Antifraud (D) Task Force
Market Regulation and Consumer Affairs (D) Committee

Mission

The mission of the Antifraud (D) Task Force is to serve the public interest by assisting the state insurance supervisory officials, individually and collectively to promote the public interest through the detection, monitoring and appropriate referral for investigation of insurance crime, both by and against consumers. The Task Force will assist the insurance regulatory community through the maintenance and improvement of electronic databases regarding fraudulent insurance activities. Disseminate the results of research and analysis of insurance fraud trends as well as case‑specific analysis to the insurance regulatory community. Provide a liaison function between insurance regulators, federal, state, local, and international law enforcement and other specific antifraud organizations. Coordinate between state and federal regulators regarding the USA PATRIOT Act anti-money laundering amendments to the Bank Secrecy Act. The Task Force will also serve as a liaison with the NAIC Information Systems Division and other NAIC committees to develop technological solutions for data collection, and information sharing. The Task Force will monitor all aspects of antifraud activities by its working groups and subgroups on the following charges.

2009 Charges

Ongoing Support of NAIC Programs, Products, or Services:

1. Appoint the Antifraud Training & Seminar Working Group to identify and develop (1) training sessions regarding antifraud issues of importance to insurance regulators, industry and interested parties; and (2) plan and present Basic Insurance Fraud Investigation Training for Regulators and Antifraud Seminar —Essential
2. Appoint the Information Sharing & Technology Working Groupto evaluate sources of antifraud data and propose methods for enhancing the utilization and exchange of information among insurance regulators, fraud investigative divisions, and law enforcement, insurers and antifraud organizations. Recommend secure systems for the dissemination of confidential information between insurance fraud agencies. Develop or address any other projects related to technology or information sharing that present over the following year—Essential
3. Appoint the Antifraud Liaison Working Group to (1) develop initiatives and guidelines to enhance relationships with industry Special Investigation Units (SIUs), external private sector antifraud entities and antifraud organizations to include but not limited to training opportunities, model and guideline protocols and bench marking projects. Projects will include updating the State Insurance Department Antifraud Resources Report, and (2) Develop industry SIU regulations guidelines. (3) Develop an industry antifraud plan guideline. (4) Explore the feasibility of establishing a “National Insurance Fraud Prevention Day/week. (5) Provide an advisory role to the Coalition Against Insurance Fraud, International Association of Special Investigation Unit (IASIU), the National Insurance Crime Bureau (NICB) and National Healthcare Antifraud Association (NHCAA)—Essential
4. Appoint the Federal and International Enforcement Coordination Working Group to (1) coordinate with state, federal and international law enforcement agencies in addressing antifraud issues relating to the insurance industry, (2) support insurance regulator efforts to gain access to the FBI Fingerprint Identification Record System/Criminal History Record Identification System, (3) monitor and recommend appropriate guidance on state issues arising from the application of 18 U.S.C. 1033, 1034; (4) evaluate and review existing 18 USC 1033, 1034 Guidelines and determine appropriate revisions and additions if necessary; and (5) develop educational material to enhance and promote prosecutions under 18 USC 1033, 1034 —Essential
5. Appoint the Agent & Unlawful Activities Working Group to (1) develop methods to enhance the investigation and prosecution of Agent fraud (2) identify and develop recommendation for coordination and cooperation between state insurance department and law enforcement authorities on insider insurance fraud; (3) identify and develop possible educational tool for insurance regulators regarding enhanced workflow and reporting issues from the Centers for Medicare and Medicaid Services —Essential
6. Appoint the Securities Enforcement Coordination Working Group to (1) evaluate need and, if appropriate, develop an education and training seminar in cooperation with representatives from securities regulation; (2) identify and develop recommendations of cooperation and communication between insurance and securities regulators—Essential

SPONSORS:
Sandy Praeger, Kansas
Susan Voss, Iowa
Jay Bradford, Arkansas