Workers’ comp fraud lands cheaters costly penalties

Convicts include Central Ohio doc ordered to pay $71K to BWC

Four Ohioans convicted or sentenced for workers’ compensation fraud in April include a Central Ohio physician who unlawfully distributed controlled substances and overbilled the Ohio Bureau of Workers’ Compensation (BWC).

On April 15, U.S. Judge Michael Wilson of the Southern District of Ohio ordered Kedar Deshpande, MD, to pay $117,122 in restitution, including $70,957 to BWC. The judge also sentenced Deshpande to three years of supervised release, 12 months of which is to be served under home detention, for felony counts of unlawful distribution of controlled substances and false statements relating to health care matters.

“Our Special Investigations Department found Dr. Deshpande upcoded patient office visits by falsely representing the level of examination he performed on our injured workers so he could receive inflated reimbursement from BWC,” said BWC Interim Administrator/CEO John Logue. “Congratulations to our investigators for their work on this important case and for bringing three other fraud cases to a close last month.”

Deshpande is the former owner and operator of the now-closed Orthopaedic & Spine Center, which had three locations in Central Ohio. A multi-jurisdictional task force of state and federal authorities found Deshpande pre-signed blank prescriptions for unqualified and non-licensed staff to complete and dispense to patients in his absence. The staff would fill-in the prescriptions with Schedule II controlled substances before dispensing to patients. The staff would mostly dispense the pre-signed prescriptions when Deshpande was on vacation, arrived late to the office, or was otherwise not at the clinic.

Other April fraud cases include:

William Knox of Athens, Ohio

Knox pleaded guilty April 7 in the Franklin County Common Pleas Court to one count of workers’ compensation fraud and one count of forgery, both fourth-degree felonies. Knox was sentenced to community control for five years and ordered to pay BWC restitution of $131,752.

BWC investigators found Knox inflated his weekly income from his employer of record so he could be paid at a higher weekly rate of compensation from BWC.

Tanya Houston of Shaker Heights, Ohio

A Franklin County judge ordered Houston to pay $23,489 to BWC and serve five years of probation in lieu of a one-year prison sentence after she pleaded guilty to a fifth-degree felony count of workers’ compensation fraud on April 7. BWC discovered Houston working while collecting injured-worker benefits.

Frank Phillips of Hamilton, Ohio

Phillips pleaded guilty April 26 in Franklin County to one count of workers’ compensation fraud, a fifth-degree felony, for working while receiving BWC disability benefits. He was ordered to pay BWC $12,588 in restitution and serve five years on community control.

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

Former police officer convicted for workers’ comp fraud

North Canton man owes BWC $89,000

A retired police officer for the city of Canton pleaded guilty to workers’ compensation fraud Thursday after the Ohio Bureau of Workers’ Compensation (BWC) discovered him working two jobs while claiming to be permanently disabled.

James H. Blaine of North Canton must pay BWC $66,481 in restitution and $23,000 in investigative costs after pleading guilty to the fourth-degree felony charge through a bill of information hearing in the Stark County Court of Common Pleas. A judge also ordered Blaine to serve three years of probation, obtain a full-time job, and provide 100 hours of community service.

“If you’re working two jobs, you’re clearly not permanently disabled,” said BWC Administrator/CEO Stephanie McCloud. “Kudos to our investigators for detecting this fraud and putting a stop to it.”

BWC’s Special Investigations Department discovered Blaine working as a security guard for a private company in late 2017 and operating his own landscaping business while collecting permanent total disability benefits for an injury he suffered while working for a salt company. His fraudulent activity is unrelated to his former job as a police officer in Canton, where he retired in 1997, according to city records.

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

Fayette County man owes $141,000 after second fraud conviction

Ohio BWC releases latest fraud convictions

A Washington Courthouse man pleaded guilty to felony workers’ compensation fraud Oct. 5 for working while receiving more than $141,500 in benefits from the Ohio Bureau of Workers’ Compensation (BWC).

