I THINK WE'LL GET STARTED HERE
IT'S A NINE OH FIVE.
.
THIS IS OUR FIRST HEARING OF THE
YEAR THIS IS THE ASSEMBLY
INSURANCE COMMITTEE.
ONE A WELCOME EVERYONE A TODAY'S
HEARINGS FOCUSED ON A WORKERS
COMPENSATION FRAUD.
WILL BE HEARING FIRST FROM OUR
STATE AUDITOR WHO RECENTLY
COMPLETED AN AUDIT OF THE
STATE'S.
ANTI FRAUD PROGRAMS ALL OF THE
ANTI FRAUD PROGRAMS DEALING WITH
WORKERS COMP.
WELL HERE FROM KEY REGULATORS IN
THE SYSTEM AND THE PRIMARY
STAKEHOLDERS IN THE SYSTEM.
WANNA MAKE A FEW COMMENTS ABOUT
THE ONGOING FIGHT THAT WE'VE
BEEN ENGAGED IN AGAINST WORKERS
COMPENSATION FRAUD.
THE FIGHT'S BEEN GOING ON FOR
MANY YEARS.
IT SEEMS ON ENDING.
AND THE BEST ESTIMATES BY
EXPERTS FOR THAT SOMEWHERE
BETWEEN ONE AND THREE BILLION
DOLLARS ANNUALLY OR LOST TO
FRAUD.
AND MAKE NO MISTAKE THIS IS
MONEY DIRECTLY OUT OF THE
POCKETS OF INJURED WORKERS.
AND THIS IS MONEY DIRECTLY OUT
OF THE POCKETS OF THE EMPLOYERS
IN THE STATE.
ONE OF THE REASONS I ASKED THE
STATE AUDITOR TO TAKE A LOOK AT
THE SYSTEM.
WAS DUE TO THE SEEMINGLY
INTRACTABLE PRESENCE OF IS
USUALLY AN ACCEPTABLE LEVEL OF
ONGOING FRAUDULENT ACTIVITY.
AND.
AS WELL THE NUMBER OF PLAYERS IN
THE SYSTEM.
MAKES IT MORE COMPLICATED.
I'VE BEEN LOOKING AT THIS
PROBLEM OVER THE PAST SEVERAL
YEARS AND I'VE AUTHORED A FEW
PIECES OF LEGISLATION TO ADDRESS
SOME OF THE ISSUES FACING THE
SYSTEM.
TWO YEARS AGO I AUTHORED AB
TWELVE FORTY FOR AN EFFORT TO
GET BAD ACTORS THAT OF THE
SYSTEM.
THAT BILL WAS SIGNED BY THE
GOVERNOR.
THISSESSION I HAVE AB SIXTEEN
NINETY SEVEN TO FORMALIZE AND
PROVIDE GUIDANCE FOR THE ANTI
FRAUD ANALYTICS UNIT. IN THE
DEPARTMENT OF INDUSTRIAL
RELATIONS.
I'VE ALSO INTRODUCED AB.
TWO ZERO FOUR SIX SO THE
LEGISLATURE CAN ADOPT
RECOMMENDATIONS FROM THE AUDIT
REPORT THAT WERE FOCUSED ON
TODAY.
WE WILL HEAR MORE ON THAT TOPIC
FROM OUR. OUR STATE AUDITOR
SHORTLY.
THE MEASURES I JUST MENTIONED
ARE NOT A PANACEA FOR WANTING
THE FIGHT AGAINST WORKERS
COMPENSATION FRAUD BUT I BELIEVE
THEY ARE SOUND STEPS IN THE
ONGOING PURSUIT OF ROOTING OUT
FRAUD.
I'M HOPEFUL THE TODAY WE'LL HEAR
FROM STAKEHOLDERS WHO MAY HAVE
OTHER IDEAS WORTH CONSIDERING.
AS WE MOVE FORWARD IN THIS
IMPORTANT SUBJECT
ONE A WELCOME I'M MISTER GRAYSON
AND WHOSE.
RELATIVELY NEW OR COMMITTEE AND.
.
AND THANK OF OUR COMMITTEE VICE
CHAIR OF CHAD MAYES FOR HIS
COOPERATION ANNA. AND SUPPORT IN
THIS PROCESS.
AND WITH THAT WE WILL GET TO
OUR.
SPEAKERS A WILL START WITH THE.
A ELAINE HOW.
ARE.
STATE AUDITOR.
AND I WANT TO SAY.
MISSILE I'VE BEEN IMPRESSED
SINCE THE DAY I ARRIVED HERE
FIVE YEARS AGO I'VE BEEN
IMPRESSED WITH THE WORK OF YOUR.
YOUR DEPARTMENT AND I CONTINUE
TO BE AND I REALLY APPRECIATE
THE THOROUGHNESS AND
PROFESSIONALISM OF YOUR AUDIT.
THANK YOU.
BUT. I'VE.
MISTER CHAIRMAN THANK YOU.
THANK YOU MISTER CHAIRMAN OFF
FOR THE RECORD MY NAME'S ELAINE
HOW CALIFORNIA STATE OUT AND I
DO APPRECIATE THE COMMENTS. OF
MISTER CHAIR ABOUT THE OFFICE I
DIDN'T VERY PRIVILEGED TO SERVE
AS THE STATE AUDITOR AND AND
WORK WITH.
TREMENDOUSLY TALENTED STAFF WHO
ARE REALLY COMMITTED TO WHAT
THEY DO.
AND SPEAKING OF TALENTED STAFF
TO MY RIGHT IS MIKE TILL THEN
MISTER TILDEN WAS THE AUDIT
PRINCIPLE ON THIS PARTICULAR
PROJECT TO MY LEFT IS A DALE
CARLSON MISTER CARLSON AT THE
TIME. WAS THE AUDIT SUPERVISOR
ON THIS PARTICULAR PROJECT HAS
RECENTLY BEEN PROMOTED TO
PRINCIPAL SO HE'LL BE TAKING ON
MORE RESPONSIBILITIES WITH THE
OFFICE.
WHAT I INTEND TO DO IS JUST GIVE
YOU A VERY HIGH? HIGH LEVEL
OVERVIEW OF THE ISSUES THAT COME
MISTER CHILDREN IN MISTER
CARLSON WILL BE DISCUSSING IN
MORE DETAIL AND CERTAINLY THE
RECOMMENDATIONS THAT WE'VE MADE.
AND AS I'M SURE MANY OF YOU KNOW
AFTER WE ISSUE A REPORT THIS WAS
ISSUED IN DECEMBER OF LAST YEAR.
WE HAVE A FOLLOW UP PROCESS
WHERE EACH OF THE ENTITIES WE
AUDITED FOR WHICH WE'VE MADE
RECOMMENDATIONS THEY'RE REQUIRED
TO RESPOND BACK TO US.
AT A SIXTY DAY INTERVAL SIX
MONTHS AND ONE YEAR AND THEN
ANYTHING THAT'S OUTSTANDING
AFTER A YEAR WE WILL CONTINUE TO
FOLLOW UP WITH THE DEPARTMENTS.
ARE THE RESPECTIVE AGENCIES TO
MAKE SURE THEY GET THOSE
RECOMMENDATIONS IMPLEMENTED SO
THE THE REPORT IS BROKEN DOWN
INTO TWO SUBJECT AREAS
ESSENTIALLY ONE CHAPTER THAT
DISCUSSES PREVENTION DICK
DETECTION. ARE OF WORKERS
COMPENSATION FRAUD IN MISTER
CHILDREN WILL BE COVERING THAT
NUMBER THREE KEY ISSUES.
ONE WAS RELATED TO INSURANCE
INSURANCE COMPANIES AND THEIR
RESPONSIBILITY. OUR STATE LAW
REQUIRES THEM TO HAVE A SPECIAL
INVESTIGATIVE UNIT THAT SHOULD
BE REFERRING SUSPECTED FRAUD TO
THE DEPARTMENT OF INSURANCE SO
WE LOOKED AT THAT PROCESS. HOW
OFTEN?
INSURANCE COMPANIES ARE
REFERRING US SUSPECTED FRAUD TO
INSURANCE AND AND WE HAVE SOME
SUGGESTIONS FOR IMPROVEMENT
THERE. WE ALSO LOOKED AT THE
DEPARTMENT OF INDUSTRIAL ASIANS
LOOKING AT DATA ANALYTICS AS YOU
INDICATED MISTER CHAIRMAN THEY
DO HAVE. A SOME TOOLS THAT THEY
PUT INTO PLACE ARE WE'VE ALSO
MADE SOME RECOMMENDATIONS IN THE
REPORT AND MISTER TELL THEM
WE'LL TALK ABOUT SOME OF THE
EFFORTS THAT WE THINK HINGED. ON
DUSTER RELATIONS IS TAKING THAT
ARE ARE POSITIVE ARE AND THEY
ACTUALLY ARE TAKING STEPS TO USE
ANALYTICS AND ACTUALLY IMPROVE
THE USE OF ANALYTICS.
THE LAST ISSUE MISTER CHILDREN
WILL BE TALKING ABOUT IS OUR
SUGGESTION THAT EXPLANATION OF
BENEFITS WOULD BE ANOTHER TOOL
THAT WE BELIEVE WOULD BE VERY
EFFECTIVE IN COMBATING A WORKERS
COMPENSATION FRAUD IT USED IN
OTHER INDUSTRIES DISABILITY
INSURANCE. A CERTAINLY THE
PRIVATE SECTOR USES AS THEY
REFERTO AS HE'LL BE SO MISTER
CHILDREN WE TALKING ABOUT THAT A
BIT SO THAT'S THE DETECTION
SIDE.
