On-line Fraud Reporting System (OFRS)
Instructions for Consumers

To submit a report of suspected fraud, you will navigate through five pages of simple forms where you will specify:

To go to the instructions for one of these pages, click on the appropriate link above.

Click here to find out what happens to your report after you submit it.

General Navigation Instructions

To move through the individual fields, where you will be entering or selecting your answers and information, you can use the Tab key on your keyboard or click inside the field using the left mouse button. Use the Next Page button to proceed to the next page, after entering at least all the required fields (those marked with the red asterisk). You will not be allowed to go to the next page unless you provide a value for every field marked with the red asterisk.

If you go to a different web site by typing in a different URL (web address) or by selecting a site from the Favorites menu, all the data you entered will be lost. Therefore, it is recommended that you fill out each page and then click on the Submit Report button before going to another web site.

Dates should be entered in the MM/DD/YYYY format.

Accessing OFRS

NAIC’s On-line Fraud Reporting System allows Consumers to report suspected fraud to any state that accepts suspected fraud reports from the NAIC. To enter a report of suspected fraud, go to https://eapps.naic.org/ofrs/  and click on the Consumers - Report Suspected Fraud link in the second paragraph on the page. This will bring you to a map of the states and jurisdictions that are members of the NAIC.

Choosing a Primary State - the Map page

Indicate the state where the suspected fraud occurred by either clicking on the state or jurisdiction on the map or by clicking on the state or jurisdiction listed in the textual list below the map. You will be allowed to specify additional states that you would like your report of suspected fraud sent to in a moment.

Because not all states use the OFRS to accept reports of suspected fraud, when you click on certain states you will be forwarded to that state’s web site, rather than being taken into OFRS. If you are reporting suspected fraud for one of these states, please follow the instructions provided by that specific state.

If you intend on having the report of suspected fraud sent to more than one state, and the first state that you choose does not accept reports from the OFRS (you get directed to that state’s web site), you can use the Back button to return to the Map Page and select one of the other states from your list of states that you want the report to go to.

For states that do accept reports of suspected fraud from the OFRS, you will be directed to the first of three data entry pages/forms. The first form is where you can specify additional states to forward your report of suspected fraud to. Only states accepting OFRS reports are available in the list.

More States to Report to? - the Additional States to Notify page

Choose any additional states that you would like this specific report of suspected fraud forwarded to and click on the Next Page button.

To select more than one state from the list, hold down the Cntrl key, while clicking on each state using your left mouse button. After selecting all the states of interest to you, just release the Cntrl key after selecting the last state and click on the Next Page button.

You will then be directed to the second page where you will provide information about yourself, or indicate that you wish to remain anonymous.

 

Information About You - the Person Reporting Suspected Fraud page

If you would like to submit your report anonymously, click on the Yes radio button after the question at the top of the form.

If you are not reporting anonymously, enter your name, mailing, and contact information as requested.

When finished entering information, click on the Next Page button. You will be directed to the third page, where you will provide information about the person or business that you suspect of committing fraud.

Who do you Suspect? - the Person/Business Suspected of Fraud page

Provide as much detail as possible about the person or business that you suspect of committing fraud. Without enough identifying information, the state will not be able to properly investigate the information in your report.


After entering all of the information available to you about the suspected person or business, click the Next Page button. You will be taken to the final data entry form, where you will provide details about the suspected fraudulent activity.

Details, Details - the Description of Suspected Fraud page

Provide as much detail as possible about the activities surrounding the suspected fraud. Any information that helps to substantiate your belief that fraud was committed is helpful. To investigate thoroughly, the state needs dates, names of those involved, names of witnesses, etc.

After entering these details click the Next Page button. You have completed the data entry forms and now just need to submit, and optionally review, your report.

Reviewing and Submitting Your Report - the Submission Page

If you would like to have a printed copy of the information you supplied, be sure to use the View Report button and print the summary page that is displayed. Once you have submitted a report, you will not be able to view or print it.

To review the information that you have entered, click on the View Report button and use the right scroll bar to move through the report. If you find something that you would like to change, use the Back button on your browser toolbar or the Previous Page button at the bottom of each data entry form until you have stepped back to the page that you would like to change. After making the change, just use the Next Page button continuously until you get back to the Submission page.

Whether you choose to review the information or not, you can submit your report to all of the states that you specified by clicking on the Submit Report button. You will be provided a transaction number that you can use to reference a specific report of suspected fraud. You will need this number if you end up corresponding with any of the states that you reported the suspected fraud to. You may wish to print this page to keep for your records.

What Happens After I Submit my Report of Suspected Fraud?

