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

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Date Published: 09/01/2018 04:00 AM
AB1697:v95#DOCUMENT

Enrolled  August 31, 2018
Passed  IN  Senate  August 27, 2018
Passed  IN  Assembly  August 29, 2018
Amended  IN  Senate  August 20, 2018
Amended  IN  Senate  April 12, 2018
Amended  IN  Assembly  April 06, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 1697


Introduced by Committee on Insurance (Assembly Members Daly (Chair), Melendez (Vice Chair), Bigelow, Caballero, Calderon, Chu, Cooley, Cooper, and Frazier)

February 27, 2017


An act to add Section 139.8 to the Labor Code, relating to workers’ compensation.


LEGISLATIVE COUNSEL'S DIGEST


AB 1697, Committee on Insurance. Workers’ compensation.
Existing law establishes a workers’ compensation system, administered by the Administrative Director of the Division of Workers’ Compensation, within the Department of Industrial Relations, to compensate an employee for injuries sustained in the course of his or her employment. Existing law makes it a crime to commit various acts of fraud relating to workers’ compensation, including to knowingly make or cause to be made a false or fraudulent claim for payment of workers’ compensation health benefits.
Existing law creates the Fraud Division, within the Department of Insurance, to administer provisions related to insurance fraud. Existing law requires the Insurance Commissioner to ensure that the Fraud Division aggressively pursues all reported incidents of probable workers’ compensation fraud.
This bill would require the administrative director to establish an antifraud support unit within the Division of Workers’ Compensation. The bill would set forth the duties of the unit, including coordinating and advancing antifraud activities for the division and serving as the point of contact between the division and other agencies and entities engaged in antifraud activities. The bill would require the unit to 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 specified. The bill would require state entities to submit the data to the unit for analysis, as specified. The bill would also require the unit to report to the Legislature, not less frequently than every 3 years, on the effectiveness of its data analytics efforts and to revise the data analytics processes if it identifies improved methods of detecting fraud.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

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

139.8.
 (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.
(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.