BWC secures 14 fraud-related convictions in October

Fraudsters owe BWC more than $283,000 in restitution

The Ohio Bureau of Workers’ Compensation (BWC) secured 14 fraud-related convictions in October, with those convicted owing BWC a combined $283,146 in restitution.

Those convicted include injured workers found working while collecting disability benefits, family members collecting their deceased parent’s compensation benefits, and business owners whose coverage had lapsed.

“When people cheat BWC or fail to cover their own employees, they are cheating the injured workers who really need our help and the employers in our system that follow the law,” said BWC Administrator/CEO Stephanie McCloud.

In order of most recent court appearance, those convicted in October include:

Bruce Starkey of Cincinnati, Ohio
Starkey pleaded guilty Oct. 17 and was sentenced in Hamilton County Common Pleas Court Nov. 4 on one count of workers’ compensation fraud, a fifth-degree felony. Starkey received 100 hours of community service and was required to pay BWC full restitution for the $1,459 in permanent total disability benefits he took from his mother’s bank account after she passed. He failed to inform BWC of her passing and wrote 15 checks, forging his mother’s signature.

Cecil Piner of Xenia, Ohio
Piner pleaded guilty Oct. 31 in Franklin County Common Pleas Court on one count of workers’ compensation fraud, a fifth-degree felony, after BWC found him driving a school bus while receiving $17,901 in disability benefits. He was sentenced to five years’ probation in lieu of 12 months in jail and ordered to pay court costs and full restitution.

Kyle Foreman of New Carlisle, Ohio
Foreman pleaded guilty Oct. 30 in Clark County Municipal Court on two counts of failure to comply, both second-degree misdemeanors. His coverage for Kyle S. Foreman Enterprises had lapsed since November 2017, and he failed to pay the premiums before taking his company into bankruptcy. He was ordered to pay a $100 fine and court costs for each count.

Michelle Smith of Cincinnati, Ohio
Smith, 57, pleaded guilty Oct. 23 to one count of workers’ compensation fraud, a fifth-degree felony, 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. 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.

Louis Tombazzi of Cleveland, Ohio
BWC found Tombazzi owed the agency approximately $75,000 in premiums after letting the policy lapse for his business, Garda Architectural Fabrication. He pleaded guilty Oct. 16 in Cleveland Municipal Court to one count of failure to comply, a second-degree misdemeanor, and was ordered to serve 90 days in jail (suspended), pay a $400 fine, and serve two years’ probation. He also was ordered to report monthly to the court his effort to reduce or pay off his BWC obligation.

Natalia Daniels of Concord Township, Ohio
Daniels pleaded guilty Oct. 16 to one count of workers’ compensation fraud, a first-degree misdemeanor, after receiving $3,600 in BWC disability benefits while working as a bus driver for a senior living facility and as a laborer for an insurance company. A judge ordered her to pay full restitution to BWC and serve 18 months of probation in lieu of a 180-day jail sentence.

Vicki Aloisio of West Chester, Ohio
Aloisio was convicted Oct. 11 on two counts of failure to comply, both second-degree midemeanors, for failing to carry BWC coverage on her business, Richard Aloisio Trucking Inc., despite numerous BWC attempts to assist her. Aloisio owes $28,000 in past-due premiums and penalties. Sentencing in a Butler County courtroom is scheduled for Dec. 6.

Ahmad Al-thamra of Akron, Ohio
Al-thamra pleaded guilty Oct. 10 in Akron Municipal Court to two counts of failure to comply, both second-degree misdemeanors, for failing to maintain workers’ compensation coverage on his business, The Family Corner Store. He was ordered to pay $300 in fines and ordered to pay court costs and obey all laws for one year.

Jason Gaschler of Cheswick, Pennsylvania
Gaschler pleaded guilty Oct. 10 of one count of theft, a first-degree misdemeanor, for operating a construction company, General License Contracting, in Pennsylvania while receiving $6,864 in BWC benefits. He was sentenced to one day in jail (time served) and made full restitution at the time of his hearing.

Jason Rissner of Rockford, Ohio
Rissner pleaded guilty Oct. 9 in Mercer County Common Pleas Court to one count of petty theft, a first-degree misdemeanor, after he was caught operating his own construction company while receiving $35,261 in temporary total disability benefits from his employer, O’Reilly Auto Parts. He was ordered to spend 180 days in jail, which would be suspended if he committed no more crimes within a year and pay full restitution to O’Reilly.

Brian Franklin of Sharonville, Ohio
Franklin avoided conviction on one charge of workers’ compensation fraud, a fifth-degree felony, after he agreed Oct. 8 in Franklin County to pay BWC $18,081 in restitution. BWC found Franklin working at a community center in 2018 while collecting BWC benefits.

