Report Report - Ohio Department of Insurance - State of Ohio

Department Areas
Fraud, Enforcement and Licensing Division
The Fraud, Enforcement and Licensing Division oversees the licensing of insurance producers and
business entities. The Division also investigates allegations of agent and agency misconduct and
insurance fraud.
Fraud Unit
The Fraud Unit is a criminal justice agency that investigates suspected cases of insurance fraud.
Insurance fraud, which is defined as the intentional filing of a false or deceptive claim, can include
a policyholder filing a false claim with a carrier, a policyholder or claimant misrepresenting the
facts and/or circumstances surrounding their claim in order to receive insurance proceeds, or an
individual submitting inflated or fictitious receipts or a medical provider billing an insurance carrier
for services they did not provide. As a criminal justice agency, Fraud Unit personnel often work with
federal, state and local law enforcement agencies. Staff refer cases to local and federal prosecutors
for consideration and testify in criminal proceedings.
Enforcement Unit
Every person who sells insurance in Ohio must be licensed and must adhere to the standards of
conduct set forth in Ohio law. The Enforcement Unit is responsible for investigating allegations of
alleged agent misconduct. If evidence obtained by the Enforcement Unit confirms an agent violated
the Ohio law, the agent may face administrative action being taken against their license, and may
be subject to a fine, a suspension, or revocation. If an agent’s conduct is criminal in nature, the case
may also be referred to a prosecutor for potential criminal prosecution.
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www.insurance.ohio.gov