2024 Membership

The mission of the Antifraud (D) Task Force is to serve the public interest by assisting the state insurance supervisory officials, individually and collectively, through the detection, monitoring, and appropriate referral for the investigation of insurance crime, both by and against consumers. The Task Force will assist the insurance regulatory community by conducting the following activities: 1) maintaining and improving electronic databases regarding fraudulent insurance activities; 2) disseminating the results of research and analysis of insurance fraud trends, as well as case-specific analysis, to the insurance regulatory community; and 3) providing a liaison function between state insurance regulators, law enforcement—i.e., federal, state, local, and international—and other specific antifraud organizations. The Task Force will also serve as a liaison with the NAIC Information Technology Group (ITG) and other NAIC committees, task forces, and/or working groups to develop technological solutions for data collection and information sharing. The Task Force will monitor all aspects of antifraud activities by its working groups on the following charges.

2025 Proposed Charges

1.    The Antifraud (D) Task Force will:

• A.    Work with NAIC committees, task forces, and working groups (e.g., Title Insurance (C) Task Force, etc.) to review issues and concerns related to fraud activities and schemes related to insurance fraud.
• B.    Coordinate efforts to address national concerns related to agent fraud and activities of unauthorized agents related to insurance sales.
• C.    Coordinate the enforcement and investigation efforts of state and federal securities regulators with state insurance fraud bureaus.
• D.    Coordinate with state, federal, and international law enforcement agencies in addressing antifraud issues relating to the insurance industry.
• E.    Review and provide comments to the International Association of Insurance Supervisors (IAIS) on its Insurance Core Principles (ICPs) related to insurance fraud.
• F.    Coordinate activities and information from national antifraud organizations, and provide information to state insurance fraud bureaus.
• G.    Coordinate activities and information with state and federal fraud divisions to determine guidelines that will assist with reciprocal involvement concerning antifraud issues resulting from natural disasters and catastrophes.
• H.    Coordinate efforts with the insurance industry to address antifraud issues and concerns.
• I.    Evaluate and recommend methods to track national fraud trends.
• J.    Develop seminars, trainings, and webinars regarding insurance fraud. Provide three webinars by the 2025 Fall National Meeting.

2.    The Antifraud Technology (D) Working Group will:

• A.    Work with the NAIC to develop an Antifraud Plan Repository to be used by insurers to create and store an electronic fraud plan for distribution among the states/jurisdictions. Complete by the 2025 Fall National Meeting.
• B.    Evaluate sources of antifraud data, and propose methods for enhancing the utilization and exchange of information among state insurance regulators, fraud investigative divisions, law enforcement officials, insurers, and antifraud organizations. Complete by the 2025 Fall National Meeting.

3.    The Improper Marketing of Health Insurance (D) Working Group will:

• A.    Coordinate with state insurance regulators, both on a state and federal level, to provide assistance and guidance monitoring the improper marketing of health plans, and coordinate appropriate enforcement actions, as needed, with other NAIC committees, task forces, and working groups.
• B.    Review existing NAIC models and guidelines that address the use of lead generators for sales of health insurance products, and identify models and guidelines that need to be updated or developed to address current marketplace activities.
   

2024 Adopted Charges

1. The Antifraud (D) Task Force will:
     A. Work with NAIC committees, task forces, and working groups (e.g., Title Insurance (C) Task Force, etc.) to review                issues and concerns related to fraud activities and schemes related to insurance fraud.
     B. Coordinate efforts to address national concerns related to agent fraud and activities of unauthorized agents related              to insurance sales.
     C. Coordinate the enforcement and investigation efforts of state and federal securities regulators with state insurance             fraud bureaus.
    D. Coordinate with state, federal, and international law enforcement agencies in addressing antifraud issues relating to             the insurance industry.
    E.  Review and provide comments to the International Association of Insurance Supervisors (IAIS) on its Insurance                   Core Principles (ICPs) related to insurance fraud.
    F.  Coordinate activities and information from national antifraud organizations and provide information to state insurance           fraud bureaus.
   G. Coordinate activities and information with state and federal fraud divisions to determine guidelines that will assist with          reciprocal involvement concerning antifraud issues resulting from natural disasters and catastrophes.
   H. Coordinate efforts with the insurance industry to address antifraud issues and concerns.
    I.  Evaluate and recommend methods to track national fraud trends.
   J.  Develop seminars, trainings, and webinars regarding insurance fraud. Provide three webinars by the 2024 Fall                    National Meeting.

2.  The Antifraud Technology (D) Working Group will:
      A. Work with the NAIC to develop an Antifraud Plan Repository to be used by insurers to create and store an                             electronic fraud plan for distribution among the states/jurisdictions. Complete by the 2024 Fall National Meeting.
      B. Evaluate sources of antifraud data and propose methods for enhancing the utilization and exchange of information               among state insurance regulators, fraud investigative divisions, law enforcement officials, insurers, and antifraud                 organizations. Complete by the 2024 Fall National Meeting.

3.  The Improper Marketing of Health Insurance (D) Working Group will:
      A. Coordinate with state insurance regulators, both on a state and federal level, to provide assistance and guidance                monitoring the improper marketing of health plans and coordinate appropriate enforcement actions, as needed,                    with other NAIC committees, task forces, and working groups.
      B. Review existing NAIC models and guidelines that address the use of lead generators for sales of 
          health insurance products and identify models and guidelines that need to be updated or developed 
          to address current marketplace activities.