Woman indicted for $16,000 of fraudulent insurance claims

Dover, DE   August 8, 2019 — A Wilmington woman was indicted by the New Castle County Grand Jury for insurance fraud and other felony charges. Theresa T. Milton, 44, of the 900 block of Clayton Street, was indicted on seven felony counts of insurance fraud, one felony count of theft by false pretense, and one count of falsifying business records. An Investigation by the Delaware Department of Insurance Fraud Prevention Bureau revealed that beginning on the 4th day of May, 2017, and continuing through on or about the 28th day of September, 2017, Theresa Milton submitted false claims for emergency medical services to Highmark BCBS of Delaware totaling slightly more than $16,000.  She had falsified invoices for out of network ambulance services and submitted claims for payment for those services to Highmark BCBS of Delaware.

Highmark became suspicious of one of the claims and made an inquiry to the ambulance service.  It was discovered that the claims appeared to be false, and the case was referred to the Department of Insurance Fraud Prevention Bureau for investigation.  The investigation substantiated the false claims with fictitious business records, and the indictment was issued.

Commissioner Trinidad Navarro stated, “The Fraud Unit of the Delaware Department of Insurance takes these cases seriously and actively investigates all reported cases of insurance fraud. We work closely with our partners at the Delaware Department of Justice to see these cases through, protecting consumers. A case such as this brings to light that insurance fraud costs everyone.”

If you suspect insurance fraud, you can report it by calling 302-674-7350, or email to fraud@delaware.gov.

 

The Delaware Department of Insurance protects Delawareans through regulation and education while providing oversight of the insurance industry to best serve the public.

Contact: Vince Ryan
Office: (302) 674-7303
Mobile: (302) 387-7670
Email: vince.ryan@sdelaware.gov


Insurance Data Security Act Signed into Law

On Wednesday, July 31, 2019, Governor John C. Carney, Jr., signed House Bill 174 (“HB 174”) into law. Titled the Delaware Insurance Data Security Act, this law is based on an NAIC Model Act, which establishes a comprehensive regulatory framework requiring insurers licensed to do business in Delaware to implement information security programs, report instances of data breaches in a prescribed timely manner to the Commissioner and consumers, and empowers the Department of Insurance to investigate violations of the Act and levy penalties accordingly.

HB 174’s prime sponsors were Representative William Bush, Chair of the House Economic Development, Banking, Insurance & Commerce Committee, and Senator Trey Paradee, also of Dover, and Chair of the Senate Business, Banking & Insurance Committee. Additional sponsors include a bipartisan roster of Representative Krista Griffith, Chair of the House Telecommunication, Internet & Technology Committee, Senate Majority Leader Nicole Poore, Senators Brian Pettyjohn and David Sokola, and Representatives Paul Baumbach, Sherry Dorsey Walker, Timothy Dukes, Sean Matthews, Ray Seigfried, and Michael Smith.

Regarding Governor Carney’s signing of the bill into law, Delaware Insurance Commissioner Trinidad Navarro remarked on how the Act will enhance consumer protection in Delaware.

“When hardworking consumers entrust their personal information to their insurance companies, they have a reasonable expectation that their carriers will do everything they can to safeguard that information,” stated Navarro. “Over the past several years, we have seen time and again consumers’ information be compromised or stolen by hackers’ cyber threats to insurers. By codifying a regulatory standard that requires all insurance licensees in Delaware to implement information security programs and timely report data breaches to the Department and consumers, HB 174 enhances Delaware’s consumer protection measures to hold companies accountable and give consumers the peace of mind that they deserve. I thank Governor Carney and the General Assembly for recognizing the importance of this legislation and enacting it into law.”

Prior to the implementation of this law, there were no standards for insurance companies to follow regarding protection of consumers’ data, and notifying the Department. Historically, when an insurer determined that a data breach had occurred, notification to the Department of Insurance was delayed, sometimes by several months. Notably, this Act accomplishes the following:

  1. Requires insurance companies to implement information security programs and conduct risk assessments to try to prevent data breaches and compromising of consumers’ Nonpublic Information and personal data;
  2. Requires insurers to conduct thorough investigations to determine if a cybersecurity event or data breach may have occurred and whose data may have been compromised;
  3. Notify the Insurance Commissioner within three (3) business days of determining that a data breach or cybersecurity event has occurred;
  4. Mandates that insurers notify all impacted consumers within sixty (60) days of the determination that their data has or may have been compromised;
  5. Requires that insurers offer free credit monitoring services for one year to consumers impacted by breaches; and
  6. Endows the Commissioner with the power to investigate the affairs of any insurer to determine whether they have been engaged in any conduct in violation of this Act and take action accordingly.

