Fraudulent billing leads to occupational therapist’s conviction

Agency secures 6 fraud-related convictions in December   

A northeast Ohio occupational therapist was convicted last month for felony workers’ compensation fraud for billing the Ohio Bureau of Workers’ Compensation (BWC) for treatment services she did not provide to patients.

Susanna Kagalitskaya Freedman, of Euclid, pleaded guilty Dec. 17 in a Cuyahoga County court to a fifth-degree felony count of workers’ compensation fraud. The judge sentenced her to five years of probation and a $2,500 fine. Additionally, Freedman was permanently decertified to treat BWC patients for claim-related injuries.

“As an agency, we expect providers to give superior care and service to injured workers,” said BWC Administrator/CEO Stephanie McCloud. “This particular provider obviously did not meet the standard of care injured workers deserve and she cheated our system.”

Numerous red flags in Freedman’s billing practices and treatment notes sent to BWC prompted BWC’s Special Investigations Department (SID) to initiate an investigation starting in October 2017. Investigators discovered Freedman was falsifying documents, indicating services had been rendered when they had not. BWC would then pay for the substandard care based on the falsified information Freedman provided.

SID secured five other fraud-related convictions in December, bringing calendar year 2019’s total to 94.

Jeffrey Jakob of Toledo
Jakob pleaded guilty Dec. 31 in Toledo Municipal Court to one count of failure to comply, a second-degree misdemeanor, after BWC found he was operating his business, J.A. Jakob Marine Contracting, with lapsed coverage since March 2015. BWC agents made multiple attempts to assist Jakob in getting his coverage reinstated, but he failed to do so. The judge ordered him to one year of probation and to comply with a reinstatement payment plan with the Ohio Attorney General’s office. He must also remain current on installment payments to BWC.

Harold Brown of Bellefontaine
Brown pleaded guilty Dec. 23 to three second-degree misdemeanor charges of failure to comply for running his business, Brown’s Lawn & Tree Service, without workers’ compensation coverage. BWC investigators discovered his BWC policy had been lapsed since September 2010. Brown received 30 days in jail (suspended), a $250 fine, and was ordered to make regular payments to BWC and the Attorney General until a reinstatement payment plan was paid in full. The current amount due on Brown’s BWC policy is approximately $133,000.

Marie Olinger of Delta
On Dec. 17, a Franklin County judged ordered Olinger to three years of community control for working while receiving more than $2,800 in disability benefits from BWC. The investigation found Olinger had returned to work at the Dental Center of Northwest Ohio between January and March 2017 while receiving temporary total disability benefits.

Rodney Filibeck of Mansfield
Filibeck pleaded guilty Dec. 16 in Franklin County Common Pleas Court to one count of workers’ compensation fraud, a first-degree misdemeanor. After receiving an anonymous tip, BWC investigators determined Filibeck was working construction jobs while receiving BWC disability benefits between September 2016 and June 2017. The judge handed down a 60-day jail sentence, suspended for 12 months of community control and ordered him to pay $2,519 in restitution to BWC.

Deangelo Speed of Shaker Heights
Speed pleaded guilty Dec. 2 in a Franklin County courtroom to a fifth-degree felony count of workers’ compensation fraud. BWC agents found Speed working as a truck driver while collecting BWC benefits from Oct. 20, 2015, through Jan. 27, 2017. The judge ordered Speed to pay BWC $7,599 in restitution and court costs by March 2, 2020. The judge also sentenced Speed to a six-month jail sentence, suspended for six months of probation.

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

Northeast Ohio business owners owe BWC nearly $1.3 million following fraud convictions

Two northeast Ohio businessmen must pay the Ohio Bureau of Workers’ Compensation (BWC) nearly $1.3 million in restitution following their recent convictions on multiple fraud charges in separate, unrelated cases.

“We look forward to recouping these dollars and directing them where they belong — taking care of injured workers, creating safe workplaces, and giving employers excellent coverage and service,” said BWC Administrator/CEO Stephanie McCloud.

Sentenced Monday in a Cuyahoga County courtroom, Robert E. Fitz must pay BWC $961,956 in monthly installments and serve five years of probation for his Sept. 30 conviction on a fourth-degree felony charge of workers’ compensation fraud.

