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G is for Gotcha, a city detective story

 

Above: Sgt. Bill Pudifin, left, and Sr. Police Officer J.D. Hughson, major offenders division, haul away a NASCAR video game from the One Stop for a Cop clinic. Left: Hughson carries out a box of evidence. Photos by Roger Smith.
 

By Dave Schafer

It wasn’t a dark and stormy night, but something was amiss in the metropolis of metallic skyscrapers and bustling commerce that Houstonians call home.

The date was early 2002, and workers’ compensation employees in the Human Resources Department had uncovered a mystery: How could the Houston Occupational Rehabilitation clinic serve 50 to 60 injured police officers a week?

A clinic that size, with less than 2,000 square feet and only one doctor, should be serving just half that many, said HR assistant director Ramiro Cano.

Sleuthing uncovered more red flags, such as the clinic’s resemblance to a massage parlor, complete with soft music, burning incense and curtains separating patient rooms. (For more, see Red flags box.)

State law gives classified officers the right to choose their medical care, Cano said. So the city couldn’t steer officers away from the clinic nicknamed One Stop for a Cop.

“The state is setting the environment for fraud to flourish,” Cano said.

Ward North America, which administered the city’s workers’ comp program in 2002, took its suspicions to the Texas Workers’ Compensation Commission, Cano said. The commission said fraud could not be proven.

“When you go to the powers-that-be and they tell you thanks, but no thanks, that kind of takes the wind out of your sails,” said Jerry Chandler, who as HR manager of safety and workers’ comp worked the case with Cano. “But we just kept doing what we were doing.”

Uncovering evidence
Then, in June 2003, Dr. Edward Group, One Stop’s principal doctor, resigned from the clinic. Group alleged the clinic’s owners, Jim Ihle and Suzanne Olian, were padding bills, signing his name, and claiming to be doctors, Cano said. He provided the city with supporting documents.

But Group’s allegations were just that. So in November 2003, Cano contacted HPD, which assigned the case to Sgt. Bill Pudifin in the major offenders division.

For HPD, this was personal.

Olian had worked as an insurance secretary for the police officers’ union and used that connection to attract customers, Pudifin said. Because HPD officers were the clinic’s sole patrons, the department’s budget was affected. Workers’ comp expenses come out of each department’s budget.

Just after Thanksgiving, an undercover officer began daily treatments for an imaginary knee injury.

“I went in there just to see what was going on, to find evidence if there was fraud,” the officer said. “And it was obvious that was going on.”

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Red flags
• Patient records left open on the counter.
• Cookie-cutter invoices. No matter the injury, all invoices showed the same therapies.
• Rehabilitating areas of the body unrelated to the injury.
• Double billing.
• Insistence on prompt payment for services. State law allows 45 days for payment in workers’ compensation cases.
• Reluctance to appeal the city’s invoice denials to the Texas Workers’ Compensation Commission.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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