BWC’s Special Investigations Department Achieves Another Great Fiscal Year

Columbus,OH(WorkersCompensation.com) - In its 29th year, the Ohio Bureau of Workers’ Compensation (BWC) Special Investigations Department (SID) achieved impressive results in fiscal year (FY) 2022.

This past fiscal year, SID closed 1,431 cases, had 69 convictions, and identified $90 million in savings to our system – the second highest annual savings since FY 2007. Protecting the state insurance fund, ensuring the workforce is receiving the best care possible, and employers pay their share to help keep premiums low, has been a driving force for the SID specialists. There have been many notable achievements this fiscal year by the team at BWC. Here are a few of the stories in the FY22 annual report.

Curtis Wilson – Stolen Check
Curtis Wilson of Columbus pleaded guilty to one count of receiving stolen property and was ordered to serve community control for five years and to pay restitution to the Ohio Bureau of Workers’ Compensation (BWC) in the amount of $18,369.33.

In December 2020, BWC issued a dividend check to an employer. Soon after the check was sent, the employer contacted BWC and advised they did not receive nor cash the dividend check. An investigation by the Special Investigations Department’s employer fraud team revealed the warrant was cashed via ATM deposit into the account of Curtis Wilson.

Through the investigation, it was determined Wilson did not have any relationship to the employer and was not entitled to the BWC dividend funds. On June 8, 2022, in the Franklin County Court of Common Pleas, Wilson pleaded guilty to one count of receiving stolen property, a fifth-degree felony. A Franklin County judge accepted his guilty plea and proceeded to sentencing. The judge ordered Wilson to serve five years of community control and to pay BWC $18,369.33 in restitution.

Kanubhai C Patel, MD – Billing for Services Not Rendered and Upcoding
On May 13, 2022, Kanubhai Patel, MD, pleaded guilty in the in the Franklin County Court of Common Pleas to one count of workers’ compensation fraud, a fifth-degree felony. Dr. Patel was ordered to pay the BWC $1,893.44 in restitution and $10,000 for investigative costs. Dr. Patel paid the full $11,893.44 amount and the court deemed the matter closed.

BWC’s Special Investigations Department’s health care provider team opened an investigation based upon an allegation from a managed care organization (MCO) regarding the billing practices of Dr. Patel from his medical office, Behavioral and Psychiatric Consultants (BPC). The investigation found Dr. Patel billed BWC for services not rendered. Dr. Patel’s scheme involved billing for counseling codes that he did not perform along with a high-level evaluation and management (E/M) services that did not meet requirements to bill for the higher-level E/M services during the same visit. Dr. Patel fabricated office notes and inflated treatment times to support his billing.

As part of a plea agreement, Dr. Patel signed a permanent decertification from BWC’s Health Partnership Program (HPP).

Caden Knight – Death and Violations of Specific Safety Requirements (VSSR) Benefits Fraud
On Nov. 30, 2021, Caden Knight pleaded guilty to one count of workers’ compensation fraud, a fifth-degree felony, and was sentenced to serve 12 months of incarceration (suspended) and five years of non-reporting probation and ordered to pay $81,793.60 in restitution to the BWC.

Caden Knight, the son of a deceased BWC claimant, was collecting BWC death and VSSR benefits contingent upon his enrollment at an educational institution.

A proactive review of the BWC death benefit claims identified Caden Knight had submitted documentation to BWC reporting he was enrolled as a full-time student at three universities. This enrollment documentation was required for Knight to collect death and VSSR benefits from BWC. The SIU established that before each semester began, Knight submitted photographs of his anticipated school schedule for the upcoming semester to qualify for the BWC death and VSSR benefits.

SIU’s investigation determined Knight never participated in a full-time educational program. The educational transcripts and records from the universities showed Knight repeatedly enrolled in required courses, submitted the courses to BWC, and then subsequently dropped his courses. In an interview conducted by the SIU, Knight admitted that he was aware that his deception caused BWC to issue death and VSSR benefits to which he was not entitled.

Share This Article: