AD&I Saves Ohio’s BWC Money in Fraud Fight

What’s in a name?

To the Ohio Bureau of Workers’ Compensation (BWC) automated detection and intelligence Team (AD&I), names found in certain state databases can signal potential workers’ compensation fraud.

By working with other state agencies and reviewing internal data, AD&I referred 1,386 cases for investigation in fiscal year 2004 which reportedly resulted in a savings of $35,949,946 for the agency. AD&I represented 28 percent of the total savings acquired by the special investigation department (SID) in that fiscal year.

Additionally, AD&I has already outpaced last year’s numbers. As of September, the team has referred 228 cases for investigation and has reportedly saved BWC $12 million. Since 2000, AD&I has reportedly totaled more than $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 CEO. “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, BWC has used information-sharing technology to help detect workers’ comp fraud. The AD&I, a special division of the SID, conducts computerized cross matching of information with other agencies.

On a regular basis, AD&I receives databases from many sources. The most frequent search conducted by BWC is done in conjunction with the Ohio Department of Jobs and Family Services (ODJFS). ODJFS shares employment information with the bureau on a quarterly basis to help identify workers’ comp total disability recipients who are reported working by employers.

The Ohio Department of Taxation, Ohio Department of Rehabilitation and Corrections, Ohio Lottery Commission and Ohio Department of Commerce share database information with BWC to help detect fraud.

Out-of-state bureaus of employment, such as Florida, Indiana, Alabama and Tennessee also have agreements with 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.

The AD&I furthered their investigative efforts in 1997 by examining BWC’s internal data. Today, the overwhelming majority of cases identified by AD&I are reportedly detected through the analysis of existing BWC data. AD&I uses data mining to proactively identify fraudulent behavior patterns.

By analyzing BWC’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’ comp 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.”