WORKERS' COMPENSATION Cracking down on fraud cases
The bureau has increased the number of investigators from 10 to 124.
By DON SHILLING
VINDICATOR BUSINESS EDITOR
YOUNGSTOWN -- State investigators say doctors and providers of medical equipment should beware -- a hunt is on for workers' compensation fraud.
Those in the medical industry are particular targets for investigators as the Ohio Bureau of Workers' Compensation starts its new fiscal year this month, said Tom Wersell, the bureau's director of special investigations.
He spoke Wednesday in Youngstown as part of a series of press conferences to raise awareness about workers' compensation fraud.
More attention can be paid to doctors and others in the medical industry because of the success the bureau has had in cutting back on fraudulent claims by workers, Wersell said.
Statistics
In the last fiscal year, 68 percent of fraud cases were related to employees, which was down from 85 percent the year before.
Wersell said bureau officials have been expecting a drop like that after beefing up its investigations division over the past 10 years. The bureau had just 10 investigators for the state in 1994.
"Fraud was rampant," Wersell said.
The bureau now has 124 investigators, including two in Youngstown and one in Warren.
Fraudulent employee claims include seeking payment for fake injuries or continuing to collect payments for a legitimate injury but also returning to work.
In the medical field, investigators are looking for those who bill for services that are beyond what is needed or for medical equipment that is not delivered. Offenders can be doctors, office managers or equipment providers.
Wersell said investigators will go undercover and pose as patients to locate sources of fraudulent claims.
The bureau also goes through claims looking for providers that have a higher percentage of workers' compensation cases than others in the area, he said.
Last fiscal year, 9 percent of fraud cases were related to medical providers, compared with 5 percent the year before.
Looking for lax employers
The bureau also is increasing efforts to find employers who aren't paying into the system, Wersell said.
In February, investigators visited 1,000 employers in seven areas, including Youngstown, after using documents from other government agencies to find employers that weren't part of the workers' compensation system. Investigators informed the employers about the requirement to pay into the system and worked with them for several weeks to try to bring them into compliance, Wersell said.
The effort resulted in 10 criminal convictions.
Last fiscal year, 21 percent of fraudulent cases were related to employers, up from 8 percent the year before. The state collected $5.6 million in new premiums in fraudulent-employer cases last fiscal year, compared with $1.8 million the year before.
Overall, the bureau posted a record of $126.2 million in savings in the last fiscal year, compared with $102.1 million the year before. Savings include medical payments that would have been made if cases hadn't been started and new premiums generated from employers who weren't part of the system.
shilling@vindy.com