State agencies share data to nab workers’ comp cheat

hopsonA Columbus man who worked two jobs while collecting injured workers’ benefits must pay the Ohio Bureau of Workers’ Compensation $6,000 in restitution and investigative costs and serve five years probation, a judge ruled Tuesday in the Franklin County Court of Common Pleas.

Dion S. Hopson, 43, pleaded guilty Sept. 20 to workers’ compensation fraud, a first-degree misdemeanor. He was sentenced to 180 days in jail, which was suspended in exchange for five years community control. Hopson also was ordered to pay $5,000 in restitution to BWC and $1,000 in investigative costs. He must pay $100 per month to stay in good standing with community control, which will terminate once restitution has been paid.

BWC’s Special Investigations Department started looking at Hopson after a cross-match query with the Ohio Department of Job and Family Services revealed two employers were paying Hopson wages in 2014 and 2015. SID found Hopson was simultaneously receiving Temporary Total Disability benefits from BWC.

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

BWC’s Special Investigations nets 8 convictions in August

COLUMBUS – The Ohio Bureau of Workers’ Compensation (BWC) netted eight convictions in August in criminal cases related to workers’ compensation fraud.

The eight Ohioans convicted include a Hamilton man who got an 18-month jail sentence for falsifying his wages to increase his disability rate, a Dayton-area man who filed a false injury claim and tried to extort $3,000 from his employer in return for dropping the claim, and a Toledo man who lied to his physician and used an alias to collect injured workers’ benefits.

“These convictions illustrate the nefarious lengths some will undertake to rip off the workers’ compensation system,” said BWC Administrator/CEO Sarah Morrison. “But they also highlight the skill and dedication of our staff and investigators to catch this activity and return BWC funds to their rightful purpose – preventing workplace injuries and caring for those who do get injured.”

As of Aug. 31, BWC’s Special Investigations Department (SID) had secured 69 convictions for the calendar year. August convictions include:

Matt E. Wilder of Hamilton – False Wages
SID initiated an investigation after a BWC compliance officer suspected Wilder may have filed false wage statement forms to increase his weekly injured workers’ benefits. The investigation found Wilder was legitimately injured, but he had filed false wages from another employer, which happened to be his father’s business.

Wilder pleaded guilty Aug. 30 in Montgomery County Common Pleas Court to one count of forgery (uttering), a fifth-degree felony, and one count of workers compensation fraud, a first-degree misdemeanor. Wilder was ordered to serve 12 months in state prison and an additional six months in jail in Butler County. He received credit for 115 days served. He also was ordered to pay BWC $271 in restitution and to serve three years of post-release control.

Thomas Shafer of Miamisburg – False Claim
SID found Shafer filed a false claim and was not injured as reported. SID also found he tried to get his employer to pay $3,000 to him in exchange for dropping the claim.

Shafer pleaded guilty Aug. 29 in Dayton Municipal Court to one count of disorderly conduct, a fourth-degree misdemeanor, and was sentenced to 10 days in jail. He was originally charged with falsification and workers’ compensation fraud.

Michael Scott of Lancaster – Working and Receiving
SID found Scott was working for a window company for four months in 2014 while collecting BWC benefits. A judge in Franklin County Common Pleas Court ordered Scott to pay BWC $1,836 in restitution and sentenced Scott to two years community control, which will terminate with full payment of restitution and court costs.

 Martin Halka of Oregon (Lucas County) – Lapsed Coverage
Investigators observed Halka, owner of Bay Area Concrete, and his workers finishing a concrete job in 2014, six years after Halka’s BWC coverage had lapsed. Agents worked with Halka to become compliant with BWC coverage, but Halka failed to submit all the required payroll records. He did, however, pay approximately $8,000 in back premiums.

A judge found Halka guilty of one count of failure to comply, a second-degree misdemeanor, on Aug. 23 in Oregon Municipal Court. He fined Halka $250, plus $87 in court costs, and ordered Halka to serve one year probation and 15 days of house arrest with electronic monitoring.

 Kash Marzetti of Columbus – Working and Receiving
SID found Marzetti knowingly and with fraudulent intent worked for his company, Marzetti Swimming Pool Services, Inc., while collecting injured workers’ benefits. Marzetti pleaded guilty to one count of workers’ compensation fraud, a first-degree misdemeanor, Aug. 22 in Franklin County Common Pleas Court. He had to pay BWC $5,642 in restitution and a $50 court fine as part of his sentence.

 David Abitua of Toledo – Falsification
Abitua, 51, pleaded guilty Aug. 18 in Franklin County Common Pleas Court to one count of workers’ compensation fraud, a fifth-degree felony. SID found in 2014 that Abitua had lied to his physician, used a false social security number and an alias of Jose L. Vasquez to collect injured workers’ benefits from Nov. 2, 2009 until Oct. 6, 2012. A judge fined Abitua court costs and sentenced him to six months community control, plus one year in jail if he violates the terms of his probation.

 Ambrose Adams of Lexington – Working and Receiving
SID found Adams had returned to work as a self-employed home improvement contractor for his business, Double A Home Maintenance and Repair, while concurrently receiving workplace injury benefits from BWC.

Adams pleaded guilty Aug. 16 in Franklin County Common Pleas Court to one misdemeanor count of workers’ compensation fraud. He was sentenced to 60 days in jail, suspended, and one year of probation. BWC recovered $11,965 in restitution prior to his plea.

