Portage County Legal News

Watchdog report leads to theft, forgery indictments for two BWC workers

KEITH ARNOLD
Special to the Legal News
Published: February 26, 2019

A pair of medical claims workers at the Ohio Bureau of Workers' Compensation Medical Claims have been indicted by a Franklin County grand jury on a count each of theft in office and three counts each of forgery, the Ohio Inspector General reported last week.

The indictments resulted from the women's practice of submitting fake doctors' excuses to take advantage of the state agency's sick leave and vacation-in-lieu of sick leave policy, the report detailed.

At the conclusion of investigations by the BWC's Special Investigation's Department and the inspector general, Claims Specialist Jessica Caldwell was found to have submitted 10 fraudulent physician verification statement, or PVs, in order to use 74.2 hours of leave, totaling $1,294.73, while Medical Claims Supervisor Lauren McLuckie was found to have submitted 10 fraudulent PVs of her own to use 102.3 hours of leave, totaling $2.227.43.

According to a summary of the investigation, the bureau notified the inspector general's office Aug. 23, 2018 that Caldwell had allegedly submitted "falsified" records to her supervisor in order to use her accrued sick leave.

Bureau management previously, on Feb. 24, 2017, informed Caldwell that she was required to submit a PV prior to her use of sick leave or vacation leave for her absences from work.

A properly submitted PV provide management with the following information: The employee or family member that had been seen or treated by the physician; the date this appointment or visit occurred; and the date she could return to work.

Based on concerns expressed by Caldwell's supervisor over the woman's "dwindling leave balance" and the number of PVs Caldwell had been submitting, she compared two recently submitted doctor's excuses from a single physician and noticed differences in the physician's signature on each of the excuses.

The supervisor, next, discussed these concerns, reviewing what she had found, summary continued.

Ultimately, a labor relations official within the bureau verified with the physician that Caldwell had not been seen on either of the two dates.

Caldwell admitted to investigators that she had submitted the doctors' excuses to support her absence from work, but was unable to explain the inconsistencies in the physician's signatures. She ultimately denied creating the excuses.

Caldwell's discussion of the controversy with a coworker led investigators to McLuckie's wrongdoing, the report noted.

The bureau's Special Investigations Department SID conducted an initial review and found that the excuses McLuckie had submitted contained the same markings or dots on the documents.

When investigators contacted the medical provider, inquiring about nine different visits, the medical provider's secretary confirmed the office had issued only one excuse to McLuckie during that period.

The bureau subsequently notified the inspector general of the allegations that McLuckie had submitted fraudulent PVs for her sick leave.

McLuckie admitted to submitting the doctors' excuses, yet she was unable to explain why a physician's name was misspelled on three excuses and why some of the names were signed in cursive while others were hand-printed. Nor was she able to explain other differences in the PVs.

Although the woman denied copying excuses submitted for earlier dates and then submitting them for subsequent sick leave, she admitted to the belief that she had a standing agreement with her physician that she could call when she was unwell and a PV would be prepared for her submission, regardless of the doctor actually seeing the patient.

Investigators also examined McLuckie's work area and discovered a folder containing several versions of PVs from three medical providers.

Several of the PVs found in the folder were either blank, contained white-out portions, or had paper taped to certain sections of the forms to conceal information, the summary concluded.

The report of investigation was referred to the Franklin County Prosecutor's Office.

Caldwell resigned from employment with BWC on Aug. 24, 2018, while McLuckie was placed on administrative leave on Aug. 31, 2018. McLuckie subsequently was fired from her job on Sept. 7, 2018.

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