“In our fast-paced, technology-driven society, we have to take the necessary steps to put strong consumer protections and data security in place. Data breaches are personal, comprising critical information and forcing an individual to rebuild their entire lives,” said Rep. William Bush, chief sponsor of HB 174. “Instituting a framework with safeguards to protect Delawareans from insurance data breaches is the right thing to do. This comprehensive legislation enhances consumers’ data privacy and protection, with the ultimate goal of giving them peace of mind and security.”

“Insurance companies hold some of the most sensitive information about our residents, but until now had no state-mandated rules to follow for protecting that data or reporting hacks to consumers,” said Sen. Trey Paradee, the bill’s prime Senate sponsor. “While we can’t stop every data breach, we can – and must – do more to ensure that insurance companies are taking steps to protect Delawareans’ private data and notify customers when their information is compromised. Delaware Insurance Commissioner Trinidad Navarro deserves a lot of credit for bringing this matter to our attention and working with us to get this legislation passed.”

Work on enhancing insurance data security began after the Anthem data breach in 2015, in which hackers compromised nearly 80 million individuals’ personal information. Since then, there have been 15 insurance data breaches with Delawareans impacted, the most recent one involving Dominion National, a dental insurance carrier. The number of Delawareans impacted during the breaches during that period of time ranged from one policyholder to over 95,000 policyholders.

HB 174 passed the House on June 13, 2019, with 40 ‘yes’ votes. The bill cleared its final hurdle on June 26, 2019, with the Delaware Senate voting unanimously in favor. Consumers and producers who have questions about the new law are encouraged to contact the Department of Insurance’s Consumer Services Division at (302) 674-7310 or by email.

 


How to Report Storm Damage in Delaware

Dover, DE – Monday, April 15, 2019,  With the aftermath of Delaware’s first spring storm now starting, here are some things to help you with storm damage to your property.

  • Ensure everyone is safe and it is safe to enter the area
  • Contact your insurance company before you begin cleaning up or making repairs
  • Take pictures of any damage you see
  • After you’ve taken photographs, make repairs that will prevent further damage (cover broken windows, damaged walls, and leaking roofs), but DO NOT make permanent repairs

If you suffer property loss, your insurance company should inspect the property first and an agreement should be reached on the cost of permanent repairs. Save all receipts, including those from temporary repairs, for your insurance adjuster. With proper documentation and your full cooperation, you can avoid delays in processing your claims.

Delaware Insurance Commissioner Navarro said, “I’d like to emphasize the importance of taking the aforementioned actions when making a claim with your insurance company.  These are important steps that will greatly assist you if the need arises to make a claim. The storm last night that brought significant damage to parts of Sussex County and some other areas of our state is a reminder that these events can happen with little or no warning, and change lives forever.  ”

In the unfortunate event that you suffer property loss or damage, a Home Inventory makes the claims process much easier. Including the brand name, model and serial numbers, date of purchase, receipts, and photos in the inventory helps the insurance company make a quick and accurate assessment of your loss. An alternative to a written inventory is to photograph or video each room of your home and its respective content. The more detailed the photographs or video (open drawers, closets, sheds and garages), the more accurately your loss can be evaluated.

For posterity, email inventories, photographs, policies and emergency lists to yourself and/or a trusted friend or family member living outside of the storm’s threat. Keeping your insurance policy, inventory, and quick reference list together and stored in a waterproof, fireproof box, or safe, is a good idea. If you evacuate, remember to take this information with you.

Find a printable Home Inventory here:

https://insurance.delaware.gov/wp-content/uploads/sites/15/2018/09/Home-Inventory-Form-2018.pdf

 

If you have any problems processing your claims, do not hesitate to reach out to the Delaware Department of Insurance at 302-674-7300. Visit our website at insurance.delaware.gov.

 

Contact: Vince Ryan

Office: (302) 674-7303

Email: vince.ryan@delaware.gov

                                                         

Delaware Department of Insurance

http://www.insurance.delaware.gov

Dover Office: 302-674-7300

Consumer Services Division: 1-800-282-8611


Health Insurance Marketplace Open Enrollment Period Ends January 31; See Plan Options and Enroll at Healthcare.gov

Dover, DE-The open enrollment period for the Health Insurance Marketplace ends on January 31, 2017. If you qualify for coverage through the Marketplace, tomorrow is the last day you will be able to sign up for a health insurance plan for 2017. In previous years there has been a surge in website traffic and phone calls to sign up in the final days of the open enrollment period, sometimes causing the federal government to issue extensions. No extensions are expected to be issued this year so consumers need to sign up now if they want to be covered. “Eight out of ten uninsured Delawareans who were eligible for a Marketplace plan qualified for some level of financial assistance to help offset the cost of monthly premiums,” said Insurance Commissioner Trinidad Navarro.

