers, health care providers or others connected to the BWC system. During 2018, SID closed 381 cases referred by 169 BWC employees. The investigations resulted in 192 “founded cases” (the original allegation was proven true) and identified $3.1 million in savings to the BWC system
To show their appreciation, SID leaders conducted a thank-you tour and red-flag training from November through February, presenting Fraud Finder Award certificates to BWC employees in service offices across Ohio.
“We encourage all BWC employees and the general public 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, option 1) or visit www.bwc.ohio.gov.