MISTER CARLSON WILL BE SPEAKING
ABOUT INVESTIGATION PROSECUTION
PRIMARILY THE WORK WE DID IN
THIS AREAS WITH THE DEPARTMENT
INSURANCE. AND LOOKING AT THEIR
EFFORTS IN AS TO INVESTIGATING
FRAUD. AND SOME OF THE ISSUES WE
IDENTIFIED THAT I THINK YOU'LL
HEAR FROM THE DEPARTMENT
INSURANCE IS VACANCY RATES IN
THEIR AND THEIR.
INVESTIGATOR POSITIONS THEY'VE
TRIED TO ADDRESS THAT WITH SOME.
RESTRUCTURING OF THEIR SALARIES
ARE TRYING TO DEVELOP A STRONG
TO REACH RECRUITING STRATEGIES
LOOKING FOR RETIRED LAW
ENFORCEMENT OFFICIALS TO
PERHAPS.
COME ON WITH THE STATE A
DEVELOPING A RETENTION PLAN
ANOTHER SUGGESTION WE HAD SO
THEIR ISSUES RELATED TO STOPPING
THE RESOURCES TO GET OUT THERE
AND CONDUCT THESE
INVESTIGATIONS.
TIED TO THAT IS THERE SPENDING
SO THEY DEPARTMENT INSURANCE
RECEIVES A CERTAIN ALLOTMENT
EACH YEAR AND WHAT WE WERE
FINDING IS THAT ALLOTMENT WAS
NOT BEING FULLY SPENT BECAUSE
THEY HAVE VACANCIES. SO THERE
CAN BE A DECISION MADE BY THE
FRAUD COMMISSION.
TO EITHER.
OFFSET FUTURE BY CHARGES TO
EMPLOYERS FOR WORKERS COMP OR
YOU CAN GET THAT MONEY OUT TO
THE DA'S THE DISTRICT ATTORNEYS
AND SOME OF OUR ANALYSIS WE WERE
SUGGESTING THAT. IT MAY BE MORE
BENEFICIAL IN THE EVENT
INSURANCE HOUSE UNSPENT FUNDS
THAT THOSE FUNDS GO OUT TO THE
LOCAL D. A.'S WE DID SOME WORK
AT THREE LOCAL DISTRICT
ATTORNEYS OFFICES. LOS ANGELES
ORANGE AND SAN DIEGO.
AND MISTER CARLSON WILL TALK A
LITTLE BIT ABOUT THAT AS WELL SO
THOSE ARE THE KEY ISSUES ARE SO
AT THIS POINT AMENDED OVER
MISTER CHILDREN HE CAN GET INTO
MORE SPECIFICS ABOUT. DETECTION.
YOU VERY MUCH THANK YOU.
GO AHEAD I.
GOOD MORNING MISTER CHAIRMAN
AND MEMBERS OF THE COMMITTEE MY
NAME IS MIKE TILTON AS MISS
HOUSE AND I'M NOT A PRINCIPLE TO
CALIFORNIA STATE AUDITOR'S
OFFICE.
SO IS MISS HELL INDICATED WE
IDENTIFIED WEAKNESSES IN THE
PROCESSES OF THE CALIFORNIA
DEPARTMENT OF INSURANCE TO
DEPARTMENT OF INDUSTRIAL
RELATIONS. AND INSURERS USE TO
DETECT WORKERS' COMPENSATION
FRAUD.
.
FOR EXAMPLE STATE LAW REQUIRES
INSURERS TO INVESTIGATE
SUSPECTED FRAUD INCH REFERRED TO
CD AYE AND DISTRIBUTARIES
OFFICES.
THOSE CLAIMS THAT SHOW
REASONABLE EVIDENCE OF FRAUD.
BUT WE FOUND THE INSURERS VERY
SIGNIFICANTLY IN THE NUMBER OF
REFERRALS THAT THEY SUBMIT.
WE LOOK AT DATA FOR TWENTY ONE
INSURERS WHO EACH HAD MORE THAN
A HUNDRED AND FIFTY MILLION
DOLLARS IN EARNED PREMIUMS. IN
TWO THOUSAND FIFTEEN AND
SIXTEEN.
AND WE CALCULATED REFERRAL RATE
PER TEN MILLION DOLLARS IN
EARNED PREMIUMS.
AND WHAT WE FOUND FOR THE TWO
YEARS THAT WE EXAMINED IS THAT
FRAUD REFERRAL RATES REALLY
RANGE FROM ZERO REFERRALS TO
ELEVEN REFERRALS PER TEN MILLION
DOLLARS IN EARNED PREMIUM.
AND EIGHT OF THE TWENTY ONE
INSURERS HAD RATES OF ONE
REFERRAL OR LESS FOR AT LEAST
ONE OF THE TWO YEARS THAT WE
EXAMINED.
AND TO THE INSURER SUBMITTED NO
REFERRALS AT ALL FOR ONE OF THE
YEARS.
THOSE EIGHT INSURERS
COLLECTIVELY HAD ALMOST FOUR
BILLION DOLLARS IN EARNED
PREMIUMS IN TWO THOUSAND SIXTEEN
WHICH REPRESENTS THIRTY ONE
PERCENT OF WORKERS COMPENSATION
PREMIUMS IN ALL OF CALIFORNIA.
AND.
WE BELIEVE THAT WHEN ENSURE WITH
OVER A HUNDRED AND FIFTY MILLION
DOLLARS IN EARNED PREMIUMS
SUBMITS FEW OR NO FRAUD
REFERRALS IN A YEAR WE THINK
THAT SHOULD AT LEAST PROMPT CD I
TO MAKE AN INQUIRY.
BUT ESPECIALLY BECAUSE THESE
ENSURE REFERRALS ARE THE PRIMARY
METHOD THE STATE USES TO
INITIATE INVESTIGATIONS. INTO
SUSPECTED FRAUDULENT WORKERS
COMPENSATION CLAIMS
HOWEVER AT THE TIME OF OUR
AUDIT.
CD I DID NOT SURE THAT SELECTED
LARGE INSURERS WITH LOW REFERRAL
RATES WHEN PLANNING ITS AUDITS
OF THE SPECIAL INVESTIGATIVE
UNITS.
SO TO REDUCE INSURERS POTENTIAL
UNDER REPORTING OF WORKERS
COMPENSATION FRAUD WE HAD A
COUPLE OF RECOMMENDATIONS.
CD I
ONE WE RECOMMEND OF THAT CD I
CREATE A PUBLIC REPORT. THAT
WOULD RANK WORKERS COMPENSATION
INSURERS BASED ON THE
EFFECTIVENESS OF THEIR ANTI
FRAUD EFFORTS INCLUDING THE RATE
AT WHICH THEY SUMMIT THESE FRAUD
REFERRALS.
WE ALSO RECOMMEND AT CDI AT A
REQUIREMENT THAT IT CONSIDER
RATES OF FRAUD CLAIM REFERRALS.
WHEN SELECTING INSURERS TO AUDIT
AND IT'D GIVE PRIORITY PRIORITY
TO THOSE INSURERS WITH HIGH
VOLUMES.
PREMIUMS AND VERY LOW NUMBERS OF
FRAUD REFERRALS.
IAN CTI SIXTY DAY RESPONSE TO US
ON ITS EFFORTS TO IMPLEMENT OUR
RECOMMENDATIONS IT INDICATED
THAT AS IT HAS ALREADY REVISED
ITS AUDIT PLAN FOR FISCAL YEAR
SEVENTEEN EIGHTEEN. TO INCLUDE A
REFERRAL A REVIEW OF THE
REFERRAL RATIOS FOR ALL
INSURERS.
THE ANSWER GIVE AUDIT PRIORITY
TO THOSE INSURERS WITH HIGH
PREMIUMS AND LOW REFERRAL RATES.
CD I ALSO INDICATED THAT IT IT
HAS IDENTIFIED A NUMBER OF
FACTORS INCLUDING THE RATE AT
WHICH ENSURE SUMMIT THE FRAUD
REFERRALS. THAT IT'S CONSIDERING
INCLUDING IN A PUBLIC REPORT.
THAT WILL RANK WORKERS
COMPENSATION INSURERS.
BASED ON THEIR ANTI FRAUD
EFFORTS
CDI ANTICIPATES PUBLISHING'S
THIS REPORT THIS JUNE.
WE ALSO FOUND THAT INDUSTRIAL
RELATIONS EXCUSE ME HAD NOT
FULLY DOCUMENTED ITS PROCEDURES.
FOR IMPLEMENTING A CRITICAL TOOL
FOR COMBATING WORKERS'
COMPENSATION FRAUD BY PROVIDERS
THESE PROVIDER FRAUD CASES CAN
CONTINUE ON THOSE FOR YEARS IN A
SINGLE CASE. CAN COST INSURERS
MILLIONS OF DOLLARS
SO TO BETTER FIGHT THIS TYPE OF
FRAUD. INDUSTRIAL RELATIONS
RECENTLY BEGAN IMPLEMENTING DATA
ANALYTICS.
AND.
THIS ALLOWS YOU TO EXAMINE LARGE
VOLUMES OF DATA. TO IDENTIFY
PREVIOUSLY UNKNOWN WORKERS'
COMPENSATION FRAUD.
