March 13, 2008 - Texas Mutual Insurance Company reported today that four claimants were indicted, in separate cases, on workers’ compensation fraud-related charges. The claimants allegedly collected a combined $23,561 in benefits they were not entitled to.

Here are the individuals who were indicted and the amount in benefits they allegedly collected illegally: Randy Alexander of Hankamer, $10,032; Connie Snowden of Blooming Grove, $8,088; Billy Morgan of Irving, $2,997; and Hector Cuellar of Los Fresnos, $2,444. Alexander, Morgan and Cuellar were indicted by Travis County grand juries. Snowden was indicted by a Navarro County grand jury.

All four cases involved a scam that investigators call double-dipping. Double-dipping occurs when claimants collect benefits for being too injured to work when they are, in fact, gainfully employed. State law requires injured workers to notify their insurance carrier when they return to work.

March 12, 2008 - Texas Mutual Insurance Company reported today that a Travis County court sentenced Donald Miller of Yoakum on workers’ compensation fraud-related charges.

The court sentenced Miller to one year of probation. It also ordered him to pay $2,132 in restitution to Texas Mutual Insurance Company, plus a $500 fine.

Miller reported a job-related injury while working as a carpenter for Orr & Zinke General Contractors, headquartered in Yoakum. He claimed he was unable to work as a result of the injuries, and Texas Mutual Insurance Company began paying him income benefits.

Meanwhile, a Texas Mutual^® investigation uncovered evidence that Miller was working as a self-employed contractor remodeling a private residence while receiving income benefits. Investigators call this type of scam double-dipping because the claimant collects benefits for being too injured to work when he or she is, in fact, gainfully employed. Texas law requires claimants to contact their workers’ comp carrier when they return to work.

Left unchecked, double-dipping and other workers’ comp fraud can lead to higher premiums for all Texas employers.

The Miller investigation was part of Texas Mutual Insurance Company’s zero tolerance for fraud policy. The company maintains three teams of investigators permanently assigned to investigate every report of suspected fraud.

February 7, 2008 - Texas Mutual Insurance Company reported today that a licensed professional counselor pled guilty to charges of perjury in a workers’ compensation fraud-related case.

A Travis County district court sentenced John Ann Morgan of Bellaire to one year of deferred adjudication. The court also ordered her to pay a $2,000 fine and perform 100 hours of community service.

Morgan presented false testimony on matters relating to the investigation of Ihsan Shanti, M.D. of Houston and his health care facility, Shanti Pain & Wellness Clinic. Morgan has provided counseling services to patients at the clinic since 2002.

Shanti and his clinic were indicted in 2006 on felony workers’ compensation fraud-related charges as a result of investigations conducted by Texas Mutual Insurance Company and the State Office of Risk Management.

The indictments alleged that between January 2003 and March 2006, Shanti and his clinic over-billed Texas Mutual Insurance Company and the State Office of Risk Management for pain management services in excess of hours actually attended by patients.

January 7, 2008 - Texas Mutual Insurance Company recovered over $1 million in workers’ compensation fraud last year.

As part of the company’s ongoing commitment to combat workers’ comp fraud, Texas Mutual Insurance Company investigators Victoria Quintana and William Muhr earned the designation of Certified Fraud Examiner (CFE) from the Association of Certified Fraud Examiners (ACFE).

ACFE provides anti-fraud training and education to its 40,000 members worldwide.

“This designation is a goal for all of our investigators,” said Tim Riley, manager of special investigations. “The information in the exam study materials reinforces lessons learned from practical experience.”

The four-part exam, administered by the ACFE, covers topics from criminology and ethics to identifying the types of fraudulent financial transactions in accounting records. The exam also covers legal elements of fraud and the legal ramifications of conducting fraud examinations, including criminal and civil law, rules of evidence, rights of the accused and accuser, and expert witness matters.

The special investigations department investigates cases of injured workers who knowingly collect benefits to which they aren't entitled. Investigators also pursue health care provider and attorney fraud, as well as employers who misrepresent their payroll to lower their premium.

“Among other things, as investigators, this certification enhances our credibility when testifying in a case,” added Riley.