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.

Do you want to know Ohio’s best kept workplace safety secret?

By Ranzy Brown, Safety and Health Consultant, OSHA On-Site Consultation Program

Last month, I had the pleasure of teaching a class called The Best Kept Secret in Ohio at the Ohio Safety Congress & Expo.  My presentation let the audience in on this secret: BWC’s OSHA On-Site Consultation Program. Most of the almost 60 people in the room had never heard of us or what we do.

I began the session with a brief history of the Occupational Safety and Health Administration (OSHA) and the consultation program, then explained who is eligible to receive our free and confidential services. Basically, all employers covered by OSHA regulations can request an On-Site consultation. The program gives priority to privately-owned smaller businesses, and those in high-hazard industries. Typically, a grant from OSHA funds 90 percent of the program while BWC covers the other 10 percent (this year it’s closer to an 86-14 split). This means there is never any charge to use our services.

Most of the questions focused on the relationship between consultation and enforcement. I believe most employers want to do the right thing and provide a safe workplace; sometimes they are simply unaware of hazards that exist in their businesses. Our consultants point out these hazards with the understanding that the employer will abate the serious ones.  Our services are confidential from OSHA, however, if an employer refuses to abate serious hazards, we can refer them for possible enforcement action. While an employer is actively working with OSHA On-Site Consultation, they have “visit in progress” status, which means OSHA cannot open a programmed enforcement inspection.

Additionally, businesses that have an exemplary safety and health program can qualify for the programmed inspection exemption for up to three years by becoming a SHARP employer. SHARP – Safety and Health Achievement Recognition Program – companies have demonstrated excellence in all aspects of managing safety and health.

I ended the class by sharing information about how attendees can contact the OSHA On-Site Consultation program to ask questions or request a consultation. I also covered how recent OSHA standard revisions (e.g., walking and working surfaces or recordkeeping) could impact their workplaces. Developing a relationship with an On-Site consultant can make it easier to keep up with changes and make staying in compliance easier.

After the session, I had a good conversation with several people regarding work policies and practices that could be OSHA violations in their workplaces. My fellow consultants want to help your business too.

Don’t be shocked or surprised – use lockout/tagout

By Cari Gray, BWC Industrial Safety Consultant Specialist

The Occupational Safety and Health Administration (OSHA) has a standard called the Control of Hazardous Energy – most folks know it as lockout/tagout. This standard is one of the most important in all of OSHA’s regulations; still many do not understand or do not follow the rules. In 1990, this rule became law in a response to 122 fatalities and approximately 50,000 injuries per year. This OSHA law is 29 CFR 1901.147.

The theory behind the law is simple: if you have workers exposed to hazardous energy, you must stop the energy and lock out the energy source to prevent accidental releases that can cause injury.

OK, maybe that doesn’t sound simple – so let me give you an example. If you are changing a ballast in a light fixture, you must lock out the breaker or disconnect it while doing the work so others do not accidently turn it on. Or if you are repairing a large fan, you must put a lock on the energy source (like a breaker) so your co-worker cannot turn the fan on while your hands (and maybe your head) are in the machine.

That sounds pretty important, right? There is plenty of potential for fatalities while working on any type of equipment, this standard and these rules can keep you safe, maybe even alive, to work another day.

From a regulation standpoint, there are multiple parts to the standard. The scope of the standard defines what is included and not included. Example: the standard does not cover work on live electrical. You should never work on live electrical. However, if you do, you must follow OSHA Subpart S and the NFPA 70E standards. There are also definitions covering who the players are and their roles.

The main parts of the standard are the written program, energy control procedures, periodic inspections and training. There are very specific requirements about the equipment workers use for lockout/tagout as well as detailed instructions for group lockout, shift changes and outside personnel. I’ll focus on the four main sections I listed above.

Written program
First, a written program: This is a must and required by any company that has an energy source that could cause harm. Even if you do not perform the work internally, you must have a plan in place to ensure injuries do not occur. The written program – OSHA calls it the Energy Control Program – must be in writing and be an overview of your plan. This plan includes roles, responsibilities, procedures, inspections and training. This is the overview of how you plan to manage your program.