HOWEVER THE DEPARTMENT STILL IN
THE BEGINNING STAGES OF
IMPLEMENTING THIS NEW DATA
ANALYTICS PROGRAM. AT THE TIME
OF OUR AUDIT HADN'T FULLY
DOCUMENTED. ITS PROCEDURES FOR
USING USE ANALYTICS TO IDENTIFY
POTENTIAL PROVIDER FRAUD.
WE BELIEVE THAT DATA ALEX IS A
PROMISING TOOL WITH A
POTENTIALLY HIGHER RATE OF
RETURN AND WE THINK IT'S
IMPORTANT FOR INVESTOR
RELATIONS.
TO.
IMPLEMENT THESE ANALYTICS
EFFECTIVELY BECAUSE PROVIDER
FRAUD AS WE ALL KNOW IMPOSES
SERIOUS FINANCIAL COSTS ON
CONSUMERS. BUSINESSES AND
GOVERNMENTS.
TO THAT END WE RECOMMENDED THAT
TO ENSURE THE GROWTH AND
EFFECTIVENESS OF ITS DATA
ANALYTICS EFFORTS.
WE RECOMMENDED THAT INVESTOR
RELATIONS BETTER DOCUMENTS.
SEE JURORS FOR USING DATA
ANALYTICS WITH ITS PROTOCOL
MANUAL.
IN EARLIER THIS MONTH INVESTOR
RELATIONS DID IMPLEMENT THAT
RECOMMENDATION AND HAS MORE
FULLY DOCUMENTED ITS DATA
ANALYTICS EFFORTS.
CLUED IN PROCEDURES FOR DATA
MINING AND PREDICTIVE MODELING
IN ITS MANUAL.
FINALLY WE FOUND THAT INSURERS
DO NOT ISSUE. A STATEMENT TO
INJURED EMPLOYEES THAT PROVIDE
AN EXPLANATION OF BENEFITS
RECEIVED AND WE BELIEVE THAT
THESE STATEMENTS WOULD ALLOW
EMPLOYEES TO REVIEW THE SERVICES
PROVIDERS BILL TO INSURERS. TO
IDENTIFY POTENTIALLY FRAUDULENT
CHARGES.
THESE EXPLANATION OF BENEFITS
STATEMENTS ITEMIZE THE TYPES OF
SERVICES THAT PROVIDERS
RENDERED.
THE DATES EMPLOYEES RECEIVE THE
SERVICES AND THE FEES THAT THE
INSURERS PAID ON THE PATIENT'S
BEHALF.
AND THE STATEMENTS WOULD PROVIDE
INJURED EMPLOYEES THE
OPPORTUNITY TO REVIEW THE
SERVICES FOR WHICH PROVIDERS
BUILD THE INSURERS.
TO IDENTIFY POTENTIALLY
FRAUDULENT CHARGES.
HOWEVER CALIFORNIA DOES NOT
REQUIRE INSURERS FOR WORKERS
COMPENSATION TO ISSUE OR
OTHERWISE MAKE THESE YOU'LL BE
STATEMENTS AVAILABLE TO INJURED
EMPLOYEES.
ACCORDING TO THE LOS ANGELES
DISTRICT ATTORNEY'S OFFICE THE
LACK OF REVIEW BY PATIENTS.
THAT RECEIVE THE SERVICES
EQUIPMENT OR THE MEDICATION
CREATES OPPORTUNITIES FOR SERIAL
BILLING. IN WHICH YOU HAVE
PROVIDERS THAT POTENTIALLY ARE
BILLING MULTIPLE INSURERS FOR
THE SAME SERVICES.
WE ALSO FOUND THAT THERE ARE
CERTAIN PUBLIC AGENCIES AND SOME
INSURERS OUTSIDE THE WORKERS
COMPENSATION PROGRAM.
THAT ARE ALREADY USING THESE
YOU'LL BE STATEMENTS TO HELP.
OUR FIGHT FRIED.
FOR EXAMPLE THE U. S. CENTERS
FOR MEDICARE AND MEDICAID
SERVICES PROVIDES QUARTERLY
YOU'LL BE STATEMENTS
THE BENEFICIARIES UNDER
MEDICARE.
AND THESE BENEFICIARIES HAVE
DISCOVERED FRAUD THROUGH
REVIEWING THE STATEMENTS.
AND THAT RESULTED IN
PROSECUTIONS CONVICTIONS THE
RECOVERY OF FUNDS.
IN ADDITION CALIFORNIA LAW DOES
REQUIRE INSURERS PROVIDING
DISABILITY INSURANCE.
PROVIDE THESE YOU'LL BE
STATEMENTS TO THOSE SUBMITTING
CLAIMS.
IN SUMMARY WE BELIEVE THAT THESE
HE'LL BE STATEMENTS COULD BE AN
EFFECTIVE TOOL TO HELP PROVIDE
OR HELP FIGHT PROVIDER FRAUD. IN
THE WORKERS COMPENSATION SYSTEM.
AND WE THINK THE BENEFITS OF THE
STATE WAS WOULD LIKELY OUT WAY
ANY PERCEIVED DRAWBACKS.
FOR EXAMPLE ONE THING INSURERS
COULD DO TO KEEP YOU BECAUSE
DOWN. IS PROVIDE THEM
PERIODICALLY.
FOR EXAMPLE ONCE A QUARTER BY
CONSOLIDATING ALL CLAIMS THAT
WERE PAID IN THAT PERIOD.
INSURERS COULD ALSO FORMAT
EASIER BE STATE IN SOME WAYS
THAT MAKE THEM EASIER FOR
EMPLOYEES TO UNDERSTAND. FOR
EXAMPLE BY USING SIMPLE LANGUAGE
EXPLAINING THE MEDICAL CODES AND
PROVIDING QUESTION AND ANSWER
FORMAT.
WE RECOMMENDED THAT THE
LEGISLATURE REQUIRE WORKERS
COMPENSATION INSURERS.
PERIODICALLY PROVIDE THESE
YOU'LL BE STATEMENTS TO INJURED
EMPLOYEES BECAUSE WE BELIEVE
THAT WOULD BETTER ENSURE THAT
THE PAYMENTS INSURANCE ISSUE TO
PROVIDERS FOR WORKERS
COMPENSATION CLAIMS ARE BASED ON
BALLOTS SERVICES.
MY COLLEAGUE MISTER CARLSON IS
NOW GOING TO TALK ABOUT OUR
CONCERNS REGARDING THE
INVESTIGATION AND PROSECUTION OF
WORKERS COMPENSATION BROAD.
THINK MISTER TILDEN PLEASE GO
AHEAD SIR.
GOOD MORNING CHAIR MEMBERS I'M
BILL CARLSON I WAS THE TEAM
LEADER FOR OUR AUDIT OF THE
STATE'S EFFORTS ON WORKERS
COMPENSATION ANTI FRAUD THE AREA
THAT I'M GOING TO COVER TODAY.
DEALS WITH THE INVESTIGATION AND
PROSECUTION OF WORKERS
COMPENSATION.
FRAUD.
BUT.
I'M GONNA TALK ABOUT THREE
POINTS TODAY FIRST CD EYES ARE
GOING VACANCY RATE AMONG ITS ITS
FRAUD INVESTIGATORS.
IN THE FISCAL YEAR TWO THOUSAND
SIXTEEN SEVENTEEN BUDGET CD I
WAS AUTHORIZED TWO HUNDRED
THIRTY THREE POSITIONS.
AS FRAUD INVESTIGATORS TO GO OUT
AND AND PURSUE WORKERS
COMPENSATION FRAUD.
AS OF FEBRUARY TWENTY SEVENTEEN
CD I WAS STATING THAT IT HAD
SIXTY THREE VACANCIES. IN THESE
POSITIONS THAT RESULTED IN ABOUT
EIGHT TWENTY SEVEN PERCENT
VACANCY RATE.
WHEN WE WERE LOOKING WHAT WE
WANTED TO DO WAS SEE WHAT THE
IMPACT OF THIS VACANCY RATE
MIGHT BE ON THE STATE'S EFFORTS
TO PURSUE FRAUD. AND WE TOOK A
LOOK AT ABOUT WE TOOK A LOOK AT
THREE DIFFERENT THINGS.
NUMBER ONE.
CD I.
HAS DECREASED INVESTIGATIONS
THAT IT IS OPENING FROM CASE
REFERRALS.
ON PAGE
TWENTY FIVE ON TABLE FIVE WE
SHOW THAT CD I RECEIVED ABOUT
ANYWHERE FROM FORTY ONE HUNDRED
TO FIFTY NINE HUNDRED SUSPECTED
FRAUDULENT CLAIM REFERRALS EACH
YEAR.
IN TWO THOUSAND THIRTEEN
FOURTEEN CD I OPENED SIX HUNDRED
AND FIFTY FOUR CASES FROM THESE
REFERRALS.
TWO YEARS LATER BY TWENTY
FIFTEEN SIXTEEN.
CDI OPENED ONLY FOUR HUNDRED
EIGHTY EIGHT.
CASES WHICH IS A DROP OF A
HUNDRED AND SIXTY SIX CASES OR
ABOUT TWENTY FIVE PERCENT.
THE SECOND THING WE LOOKED AT
WAS THE INCREASE IN THE NUMBER
OF REFERRALS THAT CDI CLOSED DUE
TO INSUFFICIENT RESOURCES.
AND WE SUMMARIZE THIS ON FIGURE
SEVEN WHICH IS ON PAGE THIRTY
SEVEN OF OUR REPORT.
WHAT WE'RE SHOWING IN THAT
FIGURE IS IN FISCAL YEAR
THIRTEEN FOURTEEN CTI CLOSED
ABOUT SO
TEAM HUNDRED?
