Self-insured

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Running a small business is not for the faint of heart. In addition to offering a product or service that is in high demand, a business owner needs trustworthy employees to help carry out the company’s mission. Because employees are assets, a company owner who cares about his or her workforce will provide workers’ compensation coverage in the event there is an on-the-job injury. Today, we take a look at an untrustworthy Columbus, Ohio home healthcare company employee, who took advantage of her employer and committed workers’ compensation fraud. (She was working additional jobs while collecting workers’ compensation benefits from her employer.)

The business owner in today’s article provided a “self-funded” plan for their workers. This means that the owner paid the cost of each claim as they occurred instead of paying a fixed premium to an insurance carrier or state-sponsored workers’ compensation fund. (This pay-as-you-go approach gives employers an opportunity to control their costs and ensures that their injured employees are receiving timely healthcare, while also maximizing the company’s cash flow.) Self-funded plans can be very costly to an employer if the business does not have the cash flow to meet this unpredictable obligation.

In today’s “Fraud of the Day” article, the “self-insured” employer of a Columbus, Ohio nursing assistant was paying workers’ compensation benefits out-of-pocket when it was discovered that the woman had opened a day care center out of her home and was earning extra income. (Obviously, an employee can’t two-time the employer by earning income from another job while collecting benefits for an on-the-job injury.)

The employer approached the Ohio Bureau of Workers’ Compensation (BWC) requesting assistance in pursuing criminal charges. After an investigation was opened, it was discovered that she had actually worked for three additional home healthcare businesses while collecting disability benefits. (So, technically she was four-timing her employer.)

The 42-year-old woman pleaded guilty to workers’ compensation fraud. She was sentenced to five years of probation and must pay restitution of $11,514 to her former home healthcare company employer.

When unscrupulous individuals cheat the system meant to help employees who have a legitimate reason for not working, it affects everyone in a negative way. Today’s fraudster took advantage of her employer and has now self-insured that she will be closely watched by her employers, the BWC, and the government.

Today’s “Fraud of the Day” is based on an article entitled, “Ohio Day Care Owner Guilty of Work Comp Fraud,” posted on workerscompensation.com on March 25, 2018.

Columbus, OH (WorkersCompensation.com) – A Columbus day care owner and nursing assistant pleaded guilty Tuesday to a fifth-degree felony count of workers’ compensation fraud after her former employer reported her to the Ohio Bureau of Workers’ Compensation (BWC) for the crime.

Sharrounda Fuller, 42, must pay $11,514 in restitution to her former employer, a home health care company, and serve five years of probation, according to her sentence in the Franklin County Court of Common Pleas.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.