Record $830K Returned To OH BWC Following Insurance Fraud Conviction

“This high profile case proved to be among the most egregious examples of the greed that drives fraud, as well as the worst possible consequences that can follow,” said BWC Administrator Steve Buehrer. “This is the single largest restitution payment BWC has received following a workers' compensation fraud conviction; yet, there is no amount that can compensate for the lives lost or destroyed by Mr. Martinez's selfish actions.”

An investigation of Martinez began after questions arose about his billing practices and his ranking above all other Ohio medical practitioners in the number of claims submitted for reimbursement. The inquiry revealed a scheme that permitted Martinez to bill patients' insurance companies for unnecessary prescriptions and injections to treat pain.

Martinez often saw more than 100 patients a day and provided them with narcotics prescriptions only after requiring them to undergo expensive nerve block injections. Evidence presented by BWC showed Martinez averaged 64 injections per patient each year, far above the state average of 2.5 injections per year. Martinez also billed insurance companies for prescriptions never written.

In June of 2006 Martinez was convicted on 56 counts that included distribution of controlled substances, mail fraud, wire fraud and health care fraud. The jury also found Martinez guilty of health care fraud resulting in death after determining that he contributed to the deaths of two Ohioans receiving treatment for work related injuries. One patient died the same day he received a prescription from Martinez; the other collapsed in his office and died soon after.

he joint investigation included BWC, the Ohio Department of Job and Family Services, the Drug Enforcement Administration and several private insurers.

Martinez still owes BWC $5 million.

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