Jeffrey Janson, 70, pleaded guilty to the fourth-degree felony in Franklin County Common Pleas Court. A judge sentenced him to six months in jail, suspended for three years of probation, and ordered Janson to pay restitution of $141,578 to BWC. Janson was previously convicted of felony workers’ compensation fraud in July 2010.

“Most people learn a lesson after a conviction for workers’ compensation fraud,” said BWC Administrator/CEO Stephanie McCloud. “Obviously that’s not the case with Mr. Janson, who tempted fate again and was caught a second time by our investigators.”

BWC’s Special Investigations Department discovered Janson working as a semi-truck driver while receiving benefits for a workplace injury. Further review of his bank records proved he was, in fact, working for four additional employers during the same time period.

In other news, BWC secured five fraud-related convictions in September, bringing its 2020 calendar year total to 57. They include a case involving a Logan County man receiving benefits while coaching high school sports teams.

BWC investigators found Dennis Martin, of Bellefontaine, working as varsity baseball coach and as an assistant coach for girls varsity basketball at Botkins High School from Oct. 27, 2017 to May 7, 2018. During this same time, Martin was collecting disability benefits from BWC. A judge credited Martin for time served and terminated the case. Martin has paid restitution of $7,082 to BWC.

On Sept. 23, Jessica Holston, of Dayton, pleaded guilty to misdemeanor theft in Franklin County Common Pleas Court for collecting more than $3,200 in disability benefits from BWC while working as a home health aide for Wellcare Home Health from March 13, 2017 to May 30, 2017. A judge sentenced Holston to 180 days in jail, suspended for three years of probation, and ordered her to pay $3,242 in restitution to BWC.

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

 

Video surveillance exposes Sidney couple’s scheme to defraud BWC

Agency closes 11 cases in June, July

The Ohio Bureau of Workers’ Compensation (BWC) closed 11 cases involving workers’ compensation fraud and related charges in June and July, bringing total convictions for BWC to 47 for calendar year 2020.

“Workers’ compensation fraud can happen anywhere in Ohio,” said BWC Administrator/CEO Stephanie McCloud. “That’s why we have dedicated investigators in every corner of the state to uncover folks — whether they’re employers, injured workers or medical providers — who try to cheat the system.”

Among the June cases is a Sidney, Ohio, couple sentenced on felony charges related to workers’ compensation fraud after a BWC investigation found the husband mowing lawns, using a snow blower, and chopping wood while claiming to be permanently and totally disabled from work.

A Shelby County judge sentenced David Juillerat on June 8 to five years of probation in lieu of jail time and a fine of $1,000 for his conviction on a reduced charge of attempted tampering with records, a fourth-degree felony. Juillerat’s wife, Wendy Juillerat, was sentenced three days earlier on a similar charge, attempted complicity to tampering with records, also a fourth-degree felony. A judge sentenced her to five years of probation in lieu of jail time and to pay court costs.

David Juillerat applied to BWC in 2018 for permanent total disability benefits, claiming a work injury left him unable to drive a car or walk without the assistance of a walker. Acting on a tip that he might be faking his injury, agents with BWC’s Special Investigations Department surveilled David for several weeks in 2019. They filmed him on multiple occasions entering and leaving medical offices with a walker. Away from a medical office, however, agents filmed him walking, shopping, working on his car, chopping wood, and other activities, all without the use of a cane or walker.

As for Wendy Juillerat, agents say she admitted to helping her husband complete his application for permanent total disability and accompanied him to numerous doctor’s appointments in which she would exaggerate his physical limitations in order for the disability to be granted.

Based on BWC’s investigation, David Juillerat’s application for disability benefits was denied in late 2019, saving BWC an estimated $233,668 in benefits over the projected life of the claim.

Other cases in June and July include:

Joseph Ferguson of Toledo

Ferguson pleaded guilty July 24 in Franklin County Common Pleas Court to one count of workers’ compensation fraud, a first-degree misdemeanor, after a BWC investigation revealed he was working as a web development supervisor while receiving benefits from BWC from October 2017 to January 2018. The judge sentenced Ferguson to five years of community control and ordered him to pay restitution of $6,473 to BWC. If he violates the terms of his community control, he will serve 60 days in jail.

