Ohio BWC Investigations Result in 15 Workers’ Comp Fraud Convictions in November

The Ohio Bureau of Workers’ Compensation (BWC) announced 15 individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during November. The court actions are the result of investigations conducted by BWC’s special investigations department (SID). The department works to deter, detect, investigate and prosecute workers’ compensation fraud.

A sampling of the cases that resulted in a guilty plea or conviction during November follows.

• Michael Paulsen pleaded guilty to a felony count of workers’ compensation fraud for working while receiving benefits. SID received information indicating Paulsen was receiving wages from two businesses during periods he was receiving Working Wage Loss benefits. Paulsen was required to report all of his earnings to BWC in order to receive this type of benefit. The investigation confirmed that Paulsen was employed by both companies and he knowingly failed to report his earnings to BWC. Paulsen was sentenced to six months of incarceration, suspended for one year of community control if he pays $11,554.87 in restitution. He must also pay court costs and maintain viable employment.

• Randall Willett pleaded guilty to a felony count of workers’ compensation fraud for working while receiving compensation. SID received an allegation from a BWC claims service specialist (CSS) alleging Willett may be operating a concrete business called Willett Concrete. The CSS noted that Willett’s work trucks were reportedly visible at his residence and business location. The investigation showed Willett did work on various concrete and construction projects during periods he was receiving Temporary Total and Living Maintenance benefits. Willett entered his guilty plea and will be required to pay BWC $9,570 in restitution. The judge ordered a pre-sentencing investigation and scheduled sentencing for January 17, 2013.

• Eric Harris pleaded guilty November 5 to a misdemeanor count of workers’ compensation fraud for filing a false claim. SID received an allegation that Harris had informed his employer he was taking an extended vacation and asked to be “laid off” in order to collect unemployment benefits as the company did not have paid vacation leave. When the employer refused, he then stated that he would file a workplace injury claim to collect benefits. Harris did file a claim indicating he had been injured in a work related incident. Investigators examined the employer’s payroll records, which revealed Harris was not working on the alleged date of injury. Harris was sentenced to six months of incarceration, suspended for two years of community control if he pays BWC $1,360.99 in investigative costs. Harris did make that payment but will face the six month of sentence if he is convicted of any crime during his two years of community control.

• Christopher Wilson, dba, Fostoria Monument Company LLC pleaded guilty to one misdemeanor count of attempted workers’ compensation fraud for underreporting payroll. SID received an allegation from a BWC auditor that payroll reports filed by Fostoria Monument Company LLC did not include payroll for employees. The employer had been previously audited and placed on notice that all payroll must be reported, however, the office manager, Christopher Wilson, continued to report zero payroll. SID’s employer fraud team interviewed Wilson, who claimed he attended a local conference on workers’ compensation and was advised family members did not need to be reported. Wilson advised he didn’t recall being told that he must report his payroll after the BWC audit but did submit amended payroll reports after speaking with investigators. Wilson was sentenced to six months of incarceration, suspended for five years of probation and 50 hours of community service. He was also ordered to pay $5,999.38 in restitution and investigative costs.

• Helen Huntington, dba, Helen’s Sunrise Café Inc., pleaded guilty to misdemeanor counts of attempted passing bad checks and attempted workers’ compensation fraud. SID received a referral from the BWC Employer Compliance Department indicating that Huntington, owner of Helen’s Sunrise Café, allowed her policy to lapse and remitted a dishonored payment to BWC. Investigators with the Employer Fraud Team interviewed Huntington and she was given 10 days to rectify the dishonored payment. Huntington was also advised she needed to submit outstanding payroll reports and either pay the resulting premiums or enter into a payment plan in order to reinstate her policy. Huntington failed to either rectify the bad payment or have her BWC coverage reinstated. Huntington was sentenced to one year of community control and 180 days in the Lake County jail, with 178 days suspended and credit for two days of time served. The court further ordered Huntington to complete 20 hours of community service.