Energy control procedures
Energy control procedures, oh energy control procedures. This may be the most difficult and tedious of the requirements, but it is oh so important. Develop, document and use the procedures when an employee performs work that could cause the release of hazardous energy. There is a defined list of requirements you must include in the procedures, including, scope, purpose, authorization, rules, enforcement and techniques for actually performing lockouts.

Periodic inspections
Periodic inspections is code for ANNUAL inspections, and don’t forget to do them. The purpose of the annual inspection is to check the written program, the energy control procedures and the training effectiveness. So yes, you need to look at all the written documentation and watch authorized employees actually lock out some of the equipment.

Training
You’ll need to provide some level of training to all employees. Affected employees (those that can be impacted by lockout, but don’t actually do it) must have basic training on what lockout is and what to do if they are affected by a piece of equipment other workers are locking out (aka leave it alone). Authorized employees get the most training because they are responsible for locking out the equipment so they can stay safe. There is no annual requirement for retraining. However, there are many circumstances where employees need retraining, like changes and failure to follow the rules.

The importance of locking out can’t be shouted loud enough. There are too many examples of workers not using lockout with horrific consequences. The 18-year-old caught in a large shredder. A 50-something accidentally pulled into a washer. The maintenance worker electrocuted while changing a live outlet at a nursing home. Unfortunately, I could go on for hours. Accidents can strike any industry, any age and any employee skill level. If a company’s management doesn’t take lockout/tagout seriously, neither will workers.

Don’t feel helpless if you don’t have a program or you’re worried yours isn’t up to par. Our Division of Safety & Hygiene offers classes, videos and expert safety consultants to help you develop or evaluate your program. Just contact them!

Lima business owner conspires with acquaintance to evade workers’ comp coverage

Doug FayA Lima (Allen County) business owner appeared in court recently after he failed to maintain workers’ compensation insurance coverage and later solicited the help of an acquaintance in an attempt to avoid paying past due premiums. Douglas Fay and Laurel Seiner were sentenced in the Allen County Court of Common Pleas.

The Special Investigations Department began investigating Douglas Fay after receiving information from BWC’s Collections Department that two premium payments for his business, Fay Crushing and Stone LLC, had been returned for non-sufficient funds, resulting in the policy lapsing. Fay had previously been investigated by BWC for failing to maintain coverage for his other businesses.

Fay was interviewed by agents and admitted he knew the payments would not clear the bank. Several months after interviewing Fay, agents received information advising Laurel Seiner had submitted an application for coverage for a stone crushing business and listed herself as the owner.

Laurel SteinerAgents interviewed Seiner and learned she was the secretary and bookkeeper for several of Fay’s businesses, including Fay Crushing and Stone LLC. When submitting the application, Seiner stated there were no other policies associated with her business. Agents interviewed Seiner and she stated Fay was now her employee. When questioned, Seiner initially denied conspiring with Fay to open a new policy in order to get a valid certificate of coverage.  However, she eventually admitted Fay asked her to open a policy in her name because his policy was not in good standing and he needed a valid BWC certificate.

Laurel Seiner and Douglas Fay entered into the diversion program on Feb. 11. Seiner pleaded guilty to one third-degree felony count of tempering with records. She was sentenced to three years post release control, and ordered to pay $8,599.72 in restitution.

Fay pleaded guilty to one third-degree felony count of tempering with records, one fifth-degree felony count of workers’ compensation fraud and one fifth-degree felony count of passing bad checks. Fay was sentenced to five years post release control, and ordered to pay $14,448.92 in restitution.

A forged relationship: The victimization of a claimant

By Jeff Baker, Program Administrator, BWC Special Investigations Department

In a September 23, 2011 blog, “Dishonored memories: Deceased claimants with dishonest relatives,” we described how dishonest relatives may express their grief over the death of a loved one quite differently than law-abiding citizens. We noted that criminals may choose to dishonor the memory of deceased relatives by committing workers’ compensation fraud in the personal, confidential records of a deceased claimant.

