Special Investigations Department

Fiscal Year 2019 Annual Report

Governor Mike DeWineAdministrator/CEO Stephanie McCloud

www.bwc.ohio.gov

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Table of contents

Letter from Director Jim Wernecke ..........................2

About us — History and structure .............................3

Leadership ......................................................................4

2019 Performance results ...........................................5

Fraud investigations — Notable cases ....................6

Inside SID ...................................................................... 10

Strategies and outreach — Building awareness ..... 12

Conclusion .................................................................... 15

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Letter from Director Jim Wernecke September 6, 2019

Dear BWC Board of Directors:

In fiscal year 2019, BWC’s Special Investigations Department (SID) celebrated its 26th year of protecting the State Insurance Fund by detecting, investigating, and deterring fraud. Through the hard work of our teams and professional staff, we improved our operational efficiency and effectiveness and strove toward a goal of being a world-class operation.

We couldn’t accomplish this important work without the 119 dedicated members of our team who serve with great skill, resourcefulness, and determination in bringing justice to those who try to cheat our system. Working together, this team accomplished impressive results in 2019: 1,732 closed cases, 101 convictions, and $65.1 million in savings – an 8% increase over 2018.

In 2019, our investigative teams continued to work closely with the law enforcement commu-nity at the local, state, and federal levels. We collaborated on several investigations, including cases involving physicians running pill mills in Ohio and surrounding states. In addition, our teams joined other state and federal investigators participating in the Document and Benefit Fraud Task Force, the Ohio Medicaid Prescription Program Integrity Group, and the Pill Mill Coordination team for the Ohio Attorney General’s Medicaid Fraud Control Unit.

In the pages ahead, you’ll find greater detail on the work our department conducts each year to protect the State Insurance Fund and fulfill our mission “to effectively and proactively pre-vent losses to the workers’ compensation system and to deter, detect, investigate, and prose-cute workers’ compensation fraud.”

Thank you for reading this report and supporting our mission. On behalf of my entire team, we are honored to serve this agency and the great state of Ohio.

Sincerely,

Jim Wernecke, Director, Special Investigations Department 

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About us — History and structure

BWC created the Special Investigations Depart-ment (SID) in FY 1994 to proactively detect, inves-tigate, and deter workers’ compensation fraud and protect the State Insurance Fund. This fund compensates Ohio’s injured workers. What began with a staff of six to 10 people in just three offices across the state is today a force of 119 agents, supervisors, and support personnel in 13 offices statewide.

Ohio law designates SID a criminal justice agen-cy. SID protects the State Insurance Fund by aggressively pursuing cases of claimant, medical provider, and employer fraud. As a result of our investigations, we declare overpayments, identi-fy actuarial savings, disallow claims, and pursue prosecutions and recovery of dollars. These actions directly impact BWC’s ability to reduce premium costs.

What is workers’ compensation fraud?

According to Ohio law, workers’ compensation fraud occurs when someone knowingly makes a false representation of a material fact to obtain or to deny workers’ compensation benefits or to avoid responsibility under the law. Fraud also oc-curs when an employer fails to obtain coverage or misrepresents the amount of payroll or classi-fication of its employees. Health-care providers commit fraud when they intentionally receive payments to which they’re not entitled.

SID comprises several teams to combat fraud. • We have three regional claimant fraud units, a health-care provider team, and an employer fraud team.• Our safety violations investigation unit (SVIU) includes team members located throughout the state who investigate potential violations of Ohio’s specific safety requirements.• Our intelligence unit, digital forensics unit, and fugitive task force operate through BWC’s central office, as does security services, which employs officers statewide, providing physical security and safety to all employees and visitors.

