While Texas Mutual Insurance Company is certainly entitled to reimbursement for the overbilling practices, there is no plan to compensate injured Texas workers who were prescribed certain medical services which were never given, but for which payment was made.
According to documents related to the case, an investigation launched by Texas Mutual, Nova Healthcare Management illegally, knowingly and wrongfully billed services for individual physical therapy, when in fact, less-expensive group therapy was actually provided.
Per the plea, Nova was forced out of Texas Mutual’s Star medical associative network, repaid $6.5 million to the insurance carrier and was ordered to pay a $5,000 fine. Other aspects of the plea deal called for court costs and reporting to the Special Prosecution Division of the Travis County D.A.’s office for two years.
This particular inviestigation was the result of Texas Mutual’s zero-tolerance-for-fraud policy, wherein the insurance giant has committed to aggressively investigate every instance of reported fraud.
It is not clear whether the plea deal absolved Nova’s overbilling practices with any other carriers outside of the agreement with Texas Mutual.