(a) As used in this section:
(1) “Claim” means any attempt to cause the Ohio Bureau of Workers' Compensation, an independent third party with whom the Administrator of Workers' Compensation or an employer contracts under Ohio R.C. 4121.44, or a self-insuring employer, to make payment or reimbursement for workers' compensation benefits.
(2) “Employer,” “employee” and “self-insuring employer” have the same meanings as in Ohio R.C. 4123.01.
(3) “Employment” means participating in any trade, occupation, business, service or profession for substantial gainful remuneration.
(4) “False” means wholly or partially untrue or deceptive.
(5) “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.
(6) “Records” means 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.
(7) “Remuneration” includes, but is not limited to, wages, commissions, rebates and any other reward or consideration.
(8) “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.
(9) “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 or bill for services; a diagnosis, prognosis, prescription, hospital, medical or dental chart or other record; and a computer-generated document.
(10) “Workers' compensation benefits” means any compensation or benefits payable under Ohio R.C. Chapter 4121, 4123, 4127 or 4131.
(b) 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. Chapter 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 Ohio Bureau of Workers' Compensation or a self-insuring employer under Ohio R.C. Chapter 4121, 4123, 4127 or 4131;
(4) Enter into an agreement or conspiracy to defraud the Bureau 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 or misleading statement or other misrepresentation concerning manual codes, classification of employees, payroll 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) Solicit, offer or receive any remuneration in cash or in kind, including, but not limited to, a kickback or rebate, in connection with a referral for the furnishing of goods or services for which reimbursement may be made pursuant to Ohio R.C. Chapter 4121, 4123, 4127 or 4131. This paragraph does not apply to any contract to provide services under the Bureau's Health Care Partnership Program or a qualified health plan entered into between a managed care organization and an organization formed pursuant to Ohio R.C. 4123.29(A)(4).
(7) Alter, forge or create a workers' compensation certificate to falsely show current or correct workers' compensation coverage; or
(8) Fail to secure or maintain workers' compensation coverage as required by Ohio R.C. Chapter 4123.
(c) Whoever violates this section is guilty of workers' compensation fraud, a misdemeanor of the first degree, provided the value of premiums and assessments unpaid pursuant to actions described in paragraph (b)(5), (7) or (8) hereof, or of goods, services, property or money stolen, is less than five hundred dollars ($500.00). The penalty shall be as provided in Section 698.02.
(d) 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 in this section, in these Codified Ordinances, in the Ohio Revised Code or in any other section of law.
(e) 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. (ORC 2913.48)