2018 Arkansas Code
Title 5 – Criminal Offenses
Subtitle 4 – Offenses Against Property
Chapter 37 – Forgery and Fraudulent Practices
Subchapter 5 – Business and Commercial Offenses Generally
§ 5-37-506. Prohibited activity by a procurer or provider
Universal Citation: AR Code § 5-37-506 (2018)
- (a) A person commits the offense of prohibited activity by a procurer or provider if:
- (1) The person is a procurer and he or she knowingly:
- (A) Offers or gives anything of value to a person in order to cause the person to seek medical care from a specific healthcare provider; or
- (B) Solicits a person currently under the care of a chiropractic physician to seek care from another chiropractic physician; or
- (2) The person is a provider and he or she knowingly permits a procurer that he or she uses, directs, or employs to engage in conduct prohibited by subdivision (a)(1) of this section.
- (b) Prohibited activity by a procurer or provider is a Class D felony.
Sec. 6 Antifraud initiative requirements The antifraud initiative requirements of Arkansas Code Annotated Sec. 23-66-510(a) may be satisfied by an insurer by means of: (1) Fraud investigators, who may be insurer employees or independent contractors and who are in full compliance with Section (7) of this rule; or (2) An antifraud plan submitted to, and approved by, the commissioner, and which is in full compliance with Section (8) of this rule; or (3) An alternative antifraud initiative submitted to, and approved by, the commissioner, under the provisions of Arkansas Code Annotated Sec. 23-66-510(a); or (4) An exemption from the antifraud initiative requirements granted by the commissioner pursuant to Arkansas Code Annotated Sec. 23-66-510(b). Sec. 7. Fraud Investigators and independent contractors A. Fraud investigators who are employees of an insurer: (1) shall be qualified by education, experience or training in the detection, investigation and proper reporting of suspected fraudulent insurance acts, and may be employees whose principal responsibilities are the processing and disposition of claims, if they meet the qualification requirements herein stated; and (2) shall complete a minimum of three (3) hours of continuing education annually in the detection, investigation and proper reporting of suspected fraudulent insurance acts. The specific curriculum, location and certification of said continuing education courses are not mandated but shall be consistent with industry standards for continuing education for insurance fraud investigators.
(a) Insurers shall have antifraud initiatives reasonably calculated to detect, prosecute and prevent fraudulent insurance acts. Antifraud initiatives may include, but not limited to: (1) Fraud investigators, who may insurer employees or independent contractors; or (2) An antifraud plan submitted to the commissioner. Antifraud plans submitted to the commissioner shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in a civil or criminal action. (b) Upon the written request of an insurer, the commissioner may grant an exemption from the requirements of this section if he determines that such an exemption would not be detrimental to the interests of the public.
For benefit checks. This check is for workers’ compensation related benefits. You must advise both the employer and (name of insurance company) of any other income received or earned, including from self-employment, while receiving these benefits. Failure to do so may result in civil and/or criminal liability.
“Any person or entity who willfully and knowingly makes any material false statement or representation for the purpose of obtaining any benefit or payment, or for the purpose of defeating or wrongfully decreasing any claim for benefit or payment or obtaining or avoiding workers compensation coverage or avoiding payment of the proper insurance premium, or who aids and abets for either of said purposes, under this chapter shall be guilty of a Class D felony.”
(a) Claim forms, proofs of loss, or any similar documents, however designated, seeking payment or benefit pursuant to an insurance policy, and applications for insurance, regardless of the form of transmission, shall contain the following statement or a substantially similar statement: Any person who knowingly presents a false or fraudulent claim for payment for a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. (b) The lack of a statement as required in subsection (a) of this section does not constitute a defense in any prosecution for a fraudulent insurance act. (c) Policies issued by unauthorized insurers shall contain a statement disclosing the status of the insurer to do business in the state where the policy is delivered or issued for delivery or the state where coverage is in force. (d) All persons to whom this section applies shall have six (6) months from the effective date of this section to comply with the requirements thereof. (e) The requirements of this section shall not apply to reinsurance proofs of loss or applications.
