Two convicted of defrauding Texas Mutual

Two convicted of defrauding Texas Mutual | Insurance Business

Two convicted of defrauding Texas Mutual

Texas Mutual Insurance Company has announced the conviction of two people who committed insurance fraud against the company.

Marcos Ricoy of Harlingen, Texas, and Enrique Colon of Deer Park, Texas, have both pleaded no contest to felony charges of engaging in organized criminal activity involving workers’ compensation healthcare fraud, the company said.

Ricoy will serve three years of deferred adjudication, complete 120 hours of community service, and pay $10,000 of restitution to Texas Mutual. Colon will serve three years of deferred adjudication, participate in any court-ordered treatment or counseling, and pay $10,000 in restitution to Texas Mutual.

The convictions are connected to alleged fraud committed by the company Expert Medical Evaluators International (EME), which determined impairment ratings and performed functional capacity evaluations on injured employees in Texas. The insurer alleged that EME used unlicensed providers to perform services and overbilled Texas Mutual. A subsequent investigation led to several indictments, Texas Mutual said.

 

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