Application and Use of Insurance Fraud-Related …

1 Application and Use ofInsurance Fraud-RelatedDatabases and Sourcesof InformationA Guide for State Insurance DepartmentsNationalAssociation ofInsuranceCommissioners Application and Use ofInsurance Fraud-RelatedDatabases and Sources of InformationA Guide for State Insurance DepartmentsAccounting & ReportingAccountants, members of the Insurance industry andeducators will find relevant information about statutoryaccounting practices and InformationConsumers, educators and members of the insuranceindustry will find important answers to common questionsin guides about auto, home, health and life Regulation Accountants, financial analysts and lawyers will findhandbooks, compliance guides and reports on financialanalysis, state audit requirements and laws, regulations and guidelines apply to membersof the legal and Insurance ActivitiesInsurance industry members will find directories, newsletters and reports affecting NAIC StudiesAccountants, educators.

2 Financial analysts, members ofthe Insurance industry, lawyers and statisticians will findrelevant products on a variety of special ReportsInsurance industry data directed at regulators, educators,financial analysts, Insurance industry members, lawyersand ProductsAccountants, educators, financial analysts, insurers,lawyers and statisticians will find guidelines, handbooks,surveys and NAIC positions on a wide variety of Valuation OfficeProvides insurers with portfolio values and proceduresfor complying with NAIC reporting Papers Accountants, members of the Insurance industry andeducators will find relevant information on a variety ofinsurance topics.

3 2002 National Association of Insurance Commissioners. All rights : 0-89382-869-6 Printed in the United States of AmericaNo part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any storage or retrieval system, without written permission from the NAIC is the authoritative source for Insurance industry information. Our expert solutions support the efforts ofregulators, insurers and researchers by providing detailed and comprehensive Insurance information.

4 The NAIC offers a wide range of publications in the following categories:For more information about NAIC publications, view our online catalog at: NAIC Central Office2301 McGee StreetSuite 800 Kansas City, MO Capital Markets &Investment Analysis Office48 Wall Street, 6th FloorNew York, NY Executive Office444 North Capitol Street, NWSuite 701 Washington, DC 20001 following companion products provide additional information on the same or similar subject matter. Manycustomers who purchase the Application and Use of Insurance Fraud-Related Databases and Sources ofInformation: A Guide for State Insurance Departments also purchase one or more of the following products:Companion ProductsAntifraud Resources ReportIncludes the results of a survey conducted by the NAIC Antifraud Task Forceon a broad range of antifraud-related areas.

5 Results are as reported by theinsurance departments and, where necessary, other state Statistical Report FormThis form was developed to assist with the uniform collection of antifraud datafrom Insurance companies on a calendar-year for Industry for Reporting Suspicious Claims or Activityto State Fraud BureausProvides uniform direction to the Insurance industry for the reporting ofsuspicious claims or activity. Specific attention is paid to the submissionprocess, including the minimum amount of information that should appearon the reporting form and the basic types of evidence that may be usedto support a report of suspicious Fraud Prevention Model Act (MDL-680)

6 Helps regulators investigate and discover fraudulent Insurance acts moreeffectively, halt fraudulent acts, and assist and receive assistance from state,local and federal law enforcement and regulatory agencies in enforcing lawsprohibiting fraudulent Insurance Fraud Prevention Law Individual Compendium Chart (MC-10)Individual chart from the Compendium of State Laws on Insurance includes: Citation; Fraudulent Insurance Act; Immunity from Liability;Fraud Warning Required; Reporting of Suspected Fraud; Statutory Creation ofFraud Unit; Provision for Confidentiality; Insurer Antifraud Activities Required;Other Antifraud Statutes; Regulation HandbookProvides one comprehensive source of reference material for the continuumof regulatory responses to potential market concerns.

7 Helps market regulatorsconduct uniform, standardized market analysis and market conductexaminations. Updated orders must be prepaid, including shipping charges. Please contact an NAIC Customer Service Representative, Monday - Friday, 8:30 am - 5 pm CT. Table of Contents ANTIFRAUD COALITION AGAINST Insurance Insurance SERVICES NATIONAL HEALTHCARE ANTI-FRAUD NATIONAL Insurance CRIME NATIONAL Insurance CRIME TRAINING NATIONAL WHITE COLLAR CRIME FINANCIAL AMERICAN BANKERS DEPARTMENT OF FEDERAL TRADE NATIONAL ASSOCIATION OF Insurance NATIONAL ASSOCIATION OF SECURITIES NORTH AMERICAN SECURITIES SECURITIES AND EXCHANGE LAW ENFORCEMENT.

8 29 DEPARTMENT OF JUSTICE CRIMINAL DIVISION COMPUTER CRIME & INTELLECTUAL FINANCIAL CRIMES ENFORCEMENT NATIONAL CRIME INFORMATION CENTER (NCIC 2000)..32 REGIONAL INFORMATION SHARING ASSOCIATION OF CERTIFIED FRAUD FEDERAL EMERGENCY MANAGEMENT HIGH TECHNOLOGY CRIME INVESTIGATION INTERNATIONAL ASSOCIATION OF Insurance FRAUD AGENCIES, INC..38 INTERNATIONAL ASSOCIATION OF SPECIAL INVESTIGATIVE INTERNATIONAL CLAIM MIB GROUP, MEMBERSHIP High Technology Crime Investigation Association International, Inc.

9 ISO Claim Search National Insurance Crime Bureau National White Collar Crime Center - Voting Membership National White Collar Crime Center - Associate Membership National White Collar Crime Center - Affiliate Membership RISSGate ORGANIZATIONAL 2002 National Association of Insurance Commissioners INTRODUCTION Mission The mission of the Antifraud Task Force is to serve the public interest by assisting the state Insurance supervisory officials, individually and collectively.

10 Upon recommendation of the NAIC Executive Committee, the NAIC Antifraud Task Force adopted a 2001 Charge to identify databases and information sources for use by regulators and the industry as follows: Compile detailed information on antifraud databases maintained by antifraud organization, financial regulators, and law enforcement, and criteria for access. Where members can meet criteria for access to such databases, negotiate agreements and encourage members to utilize those sources of data, including utilization of the NAIC Special Activities Database.