For workers compensation only. (a) Every carrier or employer who has “reason to suspect that a violation of … has occurred shall be required to report all pertinent matters relating thereto to the Workers Compensation Fraud Investigation Unit.” (b) “No such carrier shall be liable to any employer or employee for any such report, and no employer shall be liable to any employee for such report unless they knowingly and intentionally include false information.” (c) “Any such carrier or employer who knowingly and intentionally fails to report any such violation shall be guilty of a misdemeanor and upon conviction … punished by a fine not to exceed … $1,000 or … imprisonment … not to exceed one (1) year….”
Section 23-66-505 (a) A person engaged in the business of insurance having knowledge or a reasonable belief that a fraudulent insurance act is being, will be, or has been committed shall provide to the commissioner the information required by, and in a manner prescribed by, the commissioner. (b) Any person engaged in the business of insurance who knowingly fails to report as required by subsection (a) of this section shall be guilty of a misdemeanor and upon conviction shall be punished by a fine not to exceed one thousand dollars ($1,000) or by imprisonment for a period not to exceed one (1) year, or by both fine and imprisonment. (c) Any other person having knowledge or reasonable belief that a fraudulent insurance act is being, will be, or has been committed may provide the commissioner the information required by, and in a manner prescribed by, the commissioner. Reporting of Fraudulent Insurance Acts — Regulation 67 Sec. 6 Method of reporting suspected fraudulent insurance acts (a) The reporting requirement of Arkansas Code Annotated Sec. 23-66-505(a) may be satisfied by filing a completed fraud referral form with the Insurance Fraud Investigation Division of the Arkansas Insurance Department. The form shall be as prescribed by the commissioner and may be obtained from the Insurance Fraud Investigation Division. (b) A reporting form containing substantially similar language and providing all the information requested in the fraud referral form prescribed by the commissioner may be used, if previously approved by the commissioner.
Sec. 7. Fraud Investigators and independent contractors A. Fraud investigators who are employees of an insurer: (1) shall be qualified by education, experience or training in the detection, investigation and proper reporting of suspected fraudulent insurance acts, and may be employees whose principal responsibilities are the processing and disposition of claims, if they meet the qualification requirements herein stated; and (2) shall complete a minimum of three (3) hours of continuing education annually in the detection, investigation and proper reporting of suspected fraudulent insurance acts. The specific curriculum, location and certification of said continuing education courses are not mandated but shall be consistent with industry standards for continuing education for insurance fraud investigators.
Sec. 6 Antifraud initiative requirements The antifraud initiative requirements of Arkansas Code Annotated Sec. 23-66-510(a) may be satisfied by an insurer by means of: (1) Fraud investigators, who may be insurer employees or independent contractors and who are in full compliance with Section (7) of this rule; or (2) An antifraud plan submitted to, and approved by, the commissioner, and which is in full compliance with Section (8) of this rule; or (3) An alternative antifraud initiative submitted to, and approved by, the commissioner, under the provisions of Arkansas Code Annotated Sec. 23-66-510(a); or (4) An exemption from the antifraud initiative requirements granted by the commissioner pursuant to Arkansas Code Annotated Sec. 23-66-510(b). Sec. 7. Fraud Investigators and independent contractors A. Fraud investigators who are employees of an insurer: (1) shall be qualified by education, experience or training in the detection, investigation and proper reporting of suspected fraudulent insurance acts, and may be employees whose principal responsibilities are the processing and disposition of claims, if they meet the qualification requirements herein stated; and (2) shall complete a minimum of three (3) hours of continuing education annually in the detection, investigation and proper reporting of suspected fraudulent insurance acts. The specific curriculum, location and certification of said continuing education courses are not mandated but shall be consistent with industry standards for continuing education for insurance fraud investigators.
