Ohio Medical Consultant Sentenced to Prison for Workers’ Comp Fraud
The owner of a business that compiled medical reports for law firms representing injured workers has been sentenced to four years in prison for workers’ compensation fraud in Ohio, according to the Ohio Bureau of Workers’ Compensation’s (BWC).
The sentencing of Eric Zaffer, owner of Medical Consultants, located in Elyria (Lorain County), by Franklin County Common Pleas Court Judge Richard Sheward was result of an investigation by the BWC Special Investigations Department (SID) and the prosecution led by Ohio Attorney General Richard Cordray.
Unusual reporting practices gave BWC personnel reason to suspect fraud and SID was notified.
As part of its investigation, SID conducted a search warrant of Zaffer’s business in March 2009, finding evidence that he altered medical reports BWC and the Ohio Industrial Commission (IC) use to determine percent of permanent partial (%PP) awards (also known as C-92 awards).
BWC’s %PP compensation is available to injured workers with permanent injuries to a body part caused by a work-related accident or an occupational disease.
Investigators found that Zaffer was inflating percentages submitted by medical providers and/or embellishing medical conditions within the final report in an attempt to raise %PP awards and ultimately increase his business.
Zaffer pleaded guilty to one count of workers’ compensation fraud, a fourth-degree felony; two counts of tampering with records, a third-degree felony; and 10 counts of forgery, a fifth-degree felony. He was ordered to pay $139,558 in restitution and $56,340 in investigative costs to the BWC.
It is the primary responsibility of the examiner who submits medical information to the BWC and IC to guarantee its accuracy. This case led BWC to conduct an audit to review the process for awarding PP and to strengthen the integrity of the information used to determine awards.
In October, the BWC Board of Directors adopted a rule to decertify providers who submit inaccurate information as part of the %PP process. Additionally, a random review process has been implemented, with a set of guidelines established to address review outcomes.
These new internal controls are expected to minimize the risk of similar mistakes or attempts by interested parties to fraudulently alter the outcome of %PP awards in the future.
Source: Ohio BWC