Texas Mutual: Massachusetts Firm Pleads Guilty to Workers’ Comp Fraud

A Massachusetts company has pleaded guilty in a Travis County, Texas, district court to workers’ compensation fraud, according to Texas Mutual Insurance Co.

Texas Mutual says EME International Inc. (EME) of Marblehead, Massachusetts, pleaded guilty to a third-degree felony and was ordered the company to pay $30,000 in restitution to the worker’s comp insurer.

Texas Mutual investigated EME, an entity that coordinates impairment ratings and functional capacity evaluations (FCEs) in Texas. Texas Mutual’s investigation alleged, in part, that EME used unlicensed providers to perform FCEs and overbilled Texas Mutual.

Two unlicensed providers, Marcos Ricoy and Enrique Colon, performed the majority of EME’s FCEs and reported that FCEs took the maximum four hours to perform. Texas Mutual’s investigation revealed face-to-face time with injured workers was less than the time reported, resulting in inflated billing.

Previously, Marcos Ricoy of Harlingen, Texas, pleaded no contest to engaging in organized criminal activity involving workers’ compensation fraud on May 16, 2018. A Travis County district court ordered Ricoy to serve three years deferred adjudication, complete 120 community service hours, and pay $10,000 in restitution to Texas Mutual.

Enrique Colon of Deer Park, Texas, pleaded no contest to engaging in organized criminal activity involving workers’ compensation fraud on July 6, 2018. A Travis County district court ordered Colon to serve three years deferred adjudication, participate in any court ordered treatment or counseling, and pay $10,000 in restitution to Texas Mutual.

Source: Texas Mutual Insurance Co.