Ohio Insurance Director Issues Updated Bulletin Instructing Insurers Report Insurance Fraud To The Department


Columbus, OH (CompNewsNetwork) - Ohio Director Mary Jo Hudson issued an updated Reporting Suspected Fraudulent Claims bulletin, 2008-09, to outline specific procedures Ohio-licensed insurers should follow when a consumer or health care provider is suspected of committing insurance fraud. This bulletin supersedes bulletin 96-1, dated July 2, 1996.

The bulletin requires an insurer to report insurance fraud to the Department's Fraud Division involving claims more than $1,000. Claims must be reported within 60 days of receiving proof of loss (property and casualty claims) or after the fraud becomes evident (for health claims). If fraud is detected after this timeframe, the evidence should immediately be reported to the Department's Fraud Division.

Permissible reporting methods include: filing the referral electronically on-line through the National Association of Insurance Commissioner's (NAIC) fraud reporting system (preferred method) or with the Department's Fraud Division; mailing, faxing or emailing it to the Department's Fraud Division; and filing the referral with the National Insurance Crime Bureau (NICB), which will forward the information to the Department.

Kickbacks Prohibited bulletin 87-2 was also rescinded by Director Hudson. The bulletin's pertinent material has been included in Ohio Administrative Code 3901-1-24, Public Insurance Adjustors.

These bulletin changes are effective as of Oct. 3, 2008.

The bulletins are available on the Department's web site, www.ohioinsurance.gov. Those with questions can contact the Department's Legal Division at 614-644-2640.

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