Texas Department of Insurance
www.tdi.state.tx.us - Consumer Helpline 1-800-252-3439
TDI Fraud UnitWhat is Insurance Fraud?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. Insurance Fraud is a crime in Texas! Related Links Latest News
Reporting Insurance FraudInsurance Fraud Toll-Free Hotline Online Fraud Reporting
NoticesSearch the National Insurance Crime Bureau (NICB) database for vehicles and watercraft affected by Hurricanes Katrina, Rita and Wilma. Fraud Unit BackgroundDennis Pompa, Associate CommissionerP.O. Box 149336 MC 109-3A Austin, TX 78714-9336 Telephone: 512-463-6492 Fax: 512-490-1001 Types of Cases Investigated by the Fraud UnitThe Insurance Fraud Unit maintains three investigative sections. The Claimant and Provider Fraud Section focuses on fraud committed against the insurance industry, the Insurer Fraud Section focuses on fraud committed within and by the insurance industry, and the Workers' Compensation Fraud Section focuses on fraud associated with benefit and premium fraud. Return to TopFraud Unit StaffThe 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). Fraud BrochureExcerpts from TDI's brochure Insurance Fraud General tips to protect yourself against Insurance Fraud
Don't Fall Prey to Phony Insurance 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. Related Web LinksCoalition Against Insurance Fraud
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. Additional Fraud Unit Links
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For more information contact: FraudUnit@tdi.state.tx.us |
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