* Ohio Revised Code 4121.131** Ohio Revised Code 2913.48

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Leadership

Director Jim Wernecke

Jim Wernecke joined BWC in June 2015 following a 25-year career with the Ohio State Highway Patrol. He served in many lead-ership positions with the patrol, including command-er of the Ohio Investigative Unit and commander at the Mansfield Patrol Post. Jim also served as an investiga-

tive team leader with the Ohio Inspector Gener-al’s Task Force and was an assistant commander of the Special Operations Office of Investigative Services from 2006 to 2012.

A Tuscawaras County native, Jim completed advanced law enforcement and investigative training at several law enforcement agencies in and outside of Ohio. These include the United States Army War College, the West Virginia and Delaware State Police, the New York State Police Academy, and Ohio University. He also attended the Northwestern University for Public Safety and North Central State College.

Jim reports to BWC Chief Legal & Ethics Officer Michaela Peterson Baumann.

Assistant Director Jennifer Cunningham

Jennifer Cunningham joined BWC in 1994 and was pro-moted to special agent in 1996 in the Cleveland spe-cial investigations unit. She has served in numerous roles since then, including fraud analyst, special agent, and special agent in charge for the northeast regional special investigations unit.

She was promoted to assistant director, field op-

erations, in 2006. In this role, Jennifer leads crim-inal and administrative investigations of claimants and health-care providers.

Jennifer also assists with SID’s training and de-velopment committee and is a member of the International Association of Special Investigation Units, the National Health Care Anti-Fraud Asso-ciation, former Governor John Kasich’s Cabinet Opiate Action Task Force , and the Ohio Inves-tigators Association. She graduated from The Ohio State University with a bachelor’s degree in English and minor in criminal justice.

Assistant Director Dan Fodor

Dan Fodor joined SID in Nov. 1999 as special agent in charge of the intelligence unit following eight years in BWC’s internal audit depart-ment. Among his achieve-ments in SID, Dan started and supervised our digital forensics unit in 2001. He also supervised our safety

violations investigation unit for two years. Ap-pointed assistant director in June 2016, Dan over-sees our employer fraud team, the intelligence unit, and central operations.

Dan has a bachelor’s degree in accounting from The Ohio State University.

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2019 performance results

Our performance results for FY 2019 compare favorably with previous years in our history.

During FY 2019, we identified $65.1 million in savings, 8% more than last year. We received 2,925 allegations and closed 1,732 cases, a 7% increase over 2018. The average closed case identified $37,612 in savings to our workers’ compensation system, representing the third-highest average savings identified per closed case since 2000.

PERFORMANCE MEASURES FY 2019 FY 2018 FY 2017 Allegations 2,925 3,150 2,323 Cases referred for prosecution 189 166 163 Indictments 119 111 117 Convictions 101 101 133 Cases closed 1,732 1,622 1,174 Number open cases at end of year 668 759 706 Savings to State Insurance Fund $65.1 million $60.1 million $41.8 million $$ saved to $$ spent $4.93 $4.81 $3.48

Performance results by team type

SID teams Prosecution Indictments Convictions Identified referrals savings Employer 69 63 53 $15,415,430 Health-care provider 7 6 4 $5,065,993 Claimant 113 50 44 $44,662,898 Total 189 119 101 $65,144,322

Results achieved since FY 1994 Allegations 125,651 Cases referred for prosecution 5,367 Convictions 2,905 Cases closed (founded) 28,359 Savings to State Insurance Fund $1.9 billion 

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Fraud investigations — Notable cases

While SID is a sophisticated criminal justice agency, we rely on the public’s eyes and ears to help us identify and prevent fraud. We routinely team with BWC’s communications department to promote our completed cases through BWC’s website, the media, and various social media channels. By doing so, we’re putting workers’ comp criminals and would-be cheaters on alert — we are looking for you, we will find you, and we will prosecute you to the fullest extent of the law.

From our blog — An employer case in point

Southwest Ohio business owner gets prison time, hefty fine for work comp fraud: Busi-ness owner defrauded BWC of $425K

Dec. 7, 2018 / BWC Social Media Team

The owner of a former payroll services com-pany in southwest Ohio was sentenced to six months in federal prison and fined $10,000 today for defrauding the Ohio Bureau of Workers’ Compensation (BWC) out of more than $425,000.