Marshann Kinman of Cedar Grove, Ohio
Kinman pleaded guilty Oct. 8 to one count of workers’ compensation fraud, a fifth-degree felony, in Hamilton County Common Pleas Court. Kinman failed to let BWC know her mother had passed so she could take $6,321 in BWC widow death benefits intended for her mother. Kinman received two years of community service and was ordered to pay BWC full restitution.

Charles Ayler of Cincinnati, Ohio
Ayler pleaded guilty Oct. 3 to one count of workers’ compensation fraud, a first-degree misdemeanor, after BWC found him working while receiving BWC benefits. He was sentenced to 180 days in jail, which was suspended for two years of community service, the promise to avoid similar offenses, and to pay BWC full restitution of $6,090 and court costs of $150 by Dec. 31, 2020.

Ronald J. Dorfeld of Brunswick, Ohio
Dorfeld must pay BWC $78,957 in restitution after pleading guilty to a fifth-degree felony charge of workers’ compensation fraud Oct. 1 in a Franklin County courtroom. BWC found Dorfield operating his own business, Xtreme Multimedia Marketing, while receiving disability compensation. A Franklin County judge sentenced Dorfeld to ninth months in jail, which was suspended for five years’ probation and full restitution.

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

Happy Anniversary to Us!

On Nov. 14, 2019, our BWC Special Investigations Department celebrated the second anniversary of its Fraud Hotline system.

We launched this system during Fraud Awareness Week 2017 as an important new customer service tool for external sources to report their suspicions of workers’ compensation fraud. What a successful launch and two years it has been!

We’ve received more than 3,300 calls since then, an average of nearly seven each work day!

If you suspect workers’ compensation fraud in Ohio, call us on it.

We look forward to hearing from you. Give us a call at 1-800-644-6292. We will conduct an 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 2019, we thank you for your support!

Fraud of the Day during Fraud Awareness Week

By Jeff Baker, BWC Special Investigations Department

When the Ohio Bureau of Workers’ Compensation (BWC) created its Special Investigations Department (SID) in 1993, investigative professionals in the new department knew they would need to do more than detect, identify and investigate suspected workers’ compensation fraud. To fully meet the department’s mandate and mission, SID professionals would need to also deter fraud.

We felt one of the most effective ways to deter fraud might be to raise public awareness of what we do by reaching out to the media about our latest cases. In the years since, SID has collaborated with BWC’s Communications Department to issue news releases on many of the nearly 3,000 subjects convicted and sentenced as a result of our work.

To reach an even wider audience, we created our first social media accounts in 2011 and launched our Fraud Awareness Series via ohiobwcfraud and
twitter.com/ohiobwcfraud. Through our YouTube channel, we added videos showing undercover surveillance footage of subjects caught in act of committing their crimes.

The success of our Fraud Awareness Series can be measured by its reach beyond our initial audience. That is why we take note (ok, we admit we are thrilled) whenever one of our prosecution news releases is shared or re-Tweeted by a follower. Since 2014, we have seen this occur 39 times from just one follower — Larry Benson.

Larry has used our news releases as the basis for 39 of his Fraud of the Day blogs published by LexisNexis. Larry sees news releases for countless other successful fraud investigations by government agencies within hundreds of jurisdictions (local, state, and federal), so we are always delighted when he takes note of ours. We also appreciate his Fraud of the day website permits users to select their favorite examples by fraud type and state. For example, here is a filtered link to the Fraud of the Day articles for Ohio, including the 39 (and counting) articles pertaining to BWC.

Conveniently, E-mail subscribers to Fraud of the Day blogs may “get their fraud fix” by “waking up five days a week to the most current fraud article delivered straight to their inbox.”

But no matter how you access the Fraud of the Day blogs, you will note Larry’s clever use of headlines and tags referencing the subject’s type of fraud. A few of our favorites include:

Of course, as humorous as these titles may be, we know that no fraud is a matter for laughter. We certainly take all crime seriously. That is why we have dedicated our careers to detecting, identifying, investigating, prosecuting, and deterring fraud. Like Larry, we, too, are willing to deploy clever or funny headlines in news releases, but that’s only to increase the likelihood that the media and general public will take note and read and heed the releases as the cautionary tales they are.

Widening our reach, getting our word out, deters fraud. In the spirit of International Fraud Awareness Week, we invite all of you to join us in combatting crime by continuing to follow this blog and Larry’s Fraud of the Day series this week and beyond.

A letter from Jim Wernecke – Director of BWC Special Investigations

As Director of the BWC Special Investigations Department (SID), I am honored to kick off Fraud Awareness Week. I invite you to view my video message, “Fraud Hurts Us All.