Fitz, an attorney and owner of Action Maids residential cleaning company in Westlake, Ohio, had refused to cooperate with BWC to bring his lapsed policy into compliance, leaving the agency to pick up the costs on 43 injury claims since 2003, five in the last five years.

On Oct. 21 in Stark County, a judge ordered an Alliance man to pay BWC $300,230 in restitution after BWC found him defrauding the agency in multiple ways, including working at two businesses he owned while collecting workers’ compensation for work injuries he claimed left him permanently and totally disabled.

Roger L. Kale, Jr., 51, also must serve five years of probation and perform 100 hours of community service. BWC’s Special Investigations Department also found the following:

  • To establish his compensation rate for his 2009 workplace injury, Kale reported wages for himself that were higher than what he reported on his BWC payroll reports for all of his employees combined.
  • Kale operated A-1 Brosch Tree Service without workers’ compensation coverage required by Ohio law.
  • Kale under-reported his payroll and misclassified his employees to lower the cost of his BWC premiums.
  • Kale presented clients an altered BWC certificate of coverage to make it appear his business had coverage when it did not. One client reported Kale to BWC.

Video obtained from the Ohio State Highway Patrol shows Kale operating a tow truck while claiming to be permanently disabled.

Kale pleaded guilty to one count of tampering with records, a fourth-degree felony; three counts of workers’ compensation fraud, all fourth-degree felonies, and two first-degree misdemeanor charges of workers’ compensation fraud.

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

Cincinnati caterer convicted of workers’ comp fraud

Woman ran catering business while collecting disability benefits

A Cincinnati woman claiming to be permanently disabled from work owes the Ohio Bureau of Workers’ Compensation (BWC) nearly $41,000 after her felony conviction Oct. 24 for workers’ compensation fraud.

Michelle D. Smith, 57, pleaded guilty to the fifth-degree felony in the Franklin County Common Pleas Court after BWC discovered she owned and ran two businesses, Expression Unique LLC and Later in Life Brides, while collecting BWC benefits for workers deemed permanently and totally disabled.

“Our Special Investigations Department found records indicating Ms. Smith worked 35 hours per week at her businesses,” said BWC Administrator/CEO Stephanie McCloud. “I don’t think that meets anyone’s definition of ‘permanently and totally disabled,’ let alone BWC’s.”

Smith, who was injured on a job in 2000, declined through her attorney to be interviewed by BWC investigators about her case. Investigators gleaned much of their evidence from customer interviews and a catering contract Smith had with the city of Cincinnati.

A Franklin County judge ordered Smith to pay BWC $40,873 dollars in restitution and serve five years of non-reporting community control (probation). If she violates her probation, she must serve a year in prison.

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

Nearly $1 million owed BWC in employer fraud case

Cleveland-area business owner convicted of fraud Monday

A northeast Ohio business owner owes the Ohio Bureau of Workers’ Compensation nearly $1 million in restitution following his conviction Monday in Cleveland on workers’ compensation fraud charges.

Robert E. Fitz, an attorney and owner of Action Maids residential cleaning company in Westlake, Ohio, pleaded guilty to a fourth-degree felony charge of workers’ compensation fraud after refusing to cooperate with BWC to bring his lapsed policy into compliance.

“Mr. Fitz owes at least $965,000 in unpaid premiums and for the costs of injured worker claims that occurred while his policy was lapsed,” said BWC Administrator/CEO Stephanie McCloud. “If he had just followed the law and paid his premiums, he wouldn’t be in this trouble today.”

At his conviction hearing in the Cuyahoga County Court of Common Pleas, Fitz agreed to work with BWC and the Ohio Attorney General’s Office to provide his company’s financial reports and enter a reinstatement payment plan prior to his sentencing date of Nov. 4.

According to BWC’s Special Investigation Department, Fitz’s BWC policy has been lapsed since Sept. 1, 2003. Since then, BWC has picked up the costs on 43 injury claims, including five since 2014.

