November 14, 2017

New TDI-DWC Prosecution Unit Gets Indictments for Health Care Fraud

Austin, TX – A Travis County grand jury has indicted EME International, Inc. and three individuals on charges of engaging in organized criminal activity for overbilling for exams of injured employees. The indictment alleges fraud of between $20,000 and $100,000.

The Texas Department of Insurance, Division of Workers’ Compensation’s (DWC) new prosecution unit obtained the indictments. The DWC prosecution unit is embedded in the Travis County District Attorney’s Office and was created during the 85th Texas Legislature.

The indictments list EME International located in Marblehead, Mass.; Christine Caldwell of Marblehead; Marcos Ricoy of Rancho Viejo, Texas; and Enrique Colon of Deer Park, Texas; for submitting false workers’ compensation health care claims to Texas Mutual Insurance Company. The claims are related to functional capacity evaluations of injured employees. A functional capacity evaluation is a medical exam to determine if an injured employee is physically able to perform their job duties after a work-related injury or illness. The defendants are accused of submitting false medical claims for more time than the services actually took to gain extra payments from the insurance company.

“We are doing our part here in Texas to crack down on fraudulent billing so that we can keep insurance premiums low for Texas employers,” said Tim Riley, DWC’s deputy commissioner of Compliance and Investigations.

A grand jury indictment is a formal accusation – not a conviction – of criminal conduct.

Report suspected cases of insurance fraud by calling 1-800-252-3439 or visit www.tdi.texas.gov/fraud/report.html.

Source: TDI-DWC

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