(A) No person, with purpose to defraud or knowing that the person is facilitating a fraud shall do any of the following:
(1) Receive workers’ compensation benefits to which the person is not entitled;
(2) Make or present or cause to be made or presented a false or misleading statement with the purpose to secure payment for goods or services rendered under Ohio R.C. Ch. 4121, 4123, 4127 or 4131 or to secure workers’ compensation benefits;
(3) Alter, falsify, destroy, conceal or remove any record or document that is necessary to fully establish the validity of any claim filed with, or necessary to establish the nature and validity of all goods and services for which reimbursement or payment was received or is requested from the Bureau of Workers’ Compensation, or a self-insuring employer under Ohio R.C. Ch. 4121, 4123, 4127, or 4131;
(4) Enter into an agreement or conspiracy to defraud the Bureau of Workers’ Compensation or a self- insuring employer by making or presenting or causing to be made or presented a false claim for workers’ compensation benefits;
(5) Make or present or cause to be made or presented a false statement concerning manual codes, classification or employees, payroll, paid compensation or number of personnel, when information of that nature is necessary to determine the actual workers’ compensation premium or assessment owed to the Bureau by an employer;
(6) Alter, forge or create a workers’ compensation certificate or falsely show current or correct workers’ compensation coverage; and/or
(7) Fail to secure or maintain workers’ compensation coverage as required by Ohio R.C. Ch. 4123 with the intent to defraud the Bureau of Workers’ Compensation.
(B) Whoever violates this section is guilty of workers’ compensation fraud. Except as otherwise provided in this division, workers’ compensation fraud is a misdemeanor of the first degree. If the value of premiums and assessments unpaid pursuant to actions described in divisions (A)(5), (A)(6) or (A)(7) above, or goods, services, property or money stolen is $1,000 or more, workers’ compensation fraud is a felony to be prosecuted under appropriate state law.
(C) Upon application of the governmental body that conducted the investigation and prosecution of a violation of this section, the court shall order the person who is convicted of the violation to pay the governmental body its costs of investigating and prosecuting the case. These costs are in addition to any other costs or penalty provided under federal, state or local law.
(D) The remedies and penalties provided in this section are not exclusive remedies and penalties and do not preclude the use of any other criminal or civil remedy or penalty for any act that is in violation of this section.
(E) For the purpose of this section, the following definitions shall apply unless the context clearly indicates or requires a different meaning.
CLAIM. Any attempt to cause the Bureau of Workers’ Compensation, an independent third party with whom the administrator or an employer contracts under Ohio R.C. 4121.44, or a self-insuring employer to make payment or reimbursement for workers’ compensation benefits.
EMPLOYER, EMPLOYEE and SELF-INSURING EMPLOYER. Have the same meanings as in Ohio R.C. 4123.01.
EMPLOYMENT. Participating in any trade, occupation, business, service or profession for substantial gainful remuneration.
FALSE. Wholly or partially untrue or deceptive.
GOODS. Includes, but is not limited to, medical supplies, appliances, rehabilitative equipment and any other apparatus or furnishing provided or used in the care, treatment or rehabilitation of a claimant for workers’ compensation benefits.
RECORDS. Any medical, professional, financial or business record relating to the treatment or care of any person, to goods or services provided to any person, or to rates paid for goods or services provided to any person, or any record that the administrator of workers’ compensation requires pursuant to rule.
REMUNERATION. Includes but is not limited to wages, commissions, rebates and any other reward or consideration.
SERVICES. Includes, but is not limited to, any service provided by any health care provider to a claimant for workers’ compensation benefits and any and all services provided by the Bureau as part of workers’ compensation insurance coverage.
STATEMENT. Includes, but is not limited to, any oral, written, electronic, electronic impulse or magnetic communication notice, letter, memorandum, receipt for payment, invoice, account, financial statement, bill for services; a diagnosis, prognosis, prescription, hospital, medical or dental chart or other record; and a computer generated document.
WORKERS’ COMPENSATION BENEFITS. Any compensation or benefits payable under Ohio R.C. Ch. 4121, 4123, 4127 or 4131.
(ORC 2913.48)