|
Media Advisory: Sept. 26, 2008
BWC Fraud Investigations Lead to Two Guilty Pleas
Physician fined; Third-party Administrator Faces Jail
COLUMBUS – A Columbus physician and a Cleveland area third-party administrator have pleaded guilty,
in separate cases, to charges related to workers’ compensation fraud.
Dr. James Lipscomb of Worthington faced charges he billed the Ohio Bureau of Workers’ Compensation (BWC)
for services he did not provide to injured workers in his care. After allegations of up-coding surfaced,
an investigation by BWC's Special Investigations Department (SID) revealed questionable billing practices.
The investigation eventually led to the execution of search warrants at Lipscomb’s home and Columbus office.
During the investigation, Lipscomb surrendered his medical license. Meanwhile, BWC forwarded a report
of the SID investigation to the Office of the Ohio Attorney General in June 2007 for prosecution.
Lipscomb faced one count of workers’ compensation fraud and one count of theft, both fourth-degree felonies,
when he pleaded guilty Wednesday. He also provided a $1,500 cashier’s check, payable to BWC to apply toward
restitution, which may exceed $100,000. The Franklin County Court of Common Pleas has ordered a pre-sentence
investigation. The court scheduled sentencing for Nov. 20.
“Quality medical care is the right of every injured worker,” said Tom Wersell, SID director. “BWC’s special
investigations department is diligent in its efforts to protect the integrity of Ohio’s workers’ compensation
system and especially the rights of our customers who may be most vulnerable.”
In an unrelated case, Thomas Burke pleaded guilty to two counts of forgery, both fifth-degree felonies.
An investigation by BWC’s SID found that Burke forged numerous documents used to generate new business for a
managed care organization (MCO), which coordinates medical services for injured workers. BWC sent the
investigation report to the Office of the Ohio Attorney General for prosecution.
Burke is a co-owner of Burke & Associates, located in Cleveland. The company is a third-party administrator,
which privately contracts with employers to manage their workers’ compensation accounts. Premier Managed Care
hired Burke to market its managed care services to Ohio employers during the 2006 open enrollment period.
In June 2006, BWC investigators received an allegation of suspected forgery from Genex Care, an MCO. Genex
claimed that someone had submitted one of its largest clients’ enrollment forms to a new MCO without the
client’s knowledge. The document authorized a change in the employer’s MCO coverage from Genex to Premier
Managed Care. Investigators determined the company’s authorized representative did not sign the authorization
document to switch MCO coverage. Investigators also directly linked Burke to at least six of 10 forged
documents. Premier Managed Care was not aware of the alleged forgeries and cooperated in this investigation.
Wednesday, Cuyahoga County Judge Nancy Russo, sentenced Burke to six months in prison on each count, to run
concurrently. Russo also sentenced Burke to pay a $5,000 fine.
# # #
Maria Smith
614-728-8045 or 614-205-5709
mariasmith@bwc.state.oh.us
Melissa Vince
614-466-2956 or 614-202-2329
melissa.vince@bwc.state.oh.us
|