Ready to enroll? Consumers can find more details about the various plans and their related premiums and deductibles, as well as any potential premium subsidies they may be eligible for www.healthcare.gov. Federal application counselors are also available to help with enrollment 24 hours a day, 7 days a week, by calling 1-800-318-2596. All of the plans sold on the federal marketplace meet the coverage standards and consumer protections mandated by the Affordable Care Act (ACA).

“It is important for consumers to be cautious when shopping for health insurance coverage outside of the Marketplace, especially when looking for plans online,” said Commissioner Navarro. The Department of Insurance’s Consumer Services Division has received numerous complaints from members of the public who thought they had enrolled in an ACA-compliant plan only to learn that they had actually purchased a limited benefit plan. A limited benefit medical plan is not a comprehensive major medical plan, nor is it intended to replace a major medical plan.

After January 31, 2017, you cannot buy a health insurance plan for the rest of 2017 unless you have a qualifying life event—a change in your situation like having a baby, getting married, or losing other health coverage — which makes you eligible for a Special Enrollment Period. Once you have enrolled in a plan, check your mail for information from your insurance company. When a welcome packet has arrived or is delivered to your email inbox, be sure to read the information thoroughly and save everything in a secure place.

It is also very important that you pay your premium on time. If you fail to pay your monthly premiums then your insurance company can eventually cancel your policy. If your policy is cancelled due to non-payment you will likely not qualify for any other coverage until January 1, 2018.

“When you are shopping for health insurance coverage it is important to consider more than just the cost of the monthly premium alone,” said Commissioner Navarro. “Before you enroll in a plan make sure you know how much the deductible will be since deductibles on different plans can vary by thousands of dollars. It is also important to see what the plan will require you to contribute for co-pays or co-insurance,” he said. Need help understanding the words and terms used by the health insurance industry? Visit https://www.healthcare.gov/glossary/ for simple definitions.

Small businesses can apply for SHOP coverage for their employees any time, all year. Simply click on the Small Business tab at the top of Healthcare.gov to get started.

For more information about health insurance visit www.choosehealthde.com or www.healthcare.gov.

Additional resources are available at insurance.delaware.gov. Consumers in Delaware who have insurance related issues or complaints may also contact the Delaware Department of Insurance Consumer Services Division at 1-800-282-8611.

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Contact: Vince Ryan

Office: (302) 674-7303

Mobile: (302) 387-7670

Vince.Ryan@delaware.gov

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Delaware Department of Insurance

http://www.insurance.delaware.gov

Dover Office: 302-674-7300

Consumer Services Division: 1-800-282-8611


19,000 Delaware Consumers Affected by Data Breach

DOVER, DE— As a result of multiple consumer complaints, the Delaware Department of Insurance has been made aware of a security breach, involving Summit Reinsurance Services, Inc. (“SummitRe”) and BCS Financial Corporation, both subcontractors of Highmark Blue Cross Blue Shield of Delaware. The breach affects thousands of Delawareans with employer-paid plans. As reported by Karen Kane, Director of Privacy and Information Management for Highmark Blue Cross Blue Shield of Delaware, the breach impacts a total of sixteen current and former Highmark self-insured customers and approximately 19,000 of their members. In response, Commissioner Navarro issued the following statement:

 

“We are aware of the reported breach. I would like to ensure Delaware consumers that the Department of Insurance takes this matter seriously and is currently investigating how this occurred. I have directed my staff to closely monitor the situation as it develops. Many Delawareans have received mailed correspondence frpom SummitRe explaining the breach (See Attachment). Unfortunately, we fear that many may have misinterpreted or inadvertently discarded the letter as some form of a sales ad (due to the fact that they had not purchased any line of insurance from SummitRe).  If consumers have received a letter from SummitRe regarding this situation and have questions, they may contact the Delaware Department of Insurance at 1-800-282-8611 or 302-674-7300, or by e-mail at consumer@delaware.gov.”

 

The Commissioner has ordered an investigation into the reported breach. Highmark Blue Cross Blue Shield of Delaware is cooperating with the Delaware Department of Insurance to resolve the matter.

 

PDF attachment: 19000-de-consumers-affected-by-data-breach-1-13-17

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Contact: Vince Ryan

Office: (302) 674-7303

Mobile: (302) 387-7670

Email: vince.ryan@delaware.gov