31A-31-112. Insurance antifraud plan.
(1) An insurer, as defined in Section, shall prepare, implement, and maintain an insurance antifraud plan for its operations in this state. 31A-31-102
(2) The insurance antifraud plan required by Subsectionshall outline specific procedures, actions, and safeguards that include how the authorized insurer or health maintenance organization will do each of the following: (1) detect, investigate, and prevent all forms of insurance fraud, including: fraud involving its employees or agents; fraud resulting from misrepresentations in the application, renewal, or rating of insurance policies; fraudulent claims; and breach of security of its data processing systems; educate employees of fraud detection and the insurance antifraud plan; provide for fraud investigations, whether through the use of internal fraud investigators or third-party contractors; report a suspected fraudulent insurance act, as described in Section, to the department as required by Section; and 31A-31-103 31A-31-110 pursue restitution for financial loss caused by insurance fraud.
(3) The commissioner may investigate and examine the records and operations of authorized insurers and health maintenance organizations to determine if they have implemented and complied with the insurance antifraud plan.
(4) The commissioner may: direct any modification to the insurance antifraud plan necessary to comply with the requirements of this section; and require action to remedy substantial noncompliance with the insurance antifraud plan.