Insurance fraud is an intentional deception committed by applicants, policyholders, claimants, providers, agents and company employees. It may occur during the process of buying, using, selling or underwriting insurance and is usually motivated by greed.
or by phone at 512-305-7235.
Fraud Unit Staff
The TDI Fraud Unit is a Law Enforcement agency employing both commissioned and non-commissioned investigators. The unit employs peace officers pursuant to Chapter 701 of the Texas Insurance Code and Article 2.12(28) of the Texas Code of Criminal Procedure. TDI received the authority to Commission peace officers from the Texas Legislature in 1995. The Fraud Unit currently employs peace officers, non-commissioned investigators, prosecutors and criminal analysts.
TDI Fraud Unit investigators work on a variety of cases. One type of case is Claim Fraud, including workers' compensation, committed by consumers and health care providers against insurance companies. Insurance agents converting premium payments to their own use, insurance company officials embezzling funds, and persons who are doing the business of insurance in Texas without the appropriate license are also subject to investigation and prosecution.
TDI investigators cooperate with other law enforcement agencies, and regularly conduct joint investigations with local police, sheriffs departments, Texas District and County attorneys, Texas Department of Public Safety (DPS), Federal Bureau of Investigation (FBI), Internal Revenue Service (IRS), United States Postal Inspectors and the United States Department of Labor (DOL). Upon completing an investigation, the investigator refers the case to State or Federal prosecuting attorneys for indictment and prosecution. After the referral has been made, investigators continue to assist prosecutors and often serve as witnesses before grand juries and during trials.
The Fraud Unit´s Investigators employ a variety of investigation methods and techniques such as financial and document analysis, witness and suspect interviews, undercover operations, search and arrest warrants, internet and other electronic resources, and good old-fashioned leg work.
The Fraud Unit does not investigate Medicaid/Medicare fraud. These complaints should be directed to the Office of the Attorney General, Medicaid Fraud Division (512-463-2011).
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Fraud Brochure
Excerpts from TDI's brochure Insurance Fraud
General tips to protect yourself against Insurance Fraud
- Never sign blank insurance claim forms or applications. Get a copy of every form that you sign.
- Keep a file of documents related to your insurance, including the policy, correspondence, copies of advertisements, premium payment receipts, notes of conversations, and details of any claims submitted.
- Never pay premiums in cash. Always pay by check or money order and make your check payable to the insurance company or agency, not the individual agent. Never pay with a blank check. If you´re paying in installments, make sure you understand how much your payments will be. Be suspicious if an agent tries to bill you for future installments. Normally only the company or premium finance company will do this.
- Demand detailed bills for auto and home repair and medical services. Check closely for accuracy.
- Be cautious of buying insurance from door-to-door or telephone salespeople or off the Internet.
- Know what your policy does and doesn´t cover.
- Keep your insurance identification number confidential. Go elsewhere if an agent becomes evasive when questioned about things like coverages, prices, or installment plan arrangements. Deal only with reputable agents. Ask your friends or family to recommend agents they found helpful and reliable.
- Deal only with licensed companies or otherwise eligible insurers and with licensed agents. Selling insurance without a license is a felony in Texas. Licensed insurance companies must demonstrate to TDI that they are financially sound. In addition, guaranty associations pay claims of licensed insurance companies that fail. Claims against unlicensed insurance companies could go unpaid if the company becomes insolvent. You can verify company licenses and agent licenses online or by calling TDI´s Consumer Help Line at 1-800-252-3439 or 463-6515 in Austin.
More on Insurance Fraud
Don't Fall Prey to Phony Insurance
TDI's Unauthorized Insurance Resource
Be aware that entities are selling insurance without a license to do so. The Texas Department of Insurance (TDI) has become aware of an increase in unauthorized insurance plans and operators seeking to take advantage of Texas consumers in the health insurance marketplace.
Unauthorized Insurance Plans
Related Web Links
Coalition Against Insurance Fraud
Since its founding in 1993, the coalition has worked effectively to:
- enact tough new anti-fraud laws and regulations
- educate the public how to fight back
- serve as a national clearinghouse of fraud information
Source: Coalition Against Insurance Fraud website
National Healthcare Anti-Fraud Association
Founded in 1985 by several private health insurers and federal/state law enforcement officials, the National Healthcare Anti-Fraud Association (NHCAA) is a unique, issue-based organization comprising private and public sector organizations and individuals responsible for the detection, investigation, prosecution and prevention of health care fraud.
Source: NHCAA website
Additional Fraud Unit Links
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Texas Department of Insurance
