Fraud
REQUIRED SUMMARY OF ANTI-FRAUD
The insurer, as defined in 10-1-102(6), C.R.S., is required to include a summary of its anti-fraud efforts as part of its annual statement, which is filed with the Division of Insurance ("Division") pursuant to C.R.S. §§10-3-109 and 10-1-128(5)(c). The insurer is not required to file its anti-fraud plan with the Division. The insurance company should file the summary of its anti-fraud efforts, on or before the first day of March each year, with its annual statement. The format of the summary should be submitted in a document, which is separate from the bound annual statement. The cover page of the submittal should be marked "CONFIDENTIAL." The title of the summary should be stated as "SUMMARY OF ANTI-FRAUD PLAN." The cover page should also contain the effective date of the anti-fraud plan, the name, title and phone number of the person completing the summary, the name of the company, the company address and the NAIC Company Code.
Compliance with the above format requirements is necessary to assure that the company's summary of its anti-fraud plan is correctly processed and maintained as a confidential document by the Division.
| Please note the following exemptions: |
| § 10-1-128(5) C.R.S., shall not apply to entities whose principal business is in the assumption of reinsurance contracts, reinsurance agreements, or reinsurance claims transactions. |
| § 10-16-421(1) C.R.S. Except for sections 10-1-102, 10-1-121, 10-1-122, 10-3-118, 10-3-128, and 10-3-208(7), and parts 4 to 8 of article 3 of this title, and as otherwise provided in this article, the provisions of the insurance law and provisions of nonprofit hospital, medical-surgical, and health service corporation laws shall not be applicable to any health maintenance organization granted a certificate of authority under this part 4. |
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