BWC News

Fighting Fraud: BWC Administrator Warns: ‘Steal from BWC, and We’ll Find You and Prosecute”

Fighting fraud is one of the primary missions of the Ohio Bureau of Workers’ Compensation (BWC). For every dollar Ohio spends to fight workers’ compensation fraud, more than $8 is saved.

BWC Administrator/CEO James Conrad has offered a stern warning: “Steal from BWC, and we’ll find you and prosecute.” The agency uses hotline tips (1-800-OHIO-BWC), special investigators and sophisticated computer cross-matches to identify potential fraud. The cross-matches tap into the computer systems of the Ohio Bureau of Employment Services, and the Ohio Department of Rehabilitation and Correction.

Claimants, employers, health care providers and attorneys can commit fraud.

In claimant fraud, “injured” workers try to bilk the system by “double dipping” (working at a new job while collecting workers’ compensation benefits from a previous employer), lying about injuries or where they occurred, or collecting benefits after recovery.

Experts have identified a number of red flags that could be indications of employee fraud. Fraudulent cases almost always contain at least some of these elements:

• Claimant cannot be reached by phone
• Injury is timed closely with a layoff, termination or early retirement
• No witnesses to the accident
• All paperwork is submitted in person or mail is sent to a post office box
• Claimant has a history of workplace injuries and always uses the same medical/legal team
• Medical reports of injuries do not support the claimant’s version of the accident.

Employer fraud - also known as premium fraud - occurs when an employer intentionally manipulates data to pay a lower premium for workers’ compensation insurance. The methods of exploitation include: underreporting payroll, declaring independent contractors, misclassifying workers, misrepresenting claims history and underestimating employment projections.

Medical provider manipulations include “creative” billing, inappropriate self-referrals, product switching, inadequate or unnecessary treatments, and kickbacks for patient referrals.

The state maintains that it has no problem approving legitimate claims and helping all parties understand the claims process. However, where it suspects fraud, it will go to great lengths to expose and punish it.