Texas DOI Reports Top 10 Insurance Fraud Cases of 2017

In 2017, Texas Department of Insurance fraud investigations resulted in 135 suspects referred for prosecution, 113 indictments, and $2.3 million in court-ordered restitution for victims. Those cases included:

1. Gainesville clinic owner Mark Allen Cox pleaded guilty to insurance fraud and was ordered to repay $1 million after an investigation by the Texas Department of Insurance found that he billed for chiropractic services without having a licensed chiropractor on staff.
2. In Dallas County, Reginald Cofer recruited 12 other people to participate in a scheme involving arson of residences. Cofer owned a restoration business and used the fires to generate work. He pleaded guilty to engaging in organized criminal activity and was sentenced to six years in prison.
3. James Halsell, a licensed insurance agent, operated a commission scheme in Bexar County where he used Social Security numbers, dates of birth, and addresses to create fictitious people as applicants for life insurance policies. He would collect commissions for the policy sales and then allow the policies to cancel. He also used a similar method where he stole actual identities and took out policies without permission to collect commissions. Halsell was sentenced to five years in prison and ordered to pay $52,364 in restitution.
4. In Bexar County, insurance agent Paula Villareal defrauded her victims into rolling their retirements into IRAs and then depositing the funds for the IRAs into her personal account. She was sentenced to seven years in prison and ordered to pay a $2,000 fine and return $55,373 to her victims. As part of the sentence, she permanently surrendered her insurance license.
5. Ariel Ratcliff operated an internet business selling fake insurance certificates and other documents. The victims were unaware that they were uninsured and that their premiums were being deposited directly into Ratliff’s bank account. Ratliff was sentenced to two years in prison.
6. Cornell Tanner filed fraudulent claims with multiple insurance companies for three separate accidents using fake medical bills. Tanner claimed more than $53,000 in fabricated medical treatment and received $25,269 in payments. Tanner was sentenced to two years in prison and repaid all restitution to the insurance companies.
7. In Tarrant County, Mary Burress fabricated medical bills and submitted claims for injuries that never happened. She pleaded guilty to third-degree felony insurance fraud and was sentenced to five years of probation and ordered to pay $53,735 in restitution.
8. Damon Carter reported an accident in which he claimed a phantom driver had swerved into his lane and caused him to go off the road and into a tree. Carter staged the accident by ramming his vehicle repeatedly into the tree. Carter and three other people made claims for injuries. He was sentenced to six years in prison and ordered to pay $9,000 in restitution.
9. Jason Halstead, a licensed insurance agent, used life insurance proceeds belonging to a niece with a disability to buy an annuity without her consent. Halstead then withdrew a large portion of the principal, incurring a penalty, to make a down payment on his house and used the annuity payments for personal expenses. He was sentenced to six years probation and ordered to pay $41,000 in restitution.
10. Tiffany Sibley, a billing agent for a hospital, submitted fake insurance claims over two years. Each of her claims was supported by fabricated hospital bills allegedly from the hospital where she worked. Sibley received more than $14,000 in payments from her scam. Sibley was sentenced to five years probation and ordered to pay a $2,000 fine and restitution of $14,408.

Source: TDI