EXPECTED FRAUDULENT CLAIMS DUE
TO INSUFFICIENT RESOURCES AT
THAT TIME THAT WAS ABOUT TWENTY
EIGHT PERCENT OF THE TOTAL
NUMBER SUSPECTED FRAUDULENT
CLAIM.
ALLEGATIONS THAT IT RECEIVED.
TWO YEARS LATER IN TWENTY
FIFTEEN SIXTEEN. THE NUMBER OF
SF SEES CLOSED DUE TO
INSUFFICIENT RESOURCES HAD
INCREASED BY OVER TWENTY NINE
HUNDRED. WHICH WAS ABOUT FIFTY
FOUR PERCENT OF THE TOTAL SF
SEES.
THAT CD I RECEIVE.
THE THIRD ISSUE WE LOOK THAT WAS
THAT CD EYES HIGH VACANCY RATE
CAN HAVE AN EFFECT ON THE
ABILITY OF DISTRICT ATTORNEYS
OFFICES TO PROSECUTE WORKERS
COMPENSATION PROG CASES.
THE LA DISTRICT ATTORNEY'S
OFFICE.
PAUL THAT'S THAT IT COULD NOT
ADEQUATELY PROCESS ITS CASE LOAD
UNLESS CD I HAVE A SUFFICIENT
NUMBER OF FRAUD INVESTIGATORS TO
HANDLE CASES.
CDI SOUTH LOS ANGELES REGIONAL
OFFICE WHICH WORKS WITH THE LA
DA'S OFFICE HAD A FORTY SEVEN
PERCENT VACANCY RATE IN FISCAL
YEAR FIFTEEN SIXTEEN. THE LA DA
STATED BECAUSE IT COULD NOT
COMPENSATE FOR CD ICE RESOURCE
LIMITATIONS. IT MIGHT HAVE TO
DECLINE NEW REFERRALS ESTABLISH
A MINIMUM LAS RITERION OR CLOSE
CASES DUE TO LACK OF
INVESTIGATIVE RESOURCES.
IN OTHER WORDS IT WAS A HAVING
AN IMPACT ON THE LA DA'S OFFICE
TO PURSUE WORKERS COMP FRAUD.
BUT OUR SECOND POINT ALTHOUGH CD
EYES TAKING CERTAIN STEPS TO
ADDRESS VACANCIES WE FEEL CAN
TAKE OTHER STEPS AS WELL.
CGI'S ACKNOWLEDGE THE HIGH
VACANCY RATE IS A PROBLEM. AND
IT SOUGHT AND RECEIVED A PAY
INCREASE FOR ITS FRAUD
INVESTIGATORS THAT WAS EFFECTIVE
IN JULY TWENTY SEVENTEEN.
THIS PAY INCREASE REDUCE THE GAP
BETWEEN CD ICE FRAUD
INVESTIGATORS INEQUIVALENT OR
COMPARABLE. ABOUT LAW
ENFORCEMENT POSITIONS WITH BOTH
THE DEPARTMENT OF JUSTICE IN CDC
ARE.
CD I ALSO SET UP A TEAM
RESPONSIBLE FOR RECRUITING
ACTIVITIES IN AUGUST TWENTY
SIXTEEN. CDS RECRUITING TEAM
CREATED RECRUITING PLAN WHICH
FOCUSED ON BUILDING NEW
RECRUITING EFFORTS AND
STREAMLINING ITS PROCESSES FOR
HIRING INVESTIGATORS.
IT ALSO SET UP A STRATEGIC
VACANCY REPORT THROUGH WHICH
VACANCIES CAN BE MONITORED.
WE IDENTIFY TWO CONCERNS NUMBER
ONE CDI ITS RECRUITMENT PLAN DID
NOT INCLUDE EFFORTS TO RECRUIT
RETIRED OR EXPERIENCE LAW
ENFORCEMENT OFFICERS.
WE FOUND THAT OTHER STATES AND
THREE TWO OF THE THREE COUNTY
DISTRICT ATTORNEY'S OFFICE IS
THAT WE VISITED.
HIGHER RETIRED OR EXPERIENCE LAW
ENFORCEMENT OFFICERS AS WORKERS
COMPENSATION FRAUD INVESTIGATORS
CD ICE PLAN FOCUSED ON HIRING
RECENT COLLEGE GRADUATES.
OUR SECOND CONCERN WAS THAT CD I
CREATED THE RETENTION PLAN.
BURKE CB SI I HAD NOT CREATED
RETENTION PLAN TO ASSESS THE
REASONS WHY IT'S FRAUD
INVESTIGATOR FOR LEAVING.
THE FIRST STEP IN ENTITY SHOULD
CONSIDER WHEN DEVELOPING A
RETENTION PLAN.
IS A FORMAL METHOD TO ASSESS
EMPLOYEE SATISFACTION THROUGH
EXIT SURVEYS OR INTERVIEWS
ALTHOUGH CD I SENT VOLUNTARY
SURVEYS TO RECENTLY SEPARATED
STAFF. IT DID NOT COMPLETE
WRITTEN ANALYSES OF THE SURVEY
RESULTS.
OUR ANALYSIS OF SIX SURVEY
RESPONSES FROM FRAUD
INVESTIGATOR. SHOWED THAT THEY
WERE DISSATISFIED NOT ONLY WITH
PAY. BUT ALSO WITH TRAINING
GROWTH OPPORTUNITIES PROMOTIONAL
POTENTIAL AND CD EYES POLICIES
AND PROCEDURES.
WE MAKE TWO RECOMMENDATIONS
FIRST THAT CD I REVISE ITS
RECRUITMENT PLAN.
TO INCLUDE THE RECRUITMENT AND
HIRING OF RETIRED LAW
ENFORCEMENT OFFICIALS.
AND CDI HAS TAKEN ACTION TO
IMPLEMENT THAT RECOMMENDATION.
SECOND.
WE RECOMMENDED THAT CDI DEVELOP
AND IMPLEMENT A RETENTION PLAN.
CDI IS IN THE PROCESS OF
DEVELOPING THAT.
PENSION PLAN AND HOPES TO HAVE
ADOPTED BY JUNE FIRST OF THIS
YEAR.
AND THEN LASTLY DISTRICT
ATTORNEYS OFFICES COULD HAVE YOU
CD EYES ON SPENT ANTI FRAUD
FUNDS.
FOR THE FOUR YEARS THAT WE
LOOKED AT THE INSURANCE
COMMISSION IN THE FRAUD
COMMISSION.
AWARDED SIXTY PERCENT OF THE
FRAUD ASSESSMENT AMOUNT TO
DISTRICT ATTORNEYS OFFICES.
WHAT THIS MEANS IS THAT CD I
RECEIVE THE MINIMUM FORTY
PERCENT REQUIRED BY LAW FOR
ABOUT TWENTY FOUR MILLION
DOLLARS IN ANNUAL?
FOR FIFTEEN SIXTEEN CD I DID NOT
SPENT TWO POINT FOUR MILLION OR
ABOUT TEN PERCENT OF ITS
ALLOCATION.
STATE LAW CURRENTLY GIVES THE
INSURANCE COMMISSIONER IN THE
FRONT COMMISSION THE OPTION OF
USING UNSPENT CD I FUNDING TO
EITHER OFFSET OR AUGMENT FUTURE
PROGRAM FUNDING.
THE INSURANCE PRESSURE IN THE
FRONT COMMISSION MISSED AN
OPPORTUNITY TO INCREASE THE
AMOUNT OF FUNDING AVAILABLE TO
DISTRICT ATTORNEYS OFFICES IN
SUBSEQUENT YEARS.
WHEN THEY USE CD EYES UNSPENT
FUNDS TO OFFSET A SUBSEQUENT
YEARS FRAUD ASSESSMENT.
CDI DEPUTY GENERAL COUNSEL
MENTIONED THAT CD I WOULD NEED
PROCESSES FOR DETERMINING HOW
MUCH TO REALLOCATE EACH DISTRICT
ATTORNEY'S OFFICE. AND FOR
TRANSFERRING THE FUNDS FROM CD I
TO THE LOCAL BA'S WE RECOMMENDED
THAT CD I DEVELOP AND IMPLEMENT
A PROCESS TO USE ITS UNSPENT
FUNDS TO AUGMENT FUNDING. TO THE
DA'S OFFICES RATHER THAN OFFSET
COLLECTIONS FROM EMPLOYER IN
SUBSEQUENT YEARS.
AS OF THIS MONTH CDI HIS
IMPLEMENTED THIS RECOMMENDATION.
MISTER CHAIRMAN MEMBER MISS HOW
MISTER CHILDREN AND I. ARE READY
TO RESPOND ANY QUESTIONS THAT
YOU MAY HAVE.
WONDERFUL THANK YOU VERY MUCH A
VERY VERY FINE OVERVIEW OF YOUR
AUDIT IN THE FINDINGS AND
RECOMMENDATIONS. THE COMMITTEE
MEMBERS ANY QUESTIONS FOR MISS
HOWELL AND HER TEAM.
ANY QUESTIONS AT THIS POINT.
MISTER HARPER HAS ONE IN MS
COPIER HAS MY GO AHEAD MR
HARPER.
AYE I THINK YOU BRING UP AN
EXCELLENT POINT IS THE
DIFFICULTY IN TERMS OF FINDING
NEW INVESTIGATORS IS THAT THERE
ISN'T REALLY KIND OF AN
ESTABLISHED CAREER PATH PEOPLE
AREN'T. ON THIS PATH IN IN HIGH
SCHOOL OR FOR COLLEGE AND SO.
