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Blair Indicted Following Workers' Comp Fraud Investigation

20 Apr, 2009 WorkersCompensation.com

                               
Columbus, OH (CompNewsNetwork) - A former employee of a managed care organization under investigation by Attorney General Richard Cordray and the Ohio Bureau of Workers' Compensation's (BWC) special investigations department (SID) has been indicted on one count of tampering with records and one count of telecommunications fraud. The indictment is part of a two-year investigation into Christine Lynn Blair's conduct, after it was found she instructed her staff to submit falsified return-to-work data to BWC. The investigation is ongoing.

A Franklin County Grand Jury returned the two-count indictment against Blair late yesterday. Blair is a former quality assurance manager with Gates McDonald Health Plus, a Columbus-based managed care organization (MCO) that manages medical care for workers' compensation claims. Over a two year period, Blair intentionally instructed staff to submit false return-to-work data to BWC. MCOs report this data to BWC to demonstrate how quickly injured workers under their care return to work following a workplace accident. Blair was reporting that injured workers under Gates McDonald's care were returning to work on the same day they were injured.

This data directly impacts BWC incentive payments made to MCOs, and MCO performance measures as reported on the MCO Report Card. The MCO Report Card helps employers determine which MCO they will select to manage the claims of their injured workers. The report card evaluates the performance of an MCO by measuring the quality of medical management, return-to-work strategies and timeliness of service. A strong performance on the report card can attract additional business to an MCO and is often used by MCOs to market their services.

"This case demonstrates our determination to vigorously prosecute crimes affecting the integrity of the records maintained by the Bureau of Workers' Compensation," said Attorney General Richard Cordray.

In February 2007, BWC suspected the accuracy of Gates McDonald's return-to-work data. BWC notified law enforcement and worked closely with the Attorney General's office throughout the investigation. Investigators found that Blair intentionally directed staff under her management to enact new data entry procedures for the deliberate purpose of misrepresenting return-to-work data.

"Employers selecting a managed care organization need accurate information and data on which to base the important decision of who will care for workers injured on the job," said Tom Wersell, director of the SID. "We continue to closely monitor and manage the MCO program to ensure its integrity on behalf of injured workers and employers."

Blair's arraignment is scheduled for April 29.

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