Each state has different requirements to effectively fight against fraud, and it is the responsibility of the insurer to stay up to date on the governing statues in the states in which they do business.
To help combat increasing risk of fraud-related losses, multiple states have new and changing requirements designed to help insurance providers better identify and combat fraudulent claim activity.
The following example is Florida, but it shows that if you are not aware of changes, you could easily be out of compliance.
- In September, 2017 Florida Anti-Fraud requirements for Insurer investigative units, reporting, and penalties for noncompliance changed. The deadlines for the changes / implementations were noted to be December 31, 2017, December 31, 2018 and March, 1, 2019. FS 626.9891
- Every insurer admitted to do business in the state needs to ask themselves the following questions. As of December 31, 2017:
- Do we have an internal Anti-Fraud unit or externally contracted SIU?
- Do we have a designated employee with primary responsibility for implementing these requirements?
- Do we have an Anti-Fraud Plan currently in place?
- Have we electronically filed a Detailed description of our Anti-Fraud unit or externally contracted SIU with the Division of Investigative and Forensic Services?
If not, you are not currently in compliance (Florida) and could incur penalties on a daily basis.
Again, each state has different requirements, deadlines, and penalties. Fraud is more and more prevalent than ever and states are stepping up their game!
The Brumell Group offers SIU Management and Compliance Services to insurance providers nationwide. For information on a customized anti-fraud plan, SIU services, or both, contact the Brumell Group today at 904-880-5150 or email us.