PERHAPS THERE'S AN OPPORTUNITY
PARTNER WITH THE CAL STATE FOR
THE UC OR SOMETHING LIKE THAT
AND SO I JUST WANT TO GET YOUR
THOUGHTS.
BUT IN REGARDS TO TO TRYING TO
LOOK FOR A LONG TERM SOLUTION TO
MAKING SURE WE HAVE.
A WORKFORCE WHICH IS A VERY
IMPORTANT ROLE IN OUR STATES.
INSURANCE.
IN CDS WERE.
GIVE ME SERIOUS RECRUITMENT PLAN
DOES DISCUSS A NUMBER OF THOSE
THINKS I'M SURE THE CD AYE
REPRESENTATIVES CAN GO INTO MORE
DETAIL. ABOUT THOSE VERY POINTS
WHAT WE WERE LOOKING FOR WAS THE
CREATION OF RETENTION PLAN AND
HOPEFULLY DWIGHT DOWN HELP THEM
IDENTIFY WIRE THE FOLKS LEAVING
CDI SORRY TAKING ACTION ON THE
SALARY SITE TO TRY TO CLOSE THE
GAP.
IF THE OTHER COMPARABLE
POSITIONS AND WHAT WE'RE HOPING
IS IT THAT THE RETENTION PLAN
WILL HELP CD I IDENTIFY. WHAT
OTHER REASONS ARE THERE THAT
PEOPLE MIGHT THAT THEIR FRAUD
INVESTIGATORS MIGHT BE LEAVING?
AND THEREFORE WHAT ACTIONS IT
MIGHT BE ABLE TO TAKE TO RESOLVE
THOSE CONCERNS.
AND MISS COPIER.
THANK YOU VERY MUCH FOR FOR YOUR
PRESENTATION AND REPORT.
.
A COUPLE OF QUESTIONS JUST IN
TERMS OF.
.
OF STAFFING AND.
LOOKING AT.
HIRING.
COLLEGE STUDENTS AS OPPOSED TO
MAYBE RETIRED POLICE OFFICERS
ARE ARE OUTLINED FORCE ME.
DID YOU FIND ANY DIFFERENCE.
IN TERMS OF HIRING. BY REGIONS
OF THE STATE.
I OR WITHIN AREAS OF THE STATE
NUMBER ONE AND.
I'M ASSUMING THAT.
NEWLY HIRED COLLEGE GRADUATES
PAY IS LESS THAN A RETIRED
POLICE OFFICER PAY.
AND YOU HAVE SOME LIMITATION OF
LIMITATIONS ON THE NUMBER HOURS
IT CAN WORK.
IF THERE WERE RETIRED INTO THEIR
THEY'RE NOT COMING BACK INTO
SERVICE SO TO SPEAK SOME
WONDERING IF THAT AFFECTS.
THAT. THE AMOUNT THAT CD I WILL
BE SPENDING HAS.
THE TWO MILLION DOLLARS AND TEN
PERCENT IS DISTURBING NOT TO USE
WHEN THEY'RE WE KNOW THAT
THERE'S FRAUD AND YOU WANT TO BE
ABLE TO STOP IT.
IN SOME WONDERING. YOU KNOW.
ABOUT THAT IN THEN FINALLY.
.
LOADS OR SERVICE LOADS ARE OR.
.
AND IT DID YOU DO ANY ANALYSIS
OF HOW MANY AND INVESTIGATIONS
COULD BE CONDUCTED PER PERSON
PER YEAR SO THAT WE CAN GET A
BETTER IDEA OF. WHAT THE BUDGET
LOOKS LIKE AND WHETHER WILL
ALWAYS BE BEHIND?
THE CURVE IN TERMS OF TRYING TO
LOOK AT THIS ISSUE BECAUSE WE
DON'T WE JUST DON'T HAVE AN
APPLE M. PUT ENOUGH RESOURCES
INTO IT.
SO IN TERMS OF I WOULD ADDRESS
YOUR SERVICE LOVE QUESTION FIRST
IN TERMS OF SERVICE LOADS ONE OF
THE THINGS THAT WE DID WHEN WE
WERE LOOKING AT THE VACANCY
SAYS.
WHAT KIND OF IMPACT ON THE ON
INVESTIGATED CASES WITH THIS BE
AND BECAUSE OF VARIANCES IN THE
NUMBER OF CASES OVER TIME THAT
CD I LOOK BAD AND THE NUMBER OF
INVESTIGATORS THAT THEY HAVE WE
CALCULATED YEAH A RANGE OF AN
AVERAGE? OF FOUR THOSE SIXTY
THREE ON HIGHER POSITIONS WHAT
WAS THE MISSING CASELOAD
ASSOCIATED WITH THAT.
OUR CALCULATION WERE IT WAS A
RANGE BETWEEN TWO HUNDRED AND
THREE HUNDRED CASES THAT WE
BELIEVE CD I COULD'VE
INVESTIGATED HAD IT BEEN FULLY
STAFFED.
REGARDING THE RETIREMENT
UNDERSTAND OR WE UNDERSTAND
THAT.
IF THE PERSON RETIRES FROM A COW
PER TYPE SYSTEM BRINGING ON A
RETIRED LAW ENFORCEMENT OFFICER.
CAN AFFECT THEIR RETIREMENT BUT
THERE ARE MANY POLICE OFFICERS
WHO ARE NOT PART OF CALPERS
DEPARTED INDEPENDENT RETIREMENT
ASSOCIATIONS AND WHAT WE SAW BUT
AT ORANGE COUNTY AND.
IN ONE OTHER COUNTY WHICH THEY
WERE BRINGING ON RETIRED LAW
ENFORCEMENT AND THEY WERE.
ESSENTIALLY EARNING THEIR
RETIREMENT BUT THEY WERE ALSO
WORKING FULL TIME AT AT PAY. BUT
IN FOR THOSE DISTRICT ATTORNEY'S
OFFICE.
SO IF I COULD JUST MAKE A
COMMENT RHETORIC IS THAT. BOMB
IT JUST OCCURS TO ME THAT.
ONE OF THE THINGS WE MIGHT WANT
TO LOOK AT.
LONG TERM IS THERE AT. THE END
OF THE STATE HIRES PROBABLY THE
CATEGORY THAT'S THE HIGHEST
CATEGORIES INVESTIGATORS AND.
PUBLIC SAFETY.
OFFICERS IF YOU LOOK AT C. H. P.
AND THEN YOU LOOK AT THE
DEPARTMENT OF CONSUMER AFFAIRS
THERE THERE ARE AT SWORN
OFFICERS THROUGHOUT.
THE THE ORGANIZATION AND IT
MIGHT BEHOOVE US TO LOOK TO SEE
WHETHER THERE ARE THERE'S A WAY
FOR US TO CATEGORIZE THAT THE
LAB THAT.
THE LEVELS THAT YOU CAN MOVE UP
SO THAT YOU GET PEOPLE THAT ARE
MOVING. THAT THAT HAVE GOOD
TRAINING WITHIN THE STATE IN
THAT CAN MOVE. ON UP A CAREER
LADDER NOT NECESSARILY WITHIN
THE SAME ORGANIZATION BUT MAYBE
IF THEY MOVE IN INTO OTHER
ORGANIZATION IS WELL I JUST.
WHEAT YOU KNOW YOU HAVE AYE A.
B. C. YOU'VE GOT THE CA THERE
JUST JUST A NUMBER OF.
SWORN OFFICER OPPORTUNITIES SO.
THANK YOU.
ALRIGHT AND MR COOPER WAS NEXT
AND THEN WE'LL HEAR FROM MR
GRAYSON.
I DON'T THINK WITH OUR TEAM FOR
IT FOR A VERY THOROUGH REPORT IN
THE PUBLIC PART OF PALM IS.
WHY YOU WANNA CONVERT FOR THE
STATE TO THE STATE'S PAYS IS NOT
THAT GOOD?
WITHIN THAT WITH ABC NOW DC I.
MANY LAST YEAR A. B. C. GOT A
RAISE THEIR PROBLEM WITH
RECRUITMENT RETENTION. AND SO TO
SOME CD I.
AND OVERALL IT'S A BIG
DEPARTMENT NUMBER ONE I MEAN
THAT AVERAGED PLEASE PERMITS
PLAY ABOUT A HUNDRED OFFICERS
THIS IS A TWO AND THIRTY THREE.
AND FURTHERMORE SMOKE COMING OUT
OF COLLEGE TO ONCE WELCOMING THE
CTI THE HAS NO INVESTIGATIVE
EXPERIENCE. YOU WANT VETERAN LAW
ENFORCEMENT OFFICERS AT YOUR
BEST BET WOULD RETIRED
ANNUITANTS OR EVEN FOLKS THAT.
WERE DIFFERENT HARMON SYSTEMS
THAT EVERYBODY'S NOT PURRS.
LOOK LA THEY HAVE THEIR OWN
RETIREMENT SYSTEM IS THE SECOND
COUNTY AND. IN A SEVERAL OTHER
AGENCIES ARM WHAT'S DISTURBING
IS THE AMOUNT OF CASES THAT WERE
CLOSED.
FORTY PERCENT A WORKERS COMP
CASES REFERRALS.
WE'RE NEVER INVESTIGATED DUE TO
LACK OF MANPOWER AND TO ME
THAT'S THE THAT'S THE BIG ISSUE.
AND ONE THING ABOUT THE STATE
HAVING BEEN HERE FOR SOMETIME
NOW. WHEN YOU LOOK AT.
