DECEMBER 17, 2003— Texas Mutual Insurance Company announced today that it is increasing its scholarship assistance program. The program will pay up to $4,000 for tuition and fees and up to $500 for course-related books and supplies, per semester or equivalent, to qualifying individuals.
Acting on the recommendations of President Russ Oliver, the Texas MutualSM board of directors also unanimously approved a plan to expand the program's scope to include financial assistance for Texas MutualSM policyholders’ employees, who have qualified for lifetime income benefits (LIBs) pursuant to the Texas Workers’ Compensation Act, and their qualifying family members.
Originally, the program offered up to $2,000 per semester to surviving, unmarried spouses or surviving children of an individual who died from a compensable injury while working for a Texas MutualSM policyholder while the policy was in effect. The board also approved a requirement for scholarship recipients to maintain a 2.50 grade point average during the period(s) the scholarship is in effect.
“As a company, we strive to help reduce the number of work-related injuries and illnesses in Texas, and we also work to minimize their consequences,” said Oliver. “In extreme cases, such as a compensable workplace fatality or an injury or illness severe enough to qualify for LIBs, we hope our scholarship program will help reduce the financial burden of education on the worker’s family.”
The Texas MutualSM scholarship program is completely discretionary, and Texas Mutual Insurance Company may consider several factors before offering a scholarship, including the recipient’s economic need, standardized test scores, and high school or college academic performance, as applicable.
NOVEMBER 17, 2003—The Texas Restaurant Association (TRA) received a group dividend from Texas Mutual Insurance Company worth approximately $523,000, according to Texas MutualSM President Russ Oliver.
The TRA group dividend is separate from the approximately $25 million in dividends that Texas Mutual Insurance Company paid to qualifying policyholders earlier this year. Some TRA members may receive dividends from both programs.
“We’re proud to partner with TRA in helping to create and maintain safer workplaces,” said Oliver, who met with TRA executive vice president and CEO Richie Jackson on Monday to discuss the dividend. TRA will distribute the money to its eligible members.
Foodservice companies represent a $24 billion a year industry, according to the TRA website, and they employ over 650,000 workers in more than 40,000 locations statewide. TRA serves as the industry’s main advocate.
Texas Mutual Insurance Company is the state’s leading provider of workers’ compensation insurance and the state’s leading writer of safety groups for workers’ compensation. Although state law prohibits insurance companies from guaranteeing future dividends, Oliver explained that Texas Mutual Insurance Company’s philosophy is to reward qualifying policyholders when money is available.
For more information about TRA or other Texas MutualSM Safety Groups, CLICK HERE.
NOVEMBER 10, 2003—Jimmy L. Jones of Victoria pleaded guilty to workers’ compensation fraud-related charges today. The court sentenced Jones to two years in a state jail facility, probated for three years.
The court also ordered Jones to pay $3,825 in restitution to Texas Mutual Insurance Company, serve 60 hours of community service, pay the court costs, and complete any counseling recommended by his probation officer.
The Jones case began when he belatedly reported an alleged job-related injury from his job at Jen’s Oilfield Service in Edinburg. After reviewing the injury report, Texas Mutual Insurance Company disputed the claim.
At a Texas Workers’ Compensation Commission (TWCC) benefit review conference, Jones testified that he had been disabled and unable to work between August 15, 2001 and December 3, 2001. TWCC ordered Texas Mutual Insurance Company to pay Jones $3,825 in back income benefits for the period of his alleged disability.
A Texas MutualSM investigation later revealed that, in fact, Jones was gainfully employed during the period of his alleged disability. Therefore, he was not entitled to temporary income benefits for his alleged injury.
The Jones investigation was part of the Texas MutualSM “Zero Tolerance for Fraud” program. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate reports of suspected fraud.
NOVEMBER 7, 2003—Ruben Perez of Dallas pleaded guilty to workers’ compensation fraud-related charges today. Perez received a two-year deferred adjudication sentence and must pay $6,000 in restitution to Texas Mutual Insurance Company. The court also sentenced him to serve 160 hours of community service.
Perez’s scam was not an uncommon one. He was injured on-the-job and began to collect temporary income benefits (TIBs) from Texas Mutual Insurance Company. After he returned to work, he repeatedly lied to a Texas MutualSM claim adjuster by saying that he was still unable to work so he could continue to receive $356 per week in TIBs.