In other fraud news, a northeast Ohio man must pay BWC nearly $79,000 in restitution after pleading guilty to a fifth-degree felony charge of workers’ compensation fraud Tuesday in a Franklin County courtroom.

Ronald J. Dorfeld of Brunswick, Ohio, must pay BWC $78,957 and serve five years of probation in lieu of a nine-month jail sentence for working while collecting BWC disability benefits.

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

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.

Former deputy sheriff owes BWC $235K for workers’ comp fraud

Zanesville man earns felon status after Monday’s conviction

A Zanesville man and former county deputy sheriff must reimburse the Ohio Bureau of Workers’ Compensation nearly $235,000 in restitution following his felony conviction for workers’ compensation fraud Monday in a Franklin County courtroom.

A judge ordered Gregory A. Fitzer, 56, to pay BWC $211,536 in restitution and $23,187 in investigative costs after Fitzer pleaded guilty to a fourth-degree felony charge of workers’ compensation fraud. She also ordered the former Muskingum County deputy sheriff to serve four years of probation in lieu of a year in jail.

“Our investigators found Mr. Fitzer knowingly and with fraudulent intent deceived our agency and his physicians in order to receive disability benefits,” said BWC Administrator/CEO Stephanie McCloud.

Acting on a tip, BWC’s Special Investigations Department discovered Fitzer worked as a process server and investigator for several law firms in and around Zanesville from January 2007 to March 2016 while collecting disability benefits from BWC. The investigation, which included surveillance, multiple interviews and a review of bank and employment records, also found he worked as a truck driver and laborer for a local retailer.

In other fraud news:

BWC secured eight fraud-related convictions in August, bringing 2019’s total to 63. They include a Central Ohio nurse practitioner convicted on health care fraud charges.

BWC assisted in the investigation that led to the Aug. 30 sentencing of nurse practitioner Amy Wood-Kirk of Grove City and fiancé Ryan Edney on one count of conspiracy to commit health care fraud. Amy Wood-Kirk prescribed large quantities of medications, including prescriptions for compounded pain cremes, outside acceptable medical standards for the personal profit of herself and Edney.

The U.S. District Court for the Southern District of Ohio sentenced Wood-Kirk to five years of probation and ordered her and Edney to repay Medicaid, TriCare, and Medical Mutual of Ohio $751,809 in restitution. Wood-Kirk was also sentenced to 180 days home confinement.

In order of most recent court appearance, other August convictions include:

Jim Hesler, dba Robert’s Roofing, Batavia, Ohio
Hesler was found guilty Aug. 23 in Clermont County Common Pleas Court on two counts of workers’ compensation fraud, both fifth-degree felonies. BWC investigated Hessler after learning he had not been reporting his payroll to the agency and several injury claims had been filed.

Investigators found his business was still in operation. Sentencing is scheduled for Oct. 8, at which time a judge may determine the amount of restitution owed BWC.

Eric Johnson, Akron, Ohio
Johnson pleaded guilty Aug. 22 to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC found him working while receiving disability benefits. Prior to entering the plea, Johnson deposited full restitution of $1,062 at the clerk of court’s office.

Gregory White, dba White’s Auto Care LLC, Lorain, Ohio
White pleaded no contest Aug. 22 to one count of failure to comply, a second-degree misdemeanor, for not reinstating his BWC policy while operating his business. A second count was dismissed as White had brought his BWC account current prior to court. White was ordered to pay court costs of $167.

Everett Ferryman, Marysville, Ohio
Ferryman pleaded guilty Aug. 21 to one count of workers’ compensation fraud, a fifth-degree felony, after BWC discovered him working as a truck driver and receiving cash “under the table” while receiving BWC disability benefits. The court sentenced him to a term of probation not to exceed five years but could terminate sooner upon payment of $22,851 in restitution. The court also imposed a suspended sentence of 12 months in prison.

Tammy Hill, Jackson, Ohio
Hill pleaded guilty Aug. 12 in Jackson County Municipal Court to theft by deception, a first-degree misdemeanor, after BWC found her cashing BWC benefit checks belonging to an injured worker. A judge ordered Hill to serve up to five years of probation, complete 500 hours of community service, 180 days in jail (suspended), and pay a $100 fine and court costs within 12 months.

