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.

Check Smart clerk outsmarts phony owner of BWC rebate check

BWC investigators report 9 convictions in October

An Akron sex offender added forgery to his criminal record last month after a clerk at a Check Smart thwarted his attempt to cash a $5,500 rebate check from the Ohio Bureau of Workers’ Compensation (BWC) that belonged to a church-owned day care center.

“We have to give credit to the clerk, she made our job easy,” said Jim Wernecke, director of BWC’s special investigations department (SID). “She could tell the man added his name to the check and he wasn’t the rightful owner. But instead of simply turning him away, she took his picture, photocopied his driver’s license and had him fill out an application. Then she confiscated the check and refused to cash it.”

A Summit County judge sentenced Keith A. Galloway, 45, to one year in prison Oct. 24 after Galloway pleaded guilty to forgery, a fifth-degree felony. The judge ordered the term be served concurrently with Galloway’s three-year sentence on unrelated drug charges and for failing to register his address with the Summit County Sheriff’s Office.

Galloway attempted to cash the rebate check in July 2017. The check was part of BWC’s $1 billion rebate to Ohio employers that year.

In other news, SID secured eight other workers’ comp fraud or fraud-related convictions in October, bringing calendar year 2018’s total to 72. In order of most recent court case, those convicted include:

Jason Moffitt of Columbus
Moffitt pleaded guilty Oct. 31 to one count of workers compensation fraud, a first-degree misdemeanor, after investigators found he had falsified records to increase his BWC cash benefits. He was sentenced to three months incarceration, which was suspended for two years of community control on the condition he pay BWC $5,325 in restitution.

Philip Ayers, dba Ayers Transportation Services, of Cincinnati
Ayers pleaded guilty Oct. 24 in Hamilton County to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC found him operating his business with lapsed coverage and non-compliant claims filed against his policy. A judge sentenced Ayers to two years of probation and ordered him to maintain full-time employment and cooperate fully with BWC and the Ohio Attorney General’s office on his payment plan to BWC. Ayers owes BWC more than $159,000.

Kurt Ballish, dba Kurt Ballish Construction & Custom Decks, of Chardon
Ballish pleaded guilty Oct. 22 to two misdemeanor counts of failure to comply, the same charges he pleaded guilty to in 2016. A judge in Chardon Municipal Court sentenced Ballish to one year of probation in lieu of 90 days in jail and ordered Ballish to pay fines and court costs totaling $642 by Nov. 30. Ballish owes BWC nearly $19,000.

Frank Krailler, dba Transmission Specialists of Montgomery, of Cincinnati
Krailler pleaded guilty Oct. 22 in Hamilton County to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC discovered him operating his business without workers’ comp coverage. As part of his plea deal, Krailler paid $4,000 in restitution.

Gyorgy Benedek of Columbus
Benedek, owner of Maintenance Free Building Services Inc., pleaded guilty Oct. 18 in Franklin County to a reduced charge of failure to comply after submitting a check to BWC for $43,069 in restitution.

Penny Sibila of Canton
Sibila must pay BWC $26,719 in restitution after pleading guilty to a fifth-degree felony charge of workers’ compensation fraud Oct. 18 in a Franklin County courtroom. Acting on a tip, BWC investigators found Sibila working as a property manager for an apartment complex while collecting BWC benefits for an injury she suffered in 2014. In addition to restitution, a judge sentenced Sibila to two years of non-reporting probation in lieu of a seven-month jail sentence.

Thomas Banig of Cleveland
Banig pleaded guilty Oct. 17 to one count of workers’ compensation fraud, a first-degree misdemeanor, after he filed a false claim in 2014 against an employer he had not worked for since 2003. A judge sentenced Banig to 180 days incarceration, suspended for one year of community control.

Rami Khayat, dba Triple Auto Sales, of Cleveland
Khayat pleaded guilty Oct. 1 to one count of failure to comply, a second-degree misdemeanor, after BWC found he was operating his business without BWC coverage. A judge ordered Khayat to pay BWC $965 in restitution.

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

Contractor safety: When you bring outside people in to do work

By Cari Gray, CSP, BWC Safety Consultant Specialist

What do you do when you need an outside company to come into your business to fix or replace something? Say a pipe bursts or your boiler stops working. Do you have a contractor safety policy in place?

In safety we spend so much time focusing on the safety of our employees that sometimes we are blindsided when an outside company comes in and creates a new hazard. Almost all of us use contractors. Although they are not on your payroll, there is still a chance of injury to themselves or your employees. There are many hazards that outside contractors can bring with them, for starters:  lockout issues, hazardous chemicals or even new or different dangerous equipment. You need an intentional focus on dealing with contractors!

Often companies bring in outside contractors to do dangerous or non-routine jobs. Therefore, it’s crucial for you to determine how contract work could expose your employees to workplace injuries and create a process to minimize the hazards.

