Columbus, OH – The Ohio Bureau of Workers’ Compensation (BWC) Special Investigations Department (SID) recently delivered a report to the agency’s board of directors highlighting its Fiscal Year 2013 efforts to deter, detect, investigate and prosecute workers’ compensation fraud. Jennifer Saunders, interim director of SID, reported the department identified more than $55 million in savings for the State Insurance Fund after closing more than 2,000 cases involving claimants, employers and medical providers last year.
“Those who would commit fraud need to understand it’s not a victimless crime. They are hurting Ohio’s employers, and making it harder for us to treat truly injured Ohioans,” said BWC Administrator/CEO Steve Buehrer. “Over the past year, we have stepped our efforts to respond to allegations, actively search for signs of fraud, address prescription drug abuse and identify fraud by providers.”
Saunders reported at the Audit Committee meeting the closed cases included 140 criminal convictions and 236 referrals for prosecution. Additionally, administrative review of 915 cases either uncovered fraudulent activity, or identified additional savings for Ohio employers paying into the State Insurance Fund. She also reported on activities of the department’s teams that focus on specific fraud types, including the employer, health care provider team and claimant fraud teams. Results include:
- The employer fraud team, which investigates fraud committed by employers, closed 226 cases, generating $3,535,468 in savings. The team achieved 43 indictments and 33 convictions during FY 2013.
- Regional claimant fraud teams closed 1,353 cases, and identified $30,179,976 in savings. These teams secured 100 convictions, or 23.5 percent more than the 81 claimant subject convictions secured during FY 2012.
- The Health Care Provider Team, which investigates fraud committed by providers, pharmacies, and managed care organizations, closed 68 cases, or 83 percent more than in the previous year. The team identified $11,874,978 in savings to the workers’ compensation system and secured seven convictions.
Saunders also noted the department continues to employ significant resources to combat prescription fraud. The Intelligence Unit requested drug utilization reviews in cases where there was a question of whether BWC-paid prescriptions were medically necessary. The reviews resulted in the termination of drugs in 171 cases where the prescriptions were not necessary, generating $9,467,735 in savings. Drug complaints represented 22.8 percent of all complaints investigated by SID, second only to working while receiving benefits, which represented 28.9 percent of all complaints investigated during the last 12 months.
Source: Ohio BWC SID