Spring 2007

Fraud-Fighting Corner
By Tim Riley • Manager of Special Investigations

Fraud costs the Texas workers’ compensation system millions of dollars every year. Texas Mutual Insurance Company works hard to stamp it out.

We pursue claimants who knowingly collect benefits they are not entitled to. We pursue health care providers who knowingly inflate bills or submit false bills. We pursue employers who gain an unfair advantage over their honest competitors by knowingly misrepresenting information to lower their premiums. We investigate every report of suspected claimant, premium and health care provider fraud we receive, and we get results.

JUDGMENT—A Travis County jury found that Gary C. Quintinsky of Houston committed civil fraud against Texas Mutual Insurance Company. The jury awarded the company over $5 million in actual damages and $2.5 million in punitive damages. The award is expected to exceed $8 million after prejudgment interest is calculated.

This marks the largest premium fraud verdict in Texas Mutual Insurance Company history.

The lawsuit alleged that Quintinsky was involved in a conspiracy with other individuals and companies to defraud Texas Mutual Insurance Company of approximately $5 million. Texas Mutual Insurance Company, represented by attorney Robert M. O’Boyle of Strasburger & Price LLP, presented evidence of fraud involving false payroll records and other information given to Texas Mutual Insurance Company. The scam resulted in an undercharging of premium in the millions of dollars.

SENTENCED—Brenda Hernandez of Houston. The Travis County 299th Judicial District Court sentenced Hernandez to five years of deferred adjudication. The court also ordered Hernandez to perform 200 hours of community service and repay $14,499 in benefits she fraudulently obtained from Texas Mutual Insurance Company, plus costs.

SENTENCED—Patricia Chavez of Sabinal. The Travis County 390th Judicial District Court sentenced Chavez to three years of deferred adjudication. The court also ordered Chavez to perform 200 hours of community service, pay a $250 fine and repay $2,959 in benefits she fraudulently obtained from Texas Mutual Insurance Company.

INDICTED—Hubert McCain of Magnolia. McCain allegedly collected $8,008 in benefits he was not entitled to.

INDICTED—Frank Tisdale of Los Fresnos. Tisdale allegedly collected $6,849 in benefits he was not entitled to.

INDICTED—Marvin Reyes of Del Valle. Reyes allegedly collected $6,640 in benefits he was not entitled to.

INDICTED—Johano Gonzalez of Falfurrias. Gonzalez allegedly collected $3,508 in benefits he was not entitled to.

Note: A grand jury indictment is a formal accusation – not a conviction – of criminal conduct.

Zero tolerance for fraud
All of these investigations are part of the Texas Mutual Insurance Company “zero tolerance for fraud” policy. The company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.

Fraud-fighting resources on the Web
Visit the Fighting Fraud section to read more about these cases and others, report suspected fraud, learn the red flags for fraud and download a Fraud Stoppers_SM poster.

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Fraud-Fighting Corner

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