Department of Insurance Celebrates Response to Fraud in 2019

Fraud Bureau saw a 10% uptick in reports last year

The Delaware Department of Insurance made great strides in fraud detection and response during 2019. Throughout the year, 6 criminal arrests that included 21 charges were recommended from the Department’s Fraud Prevention Bureau to the Department of Justice, and 16 civil cases were brought forward resulting in more than $21,000 in fines. The Bureau received 551 referral cases in 2019.

“I want to commend our Fraud Prevention Bureau for their work identifying deceitful activity and helping to bring those who would defraud Delaware residents and companies to justice. Their efforts continue to send a strong message that fraud will not go unnoticed here, which can prevent future crimes,” said Commissioner Trinidad Navarro. “Through this work, we can help keep insurance premiums from rising by helping to make sure companies do not have to pay out fraudulent claims.”

Commissioner Navarro, who has a background in law enforcement, served as Vice-Chair of the National Association of Insurance Commissioners’ Antifraud Task Force over the last year and has championed fraud awareness and reporting. He was named Chair of the national Antifraud Task Force last week. The Department has experienced an increase reports over the past several years, with an approximate 23% increase since 2015.

In one prominent 2019 case, a resident was arrested after posing as family member who was terminally ill and facing imminent end-of life to open a life insurance policy. This was conducted through forgery of the family member’s identification, confirmation, and consent. After naming themself the sole beneficiary, the individual then attempted to collect $50,000 on the policy two days after the family member’s death. Charges included insurance fraud, identity theft, second-degree forgery, and crime against a vulnerable adult.

From identity theft to insurance healthcare fraud, hundreds of tips are investigated every year. In 2019, the most common schemes were seen through the application for auto insurance process, with individuals living outside the state attempting to save on premium costs by using Delaware addresses. Suspected to have risen due to possible economic factors, instances of application submissions occurring after an accident took place also grew. In addition to investigating tips from the public and insurance companies, the Bureau works with law enforcement in locating life insurance policies in death investigations.

The Fraud Prevention Bureau is fully funded by annual assessment fees, not taxpayer dollars, and employs 13 fulltime staff with extensive law enforcement and insurance investigative backgrounds and training, including credentials as Certified Fraud Specialists and Accredited Healthcare Fraud Investigators.

The Bureau facilitates the detection of insurance fraud and works to reduce fraud occurrence through enforcement and deterrence. Additionally, the Bureau requires restitution for deceptively obtained insurance benefits, and by doing so reduces the amount of premium dollars used to pay fraudulent claims, in turn decreasing the likelihood of premium increases.

The Delaware Department of Insurance Fraud Bureau can be reached toll free at (800) 632-5154, or (302) 672-7350, or by emailing fraud@delaware.gov. Reporting known or suspected fraud is free of charge and can be done confidentially.

Tweet this story


Commissioner Trinidad Navarro Appointed Chair of National Antifraud Task Force

Delaware Commissioner selected from leaders across the country to head important consumer-focused committee

Delaware Insurance Commissioner Trinidad Navarro was appointed Chair of the National Association of Insurance Commissioner’s Antifraud Task Force this week. Commissioner Navarro previously served as Vice-Chair of the committee, and served in law enforcement for much of his career before his election to Insurance Commissioner in 2016. The committee’s work takes on an inclusive consumer protection approach that encompasses identification and reduction of criminal efforts both by and against consumers.

“From my experience as a law enforcement officer to today, I have always prioritized the protection of our residents, and that means being proactive as well as responsive,” said Commissioner Navarro. “Fraud impacts everyone – even if you aren’t the target of a scheme. When an organization takes advantage of a consumer, it hurts the public trust as well as the customer’s wallet. When a resident commits fraud and takes money from an insurer, the companies make themselves whole by increasing costs on policyholders, even though it’s not their fault. Solutions to the problem are important, but we need to focus on stopping fraud before it starts.”

The Task Force works with insurance regulators across the country, as well as local, state, federal and international law enforcement and antifraud organizations. As Chair, Commissioner Navarro will work to provide guidance and resources for insurance departments across the country and in the U.S. Territories, including tracking and analyzing trends in fraud, one of which is the rapidly changing cybersecurity environment.

“Methods of fraud are always evolving, and with more of our personal data being shared digitally than ever, there is no more important time to place serious emphasis on fraud prevention than now,” said Commissioner Navarro. “To be successful, we have to be clear that a vital piece of protecting our policyholders lies in protecting their data.”

Data, its collection, use, and misuse, has quickly risen as a key issue within the insurance community and the public at large. In 2019, multiple data breaches at insurers impacted more than 100,000 Delaware residents. Commissioner Navarro, with the help of the General Assembly, worked to make sure that Delaware passed the Insurance Data Security Act following these breaches, one of the first states to do so.

Protecting residents and policyholders is central to the Commissioner’s administration. The Department of Insurance Fraud Bureau investigates consumer complaints and inquiries, polices the conduct of carriers, agents, and brokers doing business in Delaware, and prosecutes insurance fraud amongst other duties. From 2015 to date, the Bureau has seen an approximate 23% increase in reports. The department has brought forward 37 civil cases, 54 criminal charges, 18 criminal arrests, and more than $47,400 in civil penalties since 2018. In the same time period, 1,100 fraud tips and referrals have been provided to the office.

