Insurance Fraud Bureau
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INSURANCE FRAUD BUREAU

 

Office of Superintendent of Insurance’s Insurance Fraud Bureau is a statewide investigation and prosecution office, created by the Legislature in 1998 to combat the growing problem of insurance fraud.

The Bureau is committed to upholding the law within every facet of the insurance business in our state, and is working with consumers, insurance companies, insurance agents, professional insurance groups, and all law enforcement agencies.

This page is designed to provide a resource for anyone who needs to report an occurrence of insurance fraud, or a potential occurrence, in New Mexico.

 

Mission Statement The Insurance Fraud Problem What does the Fraud Bureau DO? How can you protect yourself?
Downloadable Files News

Contact Us

 

 

MISSION STATEMENT

 

The Findings of the Legislature

 

Our State Legislature determined that insurance fraud is pervasive, expensive, and has the potential to markedly increase premium rates. Such an increase would place businesses at risk, compromise the ability of consumers to raise their standard of living, and decrease the economic vitality of the State. These determinations led to the establishment of the Insurance Fraud Act.

 

The Purpose of the Act

 

The purpose of the Insurance Fraud Act is to permit the full utilization of the expertise of the Superintendent of Insurance to investigate and detect insurance fraud more effectively, to halt insurance fraud, and to work with state, local, and federal law enforcement and regulatory agencies against the commission of insurance fraud.

 

 

The Insurance Fraud Problem

Insurance fraud is one of the most costly white collar crimes in America, second only to tax evasion. Some experts estimate the annual cost to be 120 billion dollars nationally. It is estimated that the cost of insurance fraud in New Mexico alone is 280 million dollars per year. The financial impact of insurance fraud affects every citizen of our state in an immediate and substantial way.

Insurance fraud occurs when someone uses deceit to profit from insurance transactions. Insurance fraud is a criminal offense in New Mexico. Some common types of insurance fraud are:

  • Agent fraud - This may occur when a consumer gives money to an insurance agent and receives no real coverage in return, or receives a different product than he or she intended to purchase. However, unintentional mistakes can happen and do not mean a crime has occurred.

  • Unauthorized insurance - The sale of insurance by unlicensed companies.

  • Fraudulent insurance claims - This describes the filing of dishonest claims for the purpose of profit or gain. For example, a hospital might bill a patient's insurance company for procedures not performed, or a homeowner might "inflate" a claim to cheat the insurance company.

  • Counterfeit proof-of-insurance cards - The sale of counterfeit cards to people who don't carry the automotive liability insurance required by law.
Do I run a risk reporting fraud?

No. Any person reporting insurance fraud in good faith is immune from civil liability. That means that no one can take any adverse action against you for reporting what you reasonably believe to be insurance fraud. A court must award attorney's fees and costs to any person winning a lawsuit arising out of such a report.

 


What does the Fraud Bureau DO?

The duties of the Bureau are as follows:
  • To initiate inquiries and conduct investigations of insurance fraud;

  • To respond to notifications or complaints from all other agencies and persons;

  • To review notices of insurance fraud submitted by insurance companies and to conduct investigations if needed;

  • To conduct independent investigations and studies of insurance fraud and report on the results;

  • To report insurance fraud to any appropriate law enforcement agency and to prepare charges and otherwise assist any prosecutorial authority;

  • To assist any agency in the investigation of insurance fraud;

  • To maintain records and statistics and prepare an annual report;

  • To conduct, with the Attorney General and the Department of Public Safety, public outreach and awareness programs relating to insurance fraud.
What does the Fraud Bureau NOT do?

The Insurance Fraud Bureau does not investigate the following categories of fraud because they are the responsibility of other agencies:

  • Worker's Compensation Fraud

  • Medicare/Medicaid Fraud

  • Social Security Fraud

The Bureau only investigates suspected criminal activity; consumers who feel that they have been wronged by a licensed insurance professional, but are not victims of a criminal act, may contact the Agent Licensing.


 

How can you protect yourself?

 

Remember these things:

  • If it sounds too good to be true, it is.

  • Deal only with licensed companies.

  • Go elsewhere if the agent becomes evasive about any terms of the policy.

  • Don't sign blank application or claims forms.

  • Never pay premiums in cash.

 

Do I run a risk reporting fraud?

 

No. Any person reporting insurance fraud in good faith is immune from civil liability. That means that no one can take any adverse action against you for reporting what you reasonably believe to be insurance fraud. A court must award attorney's fees and costs to any person winning a lawsuit arising out of such a report.

