BWC Investigators Identify $55 Million in Savings
COLUMBUS, Ohio -- After closing 2,000 claimants’ cases last year, the Ohio Bureau of Workers’ Compensation Special Investigations Department identified more than $55 million in savings for the State Insurance Fund. The closed cases included 140 criminal convictions and 236 referrals for prosecution, Jennifer Saunders, interim director of the department, says.
In addition, an administrative review of 915 cases either uncovered fraud or identified additional savings for Ohio employers who pay into the State Insurance Fund, Saunders said Her report to the bureau's board of trustees noted that the closed cases involved claimants, employers and medical providers.
Among the results:
- The employer fraud team, who investigate fraud employers commit, closed 226 cases, generating $3,535,468 in savings. The team’s efforts led to 43 indictments and 33 convictions during fiscal 2013.
- Regional claimant fraud teams closed 1,353 cases and identified $30,179,976 in savings. These teams helped prosecutors secure 100 convictions, or 23.5% more than the 81 claimant subject convictions secured during fiscal 2012.
- The Health Care Provider Team, who investigate fraud committed by providers, pharmacies, and managed care organizations, closed 68 cases, or 83% more than in the previous year. The team identified $11,874,978 in savings to the workers’ compensation system and helped to secure seven convictions.
The department continues to employ significant resources to combat prescription fraud, Saunders said. The intelligence unit requested reviews of drug use 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 unnecessary, generating $9,467,735 in savings. Drug complaints represented 22.8% of all complaints the department investigated by the department, second only to working while receiving benefits, which represented 28.9% of all complaints investigated in fiscal 2013.
Saunders also noted the presence of the department on Facebook and Twitter, which are used to notify the public of outstanding fugitives, prosecutions, and anti-fraud efforts as well as help the public recognize common fraud schemes and report suspected fraud.
Published by The Business Journal, Youngstown, Ohio.
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