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. 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.