Ruth Asamoah of Columbus

On July 13, Asamoah pleaded guilty to one count of workers’ compensation fraud, a fifth-degree felony, for working while receiving BWC disability benefits. BWC investigators found Asamoah worked for eight employers, performing the same or similar jobs she was doing when she was injured. A Franklin County judge ordered her to pay $15,020 in restitution and sentenced her to an 11-month jail sentence, suspended for five years of probation.

Jeffrey Berkley of Taylor, Michigan

BWC investigators found Berkley working as a driver, transporting cars around the Midwest, while receiving BWC benefits from July 2014 to September 2014. On July 7, Berkley pleaded guilty in Franklin County to one count of workers’ compensation fraud, a first-degree misdemeanor. The judge sentenced him to a 12-month suspended jail sentence and ordered him to pay restitution of $2,668 to BWC. Berkley paid the full amount of restitution to the clerk of courts prior to the plea.

Marguerite Cervantes of Perrysburg

Cervantes pleaded guilty July 2 to one count of workers’ compensation fraud, a fifth-degree felony, in the Franklin County Court of Common Pleas. A BWC investigation revealed Cervantes had returned to work as a clinical nurse from April to October 2016 while collecting temporary total disability benefits. The judge sentenced her to an 11-month suspended jail sentence, five years of probation, and ordered her to pay restitution of $16,885.

Angela Berardelli of North Canton

A BWC investigation revealed Berardelli was working at a restaurant while receiving BWC benefits from January 2016 to June 2017. On June 30, Berardelli pleaded guilty to one count of workers’ compensation fraud, a first-degree misdemeanor. She received a sentence of 90 days in jail suspended for 12 months of community control. The judge ordered Berardelli to pay restitution of $10,194 to BWC. She made a payment of $6,500 at the time of plea.

Patricia Black of Cincinnati

Black pleaded guilty June 16 in Franklin County to one count of workers’ compensation fraud, a fifth-degree felony. An investigation by BWC found Black working as an office cleaner while receiving BWC benefits from January 2018 to October 2018. Black was ordered to pay $18,407 in restitution and sentenced to 12 months in prison, suspended for three years of non-reporting community control.

To report suspected workers’ compensation fraud, call 1-800-644-6292 (Option 4, Option 0, Option 1) or visit bwc.ohio.gov.

Special Investigations Dept nets 6 convictions in July

The BWC Special Investigations Department netted six convictions in July in criminal cases related to workers’ compensation fraud.

“Workers’ comp fraud is not only illegal, it impacts the entire workers’ comp system designed to protect Ohio workers and employers in the event of a workplace injury,” said BWC Administrator/CEO Sarah Morrison. “Putting an end to fraud safeguards employer premiums that should be going toward helping injured workers return to health and back on the job as soon as possible.”

As of July 31, BWC’s Special Investigations Department had secured 61 convictions for the calendar year. July convictions include:

Mike G. Abro (Cuyahoga County)
Investigators found Abro was operating several Happy’s Pizza franchise locations in Northeast Ohio with multiple BWC policies in which coverage was lapsed.  Abro worked with BWC to bring several policies back into compliance, but failed to become compliant at his East Cleveland location.

Abro pleaded guilty July 6 in Cuyahoga County Common Pleas Court to one count of failure to comply, a second-degree misdemeanor. He was sentenced to 90 days incarceration, suspended, and ordered to serve one year of non-reporting probation. As a condition of his probation, Abro was ordered to bring the lapsed policy into compliance. He made a $15,000 payment in June, and must enter into a payment plan on his remaining balance of approximately $18,000 in order to become compliant with the law.

Shannon Graham (Lorain County)
Investigators found Graham had returned to employment as a medical records and scheduling coordinator with a retirement community while receiving temporary total disability benefits by a self-insured employer.