UPPER MOBILITY PAY.
SEES PEOPLE IS A LOT MORE. IS
AGENCIES DO A LOT OF LOCAL
AGENCIES PAY A LOT MORE SO WHEN
WHEN FOLKS ARE COMING OUT OF
COLLEGE.
IT'S
WHY GO OVER FOR THE STATE WE CAN
MAKE MORE MONEY SOMEWHERE ELSE
AND HAVE MORE UPWARD MOBILITY
BECAUSE IT'S TOUGH IT'S TOUGH
HERE.
SO YOU KNOW HOW WE CHANGE THAT
DYNAMIC IN AND RECRUIT THESE
FOLKS AND NO ONE POSSIBILITY IS.
A LITTLE HERE SEXTAPE EVER
COMMIT JUST PROGRAM WHERE FOLKS
WORKING WITH.
CHP INSECT BICU THE TO HAVE
RECRUITS THE PIPELINE THAT
THAT'S ONE WAY FOR MAYBE JOB
INTERNS ARE TO COME ON BOARD
BUT.
TO EACH EVENTUALLY A FULL TIME
FOLKS BUT THAT TO ME THE PROBLEM
IS.
GETTING SOME RETIRED FOLKS IN
THERE AND OBVIOUSLY IF YOU'RE
NOT PAYING SOME OF RETIRED THE
COURT LIMIT NOT NUMBER OF HOURS
MISSION UP IN SALARY AND
BENEFITS SO. FESCUE SOME WAY TO
MATCH THAT AND AND ACTUALLY NAM
FIGURED OUT. THE NEXT
INTERVIEWS.
FOR A LOT OF AGENCIES IT IS
MANDATORY PART OF HIM LEAVING
THE HAVE IF THE INTERVIEW. THEY
CAN REVIEW IF REFUSE TO TALK TO
YOU BUT MOST FOLKS WERE TALKING
TO A WITH THE ISSUES ARE SO.
THAT'S TO BE THAT IS THE POLICY.
BEFORE YOU GET YOUR LAST CHECK
BEFORE YOU LEAVE ATTORNEY
EQUIPMENT AND YOU WILL HAVE AN
EXIT INTERVIEW.
I THOUGHT IT WAS INTERESTING
WITH THE READING THE INSURERS.
THAT THAT DO MORE CASES.
.
BUT THAT THAT'S INTERESTING YOU
KNOW IT'S IT'S YOU KNOW
OBVIOUSLY SOME FOLKS OUT THERE.
IN THE MIDDLE TO GET BY BUT THAT
THINGS AND COMING UP ON THEM. TO
HELP US LOWER OUR RACE BECAUSE
FRAUD IS A BIG ISSUE WE SEE A
LOT. AND SOME AGENCIES HAVE
TAKEN AN OATH ACKERMAN COUNTY
THE REASON DEPUTY SHERIFFS.
FULL TIME TO INVESTIGATE
WORKERS COMP FRAUD CASES
TELL BUT THAT NAY DID PUT A DENT
IN THAT SO. I THINK IS A LOT TO
DO.
A LOT TO DIVE INTO YOU WITH
THIS BUT.
LEGACY EVEN LOT INVESTIGATORS
THERE BUT THAT THAT THE VACANCY
RATE IS JUST UNACCEPTABLE WITH
WITH A RAISE LAST YEAR.
CDI HAS DO A BETTER JOB GOING
OUT AND IN RECRUITING I
INDIVIDUALS OTHER FOLKS ARE OUT
THERE LIKE IT'S COMING OUT OF
COLLEGE. THAT WANT TO GET
INVOLVED AND WANT TO GETTING GAY
SO. HOPEFULLY CAN DO SOME
INTERNET MENTORSHIP PROGRAM TO
TO BRING SOME NEW FOLKS ON.
THANKS THANK YOU MISTER COOPER A
VOICE OF EXPERIENCE IN TERMS OF
LAW ENFORCEMENT AND.
.
ALL THE VARIOUS SO.
OF CAREER PATHS THAT EXIST IN
HELD HOW THOSE SYSTEMS WORK.
A MISTER GRAYSON. THANK YOU
MISTER CHAIR AND.
THANK YOU FOR YOUR REPORT AYE A.
APPRECIATE THE THE THOROUGHNESS
OF YOUR REPORT AND HAVING GONE
THROUGH IT. BY A AND I STAND TO
BE CORRECTED BUT AS WE BEGAN TO
PRESENTATION.
BY I UNDERSTOOD THAT THERE WAS.
STATEMENTS MADE THAT.
THERE WAS A QUESTION AS TO THE
LEGITIMACY OF THE THE NUMBER OF
OR SHALL I SAY THOUGH THE
QUESTION TO MAYBE THE LACK OF.
REPORTING OF INSURANCE FRAUD.
AND HOW THAT.
THERE MAY BE INSURANCE FRAUD
THAT'S NOT BEING REPORTED.
BUT THEN I DON'T RUN AND I SEE
ALSO ANA A. A IN A FACT SHEET%
WHERE CD I IS SAYING THAT THERE
ARE ONLY.
ABLE TO DEAL WITH FIVE PERCENT
WHICH IS AN ASTRONOMICAL NUMBER.
THIS FARCE LOW FIVE PERCENT OF
THE CASES THAT ARE ACTUALLY
REPORTED.
AND THEN.
THE JUSTIFICATION FOR THAT IS A
LACK OF RESOURCES
SO MY QUESTION WOULD BE.
VISIT.
IS THE FOCUS OVER. RIGHT NOW ON.
THAT OF THE NUMBER OF REPORTS OR
LACKTHEREOF THAT ARE THAT ARE
BEING SUBMITTED OR IS IT
RESOURCES AND IF IT IS RESOURCES
ISN'T LIMITED TO JUST MANPOWER.
OR ARE THERE OTHER TYPES OF
RESOURCES THAT THEY FEEL THAT
THEY ARE LACKING THAT WOULD HAVE
MADE A BETTER. AND THEN AS FAR
AS THE FUNDING GOES.
WHAT IS THE WHAT WHAT ARE THE
FUNDING MECHANISMS BUT IS THERE
COST RECOVERY?
THAT THAT CAN HELP IN AND THE
FUNDING OF A DEPARTMENT AS WELL
AS FOR THE DA'S.
IN THEIR ABILITY TO BE ABLE TO
PROSECUTE.
SO.
A MINUTE YOU HAVE TO A LOT OF
QUESTIONS EVER TRY TO PARSE
THROUGH THEM AS AS BEST I CAN IF
YOU LOOK AT TABLE.
ONE ON PAGE EIGHT IT SHOWS IT'S
BROKEN DOWN INTO TWO PARTS THE
NUMBER OF CASES IN COURT AND
THEN THE ESTIMATED CHARGEABLE
FRAUD.
SHE CAN SEE THAT OVER TIME THE
NUMBER OF CASES ACTUALLY STAYED
FAIRLY STABLE BUT IF YOU LOOK AT
THE AMOUNTS OF CHARGEABLE FRAUD.
THAT RIGHT THERE IS TELLING US
IF YOU LOOK AT THE INCREASE FROM
THE FIRST YEAR ON THE LEFT IT'S
TWO HUNDRED AND EIGHTY TWO.
MILLION DOLLARS GOING UP TO.
UP TO ALMOST A BILLION DOLLARS
IN CHARGEABLE FRAUD ONE OF THE
CONVERSATIONS I HAD WITH THE
DISTRICT ATTORNEY'S TOWARDS THE
END OF OUR.
AT THE END OF THE AUDIT SAID IF
WE WERE TO HAVE ONE MORE YEAR
THERE THIS DISTRICT ATTORNEY WAS
TELLING ME THAT THAT ESTIMATED
CHART OF IS NOW OVER A BILLION
DOLLARS A YEAR. SO THAT'S A OF A
HUGE COMPONENT. INTO ME IT IT
SHOWS A COUPLE THINGS NUMBER ONE
CD I IN THE DA'S INVESTIGATORS.
ARE TRYING TO MAXIMIZE THE VALUE
BEHIND THE CASES THAT THEY'RE
GETTING IF YOU LOOK AT PROVIDER
FRAUD THEY MEANT A CHARGEABLE
FRAUD YOU SEE IT GOES FROM ABOUT
A HUNDRED THIRTY MILLION IN THE
FIRST YEAR. AND IT'S NOW AT
EIGHT HUNDRED MILLION SO AGAIN
IT SHOWS THAT THEY'RE PUTTING A
FOCUS ON WHERE THE MORE
EXPENSIVE FRAUD SOCK.
BUT IT CREATES KIND OF A AS A
COROLLARY TYPE CONCERN THAT THAT
YOU RAISED IS WHAT ABOUT THE
FRAUD THAT THEY'RE NOT
IDENTIFYING WHAT'S THERE AND
THAT'S THE PURPOSE BEHIND THE
CHAPTER THAT THAT MIKE DISCUSSED
ON WAYS THAT WE CAN DO. THE
STATE CAN DO A BETTER JOB OF
SURFACING THESE INSTANCES OF THE
POTENTIAL FRAUD HOPEFULLY
PROVIDER FRAUD WHICH TENDS TO BE
THE MORE EXPENSIVE OUT OF ALL
THE FRONT. IN TERMS OF RESOURCES
CDI TERMS OF ITS WORKERS COMP
FRAUD EFFORTS AS WELL AS THE
LOCAL DISTRICT ATTORNEYS ARE
PRIMARILY FUNDED BY THAT ANNUAL
ASSESSMENT FROM THE FRAUD
ASSESSMENT COMMISSION.
