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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 ENROLLED
SENATE BILL NO. 281
BY SENATOR BROWN
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 shall be filed with the commissioner of15
insurance and required by Subsection A of this Section shall outline specific16
procedures, actions, and safeguards that are applicable, relevant, and appropriate to17
the type of insurance the authorized insurer writes or the type of coverage offered by18
the health maintenance organization in this state and shall include how the authorized19
insurer or health maintenance organization will do each of the following:20
(1) Detect, investigate, and prevent all forms of insurance fraud, including21
fraud involving the insurer's or health maintenance organization's its employees or22
agents; fraud resulting from misrepresentations in the application, renewal, or rating23
of insurance policies; fraudulent claims; and breach of security of the insurer's or24
health maintenance organization's its data processing systems.25
(2) Educate appropriate employees on fraud detection and the insurer's or26
health maintenance organization's insurance anti-fraud plan.27 SB NO. 281 ENROLLED
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
(3) Provide for fraud investigations, whether through the use of internal fraud1
investigators or third-party contractors.2
(4) Report a suspected fraudulent insurance act, as defined by R.S.3
22:1923(1)(2), to the Department of Insurance as well as appropriate law4
enforcement and other regulatory authorities engaged in the investigation and5
prosecution of insurance fraud.6
(5) Pursue restitution for financial loss caused by insurance fraud, when7
applicable, relevant, and appropriate.8
C. The commissioner shall review the insurance anti-fraud plan submitted by9
each authorized insurer and each health maintenance organization pursuant to10
Subsection A of this Section to determine compliance with the requirements of this11
Section.12
D. The commissioner shall have the authority to may investigate and13
examine the records and operations of each authorized insurers and each health14
maintenance organizations to determine if the insurer or health maintenance15
organization has they have implemented and maintained compliance complied with16
the insurance anti-fraud plan.17
E. The commissioner is authorized to may direct any authorized insurer or18
health maintenance organization to make any modification to the insurer's or health19
maintenance organization's insurance anti-fraud plan necessary to obtain and20
maintain compliance comply with the requirements of this Section, and the21
commissioner may require any other reasonable remedial action to the insurer's or22
health maintenance organization's insurance anti-fraud plan if the investigation and23
examination reveals remedy substantial noncompliance by the insurer or health24
maintenance organization with the terms of the insurer's or health maintenance25
organization's insurance anti-fraud plan.26
F. The insurance anti-fraud plan and any summary report shall be filed with27
the commissioner on or before April first of each calendar year. Either on a calendar28
year basis or on whatever such other interval he the commissioner deems29
appropriate, the commissioner is authorized to may require that each authorized30 SB NO. 281 ENROLLED
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
insurer and each health maintenance organization file a summary report of any1
material change to the insurance anti-fraud plan, including the total number of claims2
and the number of claims referred to the commissioner as suspicious, and the3
commissioner is authorized to direct each insurer and each health maintenance4
organization as to may prescribe the format of the summary report.5
G. The insurance anti-fraud plan submitted to the department, as well as the6
summary report of the insurer's or health maintenance organization's insurance anti-7
fraud activities and results, and any summary report required by this Section are8
not public records and are exempt pursuant to R.S. 44:1 et seq., and specifically R.S.9
44:4.1(B)(10)(11), shall be and are hereby declared to be company proprietary and10
business confidential business records and not subject to public examination or11
subpoena.12
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: