INSURANCE ANTI-FRAUD PLAN REPORTING
Rule Chapter 69D-2, FAC required that insurers and HMOs file their SIU descriptions and anti-fraud plans at the Division’s on-line, electronic database known as Insurance Fraud Plan Reporting (IFPR). Further, the rule stipulated that insurers and HMOs must file the updated SIU descriptions and/or anti-fraud plans on forms specified by the Division. There are only two types of forms available and are indicated below. An insurer or HMO will only make one filing, either the SIU description or anti-fraud plan, depending on its premium volume. The SIU description or anti-fraud plan filings will be reviewed for acceptance and the Carrier will be notified if the filing is insufficient.
NOTE: The forms have been updated to contain the new website address: www.myfloridacfo.com/division/fraud/. Filed forms must contain the new address or the Carrier will be required to re-file the form with the updated information.
Due to IT changes in the IFPR database, insurers and HMOs may encounter a problem when filing through the website, if so please email Lorie Wiese directly at Lorie.Wiese@MyFloridaCFO.com for assistance. This includes any of the following:
• Submission of any updated or revised SIU descriptions or anti-fraud plan filings,
• changes in anti-fraud personnel (#2 on the IFPR filing),
• changes in contact information (#6 on the IFPR filing),
• Carrier changes its name or is sold to a different insurance group.
(Additionally the Carrier should submit an updated SIU description or anti-fraud plan filing via the website.)
Insurers and HMOs applying for a certificate of authority with the Florida Office of Insurance Regulation should complete one of the required filing forms and submit their SIU description or anti-fraud plan filing.
*Please note the rule and/or statute is subject to change. Please
periodically check the web site to determine if DIF has modified the rule or the
The following are required forms for submitting the SIU description and
anti-fraud plan filings:
Form DFS-L1-1689/SIU Description – Word/PDF – if more than
$10 million in Florida annual direct written premium.
plans – Word/PDF – if less than $10 million in Florida
direct written premium
Steps to filing forms through the IFPR Website:
- Click on the form and “save” the form file to your computer files. Suggestion: save it as the form number with the present year.
- The insurer or HMO should complete each of the component requirements (Questions/Answers) on the form. The Division is seeking only declaratory statements acknowledging the component requirements of the rule in the form filing. The rule filing allows an insurer to acknowledge specific component requirements as shown in the rule without having to submit the detail of these requirements to the Division. Florida has a broad public records law and the anti-fraud plan and SIU descriptions could be subject to public record.
Note: The Florida Office of Insurance Regulation’s Market Investigations Unit may conduct audits of insurers and HMOs. The insurer and HMO must be prepared to show that it has documented measures and plans in place that demonstrate the component requirements are viable within the SIU or insurer organization. However, it is important that your company develop viable investigative and detection techniques for their anti-fraud personnel and claim staff. The FL OIR will look at training documentation records, referrals made to the Division, and claim files to be certain that adjusters have knowledge of “red flags” to detect insurance fraud. Additionally, OIR will track the time frame from when the suspected fraud is detected to when the suspected fraud is referred to the Division.
- Save the completed form.
- Click on the Insurance Fraud Plan Report Filing – IFPR to make filing link on the website.
- Click on the correct Common Task –
• Activate a new account – for original filing, retain the Account Code and Password for subsequent filings
• Start a new filing - the filer must have the correct Account Code and Password to enter a new filing, this was obtained by the original filer
• Review previous filings
- Select the correct filing status and attach the completed saved form,
- Submit the filing – filer will receive confirmation of the submitted filing via the email provided through IFPR.
- Click on SIU Designated Employee List form, complete form, providing names of Designated Employees eligible for immunity (as provided by 626.989(4)(d), F.S.) and submit.
Questions on Insurance Fraud Plan Report Filing
Insurance Fraud Plan Report Filing – IFPR to
69D-2, F.A.C. Insurer Anti-Fraud Investigative Units and Anti-Fraud
SIU Designated Employee List