Return to Archives Home
|
|
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.”
1 I 2
I next>>
|
|
|
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.
|
|