Media Advisory: Feb. 12, 2010

Elyria Medical Consultant Sentenced to Prison for Workers’ Comp Fraud

Eric Zaffer falsified reports submitted to BWC and the IC

COLUMBUS – The owner of a business that compiled medical reports for law firms representing injured workers has been sentenced to four years in prison for workers’ compensation fraud. Franklin County Common Pleas Court Judge Richard Sheward sentenced Eric Zaffer, owner of Medical Consultants, located in Elyria (Lorain County) today. Today’s sentencing was the result of an investigation by the Ohio Bureau of Workers’ Compensation’s (BWC) Special Investigations Department (SID), with prosecution led by Ohio Attorney General Richard Cordray.

Unusual reporting practices gave BWC personnel reason to suspect fraud and SID was notified. As part of its investigation, SID conducted a search warrant of Zaffer’s business in March 2009, finding evidence that he altered medical reports BWC and the Ohio Industrial Commission (IC) use to determine percent of permanent partial (%PP) awards (also known as C-92 awards). BWC’s %PP compensation is available to injured workers with permanent injuries to a body part caused by a work-related accident or an occupational disease. Investigators found that Zaffer was inflating percentages submitted by medical providers and/or embellishing medical conditions within the final report in an attempt to raise %PP awards and ultimately increase his business.

“Accurate medical reports are critical in determining benefits to injured workers” said BWC Administrator Marsha Ryan. “Workers’ compensation fraud will not be tolerated, especially when it impacts the assistance provided to injured workers, many of whom are adjusting to life with a permanent medical condition.”

Ohio Attorney General Cordray added, "The partnership between BWC and our Health Care Fraud section continues to effectively expose and prosecute wrongdoing by those who try to defraud the workers' compensation system. We will aggressively pursue wrongdoing wherever we see it and send the message that cheating the system does not pay."

Zaffer pleaded guilty to one count of workers’ compensation fraud, a fourth-degree felony; two counts of tampering with records, a third-degree felony; and 10 counts of forgery, a fifth-degree felony. He was ordered to pay $139,558 in restitution and $56,340 in investigative costs to the BWC.

SID Director Tom Wersell added, “BWC closely monitors attempts to commit workers’ compensation fraud through the falsification of records, or any other means. We maintain a strong commitment to prosecuting those who try to manipulate the system for their personal benefit.”

It is the primary responsibility of the examiner who submits medical information to the BWC and IC to guarantee its accuracy. This case led BWC to conduct an audit to review the process for awarding PP and to strengthen the integrity of the information used to determine awards. In October, the BWC Board of Directors adopted a rule to decertify providers who submit inaccurate information as part of the %PP process. Additionally, a random review process has been implemented, with a set of guidelines established to address review outcomes. These new internal controls are expected to minimize the risk of similar mistakes or attempts by interested parties to fraudulently alter the outcome of %PP awards in the future.

To report suspected workers’ compensation fraud, visit ohiobwc.com, or call 1-800-OHIOBWC.

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