John R. Cacaro, 59, owner of the now-defunct Employers Choice Plus LLC, also must serve one year of house arrest and three years of supervised release under a sentence hand-ed down by U.S. District Judge Michael H. Watson in the U.S. District Court for southern Ohio.

“Multiple businesses entrusted Mr. Cacaro with processing their payroll and remitting insurance premiums to our agency and he broke that trust,” said Jim Wernecke, director of BWC’s Special Investigations Department. “Justice was served today, and I can’t thank our partners in this investigation enough, the IRS Criminal Investigation unit and the U.S. Attorney for the Southern District of Ohio.”

Cacaro was convicted in June on wire fraud and money laundering charges after BWC and IRS investigators discovered a scheme he concocted to short BWC on the insurance premiums he received from employers and pocket the difference.

“John Cacaro made a conscious decision to keep over $425,000 in workers’ compensa-tion premiums so he could live a lavish life-style that included the purchase of a second residence in Naples, Florida, and a motor home,” said IRS Special Agent in Charge

Employer fraud

Our employer fraud team has staff through-out the state dedicated to investigating allegations of fraud committed by employ-ers and third-party administrators. The most common complaints include:

• Altering BWC certificates of coverage• Misclassifying employees• Obtaining multiple BWC policies through deception• Operating without coverage• Submitting dishonored premium payments to the BWC

The team works with other BWC depart-ments and external agencies to identify non-compliant and fraudulent employers.

During FY 2019, our employer fraud team closed 253 cases. It identified $15.4 million in savings to the workers’ compensation system, 75% more than last year. The team referred 69 subjects for criminal prose-cution, achieving 63 indictments and 53 convictions.

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Ryan L. Korner. “Now he is a convicted felon headed to prison.”

At his sentencing today, Cacaro submitted a cashier’s check to the court for $425,247 in restitution to BWC. He noted that he has voluntarily closed Employers Choice Plus and he will likely have gainful employment through his car transportation business when he leaves prison.

Provider fraud

Our health care provider team (HCPT) has staff throughout the state dedicated to in-vestigating allegations of fraud committed by providers, pharmacies, and managed care organizations. The most common complaints received by HCPT included:

• Drug trafficking• False billing• Providing medically-unnecessary treatment• Services not rendered• Up-coding (billing for more services or more expensive services than those provided)

The team aggressively pursued fraudulent providers in FY 2019, including those who ran pill mills and injury mills. The team acted as both a lead and support agency to iden-tify and investigate provider fraud subjects suspected of committing health-care fraud. Throughout Ohio and points beyond, the team participated in joint investigations with local, state, and federal law enforcement agencies. Agents conducted multiple under-cover operations.

The team closed 61 cases, 13% more than last year, and identified $5.1 million in savings to the workers’ compensation system, 46% more than last year. It secured seven refer-rals for criminal prosecution, six indictments

and four convictions. HCPT is also pursuing civil charges and administrative remedies to secure restitution from subjects of closed, founded cases.

Additionally, the team continued to identi-fy and recommend policy and procedure changes to increase cost savings to employ-ers, enhance service to injured workers, and address unsafe medical practices, which impact all Ohio citizens.

From our blog — A provider case in point

Akron pain doc guilty of workers’ comp fraud: False billing cited in felony case

Aug. 3, 2018 / BWC Social Media Team An Akron pain specialist has agreed to re-imburse the Ohio Bureau of Workers’ Com-pensation more than $33,000 and stop seeing injured workers in the BWC system after pleading guilty to a fifth-degree felony count of workers’ compensation fraud July 26.

Acting on a tip from a former patient, BWC investigators found Dr. William Midian, 71, provided inadequate care and falsified patient records so he could bill the agency for services he did not render.

