Today's Law As Amended

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AB-1697 Workers’ compensation.(2017-2018)


 Section 139.8 is added to the Labor Code, to read:

 (a) The administrative director shall establish an antifraud support unit within the division. The unit shall perform all of the following duties:
(1) Coordinate and advance antifraud activities for the division.
(2) Serve as the point of contact between the division and other agencies and entities engaged in antifraud activities.
(3) Act as the repository and clearinghouse for data on antifraud activities.
(4) Ensure the efficient sharing of data among the division, other agencies, and other entities engaged in antifraud activities.
(5) Research fraud in the workers’ compensation system.
(b) The unit shall develop and implement by July 1, 2019, data analytics processes to identify the sources of previously unknown fraud and the magnitude of known or suspected fraud. As part of these processes, the unit shall create written policies and procedures to guide the unit’s data analytics efforts.
(c) The unit’s written policies and procedures for data analytics shall include, but not be limited to, the following components:
(1) Goals to be achieved.
(2) Data sources, internal and external to the division, that it will use.
(3) Data elements the unit will measure from those data sources.
(4) Indicators of possible workers’ compensation fraud.
(5) Descriptions of the analytical measures to be used, including comparisons of, and correlations among, the data elements.
(6) Feedback mechanisms, whether internal or external to the division, to assess the effectiveness of the unit’s data analytics processes.
(7) The law enforcement entities, including, but not limited to, the Fraud Division of the Department of Insurance, to which the unit will forward the results of its data analytics efforts.
(d) Notwithstanding any other law, state entities shall submit the data elements specified in paragraph (3) of subdivision (c) from the sources identified pursuant to paragraph (2) of subdivision (c) to the unit for analysis pursuant to this section. The unit shall comply with state laws governing privacy and confidentiality, except as necessary to carry out the duties required by this section.
(e) Not less frequently than every three years, the unit shall assess and report to the Legislature, in accordance with Section 9795 of the Government Code, on the effectiveness of its data analytics efforts at identifying previously unknown workers’ compensation fraud and the magnitude of known or suspected fraud. Based on the results of its assessment, the unit shall revise its data analytics processes if it identifies improved methods of detecting fraud.