How much fraud is in the Texas workers compensation system?
• It is impossible to determine with certainty the amount of fraud in the Texas system because insurance carrier s are not required to report fraud. Looking at figures from the TWCC, a total of 840 alleged fraud cases were referred to the agency for investigation in 1996 and 925 investigations were completed. The most common type of fraud referred to, and investigated by, the TWCC is injured worker benefit fraud. • More cases involving health care provider fraud were referred to district attorneys for criminal prosecution than injured worker benefit fraud cases — even though injured worker benefit fraud investigations outnumbered provider fraud investigations by more than four to one. • According to the TWCC, health care provider fraud was the most expensive type of fraud in the Texas workers’ compenstion system in 1996 (representing a total dollar amount of $1,200,952), accounting for over eight times the dollar amount of injured worker benefit fraud (a total of $134,351). • For this
