Columbus, OH – Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Steve Buehrer recently announced ten individuals were convicted of, or pleaded guilty to, charges related to defrauding Ohio’s workers’ compensation system in October. 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.
“Fraud was proven in multiple investigations involving medical providers, employers and claimants that came to an end in October,” said Buehrer. “We are pleased to close these cases, but the regrettable reality is fraud exists elsewhere and our investigators are already busy working additional cases.”
Following is a sampling of the cases that resulted in a guilty plea or conviction during October.
Dr. Timothy Smith (Cincinnati, Hamilton County) entered a Pretrial Diversion Program Oct. 21 after he was found billing BWC for services not rendered. SID opened an investigation after receiving allegations that Smith fraudulently billed BWC, prescribed excessive amounts of narcotics and failed to maintain sanitary conditions at his medical clinic. Investigators learned that Smith was hospitalized or unable to render medical treatment on two separate occasions when he claimed he had delivered care. Smith’s staff members prepared prescriptions and brought them to Smith at the hospital for his signature. The prescriptions were later issued to patients by his staff members. During these occasions, Smith claimed to have personally treated twenty-seven injured workers. To substantiate his claims, Smith generated falsified medical treatment notes and billing forms. Based on these falsified materials, BWC paid Smith for services not rendered. A Hamilton County judge approved Smith’s acceptance into the Hamilton County Pretrial Diversion Program. Smith was ordered to pay $1,699.32 in restitution to BWC, complete 120 community service hours, and attend critical thinking and counseling courses. In a separate but related matter, Smith permanently surrendered his license to practice osteopathic medicine and surgery to the State Medical Board.
Christopher Fay, dba Full Scope Construction, (Lima, Allen County) pleaded guilty Oct. 25 to two misdemeanor counts of failure to comply for operating his business without workers’ compensation insurance coverage. SID’s Employer Fraud Team opened an investigation on Fay after he was discovered operating Full Scope Construction without coverage. The case was initiated after investigators interviewed Fay regarding a prior company he operated by the name of CDAF LLC, which was also under investigation for lapsed coverage. When operating CDAF LLC, Fay hired and leased several employees to Douglas Fay Construction, his brother’s construction business, which also had lapsed coverage. BWC ultimately combined the two policies as the result of an audit and Fay was found to owe approximately $90,000 in past due premiums. During the recent investigation, agents observed workers arriving at Fay’s residence and then leaving with him and traveling to construction job sites. When interviewed, Fay indicated his workers were subcontractors, not employees, however, subpoenaed bank records revealed regular payments were being made to the workers. Some of the workers were also past employees of Fay’s prior business. Fay was ordered to pay the outstanding premiums as well as court costs and fees of $258.21.
Todd Bittner, dba Bittner Construction, (Cincinnati, Hamilton County) pleaded guilty Oct. 29 to two felony counts of workers’ compensation fraud for operating his business without workers’ compensation coverage. BWC’s Employer Compliance Department informed SID that co-owners Todd and Ross Bittner operated Bittner Construction with lapsed coverage since 2007. This is the second case the EFT has had on this business for lapsed coverage. During the first case, Bittner became compliant; however, Bittner subsequently stopped making efforts to become compliant resulting in a second allegation. Investigators attempted to work with Todd Bittner and he submitted all outstanding payroll reports but failed to pay the related premiums or enter into a payment plan. Todd Bittner ultimately completed a second application for coverage, changing the business name slightly, but failing to list the information regarding the existing policy on the application. BWC identified this new application as a potential duplicate policy for Bittner Construction and denied the coverage due to the unpaid balance. In addition, Ross Bittner filed an injury claim against the lapsed policy and was collecting working wage loss benefits. Ross Bittner submitted wages from Bittner Construction in order to receive these benefits. As part of a plea deal, Todd Bittner will have to become compliant and will be responsible for the $50,306.20 he owes BWC. A pre-sentence investigation was ordered and sentencing was scheduled for December 9, 2013.
Harry Livingston (Parma Heights, Cuyahoga County) pleaded guilty Oct. 31 to one felony count of workers’ compensation fraud for working while receiving benefits. SID opened an investigation after receiving an allegation from an anonymous source that Livingston was working as a dump truck driver. SID conducted surveillance of Livingston in which he was observed arriving at the locations that the dump truck was parked, driving the dump truck to and from the job site, and returning to parking lot. They also confirmed that he worked as a dump truck driver from May to November 2012 while receiving the temporary total benefits. Livingston repaid more than $19,000 in restitution prior to his sentencing. He was sentenced to serve six months in prison, which was suspended for a term of community control. He was also fined $500 and ordered to pay court costs.
Richard Matt (Mayfield Village, Cuyahoga County) pleaded guilty to a misdemeanor count of workers’ compensation fraud Oct. 28 for working while receiving benefits. Matt was receiving temporary total disability benefits when a cross match with the Ohio Department of Jobs & Family Services indicated he was concurrently receiving wages. SID’s investigation found Matt was employed as a sales broker for Music Blast/Beverage Plus based in Las Vegas, NV. Company records confirmed Matt was working during the period of time in which he was also receiving workplace injury benefits from the BWC. Matt pleaded guilty to a misdemeanor count of workers’ compensation fraud October 28. Franklin County Judge Sheward ordered Matt to pay restitution in the amount of $3,421.34 by Oct. 28, 2014. He will serve 180 days at the Franklin County Corrections Center if he fails to make full restitution. Matt made a restitution payment of $500 at his sentencing.
Mary Martin (Columbus, Franklin County) pleaded guilty to one count of workers’ compensation fraud Oct. 24 for deception to obtain dangerous drugs. SID’s Intelligence Unit discovered Martin had received narcotic prescriptions from multiple physicians during overlapping periods. The investigation that followed revealed she was deceiving several physicians and that she filled those prescriptions at multiple pharmacies as a way to conceal her drug-seeking behavior. Martin was sentenced in the Franklin County Court of Common Pleas to four years of community control, under the conditions that she pay court costs and restitution in the amount of $3,473.65, and obtain no new convictions.
Eric Mariol (Canton, Stark County) pleaded guilty to a misdemeanor count of workers’ compensation fraud Oct. 22 for working while receiving benefits. Mariol was receiving living maintenance benefits and temporary total disability benefits when a cross match with the Ohio Department of Jobs & Family Services indicated he was concurrently receiving wages. SID’s investigation confirmed Mariol was working as a laborer/helper for Brad Bonsky Sheet Metal and Miracle Solutions. Mariol pleaded guilty to a misdemeanor count of Workers’ Compensation Fraud October 22. Judge Pollitt ordered Mariol to pay restitution in the amount of $1,322.88 by April 30, 2014. He will serve 30 days at the Franklin County Corrections Center if he fails to make full restitution. Additionally, Mariol was ordered to pay a $250 fine and serve 72 hours of community service.
Cheryl Brenner, dba Cranberry Station, (Andover, Ashtabula County) pleaded guilty to one felony count of failure to comply Oct. 15 for operating her business with lapsed workers’ compensation insurance coverage. BWC’s Employer Compliance Department attempted to work with Brenner, owner of Cranberry Station in Andover, to bring her policy into compliance after it lapsed, but she failed to cooperate and she continued operating the restaurant without coverage. The case was then turned over to the Special Investigations Department Employer Fraud Team. Following a pre-trial on the charges, Brenner entered into a payment plan with BWC to repay her outstanding premiums of approximately $10,000, and her policy was reinstated. A judge ordered Brenner to remain compliant, assessed a $100 fine and court costs, and sentenced her to one year of community control.
Source: Ohio BWC SID