Special investigations department concludes FY 2019 with impressive results

By Jim Wernecke, Director, BWC Special Investigations Department

It’s getting harder and harder for the criminally minded to rip off BWC and the State Insurance Fund and get away with it.

That was the message I took to BWC’s board of directors Thursday afternoon when I presented the board with the Special Investigations Department’s annual report for FY 2019, which closed June 30. The report details another impressive year of our department’s efforts to deter, detect, investigate, and prosecute workers’ compensation fraud.

Here are some highlights in what was our 26th year as a department:

  • We closed 1,732 fraud cases, 7% more than in 2018.
  • We secured 101 convictions of claimants, employers, and health care providers who defrauded our agency.
  • For every dollar we spent on our efforts, we saved the state fund nearly $5.
  • We reduced our investigation time per case by 2.9 days on average, to 189 investigative days, our lowest number on this measure since 2005.
  • All told, we saved the state fund $65.1 million in 2019, an 8 % increase over 2018’s numbers.

We couldn’t have achieved this success without the 119 dedicated staff members who serve our department with great skill, resourcefulness, and determination to bring justice to those who cheat our system. Their efforts create safer workplaces and ensure those who attempt to commit fraud in workers’ compensation are held accountable to the fullest extent of the law.

In 2019, our investigative teams continued to work closely with the law enforcement community at the local, state, and federal levels. We collaborated on several investigations, including cases involving physicians running pill mills in Ohio and surrounding states.

In addition, our teams joined other state and federal investigators participating in the Document and Benefit Fraud Task Force, the Ohio Medicaid Prescription Program Integrity Group, and the Pill Mill Coordination team for the Ohio Attorney General’s Medicaid Fraud Control Unit.

As we commence our 27th year in FY 2020, we remain united in our commitment to protecting the State Insurance Fund for injured workers and the Ohio workers and employers it serves. We join our colleagues throughout this agency in delivering the people of this state the world-class workers’ compensation system they deserve.

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