National Insurance Crime Bureau 

 

Offers Free Access to Insurers’ Total Loss Claims Data (click for news release)

 

Consumers anywhere can now obtain valuable pre-purchase information about used vehicles that is made available to the NICB by participating insurance companies supporting the click here for FREE VINCheck program.

 

The expanded VINCheck will be another first-of-its-kind service offered by NICB with the cooperation of its participating member insurance companies.  This free service will greatly improve public safety and consumer protection.

  • VINCheck is free;

  • VINCheck helps prevent unsafe rebuilt wrecks from being sold to innocent consumers;

  • VINCheck allows a consumer to check to determine if a vehicle is reported stolen by an NICB member company;

  • VINCheck might save your life or another’s.

 

 

Downloadable Files

  • The Insurance Fraud Act - PDF

  • Annual Report 2011 - PDF

  • Annual Report 2010 - PDF

  • Annual Report 2009 - PDF

  • Annual Report 2008 - PDF

  • Annual Report 2007 - PDF

  • Annual Report 2006 - PDF
  • Annual Report 2005 - PDF

  • Annual Report 2004 - PDF

  • Annual Report 2003 - PDF

  • Annual Report November 2002 - PDF

  • Annual Report January 1, 2002 - PDF

  • Annual Report December 15, 2000 - PDF

  • Initial Annual Report December 10, 1999 - PDF


 

News

 

Bernalillo County Grand Jury Indicts Gilbert C. Baca III on Multiple Counts

Friday, February 26, 2010, 9:13:05 AM

On Wednesday, Feb. 24, a Bernalillo County Grand Jury indicted Gilbert C. Baca III on multiple counts of forgery, one count of computer access with intent to defraud or embezzle and racketeering.

 

CONSUMER ALERT-PROTECT YOURSELF FROM INSURANCE FRAUD

Friday, June 12, 2009, 1:13:05 PM

In Weak Economic Times, Consumers Can Avoid Becoming Victims By Staying Vigilant And Knowing Their

 

Insurance Fraud Suspect is Indicted

Friday, January 18, 2008, 4:26:12 PM
The Superintendent of Insurance Morris J. Chavez has announced on January 14, 2008 Bernalillo County Grand Jury indicted Albuquerque insurance agent Jorge Gimenez on multiple counts of Insurance Fraud, Embezzlement and one count of Racketeering.

 

NICB Adds Texting Capability to Report Fraud

 

DES PLAINES, Ill., Nov. 23 /PRNewswire-USNewswire/ -- The National Insurance Crime Bureau (NICB) is extending its outreach to the over 246 million cell phone users in the United States by offering the TIP411 text-based fraud reporting system to the American public.

TIP411 allows anyone with text messaging capabilities to text their anonymous tips related to insurance fraud or vehicle thefts directly to NICB. This will supplement our existing 1-800-TEL-NICB phone tip program and our website tip system. NICB receives over 300 tips a month through our current systems.

To send a text tip, cell phone users text the keyword "FRAUD" to TIP411 (847411) to submit their tips.

Why TIP411?

  • Over 246 million people in the U.S. have cell phones (2008) and it's growing quickly.
  • It's 100 percent anonymous (tipsters may provide their information if they choose, but it is not required).
  • Messages can be responded to in real time creating an instant two-way live "chat" with NICB personnel,
  • The system allows citizens to report on a crime without having to say a word, providing an unprecedented anywhere, anytime, silent, and anonymous approach to crime reporting.

"The American people now have a new and immediate way to report fraud," said Joe Wehrle NICB's president and chief executive officer. "We are pleased to bring this service to the nation and urge people to help us in our efforts to keep their insurance costs down by using this technology to report fraudulent activity and vehicle theft."

 

TIP411 is a web-based text messaging system created by CitizenObserver of St. Paul, Minn., in February. It is now being used by law enforcement, schools and other organizations in 30 states.

 

About the National Insurance Crime Bureau: headquartered in Des Plaines, Ill., the NICB is the nation's leading not-for-profit organization exclusively dedicated to preventing, detecting and defeating insurance fraud and vehicle theft through information analysis, investigations, training, legislative advocacy and public awareness. The NICB is supported by more than 1,000 property and casualty insurance companies and self-insured organizations. NICB member companies wrote nearly $343 billion in insurance premiums in 2008, or more than 82 percent of the nation's property/casualty insurance. To learn more visit www.nicb.org.

 

Mailing Address Phone

Office of Superintendent of Insurance
Insurance Fraud Bureau
PO Box 1689
Santa Fe, NM 87504-1689

 

stopfraud@state.nm.us

(505) 476-0560 Main Number


(505) 476-0479 Fax Number


(877) 807-4010 Toll-free Number