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Ohio BWC Fights Fraud with Technology
"COLUMBUS, Ohio -- Names found in certain state databases can signal potential workers' compensation fraud, according to the Ohio Bureau of Workers' Compensation Automated Detection and Intelligence Team. By working with other state agencies and reviewing internal data, the team referred 1,386 cases for investigation in fiscal year 2004 which resulted in a savings of $35,949,946 for the state agency. The team represented 28% of the total savings acquired by the special investigation department in that fiscal year, bureau officials report.Additionally, the team has already outpaced last year's numbers. As of September, the team has referred 228 cases for investigation and has saved the bureau $12 million. Since 2000, AD&I has totaled over $98 million in savings for BWC. "Through database cross matching and data mining, AD&I is able to catch fraudulent activity that could otherwise go unnoticed," said James Conrad, BWC administrator and chief executive officer. "Each and every day, with the help of our partners, we are identifying workers' comp fraud offenders in Ohio. It's my hope that by working with other agencies we will eliminate fraud and continue to make Ohio's workers' comp system a national leader."Since 1994, the bureau has used information-sharing technology to help detect workers' compensation fraud. The team, a special division of the special investigation department, conducts computerized cross matching of information with other agencies, Conrad said.On a regular basis, the team receives databases from many sources. The most frequent search conducted by the bureau is done in conjunction with the Ohio Department of Jobs and Family Services, which shares employment information with the bureau on a quarterly basis to help identify workers' compensation total disability recipients who are reported working by employers, Conrad said, adding that the Ohio Department of Taxation, Ohio Department of Rehabilitation and Corrections, Ohio Lottery Commission and Ohio Department of Commerce share database information with the bureau to help detect fraud.Out-of-state bureaus of employment, such as Florida, Indiana, Alabama and Tennessee also have agreements with the Ohio BWC to share information for this purpose. Florida shares employment data with BWC on an annual basis due to the large number of Ohio residents who retire to the state, Conrad noted.The team furthered their investigative efforts in 1997 by examining the bureau's internal data. Today, Conrad said the overwhelming majority of cases identified by team are detected through the analysis of existing bureau data. Team members use data mining to proactively identify fraudulent behavior patterns. By analyzing the bureau's own data, this team is able to identify who may be abusing or selling prescription drugs paid for by BWC, providers billing for medical services not rendered, providers engaging in upcoding or employers operating without proper workers' compensation coverage."BWC uses updated information routinely collected by BWC and other agencies to seek out possible workers' compensation fraud," said Tom Wersell, director of special investigations. "By increasing communication and cutting bureaucratic red tape, we are better able to serve the injured workers' of Ohio."Since its establishment in 1993, the special investigations department, which specializes in identifying and investigating workers' compensation fraud, has saved the agency over $820 million. In fiscal year 2004, the department has saved the agency approximately $126 million, the highest amount yet recorded, Conrad said.For every dollar spent on fraud investigations, BWC's SID identifies more than $11 in savings. The average take in a fraudulent workers' compensation case is $34,000, he added.Visit the Ohio Bureau of Workers' Compensation: www.ohiobwc.com"