Investigators call this sort of scam “double-dipping” because the claimant is getting paid by his employer for working and, in effect, getting paid by the insurance company for being too injured to work.
State law allows injured workers to receive TIBs only while they are unable to return to work. The law also requires injured workers to notify their workers’ compensation carriers when they return to work.
When Texas MutualSM investigator Sandra Milburn uncovered evidence against Perez, she contacted Assistant District Attorney Donna Crosby, who prosecuted the case on behalf of the Travis County District Attorney office.
Three years ago, Milburn had investigated Perez’s employer for premium fraud, and Crosby prosecuted that case, too. Ultimately, the court ordered the employer to pay $200,000 in restitution to Texas Mutual Insurance Company, and the owner received a five-year probated sentence.
Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate reports of suspected fraud.
OCTOBER 24, 2003 – Texas Home Exteriors Inc. of Austin pleaded guilty to a third-degree felony in a workers’ compensation fraud case. The 331st Travis County District Court ordered the company to pay $20,000 in restitution to Texas Mutual Insurance Company.
Texas Home Exteriors reported that it only employed company officers and clerical staff. Texas Mutual Insurance Company opened an investigation after its underwriting department noticed that the company filed a claim for a worker who was injured while installing siding. Texas MutualSM investigator Sandra Milburn uncovered evidence that the injured worker was actually employed by an uninsured subcontractor who was not covered on Texas Home Exteriors’ policy.
The investigation was part of the Texas MutualSM Zero Tolerance for Fraud policy. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud. Assistant District Attorney Donna Crosby prosecuted the case for the Travis County District Attorney Office.
OCTOBER 23, 2003—Governor Rick Perry appointed Sandra Kuprion-Thomas to Texas Mutual Insurance Company’s board of directors yesterday. Ms. Kuprion-Thomas is a certified public accountant and the president of Kuprion-Thomas & Voorhees PC, an accounting and consulting services firm in Dallas.
“I’ve spoken with Ms. Kuprion-Thomas, and she is very excited about working with Texas Mutual,” said Martin Young Jr., chairman of the board. “Her background in accounting and as a board member in other organizations makes her an excellent choice for Texas Mutual.”
Ms. Kuprion-Thomas serves as a board member for Southern Methodist University’s Cox School of Business Associate Board, the Children’s Education Fund, and she is on the executive committee of the Dallas division of the American Heart Association. She is also a member of the Texas Society of Certified Public Accountants, the American Institute of Certified Public Accountants, the Institute of Management Accountants, the Association of Fraud Examiners, the Greater Dallas Chamber of Commerce, Financial Executives Institute, and the National Association of Enrolled Agents.
Ms. Kuprion-Thomas will replace outgoing board member Brenda Pejovich, also from Dallas. Ms. Pejovich has served on the board since 1997 when Governor George W. Bush appointed her. She also served as the board’s secretary from 2001 to 2002.
“I’m looking forward to working with Ms. Kuprion-Thomas,” said Texas MutualSM President Russ Oliver. “I know she’s going to hit the ground running because next week is our annual board retreat.”
Ms. Kuprion-Thomas’ term expires on July 1, 2009.
OCTOBER 15, 2003 – Raymond Hicks of Del Valle, Texas pleaded guilty to workers’ compensation fraud before the 147th Travis County District Court. Hicks’ sentence included $8,212.60 in restitution to Texas Mutual Insurance Company, a $500 fine, court costs, the costs of any counseling or treatment required by the Travis County Community Supervision Department, two years of deferred adjudication, and 80 hours of community service.
Hicks claimed he suffered an on-the-job injury while working for Cook Mail Service in Austin, Texas. He told Texas Mutual Insurance Company and his treating doctor that he was unable to work due to the injury.
Texas Mutual Insurance Company investigators got suspicious when they received an anonymous tip through their Fraud StoppersSM program. The tipster claimed that Hicks was working while continuing to collect benefits for his alleged work-related injury. State law requires injured workers to notify their carriers of any change in their work status.
The investigation revealed that Hicks was in fact working as a truck driver for Libre Trucking Inc., based out of Austin, Texas. The investigators shot surveillance video of Hicks on the job and asked the Travis County District Attorney office to prosecute the case.
Most Fraud StoppersSM rewards begin with an anonymous call directly to the Fraud StoppersSM hotline at (800) 488-4488 or an email to email@example.com. The program is, however, flexible enough to reward other informants who provide information that leads to a fraud-related indictment or conviction. In this case, Texas Mutual Insurance Company has authorized the maximum award, $1,000, to the confidential informant who provided the case-breaking tip.
