Piece of the Fraud Pie


Many workers’ compensation fraud schemes involve supposedly injured workers who claim they are unable to work, when they actually can. Sometimes they are caught on surveillance video performing physical activities that their workers’ compensation forms claim they cannot do. Today’s fraud case is a little bit different. A Deer Park, Texas healthcare worker thought he’d get his piece of the fraud pie by submitting false claims about the injured workers he examined.

The Texas healthcare worker’s job was to perform medical exams on individuals who claimed they had an on-the-job injury. His role was to determine if the injured worker was able to perform their job duties after the work-related injury or illness occurred.

The healthcare worker committed workers’ compensation fraud by submitting claims that included false information about the amount of time that the services actually took to perform. (Where most medical exams are quick as providers try to pack in a large number of patients to generate more revenue, this guy took his time and bumped up the price.) Apparently, this was a common practice at his place of employment. His employer, along with two other employees, were also indicted for overbilling for the medical exams.

The Texas healthcare worker was sentenced for workers’ compensation fraud for falsifying workers’ compensation claims. (Hopefully, the medical exams he completed did not prevent legitimately injured workers from receiving benefits they deserved.) He was sentenced to three years deferred adjudication. (This is a sentence usually offered to first time offenders. If he finishes the term successfully, he will not have a conviction on his record.) He must also pay $10,000 in restitution.

 This fraudster, like other shady individuals who want their piece of the fraud pie, could taste the sweet reward of stealing workers’ compensation funds they didn’t deserve. Unfortunately, their thoughtlessness impacts those who truly need the benefits. (In this case, the greedy healthcare worker bit off more than he could chew, and the allure of the take has soured.)

Today’s “Fraud of the Day” is based on an article entitled, “Texas Healthcare Provider Sentenced for Workers’ Comp Fraud,” published by Claims Journal on July 13, 2018.

A Deer Park, Texas, healthcare worker has been sentenced for falsifying workers’ compensation claims.

A Travis County District Court sentenced Enrique Colon to three years deferred adjudication and ordered him to pay $10,000 in restitution.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.