Tips and Rewards

Defining Fraud

626.989 - Investigation by department or Division of Insurance Fraud; compliance; immunity; confidential information; reports to division; division investigator’s power of arrest. (1) For the purposes of this section, a person commits a “fraudulent insurance act” if the person knowingly and with intent to defraud presents, causes to be presented, or prepares with knowledge or belief that it will be presented, to or by an insurer, self-insurer, self-insurance fund, servicing corporation, purported insurer, broker, or any agent thereof, any written statement as part of, or in support of, an application for the issuance of, or the rating of, any insurance policy, or a claim for payment or other benefit pursuant to any insurance policy, which the person knows to contain materially false information concerning any fact material thereto or if the person conceals, for the purpose of misleading another, information concerning any fact material thereto. For the purposes of this section, the term “insurer” also includes any health maintenance organization and the term “insurance policy” also includes a health maintenance organization subscriber contract.

817.234- False and fraudulent insurance claims. (1)(a) A person commits insurance fraud punishable as provided in subsection (11) if that person, with the intent to injure, defraud, or deceive any insurer:

1. Presents or causes to be presented any written or oral statement as part of, or in support of, a claim for payment or other benefit pursuant to an insurance policy or a health maintenance organization subscriber or provider contract, knowing that such statement contains any false, incomplete, or misleading information concerning any fact or thing material to such claim;
2. Prepares or makes any written or oral statement that is intended to be presented to any insurer in connection with, or in support of, any claim for payment or other benefit pursuant to an insurance policy or a health maintenance organization subscriber or provider contract, knowing that such statement contains any false, incomplete, or misleading information concerning any fact or thing material to such claim; or
3. Knowingly presents, causes to be presented, or prepares or makes with knowledge or belief that it will be presented to any insurer, purported insurer, servicing corporation, insurance broker, or insurance agent, or any employee or agent thereof, any false, incomplete, or misleading information or written or oral statement as part of, or in support of, an application for the issuance of, or the rating of, any insurance policy, or a health maintenance organization subscriber or provider contract; or

Florida Department of Financial Services Insurance Fraud Rewards

In October, 1999, the Department of Financial Services (formerly known as the Department of Insurance), Division of Insurance Fraud (DIF) implemented an Anti-fraud Reward Program law pursuant to s. 626.9892, Florida Statutes. The administration of the reward is governed by Administrative Rule 69D-1 and DIF Policy 2.18. Since the inception of the reward program, the Florida Department of Financial Services has paid out more than $250,000 in reward monies to qualified individuals/tipsters for more than $16 million of potential insurance fraud losses.

Persons/citizens/tipsters can request consideration of the reward by a variety of methods. The tipsters may contact the insurance fraud hotline at 1 800 378 0445, Division of Insurance Fraud (DIF) Headquarters at 850 413 3115 or go directly to the DIF field offices to provide material information relating to a suspected fraud allegation. The tipster may remain anonymous. The reward is conditional upon an arrest and a conviction. The rule and policy contain the case criteria developed for a case to qualify for the reward program. Once it has been determined that a case qualifies and the subject is arrested and convicted, the field office supervisor and or detective submit an anti-fraud reward application to DIF Headquarters where a Reward’s Committee discusses the reward application and determines the appropriate reward amount to the tipster based on the rule guidelines. The amount of the reward is based on the estimated or potential amount of monetary loss of the suspected insurance fraud act. Once the reward amount has been recommended, it is approved by the Chief Financial Officer’s appointed representative and a check is issued by the Division of Finance and Accounting.

Employees and licensees (agents, carrier SIU personnel, adjusters, etc) of the Department of Financial Services are ineligible for the reward. Licensees are exempt from the anti-fraud reward program because pursuant to s. 626.989 (6) insurers, agents, or other persons licensed under the code, or any employees thereof, having knowledge or who believes that a fraudulent insurance act or any other act or practice which, upon conviction, constitutes a felony or a misdemeanor under the code, or under s. 817.234, is being or has been committed shall send to the Division of Insurance Fraud a report or information pertinent to such knowledge or belief and such additional information relative thereto as the department may require. Qualified individuals reporting suspected insurance fraud are eligible for rewards of up to $25,000 for information leading to an arrest and conviction. The anti-fraud program reward language is required on the Florida Workers’ Compensation and Florida Clinic Posting Notices throughout Florida.