• Joann Martin pleaded guilty to one felony count of workers’ compensation fraud for working while receiving benefits. SID received an allegation from an anonymous source stating Joann Martin was working for a home healthcare agency while receiving BWC benefits. A review of employment records, bank records and client records and statements confirmed he was working while receiving benefits. A Franklin County judge ordered Martin to serve 11 months of incarceration, suspended for five years of probation. Martin previously served twelve days in jail on this matter. The court ordered Martin to pay $39,583.07 in restitution and $2,000 in investigative costs

• Ernest Harding pleaded guilty to two misdemeanor counts of workers’ compensation fraud for filing a false claim. SID received an allegation from his employer that Harding was not working on the date he claimed he was injured on the job. SID’s investigation revealed Harding submitted multiple first reports of injury with conflicting information and dates. Additionally, investigators learned Harding entered the employer’s store on the date of injury while off work and stole money. He injured himself when he fell off a porch later that same day. Harding eventually admitted that he did not injure himself at work but sustained the injury at home. Harding appeared in the Vandalia Municipal Court where he was sentenced to one year of probation and ordered to pay $1,197.41 in restitution.

• James Benvenuto pleaded guilty to one felony count of workers’ compensation fraud for failing to report wages. SID received an allegation from Benvenuto’s parole officer that he was scrapping metals to provide extra income while receiving workers’ compensation benefits. SID obtained evidence showing Benvenuto was self-employed scrapping metal in the Lima area but failed to report any of his wages to BWC. BWC had already recouped $10,325.43 from Benvenuto and he paid an additional $6,150.50 during his court appearance. The court ordered him to have no new conviction during the next two years.

• William Bosstic pleaded guilty to one misdemeanor count of workers’ compensation fraud for working while receiving benefits. SID received an allegation from a BWC claims service specialist and their investigation confirmed Bosstic worked as a self–employed electrician while receiving Temporary Total benefits. The evidence collected revealed Bosstic was an active participant in his daughter’s business, MRB Electric. Bosstic performed work in a supervisory capacity at times and also personally performed the electrical work while receiving benefits. The court suspended Bosstic’s sentence based on his guilty plea and payment of $3,563.90 in restitution.

• David Esarco, DC pleaded guilty to one felony count of workers’ compensation fraud for billing for services not rendered. (SID) opened in an investigation into David Esarco after receiving information he was billing BWC for services he was not providing and billing for dates when injured workers were never scheduled for an office visit. SID conducted a search warrant after several interviews and surveillance supported the allegation. An undercover operative posed as a patient and Esarco later billed for services he never provided and billed on dates when the operative never had a scheduled office visit. Esarco He was ordered to pay restitution of $55,577.65 and $20,000 for investigative costs. He also agreed to voluntarily decertification as a BWC provider. Esarco has paid the full amount totaling $75,577.65. David Esarco’s brother, Dr. John Esarco, was already decertified as a BWC provider after pleading guilty last year fraud for similar offenses. John Esarco pleaded guilty in August 2011. He was sentenced to a six month suspended jail sentence, and ordered to pay restitution of $44,184.80. Esarco also signed a voluntary BWC decertification letter and repaid the full amount.

• Michael Dickerson pleaded guilty to one felony count of workers’ compensation fraud for working while receiving benefits. SID received an anonymous allegation that Dickerson was operating a lawn care business while receiving workers’ compensation benefits following a workplace injury. The allegation also indicated Dickerson was asking his customers to pay him in cash so he would not be traced by BWC. SID conducted surveillance on multiple occasions and observed Dickerson using a push mower, riding mower, leaf blower and weed trimmer at residential, retail and church properties. This work activity all occurred while Dickerson was receiving Permanent Total Disability. Dickerson was sentenced to 12 months in prison, suspended for a three year period of community control. He was also ordered to pay $18,673.06 in restitution and $10,000 in investigation costs. Surveillance video is available here.