Current through Register 2024 Notice Reg. No. 38, September 20, 2024
Each district attorney's program award shall be based on the
evaluation of the County Plan. The County Plan shall be evaluated by a Review Panel
to be comprised of two members of the Fraud Assessment Commission, the Chief of the
Fraud Division or the Chief of the Fraud Division's designee, the Director of the
Department of Industrial Relations or the Director of the Department of Industrial
Relations' designee, and an expert in consumer crime investigation and prosecution
to be designated by the Commissioner.
The County Plan shall include but need not be limited to the
following elements detailing the county's qualifications and the manner in which the
district attorney will use the funds to investigate and prosecute workers'
compensation insurance fraud:
(a)
Qualifications.
(1) A description of the district
attorney's experience in investigating and prosecuting workers' compensation
insurance fraud. Relationships with other public or private entities which may be
useful to the program should also be included.. Specific activity during the past
two years should be detailed as follows:
(A) Number
of investigations initiated, specifying number of identified suspects per
investigation;
(B) Number of warrants or
indictments issued, specifying number of suspects and/or defendants;
(C) Number of arrests made;
(D) Number of convictions obtained, specifying
number of defendants, number obtained by trial verdict and number obtained by plea
or settlement;
(E) Amount of fines and
penalty assessments ordered and collected, specifying number of defendants;
and
(F) Amount of restitution ordered
and collected, specifying number of defendants and victims.
(2) The panel shall consider each applicant
county's population size in proportion to its historic commitment of resources to
insurance fraud investigation and prosecution.
(b) Plan. The district attorney's plan for
investigation and prosecution of workers' compensation fraud, including, at a
minimum, the following elements:
(1) Problem
Statement. A description of the extent and nature of the problem in the county,
including its sources and causes, its economic and social impact, its unique
aspects, if any, and what is needed to resolve the problem. Supporting data,
evidence, or indicators of fraudulent activity related to workers' compensation
insurance should be included. The data and information may be derived from third
party administrators, self-insured employers, other local law enforcement entities,
insurers or the Fraud Division or the Investigation Bureau of the California
Department of Insurance.
(2) Program
Strategy. This section shall specify how the district attorney will use prgram funds
to address the problem defined above including:
(A)
Outreach. A description of the manner in which the district attorney will develop
the district attorney's caseload, the source(s) for referrals of cases for
investigation and/or prosecution, whether directly from the Division and/or directly
from self-insured employers, third-party administrators and insurers or a
combination;
(B) Personnel. The number,
position titles and position justification of personnel to be funded fully or in
part through grant funds, including descriptions of the qualifications of personnel
to be assigned to the program and an organization chart identifying positions to be
funded;
(C) Program Coordination. A
description of the manner in which the district attorney plans to coordinate
involved sectors, including employers, insurers, medical and legal provider
communities, the Fraud Division and the Investigation Bureau of the California
Department of Insurance;
(D) Management
Plan. The detailed plan and schedule of the steps the district attorney will
complete in achieving the objectives of the program and a discussion of how the
program will be organized and what internal quality control and budget monitoring
procedures will be employed. This part should also include how this program will be
integrated with any other anti-fraud program(s) maintained within the district
attorney's office;
(E) Staff
Development. The plan for ongoing training of personnel on the workers' compensation
system and the investigation and prosecution of fraud. Staff development may be
addressed through coordination with the Division insurers or other
entities.
(3) Objectives. This
section shall outline the district attorney's anticipated achievements in the
following areas:
(A) Estimated number of
investigations to be initiated during the grant period, including a separate
estimate of the number resulting from carryover investigations; and
(B) Estimated number of prosecutions to be
initiated during the grant period.
1. New section
filed 10-8-93; operative 11-8-93 (Register 93, No. 41).
2. Change without
regulatory effect amending first paragraph and subsection (b)(2)(A) filed 7-14-2021
pursuant to section
100, title 1, California Code of
Regulations (Register 2021, No. 29). Filing deadline specified in Government Code
section
11349.3(a)
extended 60 calendar days pursuant to Executive Order
N-40-20.
Note: Authority cited: Section
1872.83,
Insurance Code; CalFarm Insurance Company, et al. v. Deukmejian, et al. (1989) 48
Cal.3d 805, 824. Reference: Section
1872.83,
Insurance Code.
