November 19, 2019

At Texas Mutual, we have a dedicated team of fraud specialists who work to protect our policyholders from those who take advantage of the system. In 2018, we received over 2,000 referrals and estimate our work helped prevent over $13.5 million in claimant fraud, health care fraud and premium fraud. See our zero tolerance for fraud in action.

Claimant fraud is when an employee falsifies an incident or the severity of his or his injuries. We reviewed 2,137 referrals for claimant fraud and identified 165 cases. With 11 convictions, we identified $757,469 in claimant fraud in 2018. We estimate that our work helped to prevent nearly $2.5 million in future claimant fraud. 

Health care fraud is when medical providers use unlicensed providers or overbill Texas Mutual for services. In 2018, our work led to two convictions for health care fraud. We estimate we helped to prevent over $1 million of this type of fraud in 2018.

 
Premium fraud is when an employer misrepresents his or her business operations and payroll to the workers' compensation company, often with the intention of paying a lower premium. Using this workers' compensation fraud scheme could give an employer an unfair advantage over competitors and negatively affect all involved in the workers' compensation system. We identified nearly $10 million in premium fraud in 2018 and saw seven indictments.

 
We take fraud seriously and when you choose Texas Mutual, you can count on our teams to protect your premium dollars. Learn more about what fraud looks like and what to you do if you suspect fraud.