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Anti-Fraud Compliance 


 

The Department's Anti-Fraud Compliance Division works to ensure licensed entities are in compliance with state & federal fraud regulations aimed at increasing the detection, investigation, prosecution and prevention of insurance fraud in Pennsylvania.


The Department has compiled an overview of Anti-Fraud compliance requirements, available here.  Please note this is general guidance and a brief summary of the Commonwealth's Anti-Fraud plan filing, reporting and compliance requirements.  You should consult the actual statutes and regulations for a complete understanding of all requirements associated with Anti-Fraud plans, filings, reporting and compliance.


Insurers are responsible for meeting the reporting requirements in a timely manner as set forth below.  Insurance companies failing to file or timely file statements or reports are subject to the penalty provisions of Section 320(e)(1) (40 P.S. §443) of The Insurance Company Law.  Extensions to the filing deadline may be considered at the discretion of the Division Chief.  Any request for an extension must be submitted via mail or email no later than 10 business days prior to the filing deadline.  Extensions will be considered on a case-by-case basis.


Special Market Notice regarding Insurance Fraud Investigations, issued 7/14/2017... 
 

To report Insurance Fraud in PA, please visit our
Reporting Insurance Fraud page.


Helpful Anti-Fraud Resources for Licensees: 
A Matrix of Pennsylvania Anti-Fraud Compliance Requirements
Anti-Fraud Compliance Reporting & Filing Requirements
Anti-fraud Guidelines

Model Plan Template


Anti-Fraud Statistical Reporting

Anti-Fraud Statistical Reporting FAQ's


To contact the Anti-Fraud compliance division, email ra-in-fraud@pa.gov