“Our investigation revealed that on sev-eral occasions in 2016, the doctor billed our agency for services we know he didn’t provide,” said Jim Wernecke, director of BWC’s Special Investigations Department. “In addition, we found the quality of his

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care lacking. It certainly wasn’t at the level our injured workers expect and deserve.”Appearing in a Franklin County courtroom, Midian agreed to reimburse BWC $33,035 for payments he improperly received and the cost of the investigation. He also agreed to withdraw from BWC’s network of approved health care providers. 

Claimant fraud

Our regional claimant special investigations units (SIUs) have staff members located in most of BWC’s service offices. Dedicated to investigating allegations of fraud committed by claimants, these teams are assigned to one of three regions: northeast, southeast, and west.

In FY 2019, these three teams closed 1,414 cases, 11% more than in FY 2018. They iden-tified $44.7 million in savings. These teams referred 113 subjects for criminal prosecution, 57% more than last year. In addition, they secured 50 indictments and 44 convictions.

From our blog — Northeast regional SIU: A claimant case in point Prison, hefty restitution ordered for Cleve-land fraudster: Contractor collected $246K in disability from BWC, Social Security

March 15, 2019 / BWC Social Media Team A Cleveland-area man was sentenced to seven months in prison Wednesday and ordered to repay nearly $246,000 in disabil-ity benefits he fraudulently received from the Ohio Bureau of Workers’ Compensation (BWC) and the Social Security Administration.

Louis C. Cooper, 57, of North Royalton,

previously pleaded guilty to wire fraud and theft of government property after investi-gators discovered him concealing his work as a general contractor. He was sentenced Wednesday in the U.S. District Court for the Northern District of Ohio in Cleveland.

“Acting on an anonymous tip, our investi-gators discovered Mr. Cooper earned at least $185,000 over the last eight years as a general contractor while telling BWC and Social Security he was too injured to work,” said BWC Administrator/CEO Stephanie McCloud. “Our benefits are for workers who truly need them, not for fraudsters to pad their income. I commend our Special Investi-gations Department and the Social Security Administration for bringing Mr. Cooper’s criminal activity to an end.”

Cooper was injured on the job in 1996. Investigators from BWC and Social Security found he had developed a scheme dating back to at least 2010 to conceal his income as a general contractor by asking his clients to not pay him directly. While reporting to both agencies numerous times that he was too injured to work, Cooper collected nearly $168,000 from BWC and nearly $78,000 from Social Security.

According to court documents, Cooper must surrender to the U.S. Marshals Service on April 18 for transfer to a state prison. He must serve three years of probation follow-ing his release. This case was prosecuted by the U.S. Attorney’s Office for the Northern District of Ohio.

This case was featured in the Office of the Inspector General, Social Security Admin-istration’s Spring 2019 Report to The Con-gress of the United States of America, page 11, which can be found here: https://oig.ssa.gov/sites/default/files/SARC%20-%20June.pdf.

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From our blog — Southeast regional claim-ant SIU: A claimant case in point

Pataskala man owes BWC $41,000 after felony conviction

Aug. 17, 2018 / BWC Social Media Team

A maintenance man for a mobile home park must reimburse his former employer more than $41,000 after pleading guilty Tuesday to a felony count of workers’ compensation fraud.

Acting on a tip, investigators with the Ohio Bureau of Workers’ Compen-sation discovered Jason C. Smith, 35, of Pataskala, working for a mobile home park and for private individuals for nearly two years while collecting $41,413 in disabil-ity benefits from his employer, TS Tech USA Corporation in Reynoldsburg.

“You can’t claim you’re disabled and collect benefits from BWC or your employer when you’re also working under the radar and making a living,” said Jim Wernecke, direc-tor of BWC’s Special Investigations Depart-ment. “Workers’ comp benefits are for peo-ple who truly can’t work because they were injured on the job, not people who want to cheat the system and pad their income.”