These criminals falsely report to us that their deceased relatives continue to live. They pretend to be the claimants themselves, sometimes even adopting the voice of an opposite gender’s voice and/or an elderly person in an attempt to deceive us. These charlatans scheme to intercept any check addressed to a deceased claimant, forge their signature, and pretend to be the claimant (aka “uttering”) in order to cash the check to which they know they are not entitled. In situations where lost-time benefits are paid electronically, family members may inappropriately access and use monies to which they are not entitled, by concealing the claimant’s death.

Of course, such deceptive acts, born out of greed, are not limited to the relatives of our claimants. Forgery and uttering crimes are also committed by non-relatives, such as neighbors or other acquaintances. And some claimants are victimized before death, such as when the criminal uses a power of attorney to grab benefits intended for a claimant who has been deceived, often while incapacitated or otherwise dependent.

A Case In Point
blog pic 1Consuelo “Connie” Griffin and David Lusk (Cincinnati, Hamilton County) both pleaded guilty Jan. 14 in the Hamilton County Court of Common Pleas to counts of theft after they were discovered cashing BWC benefit checks for a claimant who had died.

SID opened an investigation after receiving an allegation from BWC’s claims department, which was unable to contact a claimant receiving permanent total disability for a workplace injury. The claims department reported that claimant’s phone was disconnected.

blog pic 2The investigation found that while the claimant passed away in June 2014, the BWC checks that were mailed to his home continued to be cashed. Griffin and Lusk lived in the same apartment complex as the deceased and when he was hospitalized, Griffin signed a power of attorney document giving her control over his finances. Griffin also had the claimant’s mail forwarded to her address and the pair moved into his apartment when he was hospitalized. Griffin confessed to signing Harrell’s name on the checks and cashing them. Griffin also took money out of his bank account while he was ill and wrote checks from his account to herself for cash. His account was soon closed because Griffin and Lusk spent all the money and failed to pay any of his nursing home expenses.

Lusk pleaded guilty to count of theft and one count of theft from the elderly, both fifth-degree felonies. Griffin also pleaded guilty to two counts of theft, both fifth-degree felonies. The court sentenced them to 10 months in jail, suspended, and ordered them to repay restitution of $5,072.62. They also received three years of probation.

For other case examples or more information about the SID, see our Special Investigations Department Fiscal Year 2015 Annual Report.

To report suspected fraud via a fraud referral form click here or call the BWC fraud hotline at 1-800-644-6292.

Ohio border no longer a barrier

kendraKendra DePaul, Other States Coverage Manager

I often wonder how many employers realize the jurisdictional issues associated with having employees working in other states. As you may know, each state has different laws and requirements for workers’ compensation coverage and it is not always easy for employers to know what is required of them in another state.

Unfortunately, the way employers usually find out about the differences in state laws, is when something bad happens. A claim is filed outside the state of Ohio or a letter comes from a state official with an accompanying penalty for not having proper coverage. We often get calls from employers when these things happen. They want to know what they should do to remedy the situation. Oftentimes though, the call comes too late and the only advice we can give is to work with the official to pay the penalty and get coverage for the future. This is not a great option for employers and usually not a cheap option either.

BWC has come to the realization that our employers need a better option. An option where they can get coverage up front so that the frantic phone calls can be eliminated and employers can focus on the success of their businesses. And that is why we are undertaking implementation of Other States Coverage for Ohio employers.

We are partnering with a private insurer to offer optional coverage to employers who may face financial exposure while working outside the state of Ohio. The coverage secured through BWC will be very similar to private workers’ compensation insurance that some employers have chosen to purchase on their own. And if an employer is happy with their private coverage, there is no mandate to switch. But for those who have struggled to find coverage or don’t know where to go to meet their out-of-state requirements, BWC is here and we can help.

It has been a long journey to make this possible for Ohio employers. The legislation was passed in 2014, and since then there have been countless workgroups, meetings, and training to get ready for this endeavor. I’m happy to say there is some light at the end of the tunnel. I would not say that we have it all figured out, and there will be a lot of learning along the way, but I have confidence that we will bring this coverage offering up in the next few months and have a viable option for Ohio employers who send their employees outside the state of Ohio.

