Just for Employers

Fighting Fraud

Let us know if you suspect fraud

Our fraud teams are ready to help. To report suspected fraud, you can notify your adjuster or contact our fraud team directly at fraudstoppers@texasmutual.com or (800) 488-4488.

What to include when you report:

  • Name of individual, employer, health care provider, attorney or medical facility
  • The city in which they are located
  • Reasons you suspect fraud

Your peace of mind is our priority

When workers' compensation fraud occurs, it's harmful to employers and raises costs for all over time. That's why we have dedicated fraud teams that investigate every case reported and identify millions of dollars in workers' comp fraud each year. Your peace of mind — and your bottom line are their top priority.

See our fraud fighting in action

What you can do

Fraud comes in many forms. As an employer you can be aware of the signs and take action to prevent it in your business. See our recommendations for fighting workers' comp fraud in your business.

What you need to know about fraud

Fighting fraud

What fraud looks like

Read about each type below to better understand how to protect your business.

Claimant fraud

  • Fake or exaggerated injuries   
  • Collecting benefits for injuries that were not work-related
  • Double-dipping (continuing to collect benefits after returning to work)
  • Engaging in activities that are inconsistent with their injuries



Healthcare fraud

  • Billing for services or goods not received
  • Up-coding (submitting codes for more serious diagnoses and expensive procedures)
  • Unbundling (billing for multiple procedure codes that are covered by a single comprehensive code)
  • Providing unnecessary treatment, supplies and tests

Premium fraud

  • Underreporting and/or hiding payroll
  • Misrepresenting contract labor employees as subcontractors
  • Misrepresenting the type of work performed
  • Creating a new company to obtain a lower experience modifier




Fraud awareness posters

To help you and your employees know how to recognize signs of fraud and report it, we’ve created three posters for you to download, share and post in your workplace. Increasing awareness could result in an earlier detection of fraud and reduced claim costs. If you are a Texas Mutual policyholder and you’d like 11 x 17 posters mailed to your workplace, email fraudstoppers@texasmutual.com with the type and quantity.

Claimant FraudClaimant Fraud preview

English

En español

Healthcare Fraud
Healthcare Fraud

English

En español

Premium FraudPremium Fraud

English

En español

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