Ohio BWC Gets 11 Workers’ Comp Fraud Convictions In May
Columbus, OH (WorkersCompensation.com) - Ohio Bureau of Workers' Compensation (BWC) Administrator/CEO Steve Buehrer today announced 11 individuals were convicted of or pleaded guilty to charges related to defrauding Ohio's workers' compensation system during May. The court actions are the result of investigations conducted by BWC's special investigations department (SID). The department works to deter, detect, investigate and prosecute workers' compensation fraud.
“BWC agents are extremely proactive in identifying potential fraud, as well as following up on allegations made against those who seek to game the system at the expense of others,” said Buehrer. “That means pursuing all employers, medical providers, workers and others who are committing fraud to ensure the integrity of Ohio's workers' compensation system.”
A sampling of cases that resulted in a guilty plea or conviction during May follows.
JoAnn Jennewein, dba Rustic Haven Tavern, (St. Marys, Auglaize County), pleaded guilty May 7 to workers' compensation fraud and attempted tampering with records after she was discovered operating her business without workers' compensation insurance coverage. SID received an allegation from an Occupational Safety and Health Administration inspector indicating he received a call from a former Rustic Haven employee who said he suffered an injury. He further stated his employer did not have BWC coverage and numerous employees were paid in cash. BWC's Employer Fraud Team found that Jennewein never obtained workers' compensation coverage. Agents interviewed Jennewein and she stated claimed she did not have employees, but did have numerous friends who helped her out behind the bar in the kitchen. Jennewein completed an application for coverage indicating she first hired employees in December 2009. Agents worked jointly with the Ohio Department of Taxation in conducting interviews with employees who stated they were hired by Jennewein at the end of December 2009. Follow-up interviews revealed Jennewein instructed employees to tell state agents that they were hired in December 2009 although they had been hired earlier. Jennewein paid her entire amount due of $8,712.81 prior to a plea agreement and coverage for Rustic Haven was reinstated. She also pleaded guilty to a felony taxation charge.
West Africa, dba Flawless Building Services, (Cincinnati, Hamilton County) pleaded guilty May 30 in Hamilton County to three counts of workers' compensation fraud, one felony and two misdemeanors, after he was found submitting false coverage certificates. SID received an allegation that Africa was operating Flawless Building Services without BWC coverage and submitting false workers' compensation certificates to vendors to make it appear the business had coverage. Investigators found that Africa, owner of Flawless Building Services, submitted a total of five false certificates: three to the Cincinnati Hamilton County Community Action Agency, one to the Mayerson Jewish Community Center, and one to Time Warner Cable. Africa pleaded guilty in the Hamilton County Court of Common Pleas. Sentencing is scheduled for June 27.
Samuel Barrow (Dayton, Montgomery County) pleaded guilty May 10 two counts of forgery and one count of workers' compensation fraud for falsifying documents in order to receive injured worker benefits. SID received an allegation that Barrow submitted a falsified witness statement at an Industrial Commission hearing regarding the multiple injuries he claimed to suffer while employed by The Melting Pot in Centerville. Investigators interviewed witnesses and notaries and found the statements Barrow submitted into his claim were not signed by the listed witness and were not notarized as indicated. SID also found the alleged witnesses provided by Barrow did not witness the alleged accident. SID also identified two questionable letters allegedly submitted by a doctor in a previous BWC claim filed by Barrow. The doctor confirmed the letters were falsified. Barrow was sentenced to five years of community control, and ordered to pay restitution of $3,000 for investigative costs and court costs. If Barrow violates the terms of his community control, he will serve 24 months in prison.
Erik Salmons (Copley, Summit County) pleaded guilty May 3 to one count of workers' compensation fraud for working while receiving benefits. SID learned that Salmons was arrested after reportedly causing a disturbance at a local restaurant. He was escorted home following that incident by the Copley Township Police Department but later drove himself to the police department and demanded a breathalyzer test as he insisted he was not intoxicated. He tested over the legal limit and was arrested for OVI. Further investigation by SID found that Salmons was the owner and operator of Superior Hardwood Floors while receiving Temporary Total Disability benefits and claiming that he was not working. The investigation included interviews of customers who acknowledged Salmons performed various flooring jobs, suppliers who sold flooring products to Salmons, and tool rental stores that verified Salmons rented flooring tools. Salmons was sentenced to 14 days suspended incarceration, and ordered to pay restitution in the amount of $2,091.54. Salmons paid the entire amount.
Richard Marlo (Lancaster, Fairfield County) pleaded guilty May 8 to one count of theft for falsifying wages in order to receive benefits. SID received an allegation that Marlo reported false employment and wage information in order to receive living maintenance wage loss (LMWL) benefits. LMWL is awarded to an injured worker who completes a vocational rehabilitation plan, successfully returns to work, and experiences a wage loss upon re-employment. SID found the submission of this false information caused BWC to make improper payments over a three month period. Marlo was sentenced to 30 months of community control and ordered to pay restitution in the amount of $1,741.12, in addition to court costs and $800 for investigative costs.
Maria Patterson (Vinton, Gallia County) pleaded guilty May 8 to felony counts of workers' compensation fraud and forgery for submitting false documents in order to obtain temporary total disability benefits. SID opened an investigation after receiving an allegation from a BWC employee who suspected that Patterson submitted three falsified C-84 forms. These forms are used by injured workers and their physicians to initiate or extend payment of temporary total disability benefits. The investigation revealed Patterson did falsify three forms by signing her doctorâ€™s name and misrepresenting her dates of disability. As a consequence, she was paid benefits she would not otherwise have been eligible to receive. Patterson was sentenced to 180 days incarceration on each count and ordered to pay $7,450.63 in restitution. Patterson is currently serving a nine year sentence for unrelated charges of burglary, two counts of theft, tampering with evidence and breaking and entering.
K C Berkshire/Phil Kraus (Mt. Gilead, Morrow County) pleaded no contest May 7 to two counts of failure to comply with law and two counts of attempted failure to comply with law after he failed to maintain workers' compensation insurance coverage. SID's Employer Fraud Team began investigating Kraus after he fell behind on his premiums and failed to enter into a payment plan. Kraus was previously investigated by SID for issues pertaining to under-reporting his business' payroll, which is used to calculate premium. SID closed that case after Kraus amended the payroll reports and agreed to enter into a reinstatement payment plan to pay overdue premiums. After several attempts to make contact with Kraus, BWC's collections department referred the matter back to the SID as Kraus was continuing to operate his business without coverage and without establishing a payment plan. Attempts to reach Kraus regarding the lapsed policy were unsuccessful, and SID referred the case for prosecution. He was sentenced to 18 months of community control, and ordered to pay $91,555 in restitution. He must also pay court costs and a $50 fee for each count.