The ongoing efforts of the Ohio Bureau of Workers' Compensation(BWC) to detect, investigate and prosecute fraud are paying off.The agency's most recent report to its board of directors revealsthat its Special Investigations Department (SID) identifiedmore than $55 million in savings for the state insurance fund forthe fiscal year ending June 30, 2013.

According to Jennifer Saunders, the interim directorof SID, the department closed more than 2,000 cases involvingclaimants, employers and medical providers last year. AsSaunders explained to the committee, this included 140criminal convictions and 236 referrals for prosecution.Additionally, an administrative review of 915 cases eitheruncovered fraudulent activity, or identified additional savings forOhio employers paying into the state fund.

The department has organized strategic teams, each focusingon investigating a specific type of workers' compensation fraud.Their results are listed below:

• The employer fraud team, which investigates fraud committed byemployers, closed 226 cases, generating $3,535,468 in savings. Theteam achieved 43 indictments and 33 convictions during FY2013.
• Regional claimant fraud teams closed 1,353 cases, andidentified $30,179,976 in savings. These teams secured 100convictions, or 23.5 percent more than the 81 claimant subjectconvictions secured during FY 2012.
• The Health Care Provider Team, which investigates fraudcommitted by providers, pharmacies, and managed careorganizations, closed 68 cases, or 83 percent more than in theprevious year. The team identified $11,874,978 in savings tothe workers' compensation system and secured sevenconvictions.

Like other states, Ohio contends with rising prescription drug costs and related crimes. In response,it employs significant resources to combat prescription fraud.In 2013, the Ohio BWC's Intelligence Unit requested drugutilization reviews in cases where there was a question as towhether BWC-paid prescriptions were medically necessary. Thosereviews resulted in the termination of drugs in 171 cases where theprescriptions were not necessary, generating $9,467,735 in savings.Drug complaints represented 22.8 percent of all complaintsinvestigated by SID, second only to working while receivingbenefits, which represented 28.9 percent of all complaintsinvestigated during the last 12 months.