In the video I discuss how workers’ compensation fraud increases premiums for employers, which reduces the money employers can invest in their employees, community and future growth. I explain how BWC employees are improving workplace health and safety, getting injured workers back to work, and keeping premium rates low for employers. I describe how SID employees protect the State Insurance Fund by detecting, investigating, and deterring fraud.

Lastly, I invite viewers to report, via an online form, suspected workers’ compensation fraud.

I also invite you to check back daily as we share success stories in our efforts to combat workers’ comp. fraud. Some stories we will highlight are:

We would not have achieved these successes without the 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. Since our inception in 1993, we have identified over $1.9 billion in savings, as well as:

  • Completed over 69,000 investigations
  • Referred 5,420 subjects for prosecution
  • Secured 2,941 criminal convictions

We are honored and eager to join our fraud-fighting colleagues around the country and abroad each November to participate in International Fraud Awareness Week.

The campaign, which runs through Saturday, was established by the Association of Certified Fraud Examiners to highlight the issue of fraud and minimize its impacts.

Most weeks, you’ll find us sharing our fraud news on #FraudFriday. But this week, we’ll have a new fraud feature each day! So keep an eye here on our blog and on our Facebook and Twitter pages!

Happy Fraud Awareness Week!

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.

What do you know about workers’ comp fraud? Our sleuths have questions – and answers!

By Melissa Vince, BWC Public Relations Manager

We’ve had a great time talking workers’ comp fraud this International Fraud Awareness Week. We enjoyed sharing what we do to detect, deter and put a stop to workers’ compensation fraud in Ohio.

Our fraud investigators especially look forward to participating every year because they want to raise awareness and encourage tips from the public, but also because they truly enjoy what they do.

And we appreciate them because they do a great job. So, in honor of them, we let them take a little break to have some fun putting together this quiz challenging your knowledge of workers’ compensation fraud.

So, fire up that brain and let’s get started. Just flip your monitor over for the answers listed at the bottom.

Thanks for following us this week! We’ll be back next year for Fraud Awareness Week, but don’t go away because we’re here all year long on our blog, Twitter and Facebook.

  1. True or false?
    Fraud and abuse are the same.
  2. True or false?
    Proving fraud requires evidence of “knowledge and intent”
  3. True or false?
    Abuse can be criminally prosecuted under the law.
  4. BWC has teams focused on investigating the following types of fraud:
    a) Claimant
    b) Employer
    c) Medical provider
    d) All of the above
  5. Which is an example of fraud?
    a) Billing for services not rendered (a doctor bills for procedures not performed)
    b) Classifying full-time employees as independent contractors/subcontractors.
    c) A claimant performing physical activity outside of his or her restrictions
    d) All of the above
  6. What are the two most common fraud allegations our investigators receive related to medical providers?
    a) Billing for services not rendered (a doctor bills for procedures not performed)
    b) Unlicensed provider (not licensed to practice medicine in the State of Ohio)
    c) Unbundling (charging separately for bundled services)
    d) Upcoding (billing for a more expensive service than the one provided to the claimant)
  7. What is the most common fraud allegation our investigators receive related to employers?
    a) No coverage
    b) Lapsed coverage
    c) Falsified certificate of premium coverage
    d) Underreporting payroll
  8. What is the most common fraud allegation our investigators receive related to claimants?
    a) Physical activity (performing physical activity outside of his or her restrictions; malingering)
    b) Work/Comp (working while receiving lost time benefits)
    c) False claim (staged accidents; false injuries)
    d) Altered documents

 

It’s not easy being Green: Cleveland florist convicted of work comp fraud

Green Thumb Florists owes BWC $32,000

The owner of a Cleveland flower shop owes the Ohio Bureau of Workers’ Compensation (BWC) nearly $32,000 in restitution after pleading guilty to workers’ compensation fraud in late September.

Mary Green, the owner of Green Thumb Florists, was ordered to pay BWC $31,562, sentenced to five years of community control and fined $315 after pleading guilty Sept. 27 to one fourth-degree felony count of workers compensation fraud in the Cuyahoga County Court of Common Pleas.

Acting on a tip, agents with BWC’s special investigations department (SID) discovered Green had altered a BWC certificate to make it appear her business had proper workers compensation coverage, as required by state law. Agents also discovered her actual policy had been in lapsed status since 2011.

“Our agents made multiple site visits, witnessed multiple employees and put Mary Green on notice to bring her BWC policy into compliance with the law,” said SID Director Jim Wernecke. “But when she wouldn’t cooperate, we brought her case to the county prosecutor and now she has a felony on her record. It didn’t have to go this far. We really need employers to reach out to BWC if they’re struggling to pay their premiums.”

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