Paul Gall, dba Sun Masters, Brooklyn Heights, Ohio
BWC found Gall had been operating his business, Sun Masters LLC, without BWC coverage since March 2014. In lieu of conviction, Gall entered a payment plan with the Ohio Attorney General’s office after making a down payment of $12,000 toward his $44,000 balance.

Robert McWhorter, New Albany, Ohio
McWhorter pleaded guilty Aug. 7 to one count of workers’ compensation fraud, a fifth-degree felony, after BWC found him working for his landscaping company while receiving BWC disability benefits. A judge ordered McWhorter to pay $9,888 in restitution to BWC and serve one year of probation in lieu of a 6-month jail sentence.

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

Ohio trucker, others convicted of workers’ comp fraud

Marysville man kept truckin’ while collecting disability benefits

A Marysville truck driver was convicted of workers’ compensation fraud Wednesday after the Ohio Bureau of Workers’ Compensation discovered he continued to work while collecting BWC benefits for a workplace injury he suffered more than a decade ago.

Everett Ferryman, 46, pleaded guilty in a Franklin County courtroom to a fifth-degree felony count of workers’ compensation fraud. The judge ordered Ferryman to pay BWC $22,851 in restitution and serve probation for five years or until restitution was paid, whichever came first. She also imposed a suspended sentence of a year in prison.

“The law is clear — our benefits are for workers who are truly injured,” said BWC Administrator/CEO Stephanie McCloud. “They’re not a support system for people trying to cheat BWC and Ohio employers.”

Acting on a tip in 2017, BWC’s Special Investigations Department found Ferryman working as a truck driver while collecting BWC benefits from at least March 27, 2017, to Oct. 31, 2017. He was injured as a truck driver in May 2008 and had received temporary disability benefits from BWC periodically since then.

In other news
The owner of a Central Ohio landscaping company was ordered to pay BWC $9,888 in restitution Aug. 7 after investigators found he continued to work for his company while collecting BWC benefits for nearly a year and a half.

Robert J. McWhorter of New Albany pleaded guilty to a fifth-degree felony count of workers’ compensation fraud in a Franklin County courtroom. A judge sentenced McWhorter to one year of probation in lieu of six months in jail. He has paid his restitution in full.

Also in recent news, BWC’s Special Investigations Department secured five fraud-related convictions in July, bringing total convictions for calendar year 2019 to 54. Those convicted include:

James Coon of Akron, dba James Coon Construction
Coon pleaded guilty to involuntary manslaughter July 24 after one of his workers fell to his death in late 2017. He also pleaded guilty to a fourth-degree felony charge of workers’ compensation fraud.

BWC found Coon lacked workers’ comp coverage when his employee died and that he repeatedly lied about his business over the years to minimize his premiums or avoid paying them altogether. Sentencing is scheduled for Sept. 6.

Jacci Richards of Toledo/dba Acorns to Oaks
Richards pleaded no contest but was found guilty July 16 to a second-degree misdemeanor charge of failure to comply after BWC found her operating a now-closed day care center without workers’ compensation coverage. A judge ordered her to pay $99 in court costs.

R. Gregory Lawrence of Euclid, dba Lakeshore Coffee House Inc.
BWC found Lawrence was operating Lakeshore Coffee House Inc. with lapsed BWC coverage. Lawrence pleaded guilty July 11 in Euclid Municipal Court to two counts of disorderly conduct, both minor misdemeanors. Lawrence was fined $200. Prior to the court date, Lawrence paid the balance he owed BWC and brought his policy into compliance.

Scott Laird of Cambridge
Laird pleaded guilty July 10 to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC found him working while collecting BWC benefits. A judge ordered Laird to pay BWC $3,113 in restitution and sentenced him to two years of probation in lieu of 90 days in jail.

Cynthia Gribble of New Philadelphia
Gribble pleaded guilty July 1 to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC found her working as a home health care aide while collecting BWC benefits. A judge ordered her to pay BWC $7,328 in restitution and serve six months of probation in lieu of 90 days in jail.

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

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