More About the Insurance Frauds Bureau

Bureau Structure

The Insurance Frauds Bureau was created by an act of the Legislature in 1981 as a law enforcement agency within the New York State Insurance Department. The law established the Bureau to effectively detect, investigate and prevent insurance fraud and to refer for prosecution those persons or groups who commit insurance fraud.

As part of the 2011-2012 budget, Governor Andrew M. Cuomo merged the New York State Insurance Department and the New York State Banking Department to create a new Department of Financial Services, effective October 3, 2011. Integrating these agencies under a single leadership and management structure allows for greater efficiency and helps to modernize regulatory oversight of the financial services industry in New York State.

The Bureau is headquartered in New York City, with six additional offices across the State: Garden City, Albany, Syracuse, Oneonta, Rochester and Buffalo. For contact information about the Bureau offices, please select this link.

Insurance Frauds Bureau investigators are designated as peace officers. This designation gives them the authority to carry firearms and make arrests. Investigators are seasoned professionals with years of experience in law enforcement and insurance and financial fraud investigation.

The Bureau consists of specialized units: Major Case, General, Mortgage and Title, Arson, Auto, No-Fault, Workers" Compensation, Medical and Upstate. The responsibilities of the Bureau’s units are described below.

  • Major Case Unit - takes the lead in investigating complex cases involving all types of financial and insurance fraud including commercial rate evasion, no-fault, health care fraud and workers’ compensation premium fraud. The Unit also focuses on the investigation of systemic fraud perpetrated by organized conspiracies and rings.
  • No-Fault Unit - investigates fraudulent medical claims submitted under no-fault auto insurance coverage and individuals who engage in such fraudulent activity as staged and caused accidents, runner/steerer activity, jump-ins and fraudulent medical claims, among others.
  • General Unit - investigates reports of fraud involving life, homeowners and agent/broker fraud, larceny, burglary and types of fraud not assigned to other units.
  • Mortgage and Title Unit - is responsible for combating schemes that target consumers in the real estate market.
  • Arson Unit - coordinates insurance-related arson investigations in conjunction with New York State Department of Homeland Security – Emergency Services. (formerly the New York State Office of Fire Prevention and Control), the New York City Fire Department’s Bureau of Fire Investigation, the New York City Police Department’s Arson Explosion Squad and local fire departments across the State, as well as the FBI and the Bureau of Alcohol, Tobacco, Firearms and Explosives, among others.
  • Auto Unit - investigates individuals who fraudulently report their vehicles stolen, as well as body shop operators suspected of enhancing auto damage and related fraudulent activities.
  • Workers" Compensation Unit - investigates individuals who file fraudulent claims related to injuries in the workplace or who collect workers’ compensation benefits while they are employed. This unit also investigates employers who submit applications for workers’ compensation and general liability insurance coverage containing false information about the number of employees on the payroll and/or the nature of the work being performed. In addition, its investigators also conduct investigations involving employers who submit fraudulent Certificates of Insurance as proof of coverage when in fact no coverage exists.
  • Medical Unit - investigates policyholders who submit false or exaggerated medical claims, as well as doctors and other health care providers who bill for services that were not rendered, bill for more expensive procedures that were actually provided and perform medically unnecessary procedures.
  • Upstate Unit - investigates all types of insurance fraud and includes the Bureau’s Albany, Rochester, Syracuse, Oneonta and Buffalo Offices.

Insurance Frauds Bureau Activities During 2015

Team Building

The Insurance Frauds Bureau has been a longtime advocate of team building. Toward that end, collaborative alliances with the insurance industry and law enforcement agencies on the federal, state and local levels during 2015 resulted in successful investigations that netted 330 arrests and 355 convictions obtained by prosecutors in Insurance Frauds Bureau cases across the State. A key factor in building these alliances is to promote frequent and open communication among the team members. A strong, cohesive fraud-fighting partnership is essential in combating this serious, pervasive crime.

In addition, the Bureau is an active participant in numerous task forces and working groups designed to foster cooperation among the many agencies involved in fighting insurance and financial fraud. Participation provides the opportunity for joint investigations, information sharing, networking and honing investigative skills.

For additional information about the Insurance Frauds Bureau’s activities and accomplishments, select these links to the Annual Financial Frauds and Consumer Protection Report 2015 and the Annual Health Care Fraud Report 2015.

Updated 03/31/2016