Sec. 53-445. Knowledge of health insurance fraud, report to Insurance Commissioner. Independent investigation conducted. Subject to civil liability, when.
Sec. 53-445. Knowledge of health insurance fraud, report to Insurance Commissioner. Independent investigation conducted. Subject to civil liability, when.
(a) Any person, including an insurer, as defined in subsection (c) of section 53-441,
who has knowledge of or has reason to believe that health insurance fraud, as defined
in section 53-442, has occurred, shall provide notice and any information, evidence and
documentation in the person's or its possession relative to the suspected fraud to the
Insurance Commissioner.
(b) The commissioner shall review and investigate any reports of or information
received by any person regarding insurance fraud; he shall conduct an independent
investigation of the suspected insurance fraud; and when he reasonably believes that a
violation has occurred, he shall refer such investigation to the appropriate state agency
for criminal prosecution, civil enforcement or disciplinary action. During the commissioner's investigation and prior to the referral of such investigation, the investigation
and record thereof shall be confidential.
(c) Any person, including an insurer, as defined in subsection (c) of section 53-441,
or a not-for-profit organization established to detect and prevent insurance fraud or his
or its agents or employees may disclose otherwise personal or privileged information
as defined in section 38a-976, orally or in writing to another person concerning any
alleged, suspected or anticipated insurance fraud as defined in section 53-442, when
such disclosure is limited to that which is reasonably necessary to detect, investigate or
prevent criminal activity, fraud, material misrepresentation or material nondisclosure.
(d) No person shall be subject to liability for libel, slander or any other civil liability
in connection with the filing of reports or documents, or furnishing orally or in writing
information concerning any suspected, anticipated or alleged insurance fraud, when
the reports, documents or information are provided or received in accordance with the
provisions of subsection (a) or (c) of this section or in accordance with an order issued
by a court of competent jurisdiction to provide testimony or evidence, unless such person
disclosed false information with malice or wilful intent to injure any person.
(P.A. 93-430, S. 7, 9; P.A. 00-211, S. 5.)
History: P.A. 93-430 effective October 1, 1994 (Revisor's note: In subsections (a) and (c) the words "their possession"
and "their agents" were changed editorially by the Revisors to "his or its possession" and "his or its agents" respectively,
for grammatical correctness); P.A. 00-211 amended Subsec. (a) to require notice and evidence in a person's possession
relative to suspected fraud to be provided to the Insurance Commissioner, and made a technical change for purposes of
gender neutrality.