Smith pleaded guilty to a fifth-degree felony count of workers’ compensation fraud. A Franklin County judge ordered him to pay TS Tech restitution and sentenced him to a year in jail, which he suspended in ex-change for three years’ probation.

From our blog — West regional claimant SIU: A claimant case in point

Logan County man sentenced for workers’ comp fraud

March 22, 2019 / BWC Social Media Team On the day he was sentenced to prison for breaking and entering, gross sexual impo-sition, burglary, and other charges, a Belle-fontaine man was also ordered to pay nearly $6,400 in restitution to his employer and the Ohio Bureau of Workers’ Compensation (BWC) for collecting disability benefits while secretly working another job.

Joseph A. Wilson, 32, was sentenced to six years in prison March 8 on multiple charges, including reduced charges related to workers’ compen-sation fraud — petty theft, a first-degree misdemeanor, and failure to appear in court, a fourth-degree felony. A judge in the Logan County Court of Common Pleas ordered Wilson to reimburse his employ-er (Rent-A-Center) $2,904 and pay BWC $3,469 for the cost of its investigation.

“Workers’ compensation fraud is a crime we take seriously,” said BWC Administrator/CEO Stephanie McCloud. “Fraud steals resources needed by workers who are truly injured, and it raises the cost of our entire system. Kudos to our special investigations depart-ment for bringing this case to a close.”

BWC investigators confirmed an anonymous tip they received in late 2017 that Wilson was working on a horse farm while collecting

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disability benefits from Rent-A-Center. Wilson was arrested in November on warrants for five counts of gross sexual imposition, two counts of workers’ compensation fraud, two counts of failure to appear, and single counts of receiving stolen property, theft, breaking and entering, and criminal damaging.

Inside SID

In addition to our fraud teams, we have four units that support those teams as well as security per-sonnel to ensure the safety and protection of all BWC employees and customers.

Digital forensics unit

Our digital forensics unit (DFU) provides a full range of technical support for special agents con-ducting workers’ compensation fraud investiga-tions. The unit’s primary duties include the foren-sic imaging and analysis of digital data acquired from electronic storage devices. Using special-ized training and forensic software, this team analyzes, extracts, and provides vast amounts of information to support investigations conducted by other SID teams.

The DFU’s social media analyses assist SID teams by identifying intelligence on subjects, as well as potential suspects, witnesses, and co-conspirators.

In addition, the DFU also completes internal investigative requests from BWC’s labor relations department and the Ohio Office of the Inspector General.

2019 digital forensics actions Completed requests Field assistance 797 Social media requests 119 Technical operations requests 17 Presentation requests 34 Internal investigations/reviews 46 Total 1,013

The unit also initiated a state-of-the-art unmanned aircraft system (UAS) program to support the in-vestigative operations of the SID safety violations investigation unit. The unit uses the drones to capture workplace injury scenes digitally. It does this while minimizing investigator exposure to dangerous or contaminated areas.

Intelligence unit

Our intelligence unit (IU):

• Coordinates fraud detection and loss prevention programs• Provides data analysis and visualization services to further investigations• Supports department management with reporting and special projects

During FY 2019, the IU detected 760 potential instances of fraud. These allegations were 26% of the 2,925 new allegations received by SID. When resolved, the IU allegations generated $17.3 million in identified savings. The 87 referrals for criminal prosecution resulting from IU identified cases were the highest number for IU since FY 2005 and represented 46% of the 189 referrals made by SID in this fiscal year. Additionally, the unit assisted SID employees by completing 1,241 requests for in-depth analysis and case support.

IU staff are members of a committee to support BWC’s strategic direction to incorporate data-driv-en decisions into operations. The committee is

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comprised of information technology profes-sionals and designated personnel from business operational areas. The goal of this group is to develop a vision and strategic direction to govern data and use analytics to enhance effectiveness in managing business operations. Since FY 2000, the Intelligence Unit has identified over 21,000 allegations of fraud and/or abuse and achieved over $530 million in savings due to its data anal-yses. Their vast experience will enable IU staff to make significant contributions to this committee.

