West Virginia Offices of the Insurance Commissioner 2009 Annual ...

Office of Inspector General—Fraud Unit
The Fraud Unit was created under legislation passed by the WV Legislature during its 2004
regular session. The Fraud Unit is responsible for facilitating a cooperative approach in the detection,
investigation, and prosecution of insurance fraud, as well as making the public aware of insurance
fraud and providing a way to report instances of suspected insurance fraud. Further, the Fraud Unit is
to investigate persons suspected of engaging in insurance fraud and referring cases with merit to the
appropriate authorities for criminal prosecution.
The Fraud Unit currently consists of twenty-five (25) allocated investigative positions and
seventeen (17) allocated support and administrative positions. Field Investigators now occupy field
offices in the following cities:
• Beckley
• Charleston
• Fairmont
• Huntington
• Logan
• Martinsburg
• Parkersburg
• Wheeling
The geographic locations of these field offices allow investigators to respond quickly to reports
of alleged insurance fraud. It also allows investigators to foster relationships with local law
enforcement and prosecutors that the Fraud Unit relies on and works with to bring about successful
prosecutions. Three (3) WV State Troopers are currently assigned to work full time with the Fraud
Unit.
There are three ways in which the public and the insurance industry can report suspected
insurance fraud to the Fraud Unit; by calling toll free @ 1-800-779-6853; online reporting @
www.wvinsurance.gov; and by correspondence. The Fraud Unit’s case management and reporting
application has been recognized as one of the premier systems in the nation for its ability to manage
cases, detect trends in fraud, and create investigative reports suitable for immediate presentation to
prosecutors for review. It has also been designed to receive referrals directly from the online reporting
function and is integrated with the National Association of Insurance Commissioners (NAIC) online
reporting tool.
The Fraud Unit has been proactive in its approach to educate the public on what constitutes
insurance fraud as well as the costs associated with insurance fraud. In 2009 the unit issued over
seventeen (17) press releases detailing criminal indictments and or convictions associated with
investigations that involved this office. A brochure explaining the types of fraud, what the penalties are
and what happens when someone reports suspected fraud was developed and is given out at fairs and
festivals across the state as well as distributed to each WV State Police Detachment. Additionally,
representatives from the Unit appeared at various functions, events, and meetings statewide taking the
message to the general public that insurance fraud is not a victimless crime, but one that victimizes
everyone in the form of higher costs for goods and services.
110