About Fraud Control Group
Fraud Control Group
The Fraud Control Group consist of four divisions: Criminal Investigations, Criminal Legal Services, Bail Bond Regulatory and Special Services Review. The Fraud Control Group investigates fraud matters involving insurance consumers and any entity or individual regulated by the Department. These investigations reduce the cost of fraud that is borne by the insurance consumer and the insurer.
The North Carolina Department of Insurance Criminal Investigations Division (CID) is the nation’s oldest and one of the most respected state insurance department fraud units in the country. Founded in 1945, the Division is charged with conducting criminal investigations and supporting prosecution of individuals and entities committing insurance-related crimes throughout North Carolina and across the country.
The investigative personnel are sworn law enforcement officers having statewide jurisdiction. The Special Agents are fully authorized to carry firearms, make arrests, conduct searches and present cases at all levels of prosecution. The Special Agents work in close cooperation with the insurance industry, state and federal law enforcement agencies and prosecutors. The Division remains actively involved in conducting fraud investigations that pertain to natural catastrophes, staged automobile accidents, body and repair shops, medical providers, agent embezzlement, unauthorized insurers, “insider fraud,” durable medical equipment suppliers and more.
Criminal Legal Services Division is comprised of three attorneys and one paralegal. The three attorneys that are appointed as special prosecutors. The attorneys work with state district attorneys to present evidence gathered by the Criminal Investigations Division, Bail Bond Regulatory Division or other DOI Divisions in an attempt to fully prosecute the insurance and/or bail bonds crimes that the department has investigated. The special prosecutors serve as the lead prosecutor on cases as appropriate.
The primary purpose of the Bail Bond Regulatory Division is to regulate, educate and enforce all aspects of bail bonding. The Division ensures proper and fair treatment has been given to individuals who are involved within the North Carolina legal bail bond system. The Division regulates all Professional Bail Bondsmen, Bail Bond Runners and Surety Bondsmen licensed to operate in North Carolina. Also, all Surety Insurance Companies licensed to conduct business in N.C. are regulated by the Department of Insurance. All persons acting in any capacity of bail bonding must be licensed by the Commissioner of Insurance.
The Special Services Review Division provides an in-depth review of financial and various other records of insurance companies, insurance agents, or bail bondsmen based on referred cases. These come from citizen complaints, other DOI organizational units, outside agencies, insurance companies, insurance agents, or other sources. Results of these reviews could lead to additional actions by NCDOI or referral to the Criminal Investigations Division. The Special Services Review Division works closely with other NCDOI divisions and collaborates with other state departments of insurance to help determine unlawful activity or patterns of violations that could negatively impact North Carolina citizens and policyholders.