The Fraud StoppersSM award is part of the Texas MutualSM “Zero Tolerance for Fraud” program. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
OCTOBER 15, 2003 – A Houston landscaping company pleaded guilty to workers’ compensation fraud before the 131st Travis County District Court. The court ordered the company to pay $325,000 in restitution to Texas Mutual Insurance Company.
An investigation by Texas Mutual Insurance Company uncovered evidence that the landscaping company intentionally hid its overtime and extra compensation in a second company, Dynamic Metro Services Inc., which was a company in name only. Since workers’ compensation premiums are based in part on payroll, the scam enabled the landscaping company to unfairly lower its premium.
Texas Mutual Insurance Company got suspicious when one of the landscaping company’s employees disputed his temporary income benefits, which are based in part on income. The employee claimed he made more money than his employer reported to Texas Mutual Insurance Company.
The investigation was part of the Texas MutualSM Zero Tolerance for Fraud program. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
OCTOBER 15, 2003 - A Travis County grand jury indicted an Odessa man on charges of workers’ compensation fraud, Securing Execution of Document by Deception, a state jail felony. Texas Mutual Insurance Company alleges that William Scott Anderson continued to collect temporary income benefits (TIBs) for a work-related injury while secretly returning to work.
Texas law requires injured workers to notify their insurance carriers of any change in their work status.
Anderson suffered an on-the-job injury while working as a derrick man for Mattlock Drilling LTD of Midland. He claimed he was unable to return to work because of the injury, and Texas Mutual Insurance Company began paying TIBs.
While he was still receiving TIBs from Texas Mutual Insurance Company, Anderson allegedly took a job with Rod Ric Drilling of Odessa/Midland. Later, he allegedly applied for another job with a different company. When the company called Mattlock Drilling to check Anderson’s references, Mattlock Drilling alerted Texas Mutual Insurance Company.
According to the ensuing Texas MutualSM investigation, Anderson called to check the status of one of his TIBs checks His adjustor asked him if he was working. He allegedly said he was not, but the investigator obtained written confirmation from Rod Ric Drilling to the contrary.
The investigation was part of the Texas MutualSM "Zero Tolerance for Fraud" program. Texas Mutual Insurance Company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.
Note: A grand jury indictment is a formal accusation--not a conviction--of criminal conduct.
OCTOBER 6, 2003— U.S. District Judge Terry R. Means sentenced former Arlington residents Dr. James Mark Murphy and Mr. Joseph Robert Kirkham to 87 months imprisonment and 120 months imprisonment, respectively, for defrauding several insurance companies. Judge Means also ordered Dr. Murphy to pay $732,061 in restitution and Mr. Kirkham to pay $2,751,270 in restitution.
Following a seven-day trial in May, a federal jury convicted Dr. Murphy, an anesthesiologist, and Mr. Kirkham, a businessman, of submitting fraudulent medical claims from 1996 to 2000 using various medical doctors’ names and credentials. Texas Mutual Insurance Company, along with other insurance carriers, provided federal authorities with records of the fraudulent claims the defendants used.
“The entire scheme not only defrauded insurance companies of millions of dollars, but deprived patients of the full, honest medical care they thought they were receiving,” reported a written statement from the U.S. Department of Justice.
During the trial, patients testified that they never saw Dr. Murphy, but were billed for medical services that he did not provide or supervise. Witnesses also testified that the clinics billed for medically unnecessary treatments and that Dr. Murphy and Mr. Kirkham were both aware of the fraudulent billings and knowingly participated in the scam.
Dr. Murphy and Mr. Kirkham were the last to be sentenced out of several convicted defendants in the scheme. Other health care providers convicted in earlier trials related to the case included: Dr. Victor McCall, M.D., a board-certified licensed radiologist; Dr. Mark Allen Darner, D.C., a licensed chiropractor; and Dr. Alvin Lostetter, M.D., an anesthesiologist.
Dr. McCall received a sentence of six months imprisonment to be followed by six months home confinement. Dr. Darner is presently serving a five-year prison sentence, and he must pay $2,748,881 in restitution. Dr. Lostetter was sentenced to five years probation and must pay all outstanding taxes to the IRS.
Assistant United States Attorneys Ronald C.H. Eddins and Doug Allen prosecuted the cases.