§431E-48 - Life settlement anti-fraud initiatives.
[§431E-48] Life settlement anti-fraudinitiatives. (a) Providers and brokers shall have in place anti-fraudinitiatives reasonably calculated to detect, prosecute, and prevent fraudulentlife settlement acts. At the discretion of the commissioner, the commissionermay order, or a licensee may request and the commissioner may grant, suchmodifications of the following required initiatives as necessary to ensure aneffective anti-fraud program. The modifications may be more or lessrestrictive than the required initiatives so long as the modifications mayreasonably be expected to accomplish the purpose of this section. Anti-fraudinitiatives shall include:
(1) Fraud investigators, who may be provider orbroker employees or independent contractors; and
(2) An anti-fraud plan that shall be submitted to thecommissioner. The anti-fraud plan shall include but not be limited to:
(A) A description of the procedures fordetecting and investigating possible fraudulent life settlement acts andprocedures for resolving material inconsistencies between medical records andinsurance applications;
(B) A description of the procedures forreporting possible fraudulent life settlement acts to the commissioner;
(C) A description of the plan for anti-fraudeducation and training of underwriters and other personnel; and
(D) A description or chart outlining theorganizational arrangement of the anti-fraud personnel who are responsible forthe investigation and reporting of possible fraudulent life settlement acts andinvestigating unresolved material inconsistencies between medical records andinsurance applications.
(b) Anti-fraud plans submitted to thecommissioner shall be privileged and confidential and shall not be a publicrecord and shall not be subject to discovery or subpoena in a civil or criminalaction. [L 2008, c 177, pt of §1]