The Delaware Department of Insurance Fraud Division can be reached toll free at (800) 632-5154, or (302) 672-7350, or by emailing fraud@delaware.gov. Reporting known or suspected fraud is free of charge, and can be done confidentially.

Tweet this story


Delaware Issues RFP for Office of Value-Based Health Care Delivery

Delaware’s Department of Insurance is pleased to announce that it is actively recruiting for a qualified independent contractor to staff and run its new Office of Value-Based Health Care Delivery. The Office will assist the Insurance Commissioner and Delaware’s Primary Care Reform Collaborative in evaluating primary care accessibility and affordability statewide.

“Reducing health care costs in Delaware is a key priority of my administration,” said Insurance Commissioner Trinidad Navarro. “The team leading our Office of Value-Based Health Care Delivery needs to possess a high level of expertise in health care transformation and innovation. Together with the Primary Care Reform Collaborative, we intend to identify quantitative tools that will help increase the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates.”

Earlier this year, members of the General Assembly passed Senate Substitute 1 for Senate Bill No. 116, in order to create the Office. The Office was a recommendation of the Primary Care Reform Collaborative, which is tasked with evaluating the high costs of care in Delaware. In the months since passage, the Collaborative has been working hard to develop recommendations to strengthen Delaware’s primary care system.

“The legislature’s consideration of pro-consumer bills has allowed us to continue to foster an environment where residents are prioritized over profits,” said Leslie W. Ledogar, Esq, the Commissioner’s representative within the working group. “The Office of Value-Based Health Care Delivery epitomizes that vision, and we are grateful for everyone who spent time working on this effort.”

The Request for Proposal may be downloaded from the Office of Management and Budget website. Applicant questions should be directed to the Department’s Regulatory Specialist Leslie W. Ledogar, Esq.


Workers’ Compensation Rates Decrease Third Year in a Row

DOVER, DE – Delaware Insurance Commissioner Trinidad Navarro is pleased to announce that there will be another decrease in workers’ compensation insurance rates, effective December 1, 2019.

“I am delighted to approve a decrease in workers’ compensation rates in Delaware for the third year in a row,” stated Commissioner Navarro. “These continued decreases mean significant savings for Delaware businesses both large and small and continues to be an incentive for smaller businesses to relocate to Delaware and employ more Delawareans.”

The Delaware Compensation Rating Bureau workers’ compensation rate decreases were approved on Tuesday, October 8, 2019, after review by the Department of Insurance’s (“Department”) independent actuaries and the State’s Ratepayer Advocate and a public hearing before the Honorable Joshua Martin.  The decreases are an average -12.75% for the residual market and an average of -13.29% for the voluntary market.  It is important to keep in mind that these are average changes and actual changes to a particular policy may vary depending on, among other things, class codes or insureds.

Commissioner Navarro added further, “The continued hard work of everyone involved in this process especially over the last few years continues to ensure that the process is transparent and efficient.  I am also pleased that this is the first year that all actuaries reviewing this filing agreed, not only that another significant drop in workers’ compensation rates was warranted, but that the filing as submitted to the Department needed no changes.  Lastly, I want to again acknowledge the Department’s Workplace Safety Program and its dedicated staff for their work in helping Delaware businesses save up to 19% on premiums for providing a safe working environment.”

Employers who wish to take advantage of the Delaware Workplace Safety Program are encouraged to visit its webpage at www.insurance.delaware.gov/workplacesafety, or call our office directly at (302) 674-7377.

The approved amended DCRB filing No. 1902 can be found at http://www.dcrb.com/shared/d_contents.htm.

                                                                                               ###

 

Contact: Tanisha L. Merced, Esq.

Deputy Insurance Commissioner

Office:    (302) 674-7300

                                                           

Delaware Department of Insurance

http://www.insurance.delaware.gov

Dover Office: 302-674-7300

Consumer Services Division: 1-800-282-8611


Sussex County Woman Indicted for Insurance Fraud

Dover, DE—Janet Lane, 59, formerly of Ocean View, Delaware was indicted on Monday September 9th, 2019 by a Sussex County Grand Jury for two counts of insurance fraud and one count of identity theft following an investigation by the Delaware Department of Insurance Fraud Prevention Unit.

Ms. Lane had been a passenger in a car that was struck in a motor vehicle accident in July 2015.  Ms. Lane sustained injuries from the accident.  During the course of the claim process, Ms. Lane submitted a fraudulent wage and salary verification form to her insurance company, CSAA Insurance,  utilizing her past employer’s information and forged signature. She claimed that she was employed during the time of the July 2015 accident.  However, Ms. Lane was not employed at the time of the accident. In addition, Ms. Lane submitted a fraudulent doctor’s work note to CSAA Insurance.  Based upon the fraudulent documents, Lane received $15,488 for lost wages she was not entitled to receive from CSAA Insurance.

###

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@delaware.gov