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 is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.