If the state(s) you are reporting to needs further information and you chose not to report anonymously, a representative from that state may contact you directly for further information and inquiry.


On-line Fraud Reporting System (OFRS)
Instructions for Industry

To submit a report of suspected fraud, you will navigate through several pages of simple forms that collect the same information currently requested on the Uniform Suspected Insurance Fraud Reporting Form.

Use the links below to go directly to the instructions pertaining to entering:

Because there are so many possible types of suspected fraud, the majority of the fields are optional since they are specific to one distinct type of fraud or event.

Definitions are available for a limited number of fields at the end of each section below.

General Navigation Instructions

To move through the individual fields, where you will be entering or selecting your answers and information, you can use the Tab key on your keyboard or click inside the field using the left mouse button. Use the Next Page button at the bottom of the page or the Next Page link available at the top of the page, to proceed to the next page, after entering at least all the required fields (those marked with the red asterisk). You will not be allowed to go to the next page unless you provide a value for every field marked with the red asterisk.

If you go to a different web site by typing in a different URL (web address) or by selecting a site from the Favorites menu, all the data you entered will be lost. Therefore, it is recommended that you fill out each page and then click on the Submit Report button before going to another web site.

Dates should be entered in the MM/DD/YYYY format.

Accessing OFRS

NAIC’s On-line Fraud Reporting System allows Industry to report suspected fraud to any state that accepts suspected fraud reports from the NAIC. To enter a report of suspected fraud, go to https://eapps.naic.org/ofrs/ and click on the Insurance Companies, SIUs, and TPAs - Report Suspected Fraud link in the first paragraph under the Industry subheading. This will bring you to the page where you can specify whether you will be entering a new report or providing updates to an existing one.

Add a New Report or Update an Existing One - the Industry Page

To submit a new report of suspected fraud, click on the Enter a new State Regulated Industry Fraud Report link. This will bring you to a map of the states and jurisdictions that are members of the NAIC.

To update an existing report, you must have the NAIC Fraud Submission number for the report that you wish to update. Enter this number in the appropriate text box and click on the Update button. You will be taken directly into the Reporting Person page, which looks exactly like the equivalent page used when adding a new report. The existing information for the report will not display. Only items critical for identifying which party you are updating in the report will show up on the pages. You should only provide values for the fields that you want to update/replace relative to the previous submission of that report. Phase II will allow for you to view the existing report and modify the existing values.

Choosing a Primary State - the Map page

Indicate the state where the suspected fraud occurred by either clicking on the state or jurisdiction on the map or by clicking on the state or jurisdiction listed in the textual list below the map. You will be allowed to specify additional states that the report of suspected fraud should be sent to in a moment.

Because not all states use the OFRS to accept reports of suspected fraud, when you click on certain states you will be forwarded to that state’s web site, rather than being taken into OFRS. If you are reporting suspected fraud for one of these states, please follow the instructions provided by that specific state.

If you are submitting a report of suspected fraud to more than one state because of jurisdiction, and the first state that you choose does not accept reports from the OFRS (you get directed to that state’s web site), you can use the Back button to return to the Map Page and select one of the other states from your list of states that you want the report to go to.

For states that do accept reports of suspected fraud from the OFRS, you will be directed to the first of seven data entry pages/forms. The first form is where you can specify additional states to report suspected fraud to due to jurisdiction. Only states accepting OFRS reports are available in the list.

More States to Report to? - the Additional States to Notify page

Choose any additional states that you would like this specific report of suspected fraud forwarded to and click on the Next Page button.

To select more than one state from the list, hold down the Cntrl key, while clicking on each state using your left mouse button. After selecting all the states of interest to you, just release the Cntrl key after selecting the last state and click on the Next Page button.

You will then be directed to the page where you will provide your contact information.

 

Information About You - the Reporting Person page

Provide the requested information for the person (yourself typically) that is submitting the report and that can be contacted for additional information if necessary. When you have finished entering this information, click on the Next Page button. You will be directed to the page where you will provide information about the person or entity that is suspected of committing fraud.

Company Code - The insurance company’s 5-digit number issued by the National Association of Insurance Commissioners that identifies the insurance company that is the victim of the suspected fraud. If your organization does not have an NAIC Company Code, a representative must call the NAIC to obtain one.

Who is the Suspect? - the Subject page

Provide as much detail as possible about the person or entity that is suspected of committing fraud. Without enough identifying information, the state will not be able to properly investigate the information in your report.

If there is more than one Suspect/Subject, use the Add Additional Subject button to add each one.

If a Suspect/Subject uses an alias with different dates of birth, etc., use the Add AKA button to provide only the AKA information for the specific subject.

