DFS : Protecting Marketplace Standards
- DFS | Protecting Marketplace Standards
Policyholders, Bill of Rights
Florida Insurance Code’s primary purpose is to protect the rights of the insurance buying consumer. The principles expressed in the following statements shall serve as standards to be followed by the Department of Financial Services (DFS), Financial Services Commission, and Office of Insurance Regulation (OIR) in exercising their powers and duties, in exercising administrative discretion, in dispensing administrative interpretations of the law, and in adopting rules.
Policyholders shall have the right to,
- Competitive pricing practices and marketing methods that enable them to determine the best value among comparable policies,
- Obtain comprehensive coverage,
- Insurance advertising and other selling approaches that provide accurate and balanced information on the benefits and limitations of a policy.
- A Financially Stable insurance company,
- Be serviced by a competent, honest insurance agent (or broker),
- A reasonably readable policy.
- An insurance company which provides an economic delivery of coverage and tries to prevent losses whenever possible,
- A balanced and positive regulation by the department, commission, and office.
The Department has jurisdiction over entities who knowingly submit false, misleading or fraudulent information on an application or other document required when applying for licensure as a Health Care Clinic, seeking an exemption from licensure as a Health Care Clinic, or entities demonstrating *compliance to provide services or seek reimbursement under the Florida Motor Vehicle No-Fault Law.
- [Define] Fraudulent Insurance Act:
Acting with the intent to defraud by either concealing, presenting (submitting), preparing, or allowing any type of information which contains misleading or false information to be presented to an insurer (or by an insurer) as truthful within an; application for insurance, the rating of any insurance policy, claim for payment and any other benefit associated with an insurance policy.
If, the Department or its Division of Investigative and Forensic Services has reason to believe a person or entity currently or in the past has engaged in a “Fraudulent Insurance Act” or any other action, behavior or practice which is deemed “Unfair” or “Punishable” it may, administer oaths and affirmations, request the attendance of witnesses or proffering of matter, and collect evidence.
- [S.624.15] Florida Insurance Code
Insurance Insights | News You Can Use
“Insurance fraud is a crime that affects all Floridians while undermining the integrity of health care markets. As your CFO, I’m committed to leveraging every resource possible and maximizing our partnerships across the state to bring these criminals to justice. I commend my dedicated insurance fraud detectives for their hard work on this case and the Palm Beach State Attorney’s Office for seeking to hold criminals like this accountable.”
- CFO Jimmy Patronis
- PRESS RELEASE: Tuesday, March 30, 2021
CFO Jimmy Patronis Announces Arrest of Palm Beach County Resident in Disability Insurance Fraud Scheme
Chief Financial Officer (CFO) Jimmy Patronis announced the arrest of Cheryl Denise Murphy-Green of West Palm Beach for allegedly stealing more than $16,000 from American Family Life Assurance Company (Aflac).
- According to the investigation conducted by the CFO’s investigators for the DFS, Cheryl was running an insurance billing scheme from 2016 to 2019.
Basically, she was creating fraudulent medical documents which were tied to fake hospitalizations. These documents were forged and fraudulent paperwork consisting of billing receipts to support claims for various hospitalizations.
- Cheryl submitted 18 fraudulent insurance claims on behalf of herself, her husband, and three dependents.
Cheryl obviously didn’t have insurance industry knowledge. If she did, she would have realized insurers are in the business of statistics. EIGHTEEN (18) legitimate claims over approximately three years isn’t likely. AFLAC flagged the claims and notified CFO’s Division of Investigative & Forensic Services (DIFS).
Fraud detectives obtained the fraudulent documents and collaborated with the various medical providers identified in her claims. Once they were confident Cheryl did in fact manufacture the documents, they confronted her about the 18 insurance claims.
- She admitted that the insurance claims were fraudulent along with the supporting documents.
Cheryl was arrested on March 24, 2021, and booked into the Palm Beach Main Detention Center. Her charges include Scheme to defraud & Grand theft.
If convicted faces up to 10 years in prison.
DFS | Protecting Marketplace Standards
[Continued]
The Department and its Division of Investigative and Forensic Services does not however have the authority to compel the attendance or testimony of any person or matter in any such investigation.
In instances where the individual refuses to willingly participate, the Department may choose to bring the matter to the circuit court which is in fact authorized to require the individual or entity to provide testimony on the matter.
Prior to the circuit court intervening and ordering the individual or entity to provide testimony, the Department and/or its Investigative Division must demonstrate to the satisfaction of the court that the testimony of the witness or the matter under request is not only relevant, but necessary to further the investigation.
When the matter involves a resident of another state, the Department and its Investigative Division may designate a representative, which include officials of the state in which the matter is located in to investigate on Florida’s behalf.
On the flip side, Florida regulators also assist officials from other states seeking assistance with one of our residents.