In-house Texas workers comp fraud unit boosts investigations
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A five-month-old in-house fraud unit with the Texas Division of Workers’ Compensation is boasting success with 40 new investigations and a conviction.
The owner of a health clinic in Houston didn’t have any trained medical personnel on staff but managed to collect workers comp payments for treating injured workers, according to a division statement issued Monday. Rosemary Phelan pleaded guilty to insurance fraud on Oct. 14, received seven years deferred adjudication and was ordered to pay $88,000 in restitution.
That’s just one example of the results of devoting a team to identify and investigate workers compensation fraud, according to the statement.
“It’s a huge benefit to have a fraud unit that is 100% dedicated to workers compensation,” Ryan Brannan, Texas’ workers compensation commissioner, said in the statement. “In-house investigators are more exposed to workers compensation issues, so they are aware of the latest schemes.”
Teresa Carney, the division’s director of system monitoring and oversight, said the unit reaches out to insurers, district attorneys, fraud prevention groups and Division of Workers’ Compensation employees to better coordinate its investigations.
“We can’t do it alone,” she said in the statement. “Many complaints come from injured employees or insurance carriers, but we can also be proactive by reviewing the claim or medical billing data already on hand or tap people in our hearings division or maybe a field office who help in the workers compensation system every day.”
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