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ANTI-FRAUD COMPLIANCE

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

Please note that the Department does not handle criminal investigations of insurance fraud. To report insurance fraud in PA, please visit our Reporting Insurance Fraud page.
 

FOR INDUSTRY

Compliance Requirements:

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.

Anti-Fraud Plan Submission:

In an effort to go paperless, the Pennsylvania Insurance Department, Anti-Fraud Compliance Division is requesting all Anti-Fraud plans be submitted electronically via email to ra-in-fraud@pa.gov.

   

Certification of No Business:

Effective 2019, this will be a component of the revised survey. This only applies to companies licensed but attesting that they did not write or service any premiums in PA during the calendar year surveyed.

 

Fraud Reporting:

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

Insurance companies are responsible for reporting suspected fraud. The requirements are clarified in the Pennsylvania Bulletin: Arson and Insurance Fraud Reporting: Notice 2017-10, found here. 

When licensees are involved, notification to the Department must be sent, in writing, to:

Pennsylvania Insurance Department
Attention: Bureau of Licensing & Enforcement
1227 Strawberry Square
Harrisburg, PA 17120
           
Anti-Fraud Insurer Assessment Invoices:

Two Pennsylvania Authorities issue insurers assessment invoices annually. These are not issued by PA Insurance Dept., we only become involved when they are not paid. Questions regarding these invoices should be directed to:

PA Insurance Fraud Prevention Authority (http://www.helpstopfraud.org/)

PA Auto Theft Prevention Authority (https://watchyourcar.org/)

            
Stay Informed:
To receive periodic communications directly related to anti-fraud compliance, please e-mail your name, agency and position to RA-IN-Fraud@pa.gov.

Helpful Anti-Fraud Resources: 
Model Anti-Fraud Plan Template


Statistical Reporting:
To contact the Anti-Fraud Compliance Division, e-mail ra-in-fraud@pa.gov
The Pennsylvania Insurance Department does not handle criminal insurance fraud investigations. Please see the Reporting Insurance Fraud page.