Safety violations investigation unit

Our SVIU is a statewide team dedicated to inves-tigating potential violations of specific safety re-quirements (VSSR). A claimant, surviving spouse, or dependent may file for a VSSR award when a potential safety violation contributed to an injury, illness, or death. The unit submits the results of its investigations to the Ohio Industrial Commission (IC) for its determination of the VSSR award. Upon request by the IC, SVIU employees also com-plete correction order investi-gations to ensure an employer corrects a cited code violation.

In FY 2019, the SVIU received 388 claims applying for VSSRs, 15% more than the 337 VSSR claims received last year. The unit closed 398 investigations, 26% more than the 317 investigations closed last year. Additionally, the unit conducted 62 preliminary investigations of workplace fatalities or catastrophic injuries.

The unit continued to use its unmanned aircraft system (UAS) program to assist in safety investi-gations. Three pilots around the state, each with a set of aircraft, provide assistance as needed. The pilots flew eight missions related to work-place fatalities this year. Additionally, the unit continued to coordinate and conduct joint inves-tigations with the Occupational Safety and Health Administration.

Fugitive task force

Our fugitive task force (FTF) locates subjects with outstanding arrest warrants for BWC-relat-ed charges. Although SID is a criminal justice agency, we do not have the power to make an arrest. Therefore, the FTF works with local, state, and federal law enforcement to locate and arrest these subjects. The FTF also works with Ohio Attorney General’s Office to ensure all warrants are served.

FTF agents serve letters only on misdemean-or warrants, conduct surveillance, research the location of subjects, and with the appropriate agency, coordinate the arrest of subjects for felo-ny warrants. The appropriate authorities execute these arrests, often with FTF agents present. Many times, law enforcement pulls over subjects for unrelated traffic offenses and discovers and addresses the warrants. Elsewhere, the FTF con-tacts subjects and recommends they turn them-selves in to the court. We resolved 27 warrants in 2019. The subjects of these warrants were associ-ated with $390,204 in overpayments and premi-ums/penalties owed to BWC.

Arrest warrant resolution Number of Number resolved with Overpayments and warrants resolved FTF involvement premiums/penalties

Arrested by local law enforcement 5 0 $11,153

Arrested by a sheriff’s office 4 1 $38,598

Arrested by probation 1 0 $12,861

Fugitives turned themselves in 14 11 $75,210

Warrants recalled 3 1 $252,383

Total 27 13 $390,204

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BWC security

Ensuring safety and security for employees and customers is the mission of BWC security. BWC has more than 1,700 employees and contractors located in 13 facilities throughout the state. Some of these facilities also host employees of the IC. In addition, our main headquarters in Columbus furnishes office space to five other state agencies.

BWC facilities annually experience tens of thou-sands of visitors. Furthermore, employees at the facilities experience millions of direct cus-tomer service interactions through our e-com-merce-based website (www.bwc.ohio.gov), telephone calls, mail, and email. BWC security protects employees and customers against threats and harmful incidents that may result from these interactions.

In FY 2019, BWC security continued to deploy dozens of security services statewide. The team provided oversight of security officer services maintained at seven locations. The team complet-ed 57 background checks for new security guard candidates. It also issued equipment to officers for their use in communicating emergency con-ditions directly to the central office command center at our main headquarters.

The team directed the installation of security equipment enhancements at three locations. BWC Security added an armed Ohio State High-way Patrol Police Officer to our main headquar-ters in Columbus through an agreement with the

Ohio Department of Public Safety. The team also partnered with BWC safety administration in bol-stering our floor warden and safety team training throughout the state. Threat Assessment Coordi-nator Darrin Blosser continues to work with BWC safety and wellness staff to train employees on active aggressor response/drills, per Ohio De-partment of Administrative Services policy.

