Texas Workers’ Comp Prosecution Unit Reports Fraud Indictments

October 26, 2017

A Massachusetts company and three individuals have been indicted in Texas for organized crime activity related to workers’ compensation fraud, the Texas Department of Insurance, Division of Workers’ Compensation (DWC) announced.

TDI reported that EME International Inc. located in Marblehead, Mass.; Christine Caldwell of Marblehead; Marcos Ricoy of Rancho Viejo, Texas; and Enrique Colon of Deer Park, Texas; were indicted on charges of submitting false workers’ compensation health care claims to Texas Mutual Insurance Company.

The indictment alleges fraud of between $20,000 and $100,000.

The DWC’s 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 involved claims 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.

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

Source: Texas Department of Insurance, Division of Workers’ Compensation

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