Current through Register 2024 Notice Reg. No. 52, December 27, 2024
A county plan shall include the following elements:
(a) Problem Statement: A description of the
disability insurance fraud problem in the county, including how it arose, why
it is important, its unique aspects, if any, and what is needed to resolve the
problem, including supporting data, evidence, or indicators of fraudulent
activity related to disability insurance.
(b) Supporting data may include the following
items:
(1) A narrative description of the
disability insurance fraud activity in the county, including any supporting
data, evidence or indicators of fraudulent related activity.
(2) A description of the general criminal
activity, based upon the most recent California Crime Index Annual Report by
the California Attorney General.
(3) Population density, based upon the most
recent report compiled by the California Department of Finance, Demographic
Research Unit.
(4) Disability
insurance claims frequency.
(5)
Number of disability fraud suspected fraudulent claims reported to the Division
during a 36-month period immediately preceding the submission of the
application.
(6) Evidence of prior
and current disability insurance fraud activity.
(c) Qualifications: A description of the
applicant's experience in investigating disability insurance fraud including:
(1) The total amount expended to support the
district attorney's investigation and prosecution of disability insurance
fraud, including the details of the following items:
(A) Personnel costs including salaries and
benefits.
(B) Operations expenses,
including space, equipment, travel and other expenses in support of the
program.
(2) For
applications submitted after fiscal year 2005-2006, the following factors shall
be included in the County Plan:
(A) The total
amount of funds received from the Disability Insurance Fraud Program by the
local district attorney in previous years and a copy of the most recent annual
report.
(B) The results obtained
through implementation of the program, including:
1. The number of investigations initiated or
coordinated with other law enforcement agencies.
2. The number of arrests or
convictions.
3. The number of
indictments or complaints.
4. A
comparison of the amounts originally claimed in cases determined to be
fraudulent compared to payments actually
made.
(d) Program Strategy:
(1) Outreach. A description of the manner in
which the district attorney will develop the district attorney's caseload, the
source(s) for referrals for cases for investigation or prosecution, whether
directly from the Fraud Division or from other law enforcement agencies and/or
insurers.
(2) Personnel.
Justification for the number of personnel, position titles and position
justification for personnel which will 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.
(3) Program Coordination. A
description of the manner in which the district attorney plans to coordinate
involved sectors, including insurers, medical and legal provider communities,
the Division, and local law enforcement agencies.
(4) Management Plan. A 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 staff will be
organized and what internal quality control and budget monitoring procedures
will be employed. This part shall also include how this program will be
integrated with any other anti-fraud program(s) maintained within the district
attorney's office.
(5) Staff
Development. The plan for ongoing training of personnel on the investigation
and prosecution of disability insurance fraud. Staff development may be
addressed through coordination with the Division, insurers, or other
entities.
(6) 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 funding cycle, including separate
estimate of the number resulting from carryover investigations; and
(B) Estimated number of prosecutions to be
initiated during the funding cycle.
1. New
section filed 11-3-2005; operative 12-3-2005 (Register 2005, No.
44).
2. Change without regulatory effect amending subsection (d)(1)
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
1872.85,
Insurance Code; and CalFarm Insurance Company, et al. v. Deukmejian, et al.
(1989) 48 Cal.3d 805 and 824. Reference: Section
1872.85,
Insurance Code.
