TEXAS COMMISSIONER: ‘MORE COMPLEX’ INSURANCE FRAUD ‘GROWING’

According to a recent report by the Insurance Journal, last year a Dallas County woman billed an insurer “for 110 health claims for services that were not rendered,” receiving more than $28,000 in benefits. The woman eventually wound up pleading guilty to insurance fraud.

She received a 10-year deferred sentence for the second-degree felony conviction, plus $2,000 in fines and she was ordered to pay $28,131 in restitution.   

Her story is just one of the tales the Insurance Journal lists in its top 10 cases from the Texas Department of Insurance Fraud last year.

The Texas Insurance Commissioner says insurance fraud in the state “is growing and the schemes to make false claims for insurance benefits are becoming more complex.”

Another of the cases briefly summarized by the publication involved two men who sold fraudulent marine insurance to the owner of a New York cruise company. When a cruise boat sank on a lake, killing 20 senior citizens, the owner of the company had no insurance. The two men pleaded guilty in Texas federal court to charges that resulted from an investigation by the TDI Fraud Unit, the FBI and IRS. One of the men received a sentence of 15 years and 8 months in prison, while the other was sentenced to 10 years and $2.45 million in restitution.

Another case involved a Texas man who pretended to be the owner and operator of a medical clinic at which people were treated for injuries sustained in car accidents. However, neither the clinic nor the patients were real. At trial, the man was found guilty of a first-degree felony charge of insurance fraud and sentenced to 7 years in prison. He also has to pay $131,182 in restitution.

The punishment for insurance fraud can be severe, which is why it is so important to anyone facing the charge to find a criminal defense attorney experienced in this complex area of law.

Source: Insurance Journal, “Texas Investigated More than 550 Insurance Fraud Cases in 2013,” April 28, 2014