IS CDI SHARES ABOUT.
TWENTY FOUR MILLION OF RECENTLY.
AND THEN YOU KNOW WHATEVER THAT
THE BALLOTS OF THAT IS GOING
OVER TO THAT D. A.'S OFFICES.
THE DA'S FOR SUBMITTING THEIR
REQUESTS FOR THIS FUNDING
DEPENDING ON WHAT YEAR.
THE FRONT COMMISSION MAY FUND
MOST OF THAT REQUEST.
IT MADE FUN YOU KNOW JUST SMALL
COMPONENTS OF THAT REQUEST.
BUT THE FOR PRIMARY FUND SOURCE
FOR THE STATE'S EFFORTS BOTH CDI
AND THE DISTRICT ATTORNEY'S IS
THIS FRAUD COMMISSION FUNDING.
NOT SURE THIS CD I
REPRESENTATIVE CAN GO ON A
LITTLE BIT MORE DETAIL ABOUT.
IT THE FUNDING RESOURCES
AVAILABLE TO IT.
ALRIGHT ANY FURTHER QUESTIONS SO
FOR OUR. OUR STATE AUDITOR AND
HER TEAM IT JUST FOLLOWING UP ON
MISTER GRAYSON QUESTION SO
EVERYTHING ELSE IS REMAIN
STATIC.
EXCEPT FOR THE CHARGEABLE FRAUD
HAS GONE UP MORE LESS.
CORRECT
OKAY AND. I DON'T MEAN TO BE
DISRESPECTFUL THE UNDERSTAND
WHAT CHARGEABLE FRAUD IS WHAT
CHARGEABLE WE HAVE A DEFINITION
AND REPORT CHARGEABLE FRAUD IS.
FRAUD THAT THE DA'S ARE
CONFIDENT THEY BELIEVE THEY CAN
PROVE THAT THERE WAS FRAUD THAT
WAS COMMITTED AND IT CAN RESULT
IN INCOME AND CONVICTION SO
THERE MAY BE OTHER SUSPECTED BUT
THIS IS. THIS TABLE IS
REPRESENTING FRAUD THAT D. A.'S
FEEL THEY HAVE A VERY STRONG
CASE WHERE THEY CAN PROVE.
AND CONVICT EITHER THE PROVIDER
THE EMPLOYEE WHOEVER THE. THE.
PARTY IS THAT.
THEY BELIEVE COMMITTED THE
FRAUD.
SO THEY FEEL VERY CONFIDENT
ABOUT THAT AND AND AS MISTER
CARLSON INDICATED GONE FROM TWO
HUNDRED EIGHTY TWO MILLION TWO
BILLION AND I THINK THE POINT
YOU MAKE MISTER GRAYSON IS VERY
IMPORTANT. AND THAT'S WHY WE
WERE LOOKING AT THIS PROCESS AS
YOU ASKED US TO DO MISTER
CHAIRMAN.
HOLISTICALLY FROM UP PREVENTION
AND DETECTION BECAUSE IF IF THE
DEPARTMENT OF INSURANCE. DOES
SOME ANALYSIS AND LOOKS AT SOME
OF THESE INSURERS AND SAYING YOU
HAVE OVER A HUNDRED FIFTY
MILLION IN PREMIUMS ARE ON
AVERAGE YOU KNOW TEN MILLION
PER.
A AND YOU'RE NOT REFERRING IN
THE CASES THAT JUST DOESN'T SEEM
REASONABLE. SO IF WE IF THE
STATE DOES A BETTER JOB AS FAR
AS A DEPARTMENT INSURANCE
REQUIRING INSURERS TO REALLY
TAKE THESE.
NOW REQUIREMENTS IN STATE LAW TO
HAPPY SPECIAL INVESTIGATIVE
UNITS AND RE FIRST SUSPECTED
FRAUD TO INSURANCE.
INSURANCE NEEDS TO HAVE THE
CAPACITY TO BE ABLE TO
INVESTIGATE THAT SUSPECTED
FRAUD.
AND THAT'S WHY WHEN WE LOOKED
AT DEPARTMENT INSURANCE AND WE
SAID THEY KNOW THEY HAVE A HIGH
VACANCY RATE THEY HAVE LOST
INDIVIDUALS WE DID AN ANALYSIS
AND REPORT WHERE. THEIR SALARY
LEVELS WERE NOT COMPARABLE TO
THE DEPARTMENT OF JUSTICE OUGHT
DEPARTMENT CORRECTION SO THOSE
INDIVIDUALS LOOKING FOR UPWARD
MOBILITY I'M GONNA LEAVE THE
DEPARTMENT SHARON'S I'M GONNA GO
OVER TO. OTHER DEPARTMENT
JUSTICE I WILL BE AN
INVESTIGATOR OF ADVANCEMENT
OPPORTUNITIES I WILL BE MAKING
MORE MONEY NOW THAT'S WHAT YOU
WANT OUR STATE EMPLOYEES TO DO.
SO INSURANCE NEEDS TO MAKE SURE
THAT THEY'RE ANALYZING THEIR
SALARIES AND THEY CAN BE AS
COMPETITIVE AS POSSIBLE.
AS FAR AS RECRUITING I THINK THE
POINT MISTER HARPER YOU MADE
WORKING WITH THE CSU SYSTEM IN
BRINGING AND STUDENTS IS GREAT
BUT LET'S PARTNER THOSE STUDENTS
WITH EXPERIENCE LAW ENFORCEMENT
OFFICERS WHO. EITHER JOINT STATE
SERVICE BECAUSE THEY RETIRED
FROM A DIFFERENT SYSTEM OR THEY
WANT TO COME BACK AS A RETIRED
IN NEWTON AND THEY'RE TEACHING
THE PEOPLE WHO ARE COMING OUT OF
SAX STATE ARE YOU SEE OR. KNOW
COMMUNICANT WHERE EVER.
THAT HAVE CHOSEN.
STATE SERVICE AS A CAREER THEN
WE'RE TRAINING THOSE FOLKS SO
WHERE ADDRESSING THE DIFF
WORKER'S COMP FRAUD HOLISTICALLY
AS A STATE AS FAR AS.
INDUSTRIAL ASIANS DOING THE
ANALYTICS OUGHT TO PROVIDE
INFORMATION AND LOOKING FOR.
ANOMALIES INSTEAD OF HAVING TO
DEAL WITH HUNDREDS AND HUNDREDS
OF. OF CLAIMS AND FIGURING OUT
HOW MANY PROVIDERS ARE LOOKING
LIKE THEY'RE SERIAL BILLING ARE
THERE PREDICTIVE ANALYTICS THAT
WE WILL HAVE IN THE FUTURE AS A
STATE. THROUGH INDUSTRIALIZATION
SENATE'S EFFORTS THAT IT CAN
HAND OFF TO INSURANCE AND THE
DA'S SO ALL OF THESE AGENCIES
ARE PARTNERING TOGETHER. TO
COMBAT FRAUD BUT IT'S GONNA
REQUIRE IMPROVEMENT IN ALL
DIFFERENT AREAS AWE AS FAR AS.
NOPE THE TOOLS TO PREVENT DETECT
LET'S BRING THE RESOURCES AND
EITHER THROUGH THE USE IT UC CSU
SYSTEM BRING IN THOSE EXPERIENCE
LAW ENFORCEMENT OFFICERS
STRENGTHEN OUR INVESTIGATIVE AND
PROSECUTION. AND THEN YOU'RE
GOING TO SEE MORE AND MORE
DETERRENCE AS FAR AS.
WE WE AS A STATE ARE DOING A
BETTER JOB OF.
IDENTIFYING SUSPECTED FRAUD AND
THEN BEING ABLE TO PROSECUTE
THAT FRAUD WHICH HOPEFULLY WILL
DETERMINE THE VISUALS FROM
COMMITTING FRAUD IN THE FUTURE.
AND I APPRECIATE THAT THANK YOU
FOR THAT DEEPER EXPLANATION I
JUST TO CLOSE BY THAT YOU CHAIR.
AND.
BY I MADE REFERENCE TO
RESOURCES AND THE REFERENCE WAS
THAT BECAUSE OF A LACK OF
RESOURCES ONLY FIVE PERCENT ARE
BEING DEALT WITH.
IS THIS THE WORD RESOURCE
LIMITED TO JUST MANPOWER OR IS
IT BECAUSE.
THOUGH THE MANPOWER THAT IS
PRESENT THE WORK FORCE THAT IS
PRESENT.
THEY MAY NOT HAVE THE TOOLS THAT
THEY FEEL THEY NEED THEREFORE
GETTING FRUSTRATED THEREFORE
THEY GO AND FIND SOME OTHER
PLACE TO WORK.
I KNOW THAT IN LAW ENFORCEMENT.
THERE'S A TOOL THAT I AND I ALSO
BROUGHT UP COST RECOVERY SO
THERE'S A TOOL THAT FOR CERTAIN
CRIMES YOU HAVE ASSET
FORFEITURE.
FOR IN LARGER CASES OF FRAUD.
IS THERE THAT TOOL THAT HELPS
COST RECOVERY THAT WOULD PROVIDE
THE MEANS
FOR THE TECHNOLOGY AND FOR THE
TOOLBOX FOR THE WORK FORCE TO BE
ABLE TO DO EVEN A BETTER AND
MORE EFFICIENT JOB.
SURE REST RESTITUTION FINES AND
PENALTIES THERE'S A VARIETY OF
OF LET'S SAY IN INCOME STREAM
THAT CAN COME FROM THOSE
SOURCES.
