Insurance Fraud
Integrion Group will investigate and report any reasonable suspicion of Insurance Fraud to the New Mexico Office of the Superintendent of Insurance.
“Insurance Fraud” is any act or practice related to insurance by a person who intentionally makes a material false or fraudulent statement, misrepresentation, or omission that the person knows to be untrue, or in reckless disregard of the truth, for the purposes of obtaining illegitimate money or benefit from Integrion Group.
The most common types of Insurance Fraud are premium fraud, claim fraud, and service provider fraud. Insurance Fraud can be committed by anyone such as claimants, employers, insurance agents, attorneys, or health care providers. Ultimately, Insurance Fraud results in higher claim costs and in turn, higher premiums, which hurts all policyholders and claimants.
Report any reasonable suspicion of Insurance Fraud to us, 24/7, through the AlertLine at (877)-222-2006 or online at www.lighthouse-services.com/newmexicomutual. Although you may remain anonymous, please know that our ability to effectively investigate your report may be enhanced if we can contact you for additional information. All contacts and information will be confidential.
CLAIM FRAUD
To collect illegitimate workers’ compensation benefits, claimants may submit a false report of injury or fail to disclose material facts about their medical condition or the circumstances of their injury. Claimants may also fail to report earnings while continuing to collect benefits.
PREMIUM FRAUD
Employers and/or their insurance agents may intentionally provide false information about business operations such as misclassifying the work performed by employees, understating or failing to report payroll or making false statements regarding an employee’s injury to obtain workers’ compensation insurance coverage below the appropriate premium rate.
SERVICE PROVIDER FRAUD
In order to all to increase billing or assist claimants or employers in committing Insurance Fraud, healthcare providers or attorneys may intentionally bill for services never provided, never received, unnecessary, or duplicated. They may also misstate a claimant’s condition, fail to classify or intentionally misclassify injuries or conditions as work-related injuries, up-code, or engage in kickback schemes.
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