FY 2019 BWC security cases

The team responded to 190 cases. • 55 administration assistance • 42 outside threats or security issues • 28 responses to emergencies or medical calls • 22 law enforcement inquiries or referrals • 11 harassing phone calls or emails • 10 lost or stolen state property incidents • 8 investigative reports • 14 other

BWC security also managed the employee emer-gency notification system for business inter-ruptions or office closures. It also responded to incidents/inquiries. In addition, the team re-mained informed on the latest security trends and techniques.

Strategies and outreach — Building awareness

Our staff continues to implement our depart-ment’s fourth strategic plan. Created by a commit-tee of SID criminal investigators, special agents, fraud analysts, and supervisors, the plan for FY 2017-2021 identifies strategies to keep us aligned with our departmental vision. The plan includes six broad, strategic initiatives:

• Enhance the use of technology to conduct field work and detect cases for investigation• Develop a five-year, coordinated marketing campaign to increase fraud awareness through fraud presentations, publicity, and media exposure (social and traditional)• Identify opportunities to improve upon high-quality investigations in an efficient and effective manner

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• Evaluate our current staffing continually to ensure employees are properly trained and appropri- ately assigned across our various teams• Develop a five-year plan that coordinates all training for staff to ensure safety, competency, proper certifications, and opportunities for growth• Identify needed legislative changes, risk factors, and other opportunities where Legal Services can support SID operations

We continue to implement new strategies to achieve our mission, improve year to year, and plan for the future. Improvements during FY 2019 contributed to an average of 189 investigative days from the time we received an allegation to closing the case, which was 2.9 fewer days than in 2018 and the lowest number on this measure since 2005. Examples of future, strategic plans include succession planning and the use of op-erational working groups to develop, coordinate, execute, and refine training to support profes-sional career development and succession plans.

Fraud hotline

Commencing in November 2017, we have routed all external calls to our fraud hotline directly to our investigators instead of to BWC’s Customer Contact Center. By using our trained investigators to interview callers we have reduced or elimi-nated wait times for callers and increased the number and quality of new allegations. During FY 2019, the SID Fraud Hotline processed 495 new allegations from external callers. This level of per-formance is 35% more than the 367 allegations from external calls processed by the fraud hotline during FY 2017.

Benchmarking

We consult counterpart agencies and share data to measure our performance and identify new or alternate methods of fraud detection and inves-tigation. Such collaboration allows us to examine our own methods to see:

• Where we can make improvements• How we can accomplish tasks more efficiently

• Which new strategies or technologies we can use during an investigation

Increasingly, counterpart agencies contact us to request consultations. They seek to learn the best practices we deploy to secure significant performance results, such as those specified in this report.

Social media

Our social media campaign celebrated its eight-year anniversary of using our Facebook page and @OhioBWCFraud Twitter account to promote fraud awareness and deterrence. Our ongoing social media campaign, highlighted by our Fraud Awareness Series, educates the public on how to detect and report fraud. It also notifies the public about prosecutions and anti-fraud efforts.

Our Facebook page has 940 likes. It includes surveillance video footage, booking photos, and descriptions of common fraud schemes to help readers recognize fraud and report it through an online referral form. During FY 2019, we posted 143 Facebook updates, including 33 conviction press releases, and 163 Tweets.

Using social media to get our message out and tell our story increases our visibility and respon-siveness. Our stories are routinely picked up by local, state, and national news outlets, in addition to prominent insurance fraud and workers’ com-pensation journals.

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Statewide red flag training and Fraud Finder Awards

Working with BWC colleagues outside our de-partment is essential to protecting the State Insurance Fund for those who truly need BWC services. We annually furnish red flag training to BWC employees statewide so that all know how to detect and report fraud. We received 2,925 fraud allegations this year, with 25% of those coming from other BWC personnel — claims ser-vice specialists, employer service specialists, and others. To show our appreciation, our department leaders conducted a thank-you tour from Novem-ber through February, presenting Fraud Finder Award certificates to employees in claims offices across the state.