If a serious injury results from work with contractors, or if there happens to be a compliance officer visiting you while a contractor is performing work, you are jointly responsible and can be held accountable.  You could face inspections, citations and even lawsuits. So, what should you do?  Read on, my friend.

Companies can take control and conduct a thorough review and prequalification of contractors before they allow them to enter their workplace. Once on site, contractors should have a meeting prior to starting the work. In addition, they should have audits during the work’s operations.

If you do not have a contractor safety policy or find that yours is lacking, there are steps you can take. First, think about the people that enter your workplace who are not employees. Are they exposing your employees, other contractors or your customers to additional hazards?

Next, draft your new or updated policy. Your policy could include:

  • Prequalification – This can look different for different types of contractors – you’ll need to look a bit harder at your electrical contractor than the folks who refill your vending machine.
  • Responsibilities – Who’s in charge of this program? If you don’t assign someone, guess what – no one will do it!
  • Company-equipment policy – Do you allow contractors to use your equipment?
  • Emergency procedures – Including interior shelter locations, alarm meanings and outside assembly locations.
  • Training requirements – Pre- job meetings and sometimes you may want to see a contractor’s training record.
  • Housekeeping – Spell out your requirements.
  • Personal protective equipment – What are you requiring?
  • Lockout/tagout/try out – This is a key program with some contractors – some companies require a tandem lockout with contractors. Look at this program and audit with this focus in mind.
  • Fire prevention.
  • Incident reporting.
  • Hazard Communication Standard requirements, including informing the employer about chemicals brought into the facility.
  • Enforcement and company safety rules.

Once you create your contractor-safety program, take time to review it with your employees, especially anyone that may invite a contractor in the building.  Do this at least annually. If you involve employees in creating the program and its policies, they are more likely to recognize, approach and ensure contractors are working safely.

If you see unsafe behaviors, bring it up to the contractor and correct the behavior. If the unsafe behaviors persist, remove them from the premises. You’ve got it, sometimes a contractor can’t seem to follow your safety rules. It’s OK to find another contractor that will. Keeping your employees and contractors safe is the goal.

If you need help with contractor safety policies (or any safety policies), be sure to contact your local safety consultant from your local BWC service office. They are there to help you!

Foregoing workers’ comp coverage costs Ohio businesses

The Ohio Bureau of Workers’ Compensation (BWC) secured court convictions in October against three Ohio business owners — including a Cleveland-area man for the second time since 2016 — who failed to protect their workers with proper BWC coverage.

“We made every attempt to bring these employers into compliance with Ohio law, but they wouldn’t cooperate and we were forced to bring charges against them,” said Jim Wernecke, director of BWC’s special investigations department (SID). “I can’t stress this to employers enough: If you’re struggling with your BWC premiums, work with us. Avoiding us will only make your situation worse.”

Among those convicted were Kurt A. Ballish of Chardon, Ohio, owner of Kurt Ballish Construction & Custom Decks. He pleaded guilty Oct. 22 to two misdemeanor counts of Failure to Comply, the same charges he pleaded guilty to in 2016.

A judge in Chardon Municipal Court ordered Ballish, who owes BWC nearly $19,000, to become compliant with Ohio’s workers’ compensation law or go to jail. He sentenced Ballish to one year of probation in lieu of 90 days in jail and ordered Ballish to pay fines and court costs totaling $642 by Nov. 30.

In Cincinnati, the owner of a now-closed transportation services company must pay BWC more than $159,000 in restitution following his guilty plea to a reduced charge of workers’ compensation fraud.

Philip Ayers, owner of Ayers Transportation Services, pleaded guilty Oct. 24 in a Hamilton County courtroom to the first-degree misdemeanor charge. A judge sentenced Ayers to two years of probation and ordered him to maintain full-time employment and cooperate fully with BWC and the Ohio Attorney General’s office on his payment plan to BWC.

In another employer case, the owner of Triple R Auto Sales in Cleveland pleaded guilty to one count of Failure to Comply Oct. 1 after BWC discovered the business had been in operation for 11 years without workers’ comp coverage.

A judge in Cleveland Municipal Court ordered Rami Khayat to pay BWC $965 in restitution. An injured-worker claim filed against Khayat’s business triggered BWC’s investigation.

In other news, a Columbus tow-truck driver who falsified records to increase his BWC cash benefits pleaded guilty Wednesday to a first-degree misdemeanor count of workers’ compensation fraud.

A Franklin County judge sentenced Jason E. Moffitt to two years of community control in lieu of a three-month jail sentence. The judge also ordered Moffitt to pay BWC $5,325 in restitution.

BWC investigators say Moffit intentionally inflated his income on an earnings statement and signed another person’s name to it. The letter was used to establish Moffitt’s BWC compensation payments.

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