Ohio BWC Investigations Result in 10 Workers' Comp Fraud Convictions in March

Columbus, OH (WorkersCompensation.com) – Ohio Bureau of Workers' Compensation (BWC) Administrator/CEO Steve Buehrer today announced 10 individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio's workers' compensation system in March. 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.

“Workers' compensation benefits support the recovery of Ohio workers who have been injured on the job until they can return to work,” said Buehrer. “From injured workers to employers, Ohio will not stand for any abuse of the system, which only takes resources away from their intended purpose.”

A sampling of the cases that resulted in a guilty plea or conviction during March follows.

John Burgin (Toledo, Lucas County) was found guilty March 5 in the Toledo Municipal Court of attempting to commit an offense, a second degree misdemeanor, for filing a false claim. SID received an allegation that Burgin filed a false claim against the Grand Rapids Club. Investigators found the injury he claimed happened at work actually occurred when he fell through a glass door at home. Additionally, he punched a wall at a hospital two weeks prior to his alleged work injury. Burgin did not immediately seek treatment because he did not have personal medical insurance. Burgin's case was set for trial in January 2013; however, Burgin left court before the case was called and a bench warrant was issued. Burgin was sentenced to thirty days, suspended, and placed on probation for one year.

Clareta Fisher (Cleveland, Cuyahoga County) pleaded no contest to one count of workers' compensation fraud for inappropriately receiving wage loss benefits. SID received a fraud referral from a BWC employee indicating Fisher was not reporting all of her work activity and wages in order to receive a higher weekly wage loss benefit. Investigators confirmed that Fisher did fail to properly report all earnings for her work as a licensed practical nurse. Fisher appeared in the Franklin County Municipal Court and sentencing is set for May 29. If she pays restitution of $3,082.03 and $890.90 investigative costs, the judge indicated he would fine her and that would conclude her obligations. However, she will be placed on probation if payment is not made in full.

Dr. Darrell Hall (Toledo, Lucas County) pleaded guilty to one count each of conspiracy to distribute a controlled substance, health care fraud and failure to account for and pay employment tax. SID received multiple allegations that Hall was prescribing an excessive amount of narcotics, prescriptions written by a nurse practitioner, and continuing to prescribe following inconsistent drug screens. BWC's Health Care Provider fraud team participated with the Drug Enforcement to conduct a search warrant of Hall's office, EDM Health Services LLC (EDM) in Toledo. Interviews with staff and patients revealed that EDM staff would sell prescriptions, write prescriptions based on pill bottles that a patient brought in, or give patients unsigned prescriptions at one office and direct to take them to where Hall was working in order to get them signed. EDM staff were told to use “hot keys” to create fictitious treatment notes for patients not seen or examined. Hall was sentenced March 25 to five years in prison and ordered to pay $78,113 in restitution to Ohio Medicaid, in addition to $97,384 to the federal government for unpaid payroll taxes.

Dr. Eric Barker (Dayton, Greene County) pleaded guilty to a felony count of workers' compensation fraud in Franklin County for using the information of another physician in order to receive reimbursement from BWC. SID opened an investigation into the chiropractor after receiving an allegation that Barker was inappropriately utilizing Health Insurance Claim Forms for the treatment of injured workers. Investigators learned the business, located at 1353 Woodman Drive, had been sold to Barker, who was decertified as a BWC provider in 2009 due to a felony conviction. An analysis revealed BWC reimbursed approximately $8,000 to Teeters Chiropractic after that sale for chiropractic manipulation, evaluation and management and consultation services that were in fact rendered by Barker. The bills were submitted using another assigned BWC provider number as a way of circumventing Barker's exclusion from the workers' compensation system. Barker was ordered to pay $8,587.57 in restitution, in addition to and $8,000 for investigative costs. He was also sentenced to five years of community control, which will cease once he pays full restitution. He will serve a 12 month prison term if he violates these conditions.

Patsy Krise, dba Sandusky Torching (Holland, Lucas County) pleaded guilty to workers' compensation fraud March 20 for submitting premium payment checks that were returned due to nonsufficient funds. SID received a referral from BWC Collections after receiving a non-sufficient funds check from Krise, owner of Sandusky Torching. Investigators met with Krise in an attempt to work with her to pay back the more than $1,300 owed, as well as close the policy as the business had been shut down. However, Krise again failed to remit appropriate payment. Krise was ordered to a period of rehabilitation under control and supervision of the Lucas County Adult Probation Department for two years. She was ordered to immediately pay all financial obligations.

Carolann Humberston (Howard, Knox County) pleaded guilty March 12 to one count of workers' comp fraud for working while receiving benefits. BWC's Intelligence Unit reported that an Ohio Department of Job and Family Services wage cross match indicated that Humberston earned wages from a Columbus business during the same time period she received the BWC funds. The investigation produced evidence that Humberston knowingly worked as a nurse while receiving temporary total disability benefits. Humberston was sentenced to six months in prison, suspended for a year of community control. She was ordered to pay restitution to BWC in the amount of $11,157.03, plus court costs. Humberston presented a check for the entire amount. Community control will end upon payment of court costs.

Ricky Davis (Wellston, Jackson County) pleaded guilty March 18 to workers' compensation fraud for working while receiving benefits. BWC's Intelligence Unit received a cross match report from the Public Utilities Commission of Ohio that indicated Davis underwent a commercial vehicle inspection during the time period he was receiving temporary total disability benefits. An investigation revealed he knowingly worked as a commercial truck driver while concurrently collecting Temporary Total disability benefits. He was sentenced to 12 months in prison, suspended for five years of community control. He was also ordered to pay restitution in the amount of $57,533.14, plus investigative costs of $3,201.08.

Mark Wasko (Struthers, Mahoning County) pleaded guilty March 26 in the Franklin County Common Pleas Court to one count of workers' compensation fraud for working while receiving benefits. BWC's Special Investigations Department (SID) began an investigation after receiving an allegation about Wasko from a state agency computer cross-match. Documented evidence supported the allegation that Wasko returned to work as a truck driver while receiving the temporary total disability benefits. SID personnel conducted interviews and analyzed financial records, and Wasko confessed to working while receiving the benefits. Franklin County Judge Richard Sheward sentenced Wasko to a suspended 180 days in jail, and ordered him to pay restitution in the amount of $8,622.06 by Sept. 26. Wasko deposited $5,600 at the clerk's office to be used toward restitution.

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