We at BWC will keep on working hard to get this option up and running, and we hope that if you are in need of this coverage, you will give us a call. We are excited to assist you.

More about Other States Coverage is available at bwc.ohio.gov.

Marion trucking company owner failed to maintain workers’ comp coverage

MARION – A Marion employer who allowed his workers’ compensation policy to lapse and claimed his employees were subcontractors has been sentenced for failing to comply with the law. Lakhvir S. Sidhu, owner of Liverpool Express, was sentenced Dec. 7 after he failed to cooperate with attempts by the Ohio Bureau of Workers’ Compensation (BWC) to help him obtain proper coverage.

“BWC makes good faith attempts to work with businesses to bring them into compliance, but has no choice but to pursue fraud charges when our efforts are ignored,” said BWC Administrator/CEO Steve Buehrer. “Businesses with employees must comply with the law and maintain workers’ comp coverage to protect their workforce.”

BWC’s Employer Compliance Department first attempted to work with Sidhu to bring his policy into compliance but investigators with the agency’s Special Investigations Department opened a fraud investigation after Sidhu did not cooperate.

An audit on the business showed Sidhu was paying wages to employees he claimed were subcontractors. Investigators interviewed Sidhu on several occasions regarding the lapsed policy and the requirement to report wages for his employees. After meeting with agents, Sidhu paid his past due premiums, although he still claimed the workers were subcontractors. The investigation later revealed that Sidhu reported employee wages to the Ohio Department of Jobs and Family Services that totaled $266,000 more than the wages he reported to BWC for the same time period.

The matter was then reviewed by the Marion City Law Directors office after Sidhu failed to enter into a payment plan and/or file the additional payroll information as requested by agents. He was convicted of a second-degree misdemeanor count of failure to comply with the law and was ordered to pay restitution in amount of $3,724.77, and comply with BWC regulations and Ohio laws. Sidhu must also pay fines totaling $400 and serve 90 days of incarceration, suspended for two years community control.

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 see what workers’ compensation fraud looks like in our fraud awareness video on YouTube.

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.

Do you hear what I hear?

By Jeff Hutchins, Industrial Hygiene Technical Advisor

The holiday season is filled with a variety of sounds, from singing children to ringing bells.  But if you have difficulty hearing those children’s voices, or if there is ringing in your ears even when no bells are present, then you may be one of the approximately 10 million workers with noise-related hearing loss.1

Noise-related hearing loss is a painless, progressive and irreversible condition that is common in the United States.  In addition to hearing loss and tinnitus (chronic ringing in the ears), noise exposure above 85 decibels (dB) has also been shown to cause elevated blood pressure, sleep disturbances and other stress-related illnesses.

Nearly 22 million American workers are exposed to hazardous noise levels every year1, and reducing noise exposure among Ohio’s workforce is one of the goals of the BWC Industrial Hygiene (IH) staff.  We conduct noise assessments of Ohio workplaces and recommend ways to reduce excessive noise levels.  Noise control measures may include enclosing a noisy machine or process, dampening vibrating surfaces, or silencing compressed air releases.

As a rule of thumb, when normal speech communication between individuals 3 – 4 feet apart becomes difficult, the noise level is approaching hazardous levels.  The chart below shows the noise levels of some common sounds.

When control measures alone cannot reduce the noise to acceptable levels, we assist employers in instituting a hearing conservation program.  A hearing conservation program contains elements to assure that employees:

  • Have regular hearing evaluations called audiograms;
  • Are provided proper hearing protection such as ear plugs or ear muffs;
  • Receive training about the actions they need to take to protect their hearing.

More information can be found in the BWC Educational Guide “What is Hearing Conservation?

This holiday season, don’t take for granted the gift of good hearing.  In 2016 , resolve to protect your hearing for years to come.

 

References

  1. NIOSH – Noise and Hearing Loss Prevention page (http://www.cdc.gov/niosh/topics/noise/stats.html)
  2. Canadian Centre for Occupational Health & Safety – OSH Answers Fact Sheets “Noise – Non-Auditory Effects” (http://www.ccohs.ca/oshanswers/phys_agents/non_auditory.html)

 

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.