We named an employer compliance supervisor in our Cincinnati Service Office our “Fraud Finder of the Year” after he referred to us an employer who had failed to report payroll and respond to mul-tiple attempts to schedule a premium audit. The referral helped us identify and recover $316,103 in savings to the State Insurance Fund.

Our success in uncovering fraud protects re-sources we need to take care of injured workers, create safe workplaces, and provide the best service possible to employers at affordable rates. Having skilled, vigilant staff throughout our agen-cy is essential to this cause.

International Fraud Awareness Week (IFAW) 2018

SID prominently participates in the annual IFAW campaign established by the Association of Certified Fraud Examiners. The campaign en-courages business leaders and employees to promote anti-fraud awareness and education to help minimize fraud’s impact. To commemorate IFAW 2018, BWC’s Communications Department posted dozens of topical articles on our blog and Facebook page and tweeted throughout the week of Nov. 11.

We posted a new fraud feature each day, includ-ing tips for identifying and preventing fraud, new

cases, and insights from our investigators on what they do every day to stop workers’ comp fraud in Ohio.

A Facebook article, posted Nov. 13, introduced an infographic highlighting statistics from FY 2018 to illustrate how hard we work every day to #Stop-Fraud in Ohio’s workers’ compensation system.

Presentations

We conduct fraud presentations for internal and external stakeholders to educate them about strategies we deploy to accomplish our depart-mental mission. In doing so, we also let them know how they might join us in combating fraud. These stakeholders and other audiences have included:

• BWC departments• Educators: High schools, career centers, colleges, and universities• International organizations, such as the Interna- tional Association of Special Investigation Units (IASIU)• Local, state, and federal agencies• Medical providers and managed care organizations• Members of bar associations, chambers of commerce, and safety councils• Public and private employers• Third-party administrators

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We share examples of successful cases and teach attendees how to detect and report sus-pected fraud.

We conducted 111 fraud presentations in FY 2019 with 8,035 attendees. That’s seven more presen-tations and 554 more attendees than the previ-ous year. Our customers tell us these presenta-tions make a difference. Attendees at the 2019 Ohio Safety Congress and Expo session, entitled “Drones: Safety Tools in the Sky,” furnished doz-ens of evaluations. The feedback was specific, meaningful, and a vital component to shaping future sessions. Comments included:

• “This was an excellent opportunity to hear how drones can help our business in so many ways.”• “Understanding the reason for using drones -- to keep their employees safe and out of dangerous situations.”• “Drones and presenters, they are very knowl- edgeable!”

The Ohio Safety Congress and Expo is the sec-ond-largest safety congress in the United States, after the National Safety Congress.

Acknowledgment

The significant accomplishments achieved during this fiscal year are a direct result of our dedicat-ed investigative staff. Their efforts create safer workplaces and ensure those who attempt to commit fraud in workers’ compensation are held accountable to the fullest extent of the law. SID Management celebrates the successes of each SID employee, and thanks BWC Executive Staff and the Board of Directors for their continued support in our efforts in fighting fraud and investi-gating workplace safety.

Conclusion

Fiscal Year 2019 proved to be another success-ful one for SID as we investigated thousands of allegations, ended hundreds of open cases, and saved the State Insurance Fund more than $65.1 million. As we commence our 27th year in FY 2020, we remain united in our commitment to protecting this fund and the Ohio workers and employers it serves. We join our colleagues throughout this agency in delivering the people of this state the world-class workers’ compensa-tion system they deserve.

Contacts

Jim Wernecke, Director, BWC Special Investiga-tions DepartmentJames.W.3@bwc.state.oh.us614-466-9411

Jeff Baker, Program Administrator, BWC Special Investigations DepartmentJeffrey.B.1@bwc.state.oh.us614.466.7837 An electronic version of this report is available at:https://www.bwc.ohio.gov/downloads/blankpdf/FraudAnnualReport.pdf