Graham pleaded guilty July 26 in Cuyahoga County Common Pleas Court to one count of falsification, a first-degree misdemeanor. She made an initial restitution payment of $2,500. She was sentenced to a 180 days jail, suspended for one year of community control, and ordered to pay restitution in the amount of $3,200.

Diane Kaiser (Franklin County)
Investigators found Kaiser working for an insurance company while also receiving temporary total disability benefits from BWC. Kaiser pleaded guilty July 11 in Franklin County Common Pleas Court to one count of attempted workers’ compensation fraud, a first-degree misdemeanor. She was ordered to pay $1,734 in restitution and $500 in investigative costs to BWC.

Donald Rasmussen (Lucas County)
Investigators found Rasmussen was working as a truck driver while receiving temporary total disability payments from BWC. Rasmussen pleaded guilty July 26 in Franklin County Common Pleas Court to one count of workers’ compensation fraud, a first-degree misdemeanor. The judge sentenced Rasmussen to 60 days in jail, suspended for one year if he has no other convictions. Rasmussen paid $29,720 in restitution to BWC prior to his plea.

De’Ericka Vason (Cuyahoga County)
Investigators found Vason working as a day care worker while collecting temporary total disability payments from BWC. Vason pleaded guilty July 5 in Franklin County Common Pleas Court to one count of workers’ compensation fraud, a first-degree misdemeanor. Vason was sentenced to 180 days in jail, suspended for three years of community control, and ordered to pay restitution in the amount of $2,235 to the BWC.

 Ryan Somnitz (Sherrills Ford, North Carolina)
Acting on an anonymous tip, investigators found Somnitz was not fulfilling the educational requirements he needed to receive dependent death benefits. He was required to be pursuing a full-time educational program while enrolled in an accredited educational institution. Investigators, however, found Somnitz consistently and knowingly remained in part-time student status and withheld from BWC that he was not a full-time student. Somnitz pleaded guilty July 11 to one count of workers’ compensation fraud, a fifth-degree felony. He is scheduled for sentencing Aug. 24.

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

Ohio BWC investigative unit nets 5 convictions in May

Investigators with the Ohio Bureau of Workers’ Compensation landed five convictions in May of individuals caught cheating the workers’ compensation system or deceptively obtaining prescription narcotics.

Those convicted included one woman who was cashing in on a dead man’s injured worker’s benefits, another who falsely claimed she was poisoned at work, two men who were found working while receiving BWC benefits and another who hoodwinked two physicians into writing overlapping prescriptions for painkillers.

“Investigating and putting an end to fraud helps protect the benefits of injured workers and keep employers’ premiums down,” said BWC Administrator/CEO Sarah Morrison. “That’s why BWC is so proactive in pursuing all employers, medical providers, workers and others who are committing fraud.”

The BWC’s Special Investigations Department (SID) has netted 45 convictions so far this year. May’s convictions include:

Darlean McCurdy (Hamilton County) – McCurdy pleaded guilty May 10 to one count of workers’ compensation fraud after investigators photographed her using a deceased BWC claimant’s EBT card to withdraw cash from several ATMs.

A Hamilton County common pleas court judge on May 24 ordered McCurdy to perform 100 hours of community service, serve five years probation and repay the BWC $7,321.16, plus $2,265 in investigative costs. She was also sentenced to a year in prison but only if she violates her parole.

Jennifer Martin (Morrow County) – Martin filed for BWC benefits after claiming to police someone at work poisoned her by putting bug spray in her beverage. A police investigation found her claim to be false.

Martin pleaded guilty to a misdemeanor count of workers’ compensation fraud May 10 in Mason Municipal Court. A judge sentenced her to one year probation and ordered her to repay the BWC $2,143.50 for its investigation and pay court costs of $420. The judge also sentenced her to 180 days in jail, which he then suspended.

