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BWC Sends Message: It Has More Resources to Pursue Fraud
YOUNGSTOWN, Ohio -- As it steps up its investigative efforts, the Ohio Bureau of Workers Compensation is discovering more instances of employer fraud as it sees employee fraud begin to decline.The bureau is increasing the funds saved the state treasury, 23.71% more in 2003 over 2002. Last year the BWC's anti-fraud team saved the state $126.2 million compared to $102.1 million in 2002, Tom Wersell said Wednesday. Wersell is director of the BWC's special investigations department.His unit is on a statewide tour to get the word out that the BWC is devoting more resources to uncovering and prosecuting fraud that ever before. Wersell met with reporters yesterday in the BWC's offices in the Voinovich Government Center as part of Fraud Awareness Week in Ohio. There he mentioned that when his unit was created a decade ago, it had 10 agents. It has 124 today.In his overview of 2003, Wersell reported:The department received 6,770 allegations of fraud and found nearly half, 47.9% had some degree of merit. Nearly 1,900 cases are pending. (Nearly 60% come from internal sources.) His department referred 300 of the cases it investigated for prosecution, 12 in the Youngstown-Warren region.Prosecutors secured 70 indictments statewide, 21 in Youngstown-Warren.Prosecutors obtained 100 convictions statewide, six in this region.The department has expanded its Project Oxy into Project Narc. "This project resulted in 420 referrals this fiscal year, Wersell reported. "These referrals have identified $9.5 million in project savings," because his department has identified doctors overprescribing and claimants selling what they cannot use. When abused, Oxycontin provides a euphoria not unlike heroin and is just as addictive. "We're making sure beneficiaries are not reselling their prescriptions," he remarked. It's a "disturbing trend," he went on, "of finding injured worker drug abuse cases," which he says have increased 200% over the last couple of years.The increase in employer fraud, Wersell said, can be attributed to his investigators' discovery -- often in routine inspections or audits -- of the "bureau being billed for services not delivered."With computers comes "cyber crime" and the special investigations department is finding identity theft -- it prosecuted 38 cases last year, Wersell said -- where the claimant is not who he (or she) says he is while claiming injury. Not only that the investigators are searching medical providers' computers to ferret out suspected overcharging.For example, a doctor may order a back brace that costs $200 for a patient and change BWC $1,000 without the claimant being aware of the overcharge. In some instances, the office manager has falsely jacked up the price, Wersell's investigators found. Regardless, the physician should have known and is responsible. SURVEILLANCE TOOLS -- Tom Wersell (left) director of investigative services for Ohio Bureau of Workers' Compensation, and John Sledd, head of the BWC's Youngstown office,hold what appear to be oridinary articles of attire. In reality, the denim jacket has a small lens in the Browns logo and the purse has a tape recorder.The Fugitive Task Force within the special investigations department is going after employees charged with fraud who fail to appear in court, Wersell said. The task force works with the U.S. Marshal's service and, when necessary, has the state attorney general's office issue writs of extradition on those who skip to other states. Thirty writs were issued last year and $300,000 recovered.BWC investigators, Wersell points out, are not armed and lack the power to arrest. Hence the need to cooperate with other law enforcement agencies, whether the marshal's service, the state highway patrol, sheriff's departments and local police forces.The average fraudulent claim uncovered comes to $53,000, Wersell stated. But the average recovery is 10% because the leverage BWC has to collect is limited. Physicians found guilty of fraud are cut off, even if they make restitution in full; the BWC will not honor any subsequent claims.Employee claimants often have spent the funds they've collected. Should they file a later claim, the BWC can deduct up to 40% of what they're entitled as restitution.Often, rather than prosecute in criminal court a claimant suspected of fraud, BWC will resolve the matter in civil court with the claimant agreeing to terms that provide for restitution.Wersell credited employers' enforcing safety regulations with a decease in the number of employee accidents, and hence, one factor in the decrease in the instances uncovered of employees filing fraudulent claims.Both the greater number of special investigation agents and the increasing ease of using computer data bases to cross check employers is enabling BWC in uncovering employers who fail to pay the required premiums. An employer, for example, may pay his unemployment insurance premiums but not BWC premiums. Or he may pay state income taxes but neglect to pay the BWC."Employers have no excuse for not paying premiums," Wersell said. As long as it seems neglect or oversight rather than fraud, the BWC will allow the employer to make restitution and begin paying what he owes. Visit the Ohio Bureau of Workers Compensation at www.ohiobwc.com"