Massachusetts firm ordered to pay restitution to Texas Mutual for fraud

Massachusetts firm ordered to pay restitution to Texas Mutual for fraud | Insurance Business

Massachusetts firm ordered to pay restitution to Texas Mutual for fraud

A Massachusetts-based functional capacity evaluations (FCE) firm has been ordered to pay $30,000 in restitution to workers’ compensation insurance provider Texas Mutual Insurance Company after pleading guilty to a third-degree felony on fraud-related charges.

Read more: Two convicted of defrauding Texas Mutual

Texas Mutual alleged that Expert Medical Evaluators International (EME) used unlicensed providers to perform FCEs and overbill the insurer. According to Texas Mutual’s investigation, two unlicensed providers – Marcos Ricoy and Enrique Colon – performed the majority of EME’s FCEs and reported that the evaluations took the maximum four hours to perform. However, the insurer alleged that face-to-face time with injured workers was less than the time reported, resulting in inflated billing.   

Previously, Ricoy and Colon both pleaded no contest to engaging in organized criminal activity involving workers’ compensation fraud in 2018. A Texas court ordered Ricoy to serve three years deferred adjudication, complete 120 community service hours, and pay $10,000 in restitution to Texas Mutual. Meanwhile, Colon was ordered to serve three years deferred adjudication, participate in any court ordered treatment or counseling, and pay $10,000 in restitution to Texas Mutual.