James Calvey (Cuyahoga County) — Calvey pleaded guilty to a misdemeanor count of workers’ compensation fraud May 17 after investigators filmed him working as a tow truck driver while receiving Temporary Total Disability Benefits from the BWC. A Franklin County common pleas judge sentenced Calvey to 10 days in jail, to be served in August, and fined him $100.

Carol Hoover (Pike County) – Hoover pleaded guilty May 10 in Clark County Common Pleas Court to one count of deception to obtain a dangerous drug, a felony of the fifth degree. She was sentenced June 1 to two years of community control and fined $1,000.

BWC investigators became suspicious after reviewing records indicating Hoover received narcotic prescriptions with overlapping fill dates from two different physicians. When interviewed, the physicians said they felt deceived and would not have prescribed the narcotics had they been aware of the other prescribing physician.

Spiro Frangos (Mahoning County) — Frangos pleaded guilty to one count of workers’ compensation fraud, a fifth degree felony, on May 9, after investigators found him working as a laborer while receiving BWC benefits. A Franklin County common pleas judge sentenced Frangos to two years of community control.

Tuscarawas County woman ordered to repay $9K for workers’ comp fraud

Robin Beckett of Dennison (Tuscarawas County) has been ordered to repay more than $9,000 to the Ohio Bureau of Workers’ Compensation after investigators found she knowingly committed fraud by working in violation of the workplace injury benefits she was receiving.

The Special Investigations Department Intelligence Unit noted a database cross-match with the Ohio Department of Job and Family Services showed Beckett earned wages during periods when she was also collecting disability benefits for a workplace injury. The investigation produced evidence proving Beckett knowingly and with fraudulent intent worked for Tender Touch Home Health performing various nursing duties while on temporary total disability.

Robin Beckett pleaded guilty to a fifth-degree felony count of workers’ compensation fraud on Oct. 6 in the Franklin County Court of Common Pleas. Judge McIntosh sentenced Beckett to 10 months in prison, suspended for three years of community control. Conditions of her probation include payment of restitution totaling $9,330.29.

BWC investigations result in five workers’ comp fraud convictions in November

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

“Identifying and weeding out fraud is an essential part of not only maintaining fairness, but keeping workers’ comp costs manageable for Ohio employers,” said Buehrer.

The following is a summary of the cases that resulted in guilty pleas or convictions in November:

Latonia Almon (Columbus, Franklin County) pleaded guilty Nov. 16 to a fifth-degree felony count of workers’ compensation fraud in the Franklin County Court of Common Pleas for working while receiving benefits. A cross match with the Ohio Department of Job and Family Service conducted by BWC’s Intelligence Unit identified Almon as possibly working while receiving temporary total disability benefits. SID obtained employment records that revealed Almon she continued to work as a home health aide during the entire period she was collecting benefits for a workplace injury. During an interview, Almon admitted to “kinda” working and receiving payment for the services she provided. Almon admitted she did not inform the BWC of this employment. A pre-sentence investigation has been ordered and sentencing is scheduled for January 15, 2016.

Robert Aleshire (Delta, Fulton County) pleaded guilty Nov. 3 in the Franklin County Court of Common Pleas to a fifth-degree felony count of theft for working while receiving benefits. SID’s Intelligence Unit identified that Alshire was involved in a Public Utilities Commission of Ohio (PUCO) motor vehicle inspection as a commercial truck driver while he was collecting permanent total disability benefits from BWC. The investigation found that Aleshire was driving as an independent contractor under the name MoMo Trucking. The judge ordered a pre-sentence investigation and Aleshire is scheduled to be sentenced on January 13, 2016.

Sandra Houshel (Dayton, Montgomery County) pleaded guilty Nov. 19 in the Franklin County Municipal Court to one first-degree misdemeanor count of workers’ compensation fraud for working while receiving benefits. The judge ordered her to pay a fine of $100 plus court costs. SID began investigating after receiving an allegation that Houshel was working at a restaurant in downtown Dayton while collecting temporary total disability benefits for a workplace injury. The investigation found that Houshel was working at the restaurant most the week, opening the restaurant and working as a waitress. Houshel immediately paid the full restitution of $3,369.24 to the court.