After entering all of the information available to you about the suspected person or entity and their AKAs, click the Next Page button. You will be taken to the page where you will provide specifics about the insurance claim, incident, etc.

What was reported to the Insurance Company - the Claim/Incident page

Provide the requested insurance policy information as appropriate for the insurance type that you have specified. Include dates of service and procedure codes for medical or dental procedures if appropriate. Enter the monetary and date information related to the handling of the claim by the insurance company. After providing as much detail as possible based on the type of fraudulent activity you’re reporting, click the Next Page button list the evidence and any investigative work that has occurred relative to this report of fraud.

Claim Number - Claim number of the suspected fraudulent claim. If there are additional claim numbers that relate to the same investigation, please enter a separate report in order to capture the information as it relates to each individual claim.

Policy Number - Policy number related to suspected fraud. If there is more than one policy number that relates to the investigation, please complete an additional referral form to capture the information as it relates to each individual policy.

 

Dates of Service - the date(s) the health-related services were provided to the insured or patient relative to the listed claim.

CPT/CDT Code - the five-digit CPT Codes or the CDT codes for the mental or dental services.

Reserve Amount - the dollar amount held in reserve related to the listed claim.

Amount Paid - the dollar amount currently paid related to the listed claim.

Date Paid - the date that the (amount paid) payment was made.

Loss Amount - the dollar amount of the loss related to the listed claim.

Settlement Amount - the dollar amount of any settlement paid related to the listed claim. If applicable, include parties to all settlements in the Involved Parties section.

Date Settlement Paid - the date that the settlement amount was paid.

What Investigation of the Fraud has Occurred? - the Fraud Investigation page

Provide information about whether and when the Special Investigations Unit has investigated this report of fraud and what case numbers they assigned to it if applicable. Check off each type of Evidence that is available to substantiate this report of suspected fraud. If appropriate, list each additional (other than NAIC) organization, along with their contact and case information that has been notified about the suspected fraud so that they can be contacted if necessary.

Provide one of the most critical pieces of information in this process, the description of the suspect fraud. List all information that is relevant to the fraud and that may help the state investigate the data in the report.

After entering all of the information available relative to any evidence or investigation, click the Next Page button to categorize or classify the type of fraud suspected.

What Type of Fraud is Suspected? - the Fraud Type page

Use the provided check boxes to classify or categorize the type of fraud that is suspected. The types are broken up into the following groups: Property & Casualty, Health Care, and General Fraud. Select as many items as applicable. If you utilize the ‘other’ checkboxes, because there is not a type listed that you feel is appropriate, be sure to list your interpretation of the type of fraud in the corresponding text box.

After marking as many boxes as is necessary, click on the Next Page button to identify any other parties that were involved in any way with the suspected fraud or the event, claim, or incident that is being used to commit fraud.

Who Witnessed, Participated in, or Can Provide/Substantiate Information about the Suspected Fraud? - the Involved Party page

If other persons are involved with this referral such as a witness, co-conspirator, etc., provide details about each person by filling out the appropriate fields on the page and then using the Add Additional Involved Party button to add each subsequent person.

If an Involved Party(s) uses an alias with different dates of birth, etc., use the Add AKA button to provide only the AKA information for the specific Involved Party.

After providing information for every Involved Party, along with any AKA information for them, click on the Next Page button to finalize your report and submit it to all of the states that you have indicated.

Reviewing and Submitting Your Report - the Complete Submission Page

If you would like to have a printed copy of the information you supplied, be sure to use the View Report button and print the summary page that is displayed. Once you have submitted a report, you will not be able to view or print it (in this version of OFRS).

To review the information that you have entered, click on the View Report button and use the right scroll bar to move through the report. If you find something that you would like to change, use the Back button on your browser toolbar or the Previous Page button at the bottom of each data entry form until you have stepped back to the page that you would like to change. After making the change, just use the Next Page button or link continuously until you get back to the Submission page.

To review the Regulatory Information for the states that you are reporting to, click on the State Regulatory Information link.

Whether you choose to review the information or not, you can submit your report to all of the states that you specified by clicking on the Submit Report button. You will be provided a transaction number that you can use to reference a specific report of suspected fraud. You will need this number if you end up corresponding with any of the states that you reported the suspected fraud to or if you wish to update this report in the future. You may wish to print this page to keep for your records.

What Happens After I Submit my Report of Suspected Fraud?

Once you receive the message indicating they your report has been submitted successfully, the data you entered for the report will be passed on to every state that you indicated. You will not be contacted regarding the state’s findings or decisions. You may be contacted in order to clarify or elaborate on the information entered.