Florida Senate - 2022 (PROPOSED BILL) SPB 7016 FOR CONSIDERATION By the Committee on Banking and Insurance 597-00969-22 20227016pb 1 A bill to be entitled 2 An act relating to a review under the Open Government 3 Sunset Review Act; amending s. 626.9891, F.S., which 4 provides an exemption from public records requirements 5 for certain information submitted by insurers to the 6 Department of Financial Services; removing the 7 scheduled repeal of the exemption; providing an 8 effective date. 9 10 Be It Enacted by the Legislature of the State of Florida: 11 12 Section 1. Section 626.9891, Florida Statutes, is amended 13 to read: 14 626.9891 Insurer anti-fraud investigative units; reporting 15 requirements; penalties for noncompliance.— 16 (1) As used in this section, the term: 17 (a) “Anti-fraud investigative unit” means the designated 18 anti-fraud unit or division, or contractor authorized under 19 subparagraph (2)(a)2. 20 (b) “Designated anti-fraud unit or division” includes a 21 distinct unit or division or a unit or division made up of 22 employees whose principal responsibilities are the investigation 23 and disposition of claims who are also assigned investigation of 24 fraud. 25 (2) By December 31, 2017, every insurer admitted to do 26 business in this state shall: 27 (a)1. Establish and maintain a designated anti-fraud unit 28 or division within the company to investigate and report 29 possible fraudulent insurance acts by insureds or by persons 30 making claims for services or repairs against policies held by 31 insureds; or 32 2. Contract with others to investigate and report possible 33 fraudulent insurance acts by insureds or by persons making 34 claims for services or repairs against policies held by 35 insureds. 36 (b) Adopt an anti-fraud plan. 37 (c) Designate at least one employee with primary 38 responsibility for implementing the requirements of this 39 section. 40 (d) Electronically file with the Division of Investigative 41 and Forensic Services of the department, and annually 42 thereafter, a detailed description of the designated anti-fraud 43 unit or division or a copy of the contract executed under 44 subparagraph (a)2., as applicable, a copy of the anti-fraud 45 plan, and the name of the employee designated under paragraph 46 (c). 47 48 An insurer must include the additional cost incurred in creating 49 a distinct unit or division, hiring additional employees, or 50 contracting with another entity to fulfill the requirements of 51 this section, as an administrative expense for ratemaking 52 purposes. 53 (3) Each anti-fraud plan must include: 54 (a) An acknowledgment that the insurer has established 55 procedures for detecting and investigating possible fraudulent 56 insurance acts relating to the different types of insurance by 57 that insurer; 58 (b) An acknowledgment that the insurer has established 59 procedures for the mandatory reporting of possible fraudulent 60 insurance acts to the Division of Investigative and Forensic 61 Services of the department; 62 (c) An acknowledgment that the insurer provides the anti 63 fraud education and training required by this section to the 64 anti-fraud investigative unit; 65 (d) A description of the required anti-fraud education and 66 training; 67 (e) A description or chart of the insurer’s anti-fraud 68 investigative unit, including the position titles and 69 descriptions of staffing; and 70 (f) The rationale for the level of staffing and resources 71 being provided for the anti-fraud investigative unit which may 72 include objective criteria, such as the number of policies 73 written, the number of claims received on an annual basis, the 74 volume of suspected fraudulent claims detected on an annual 75 basis, an assessment of the optimal caseload that one 76 investigator can handle on an annual basis, and other factors. 77 (4) By December 31, 2018, each insurer shall provide staff 78 of the anti-fraud investigative unit at least 2 hours of initial 79 anti-fraud training that is designed to assist in identifying 80 and evaluating instances of suspected fraudulent insurance acts 81 in underwriting or claims activities. Annually thereafter, an 82 insurer shall provide such employees a 1-hour course that 83 addresses detection, referral, investigation, and reporting of 84 possible fraudulent insurance acts for the types of insurance 85 lines written by the insurer. 