Fraud Ruling Against Texas Doctor Stands

The Austin (Texas) Court of Appeals has upheld felony workers’ compensation fraud-related charges against Howard T. Douglas III, M.D., for using his company — Western Medical Evaluators — to deliberately overbill Texas Mutual for medical exams, the insurer announced.

Douglas, of Frisco, was sentenced by a Travis County District Court to a probated prison term and was ordered to pay a fine of $5,000 and restitution of $98,411. Douglas appealed that conviction on the basis that the evidence was legally insufficient. He requested a new trial.

The Austin Court of Appeals denied Douglas’s request and affirmed the court’s decision, noting that the testimony by three patients and five former employees of Douglas’ company is sufficient evidence.

“The Austin Court of Appeals’ action upholding the prosecutorial work of the Travis County District Attorney and the decision of the District Court on one of Texas Mutual’s medical fraud cases is very encouraging,” Mary Nichols, general counsel and senior vice president for Texas Mutual, said in the company’s announcement. “Intentional overbilling and other workers’ compensation health care fraud schemes damage the system and can lead to higher premiums for all Texas employers.”

After the Western Medical Evaluators investigation, Texas Mutual uncovered evidence that Douglas then created three additional companies: North Texas Medical Evaluators, Marconi Physical Performance Testing and Nolan Physical Performance & Neurodiagnostics. These companies were used to continue the fraudulent overbilling scheme.

Douglas was convicted of these crimes in 2014 and was sentenced to five years imprisonment.

Related:

• Texas Doctor Gets 5 Years in Prison on Workers’ Comp Fraud Charges
• Court Orders Doctor to Repay $98K to Texas Mutual
• Texas Mutual: 3rd Provider Sentenced in Fraud Scheme

Source: Texas Mutual Insurance Company

Topics Texas Fraud