Frequently Asked Questions about filing an Anti-Fraud Plan
with the Louisiana Department of Insurance (LDI)

1. Does my company need to file?
If your company is an authorized insurer or health maintenance organization licensed to operate in Louisiana, then Yes.

2. Are there exemptions to filing?
Yes, if you are a “small” company as defined by La. R.S. 22:46 you can qualify for an exemption. A list of exempt entities is maintained by the Office of Financial Solvency.

3. When is the filing required?
For a newly licensed entity, the initial filing is required within 60 days of becoming authorized. The summary report is due between January 1 and April 1 for every calendar year the entity was authorized at any point in the prior year.

4. What is required in the filing?
The requirements for the initial filing are included in La. R.S. 22:572.1(B). The statute referencing the summary report was changed in 2024. The new guidelines and revised statute, La. R.S. 22:572.1(F), can be found below.

5. Are required figures dependent on lines of authority in the summary report?
The references to lines of business (authority) are for organizational purposes. The figures provided should include all lines of authority for the authorized entity from the previous calendar year.

6. Where is the filing made?
All Anti-Fraud Plan filings are made through the Industry Access Portal. Each authorized entity will have an administrator set up in conjunction with the Department of Insurance. That administrator has access to the Anti-Fraud Plan Module where the filing is made. The administrator also has the ability to grant access to someone else to make the filing on behalf of the authorized entity.

7. What needs to be done if we have changes to the initial plan filed previously?
Material changes in the Anti-Fraud Plan for the authorized entity must be reported like a summary report. The module will allow multiple material change filings where a copy of the updated Anti-Fraud Plan can be uploaded during a calendar year. The summary report will be a one-time filing in each calendar year.

8. What should I do if there are problems with any of the filings?
Technical issues will likely need to be handled by the LDI IT team. Access to the Module may require Company Licensing assistance, and questions about the filings will be handed by the Office of Insurance Fraud (OIF). Please call the OIF at (225) 342-4956 and the problem/question will be directed to the appropriate party.

The pertinent changes in LA. R.S. 22:572.1 are the following:

F. (1) The insurance anti-fraud plan and any summary report shall be filed with the commissioner on or before April first of each calendar year.

(2) Either on a calendar year basis or such other interval that the commissioner deems appropriate, the commissioner may require that each authorized insurer and each health maintenance organization file a summary report of any material change to the insurance anti-fraud plan, including the total number of claims and the number of claims referred to the commissioner as suspicious, and all of the following information:

(a) The number of policies in effect.

(b) The amount of premiums written for policies.

(c) The number of claims received.

(d) The number of claims referred for investigation to the insurer's fraud investigators.

(e) The number of claims investigated or accepted by the insurer's fraud investigators.

(f) The number of insurance fraud matters investigated or accepted by the insurer's fraud investigators that were not claim related.

(g) The number of cases referred to the department.

(h) The estimated dollar amount of losses attributable to fraudulent insurance acts, organized by type of fraud, including claimant, employer, provider, agent, and other types.

(i) The estimated dollar amount of recoveries attributable to fraudulent insurance acts, organized by type of fraud, including claimant, employer, provider, agent, and other types.

(j) The dollar amount of claims denied or not paid based on fraud investigation organized by product line.

(k) Quantification of the resources committed to investigating insurance fraud, organized by line of business, for the prior year.

For clarification, the OIF has also provided the following definitions for
Reporting Requirements in relation to the 11 fields:

(a) Number of policies in effect at the end of the calendar year for which the fraud report is being filed.

(b) Total dollar amount of premium written for all policies in the year for which the fraud report is being filed.

c) Count of all claims in the year for which the fraud report is being filed.

(d) Number of claims referred to the company’s internal fraud investigator or fraud investigation unit.

(e) Number of accepted for investigation by the company’s internal fraud investigator or fraud investigation unit.

(f) Same as (e) but accounts for all other fraud not related to claims (premium evasion fraud, application fraud, etc.).

(g) Number of referrals submitted to the LDI pursuant to RS 22:1926.

(h) Estimated dollar amount for losses, paid and unpaid, organized by claimant fraud, provider fraud, agent fraud or other fraud.

(i) Recoveries accounts for restitution or claims that were paid and the money was recovered by the company.

(j) Any claim or portion of claim that did not get paid based on a finding of fraud organized by product line.

(k) Total dollar amount expended to investigate or mitigate fraud (outsourcing the PIs, cars, gas, analytics tools, fraud designated staffing).

View La. R.S. 22:572.1 in its entirety here. Additional questions can be directed to the LDI’s Office of Insurance Fraud at (225) 342-4956.