Mike Crawley (Shelbyville, Indiana) pleaded guilty Nov. 16 in the Darke County Court of Common Pleas to one fifth-degree felony count of workers’ compensation fraud for working while receiving benefits. SID began investigating after receiving an allegation that Crawley may be working for a local trailer park. The investigation found that Crawley performed various maintenance work at the mobile home park while collecting temporary total disability benefits from BWC. Crawley is scheduled to be sentenced on January 16, 2016.

Rachel Madison (Bedford, Cuyahoga County) pleaded guilty Nov. 23 in the Franklin County Court of Common Pleas to a fifth-degree felony count of workers’ compensation fraud for improperly receiving dependent death benefits. Madison was eligible to receive death benefits up to age 25 if enrolled at an accredited educational institution. SID received an allegation that she was submitting proof of college enrollment to the BWC in order to receive the benefits but was not attending the classes. Madison’s course schedule from the University of Akron showed that either she failed to attend classes or did not remain in full-time status. She failed to report to BWC that she did not attend classes and was not enrolled as a full-time student but submitted paperwork to BWC in order to continue receiving the benefits. Madison was sentenced to six months in prison, suspended for five years of community control. As a condition of her probation, she is required to pay $12,319.98 in restitution.

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.

Bedford woman owes BWC $12,000 for workers’ comp fraud

A Bedford (Cuyahoga County) woman has pleaded guilty to workers’ compensation fraud for misleading BWC about her status as a college student.

Rachel Madison was eligible to receive death benefits up to age 25 if enrolled at an accredited educational institution. SID began investigating after receiving an allegation that she was submitting proof of college enrollment to BWC in order to receive benefits but was not attending the classes. Her course schedule from the University of Akron showed that either she failed to attend classes and/or did not remain in full-time status, which is required to continue receiving benefits.

The investigation found Madison failed to report to BWC that she didn’t attend classes and was not enrolled as a full-time student. However, she continued to submit paperwork to BWC in order to continue receiving dependant death benefits.

Rachel Madison pleaded guilty to one count of workers’ compensation fraud on Nov. 23 in the Franklin County Court of Common Pleas.  Madison was sentenced to six months in prison, suspended for five years of community control. As a condition of her probation, she is required to pay $12,319.98 in restitution to the BWC.

Wayne County realtor pleads guilty to workers’ comp and social security fraud

James Miller of West Salem (Wayne County) recently pleaded guilty to workers’ compensation and social security fraud and has been ordered to repay more than $30,000.

BWC’s Special Investigations Department began investigating Miller after receiving an allegation that he was working as a realtor while receiving living maintenance wage loss statements. This benefit is available to an injured worker who has completed a rehabilitation plan but continues to have physical restrictions and experiences a wage loss upon return to work.

Internet research showed Miller had listings and recent sales with Howard Hanna and employment and bank records revealed he had received numerous paychecks from the company. However, he had been submitting paperwork to BWC showing he had no earnings.

Miller admitted to earning the money as a realtor but claimed that his expenses as a realtor were so great that he earned $0.  However, as part of his benefits, BWC had paid for these expenses previously and were not out-of-pocket expenses to Miller. Additionally, it was discovered that Miller was receiving monthly benefits from the Social Security Administration (SSA).

Miller entered a guilty plea to two felony counts of theft and two felony counts of tampering with records in an Ashland County courtroom. The plea represents two counts for BWC and two for SSA.

The judge sentenced Miller to 150 days of house arrest with GPS monitoring for each count, which will run concurrently. Additionally, Miller will serve four years of probation supervision and 250 hours of community service.  Conditions of community control include the payment of restitution to BWC in the amount of $11,081.68 and $20,878.79 to the SSA. Miller was also ordered to pay a fine of $ 1,000.

He will face 18 months of prison time if he fails to abide by the sanctions imposed by the court.