Rule Chapter 69D-2, Florida Administrative Code (FAC) was adopted September 15, 2006. Insurers and Health Maintenance Organizations (HMO) were required to submit SIU descriptions or anti-fraud plans pursuant to section 626.9891, Florida Statutes. The type of filing was differentiated by the insurer’s volume of Florida annual direct written premium for calendar year 2006. Those insurers that write $10 million or more in annual direct written premium are subject to Section 626.9891(1), Florida Statute (F.S.) and 69D-2.003, FAC and those that write less than $10 million in annual direct written premium are subject to Section 626.9891(2), F.S. and 69D-2.004, FAC.
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.
Currently, due to IT changes in the IFPR database, insurers and HMOs should submit any updated or revised SIU descriptions or anti-fraud plan filings directly to Lorie Wiese via email at Lorie.Wiese@MyFloridaCFO.com. This also includes changes in the insurers or HMOs anti-fraud personnel (#2) or contact information (#6) from the filing forms. If a carrier changes its name or is sold to a different insurance group, the carrier should submit an updated SIU description or anti-fraud plan filing directly to Lorie Wiese via email at Lorie,Wiese@MyFloridaCFO.Com. Insurers and HMOs applying for a certificate of authority with the Florida Office of Insurance Regulation should complete one of the required filing forms below and submit their SIU description or anti-fraud plan filing directly to Lorie Wiese via email at Lorie.Wiese@MyFloridaCFO.com. The SIU description or anti-fraud plan filings will be reviewed for acceptance and a communication will be returned to the insurer or HMO.
*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 statute.
The following are required forms for submitting the SIU description and anti-fraud plan filings:
Once the proper form is selected, the user will click on the form and “save” the form file to your computer files. You can save it as the form number, but it may be better to rename it after the form has been completed. The insurer or HMO should complete each of the component requirements (Questions) on the form. For background, our Division is seeking declaratory statements acknowledging the component requirements of the rule in the form filing. The rule filing allows an insurer to acknowledge specific component requirements without having to submit the detail of these requirements to the Division. However, 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. We are only looking for acknowledgements of the component requirements as shown in the rule as Florida has a broad public records law and the anti-fraud plan and SIU descriptions could be subject to public record. 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, claim files to be certain that adjusters have knowledge of “red flags” to detect insurance fraud, and tracking the time frame from when the suspected fraud is detected to when the suspected fraud is referred to the Division.