 Christopher James of Massillon – Working and Receiving
SID found James working as a truck driver while receiving BWC benefits. James pleaded guilty to one count of workers’ compensation fraud, a fifth-degree felony, on Aug. 4 in the Stark County Court of Common Pleas.  He was sentenced to three years of community control.  James has already paid $7,705 in restitution to BWC.

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

Massillon woman bets wrong; fraud scheme ends up a bust

Brenda Pumphrey of Massillon (Stark County) claimed a workplace injury caused her to lose use of each hand, one arm and one leg. After surveillance at a West Virginia casino showed no limp and full use of her arms, Pumphrey’s luck ran out and she ended up pleading guilty to workers’ compensation fraud.

An investigation into Pumphrey’s claim started with a speeding ticket. SID received an allegation from a BWC Customer Service Specialist that Pumphrey was issued a speeding ticket in Stark County on a date following her claimed loss of her ability to use her upper extremities.

A case was opened and a review of the claim showed that Pumphrey’s physician of record had continuously advised that she was unable to use her extremities but was reluctant to obtain some treatment that was advised.

Agents conducted surveillance of Pumphrey visiting her doctor’s office. Additionally, Pumphrey’s bank records showed a high volume of ATM and debit card activity at the Mountaineer Casino, located in Chester, West Virginia. Video from the casino showed Pumphrey walking with no noticeable limp and with full use and range of motion of both arms.

The physician concluded after seeing the casino video that it appeared Pumphrey had intentionally deceived him. The Ohio Industrial Commission terminated her Permanent Total Disability benefits.

On Friday, Oct. 16, Brenda Pumphrey was sentenced on her previously entered guilty plea to a felony count of workers’ compensation fraud. She was placed on community control for three years and ordered to pay restitution of $9,192.75. Pumphrey will serve six months in jail if she violates the terms of community control.

BWC investigations result in six workers’ comp fraud convictions in October

Columbus – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer announced today that six individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in October 2015. These court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID).

“Employers pay premium to BWC with the expectation that those dollars go toward the care and recovery of their workers who are injured on the job, not to dishonest claimants, employers or medical providers,” said BWC Administrator/CEO Steve Buehrer. “I am pleased our investigators were able to put an end to these attempts to defraud the workers’ compensation system.”

The following is a sampling of cases that resulted in guilty pleas or convictions during October:

Krystal Knight (Toledo, Lucas County) pleaded guilty Oct. 6 in the Lucas County Court of Common Pleas to one misdemeanor count of attempted theft for forgery. An investigation by BWC’s special investigations department revealed that Knight cashed two checks from Catholic Healthcare Partners, which were self-insured disability payments issued to another claimant, Judith Burris, in July 2014. The checks, totaling $1,062, were cashed after Burris, her mother, passed away on June 29, 2014. The investigation proved that Knight signed Burris’ name on the checks and presented Burris’ license to Huntington Bank in order to cash the checks. As part of a plea agreement, Knight was sentenced to pay restitution to Catholic Healthcare Partners in the amount of $1,062, but Knight failed to make the payment. She is scheduled for sentencing on November 17, 2015.

James Orr (Bethel, Clermont County) pleaded guilty Oct. 6 in the Hamilton County Municipal Court to a fourth-degree misdemeanor count of disorderly conduct for filing a false claim. Orr filed a claim with the BWC alleging he was injured in 2010 while working at Solutions Plus in Amelia.  Investigators interviewed co-workers and found that Orr had told them he hurt his back landscaping and working on his personal vehicle.  A medical report noted that Orr told the doctor that he was hurt at work two days prior to the alleged injury date on the first report of injury, and had sought treatment the next day at Clermont Mercy Hospital. Investigators found that Orr had not been treated by Clermont Mercy Hospital and time cards from the employer indicated that Orr did not work on the date of the alleged injury. Orr was sentenced to three days credit in the Hamilton County Jail, court costs, and ordered to stay employed.

Ralph Dollison (Circleville, Pickaway County) pleaded guilty Oct. 28 in the Franklin County Court of Common Pleas to one first-degree misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID received an allegation that Dollison was working while receiving compensation for a workplace injury. The investigation proved Dollison worked for a concrete company as a laborer and performed duties such as digging, building forms, pouring concrete and finishing concrete. Evidence also revealed he intentionally misrepresented and withheld his employment in order to continue collecting the disability benefits. Dollison was ordered to pay $4,081.47 in restitution and placed on community control for five years. He was also sentenced to 180 days in jail, suspended as long as he complies with the community control.

Timothy Morrow (Delaware, Delaware County) pleaded guilty to one first-degree misdemeanor count of workers’ compensation fraud on Oct. 20 in the Franklin County Court of Common Pleas for working while receiving benefits. SID opened an investigation after receiving an allegation that Morrow was operating his own HVAC business while receiving disability benefits from the BWC.  The investigation, which included a review of bank records and multiple interviews, confirmed Morrow did own and operate a business, TTM Mechanical, and conducted HVAC installations and repairs during the time he was receiving benefits. The evidence obtained during the course of the investigation also revealed that he intentionally misrepresented and withheld his employment from BWC. Morrow was sentenced to 30 days in the Franklin County Jail, suspended, and was placed on six months of probation.  He was also ordered to pay court costs along with $8,399.74 in restitution to BWC.  The restitution was paid at the clerk’s office after the hearing.

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

Check out our latest cases at ohiobwcfraud.wordpress.com and view BWC’s workers’ comp fraud awareness video on YouTube.