SLS 14RS-459 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2014
SENATE BILL NO. 281
BY SENATOR BROWN
INSURANCE DEPARTMENT. Provides with respect to insurance anti-fraud plans.
(8/1/14)
AN ACT1
To amend and reenact R.S. 22:572.1, relative to insurance anti-fraud plan; to provide with2
respect to an exemption for small companies from the requirement to prepare,3
implement, maintain, and file with the commissioner an insurance anti-fraud plan;4
and to provide for related matters.5
Be it enacted by the Legislature of Louisiana:6
Section 1. R.S. 22:572.1 is hereby amended and reenacted to read as follows: 7
ยง572.1. Insurance anti-fraud plan8
A. Each authorized insurer, other than a "small company" as defined in9
R.S. 22:46, and each health maintenance organization licensed to operate in this state10
shall prepare, implement, and maintain, and file with the commissioner an11
insurance anti-fraud plan for the insurer's or health maintenance organization's its12
operations in this state.13
B. The insurance anti-fraud plan utilized by each authorized insurer and each14
health maintenance organization in this state required by Subsection A of this15
Section shall be filed with the commissioner of insurance and shall outline specific16
procedures, actions, and safeguards that are applicable, relevant, and appropriate to17 SB NO. 281
SLS 14RS-459 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
the type of insurance the authorized insurer writes or the type of coverage offered by1
the health maintenance organization in this state and shall include how the authorized2
insurer or health maintenance organization will:3
(1) Detect, investigate, and prevent all forms of insurance fraud, including4
fraud involving the insurer's or health maintenance organization's its employees or5
agents; fraud resulting from misrepresentations in the application, renewal, or rating6
of insurance policies; fraudulent claims; and breach of security of the insurer's or7
health maintenance organization's its data processing systems.8
(2) Educate appropriate employees on fraud detection and the insurer's or9
health maintenance organization's insurance anti-fraud plan.10
(3) Provide for fraud investigations, whether through the use of internal fraud11
investigators or third-party contractors.12
(4) Report a suspected fraudulent insurance act, as defined by R.S.13
22:1923(1), to the Department of Insurance as well as appropriate law enforcement14
and other regulatory authorities engaged in the investigation and prosecution of15
insurance fraud.16
(5) Pursue restitution for financial loss caused by insurance fraud, when17
applicable, relevant, and appropriate.18
C. The commissioner shall review the insurance anti-fraud plan submitted by19
each authorized insurer and each health maintenance organization pursuant to20
Subsection A of this Section to determine compliance with the requirements of this21
Section.22
D. The commissioner shall have the authority to may investigate and23
examine the records and operations of each authorized insurers and each health24
maintenance organizations to determine if the insurer or health maintenance25
organization has they have implemented and maintained compliance complied with26
the insurance anti-fraud plan.27
E. The commissioner is authorized to may direct any authorized insurer or28
health maintenance organization to make any modification to the insurer's or health29 SB NO. 281
SLS 14RS-459 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
maintenance organization's insurance anti-fraud plan necessary to obtain and1
maintain compliance comply with the requirements of this Section, and the2
commissioner may require any other reasonable remedial action to the insurer's or3
health maintenance organization's insurance anti-fraud plan if the investigation and4
examination reveals remedy substantial noncompliance by the insurer or health5
maintenance organization with the terms of the insurer's or health maintenance6
organization's insurance anti-fraud plan.7
F. The insurance anti-fraud plan and any summary report shall be filed with8
the commissioner on or before April first of each calendar year. Either on a calendar9
year basis or on whatever such other interval he the commissioner deems10
appropriate, the commissioner is authorized to may require that each authorized11
insurer and each health maintenance organization file a summary report of any12
material change to the insurance anti-fraud plan, including the total number of claims13
and the number of claims referred to the commissioner as suspicious, and the14
commissioner is authorized to direct each insurer and each health maintenance15
organization as to may prescribe the format of the summary report.16
G. The insurance anti-fraud plan submitted to the department, as well as the17
summary report of the insurer's or health maintenance organization's insurance anti-18
fraud activities and results, and any summary report required by this Section are19
not public records and are exempt pursuant to R.S. 44:1 et seq., and specifically R.S.20
44:4.1(B)(10)(11), shall be and are hereby declared to be company proprietary and21
business confidential business records and not subject to public examination or22
subpoena.23
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
Brown (SB 281)
Present law requires each authorized insurer and each health maintenance organization
licensed to operate in this state to prepare, implement, and maintain an insurance anti-fraud
plan for operations in the state.
Proposed law exempts a small company as defined in present law from the requirement to SB NO. 281
SLS 14RS-459 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
have an anti-fraud plan.
Proposed law provides for technical changes.
Effective August 1, 2014.
(Amends R.S. 22:572.1)