Ohio Workers’ Comp Agency Investigator Goals Called Into Question

Ohio’s injured worker insurance fund sets goals for the number of fraud cases its investigators should refer for prosecution annually – an arrangement some former employees say encourages the pursuit of innocent people, an Ohio TV news investigation has found.

A 2009 evaluation within the Ohio Bureau of Workers Compensation’s Special Investigations Unit listed expectations for each agent of 16 closed cases, five criminal referrals and three indictments, WCMH-TV in Columbus reported as part of a six-month investigation. The indictment target has since been dropped, but the other goals continue to appear in evaluations from last year the station reviewed.

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Doug Hunter, a former special investigator who was fired in 2010, said the goals amounted to quotas – placing investigators in an ethical dilemma.

“The agent must choose between meeting this goal in order to preserve . his/her employment or make a criminal referral on an injured worker who has not committed a crime,” he wrote in his evaluation response.

Massillon business owner Kathy Trumm, 70, is among those pursued by the special investigations department. She and her neighbors and friends witnessed at least five bureau agents tailing her at work and at home over a period of years.

Records show the bureau spent nearly $64,000 on her case. Investigators determined in November 2011 that Trumm – owner of Korcar, an injured-worker claims company – had overcharged the state $2,632 by billing for her maximum travel time and mileage each day rather than pro-rating the sums.

Her case was referred to the Ohio attorney general, but a September 2013 memorandum obtained by the television station said the state lacked evidence that Trumm “acted intentionally and with purpose to defraud BWC” and suggested she just be required to pay the overage. After spending $10,000 to defend herself, she said she ended up paying nothing.

Former BWC special investigations analyst Becky Roach said the agents she supervised in the mid-2000s were “constantly” pressured to meet performance targets.

“It was monthly, a monthly thing: ‘How far, how many cases do you have that can be referred for indictment, how many indictments are you getting, how many convictions, what’s it look like?”‘ she said. “It was constant.”

Roach quit the bureau in 2009 after facing a series of pending disciplinary reviews.

In a statement, the bureau said it does not impose quotas on its investigators, nor can it force prosecutions.

Since 1993, when the Special Investigations Department was created, its investigations have produced nearly 25,000 cases of wrongdoing that allowed the collection of more than $1.5 billion and sent nearly 4,500 cases to prosecutors, netting 2,379 criminal convictions.

“It’s important to root out fraud to ensure continued care for Ohio’s injured workers,” the agency said.

It added: “As with any position, investigators do have goals and performance expectations to measure productivity and effectiveness. The goals include the expectation that our investigators put together evidence for strong criminal referrals but do not include quota requirements.”

Former Ohio Attorney General Jim Petro said he is concerned that if the bureau’s performance targets are viewed by investigators or supervisors as quotas, it could encourage investigators to suppress evidence favorable to their suspects.

“I am concerned because I don’t want to see a justice system anywhere that tolerates that kind of activity that we know leads to wrongful conviction,” he said.