86 (5) Each insurer is required to report data related to 87 fraud for each identified line of business written by the 88 insurer during the prior calendar year. The data shall be 89 reported to the department by March 1, 2019, and annually 90 thereafter, and must include, at a minimum: 91 (a) The number of policies in effect; 92 (b) The amount of premiums written for policies; 93 (c) The number of claims received; 94 (d) The number of claims referred to the anti-fraud 95 investigative unit; 96 (e) The number of other insurance fraud matters referred to 97 the anti-fraud investigative unit that were not claim related; 98 (f) The number of claims investigated or accepted by the 99 anti-fraud investigative unit; 100 (g) The number of other insurance fraud matters 101 investigated or accepted by the anti-fraud investigative unit 102 that were not claim related; 103 (h) The number of cases referred to the Division of 104 Investigative and Forensic Services; 105 (i) The number of cases referred to other law enforcement 106 agencies; 107 (j) The number of cases referred to other entities; and 108 (k) The estimated dollar amount or range of damages on 109 cases referred to the Division of Investigative and Forensic 110 Services or other agencies. 111 (6) In addition to providing information required under 112 subsections (2), (4), and (5), each insurer writing workers’ 113 compensation insurance shall also report the following 114 information to the department, on or before March 1, 2019, and 115 annually thereafter: 116 (a) The estimated dollar amount of losses attributable to 117 workers’ compensation fraud delineated by the type of fraud, 118 including claimant, employer, provider, agent, or other type. 119 (b) The estimated dollar amount of recoveries attributable 120 to workers’ compensation fraud delineated by the type of fraud, 121 including claimant, employer, provider, agent, or other type. 122 (c) The number of cases referred to the Division of 123 Investigative and Forensic Services, delineated by the type of 124 fraud, including claimant, employer, provider, agent, or other 125 type. 126 (7) An insurer who obtains a certificate of authority has 6 127 months in which to comply with subsection (2), and one calendar 128 year thereafter, to comply with subsections (4), (5), and (6). 129 (8) If an insurer fails or otherwise refuses to comply with 130 the provisions of this section, the department, office, or 131 commission may: 132 (a) Impose an administrative fine of not more than $2,000 133 per day for such failure until the department, office, or 134 commission deems the insurer to be in compliance; 135 (b) Impose an administrative fine for failure by an insurer 136 to implement or follow the provisions of an anti-fraud plan or 137 anti-fraud investigative unit description; or 138 (c) Impose the provisions of both paragraphs (a) and (b). 139 (9) On or before December 31, 2018, the Division of 140 Investigative and Forensic Services shall create a report 141 detailing best practices for the detection, investigation, 142 prevention, and reporting of insurance fraud and other 143 fraudulent insurance acts. The report must be updated as 144 necessary but at least every 2 years. The report must provide: 145 (a) Information on the best practices for the establishment 146 of anti-fraud investigative units within insurers; 147 (b) Information on the best practices and methods for 148 detecting and investigating insurance fraud and other fraudulent 149 insurance acts; 150 (c) Information on appropriate anti-fraud education and 151 training of insurer personnel; 152 (d) Information on the best practices for reporting 153 insurance fraud and other fraudulent insurance acts to the 154 Division of Investigative and Forensic Services and to other law 155 enforcement agencies; 156 (e) Information regarding the appropriate level of staffing 157 and resources for anti-fraud investigative units within 158 insurers; 159 (f) Information detailing statistics and data relating to 160 insurance fraud which insurers should maintain; and 161 (g) Other information as determined by the Division of 162 Investigative and Forensic Services. 163 (10) The department may adopt rules to administer this 164 section, except that it shall adopt rules to administer 165 subsection (5). 166 (11)(a) The information submitted to the department 167 pursuant to paragraphs (3)(d), (e), and (f) and paragraphs 168 (5)(d), (e), (f), (g), and (k) is exempt from s. 119.07(1) and 169 s. 24(a), Art. I of the State Constitution. 170 (b)
This subsection is subject to the Open Government171 Sunset Review Act in accordance with s. 119.15 and shall stand172 repealed on October 2, 2022, unless reviewed and saved from173 repeal through reenactment by the Legislature.174 (c)This exemption applies to records held before, on, or 175 after the effective date of this act. 176 Section 2. This act shall take effect October 1, 2022.