Prevent Insurance Fraud
Also read TDI's brochure Insurance Fraud.
(February 2012)
What is Insurance Fraud?
Insurance fraud occurs when companies, agents, adjusters, doctors and hospitals, or consumers lie
or misrepresent facts for financial gain.
Know the common types of insurance fraud to recognize and prevent it:
- Unlicensed insurance. It is illegal to sell insurance in Texas without a license. Unlicensed
companies usually don’t meet the state’s minimum financial requirements and may not have
the money to pay claims. Consumers and small businesses who have difficulty affording coverage are particularly vulnerable to these schemes. You can learn a company's or agent's license status by calling the Texas Department of Insurance (TDI) Consumer Help Line or by visiting our website
1-800-252-3439
463-6515 in Austin
www.tdi.texas.gov - Health care provider fraud. Doctors and hospitals commit fraud when they over-bill insurance companies for services they provided, bill for services they didn’t provide, or perform unnecessary tests and procedures.
- Agent fraud. Insurance agents commit fraud when they issue fake policies, falsify information on an insurance application, or keep your premium for their personal use.
- Homeowner fraud. People commit homeowner fraud when they exaggerate or pad claims or file fake claims, including burglary and arson claims.
- Auto accident fraud. People commit auto accident fraud by padding their claims or filing a claim for an accident or theft that never occurred. Causing an accident and making it look as though it was someone else’s fault is also a form of fraud.
- Workers’ compensation fraud. Employees commit fraud when they lie about a work-related injury or illness to receive medical or income benefi ts. Attorneys and doctors can participate in fraud if they submit bills for unnecessary services or services that they never provided.
- Mortgage fraud. Residential mortgage fraud occurs when borrowers make false or misleading statements to get mortgage loans. Mortgage fraud also includes diverting escrow funds at settlement.
Report Insurance Fraud
Insurance fraud is a crime in Texas. Texas law requires you to report insurance fraud within 30 days. The law protects you from any retribution or liability as a consequence of reporting fraud.
You may report suspected insurance fraud to the Fraud Unit by
- calling the Consumer Help Line at 1-800-252-3439
- visiting our website at www.tdi.texas.gov
- mailing your report to:
Texas Department of Insurance
Fraud Unit
P O Box 149336
Mail Code 109-3A
Austin, TX 78714-9336
TDI’s Fraud Unit
The TDI Fraud Unit is a law enforcement agency that
- investigates reports of fraud
- makes referrals to criminal district attorneys and federal prosecutors
- seeks criminal indictments
- makes arrests
- assists in prosecutions by working with other law enforcement agencies.
Fraud Unit staff includes peace officers, attorneys, fraud examiners, and investigators. It also has two special prosecutors that work out of district attorney offices in Dallas and Harris counties.
The Fraud Unit in 2011:
- received 11,124 fraud reports
- opened 577 investigations
- identifi ed $23.8 million of fraud
- referred 187 cases for prosecution, which led to 116 indictments and 112 convictions
- helped victims of fraud receive $6.5 million in restitution
Request a Speaker
The TDI Fraud Unit can send a speaker to your event or presentation to talk about insurance fraud. To request a speaker, call the Speakers Bureau program or visit our website
512-305-7196
www.tdi.texas.gov
We also provide training to law enforcement agencies and insurance companies. To request training, call the Fraud Unit
512-463-6492
For more information contact:
Last updated: 02/23/2012
