What types of fraud exist in the Texas workers compensation system and how is workers compensation fraud investigated?
• There are currently five types of fraud in the Texas workers’ compensation system: injured worker benefit fraud; insurance carrier fraud; employer premium fraud; h ealth care provider fraud; and attorney fraud. • Insurance carriers use several clues to identify a potential workers’ compensation fraud case including: when the injury occurred; past history of workers’ compensation claims; frequent change of doctors; employer classification codes not consistent with the duties normally associated with the employer’s type of business; multiple businesses located at the same address; duplicate medical billings; health care providers attempting to bill an injured worker for medical services provided on a workers’ compensation claim; and incorrect information on attorney bills or duplicate billing. • According to insurance carriers, on average, attorney fraud cases took the longest time to investigate (one to two years) while injured worker benefit fraud cases took the least amount of time