WE WE SAW THAT THEY WERE THERE
WE DID NOT SPEND ANY TIME
ANALYZING THAT WE WERE FOCUSING
PRIMARILY ON THE ALLOCATIONS
THAT CAME THROUGH THE FRONT OF
SEISMIC MISTER.
AND THE VICE CHAIR MISTER MAYES
HAS QUESTION.
I JUST FOR CLARIFICATION YOU
MIGHT OF.
MIGHT A PARTY ADDRESS THIS BUT
JUST LOOKING AT THIS A TABLE ONE
HERE.
LOOKING AT THE TOTAL NUMBER OF
CASES IN COURT A RELATIVELY
FLAT.
FROM THAT THAT THE THREE YEAR
PERIOD OF TIME.
WELL ALTHOUGH THE CHARGE WILL
FRAUD NUMBERS ARE THREE TIMES
THE AMOUNT AND IT LOOKS LIKE THE
PROVIDER.
IS IS THE CAUSE THAT CAN YOU
TALK ABOUT THAT.
YES PROVIDER FRAUD IS WHEN WE
LOOK AT THE SF SEASON THOSE AT
BAY WAR. INVESTIGATING BECAUSE
OF THE LACK RESOURCES WHAT WE
DID IS BECAUSE OF THE WAY
THEY'RE TRACKING SYSTEM IS IT
ALLOWED US TO LOOK AT WHAT TYPE
OF FRAUD WAS IT WAS AN EMPLOYEE
FRAUD WAS EMPLOYER FRAUD WAS A
PROVIDER FRAUD.
AND WHAT WE SAW AND THOSE THAT
WERE.
BUT EMPLOYEE FRAUD THE AVERAGE
WAS IN THIS IN IT IN THE FEW
THOUSAND RANGE WHEN WE LOOKED AT
WHAT THE AVERAGE AMOUNT OF THIS
IS ALLEGE FRAUD AS OPPOSED TO
THAT CHARGEABLE FRAUD.
THE ALLEGE FRAUD ON THE PROVIDER
SIDE WAS IN THE SEVENTY THOUSAND
PER RANGE SO EACH PROVIDER
BASICALLY ON THESE ALLEGATIONS.
THAT THE CONCERN IS THAT THEY
ARE GOING AFTER BIGGER CHUNKS OF
THE WORKERS COMPENSATION POT.
IT IS THEN SAY AN EMPLOYEE OR
PERHAPS EVEN A PROVIDER.
SO IT'S SO TO TO ADD TO THAT SO
EMPLOYEE COMMITTING FRAUD MAY BE
FIVE TEN THOUSAND DOLLARS A
PROVIDER MAY BE COMMITTING
FRAUD.
WITH A VARIETY OF DIFFERENT.
INDIVIDUALS WHO WERE RECEIVING
CARE FOR THAT FROM THAT PROVIDER
SO THE PROVIDER MAY BE
COMMITTING TEN MILLION DOLLARS
WORTH OF FRAUD THAT'S WHY YOU'RE
SEEING THE AMOUNT GOING UP AS WE
HAVE MORE PROVIDERS. IT'S OF
RELATIVELY FLAT AS FAR AS THE
NUMBER OF CASES BUT THE VOLUME
THE DOLLAR VOLUME FOR A PROVIDER
IS MUCH HIGHER THAN A SPECIFIC
INDIVIDUAL EMPLOYEE WHO MAYBE.
FRAUDULENTLY CLAIMING CLAIMING A
AN INJURY.
GOOD ALRIGHT ANY FURTHER
QUESTIONS SIR THANK YOU AGAIN
FLORA MEMBERS OUTSTANDING ANNA.
WORK AND THE.
REALLY FINE PRESENTATION TODAY
THANK THANK YOU VERY MUCH.
WE NOW WILL HEAR FROM A.
ARE.
STANDING.
STATE FOX A TWO DIFFERENT
DEPARTMENTS OF THE DEPARTMENT OF
INDUSTRIAL RELATIONS HEADED BY
CHRISTINE BAKER.
AND.
LET'S HEAR FROM CHRISTINE FROM
MISS BAKER AND THEN WE'LL HEAR
FROM THE DEPARTMENT INSURANCE
FOLKS.
YEAH LET'S SIR IN IF THE
DEPARTMENT OF INSURANCE FOLKS
WOULDLIKE TO COME UP NOW THIS
WOULD BE A. GOOD TIME MR LAU
SURE AS MR LASHER HERE.
GOOD IN THEN I THINK ANOTHER.
PERSON AS WELL.
SO I THINK WE HAVE ENOUGH
CHAIRS.
THERE WE GO.
I THINK WE DO HERE WE HAVE
ENOUGH CHAIRS.
ALRIGHT MS BAKER THANK YOU FOR.
FOR BEING WITH US TODAY OF THE
PLEASE GO AHEAD THANK YOU
HONORABLE CHAIR AND MEMBERS
THANK YOU SO MUCH FOR THE
OPPORTUNITY TO BE HERE TODAY.
ARM AND ALSO THANK YOU FOR
GIVING US THE TOOLS
TO COMBAT FRAUD AND WE'VE TAKEN
THAT THOSE TOOLS VERY SERIOUSLY
AND.
WE WILL BE REPORTING TODAY WITH
UP WITH REGARD FOR PROGRESS.
I'M AS YOU KNOW. I ALSO HAVE MY
TEAM HERE OF MY TOP NOTCH TEAM.
THE ADMINISTRATIVE DIRECTOR OF
THE WORKERS COMP SYSTEM THE
CHIEF JUDGE OF THE WORKERS COMP
SYSTEM AND THE CHIEF OF THE
FRAUD UNIT ALL WORKING IN
COORDINATION TO UP COMBAT FRAUD.
I'M.
WE HAVE THE CALIFORNIA
COMPENSATION SYSTEM IS THE
LARGEST IN THE COUNTRY AND
PROVIDES MEDICAL CARE INDEMNITY
BENEFITS AND RETURN TO WORK
BENEFITS FOR SEVEN HUNDRED
THOUSAND WORKERS.
WHO SUFFER ON THE JOB INJURIES
THAN ILLNESSES?
SUPPORTED BY THE GOVERNOR
BROWN'S ADMINISTRATION
CALIFORNIA BUSINESSES AND LABOR
REPRESENTATIVES HAVE COMMITTED
TO WORKING TOGETHER TO REFORM
THE STATE WORKERS COMP SYSTEM.
AND WE AS THE AS THE KEY
STAKEHOLDERS THEIR WILLINGNESS
TO COMPROMISE AND FORCE YOU
POLICY FOR THE BENEFIT OF ALL
TRANSFORM THE SYSTEM. INTO A
STABLE. AND SUSTAINABLE BENEFIT
MODEL THIS HAS THIS IS UNIQUE.
BUT THERE HAVE BEEN REFORMS IN
THE PAST BEST BUT THIS IS THE
LONGEST PERIOD OF SUSTAINABLE
REFORM AND.
WERE VERY PLEASED WITH THE
RESULTS
THE LANDMARK SB EIGHT SIX THREE
LEGISLATION. CODIFIED THESE
EFFORTS.
THE DIR NDW SEE WORK TIRELESSLY
TO FACILITATE THESE MONUMENTAL
ACHIEVEMENTS BUILT ON A POLICY
FRAMEWORK WITH THE THREE GOALS
PROVIDE TIMELY AND APPROPRIATE
HIGH QUALITY CARE FOR INJURED
WORKERS.
INCREASED BENEFITS FOR
PERMANENTLY DISABLED WORKERS AND
REDUCE FRICTIONAL COSTS
ARM AND ADMINISTRATIVE BURDEN
FOR EMPLOYERS.
WE HAVE FOCUSED ON EFFORTS
DEVOLVING A SOLID FOUNDATION BY
USING EMPIRICAL RESEARCH TO
IMPROVE POLICY.
USING THE BEST MEDICINE FOR BY
ALIGNING TREATMENT AND EVIDENCE
BASED GUIDELINES.
GRADING TRANSPARENCY BY
TRANSITIONING ONLINE PROCESSING
AND REPORTING AND STOPPING ABUSE
BY FORMALIZING TOOLS THAT YOU
HAVE GIVEN US TO DETER.
BAD BEHAVIOR AND PURSUING PRO
ACTIVE DATA DRIVEN ANTI FRAUD
STRATEGIES.
S. B. EIGHT SIX THREE BROUGHT
THE FOCUS BACK ON THE KEY
STAKEHOLDERS IN THE SYSTEM
BENEFITS FOR WORKERS FOR
INCREASED BY THIRTY PERCENT.
INCLUDING EIGHTY PERCENT WAGE
REPLACEMENT RATES AND REFORMS
PREVENTED ANTICIPATED PREMIUM
RATE SPIKE LEADING TO AN ALL FOR
ALL. RATE REDUCTION OF ABOUT TWO
TWENTY TWO PERCENT ARM SINCE TWO
THOUSAND THIRTEEN.
INDEPENDENT MEDICAL AM BILL
REVIEW PROCESSES TOOK MEDICAL
TREATMENT AND BILLING DISPUTES
THIS IS IMPORTANT BECAUSE WE
HAVE THIS DATA DRIVEN
INFORMATION AND I'M GOING TO GET
TO THE REASON WHY DISS ALL VERY
IMPORTANT. THIS IS THE
FOUNDATION OF THE DATA DRIVEN
ANALYTICS.
THE INCREASE SPOTLIGHT ON FRAUD
ATTRACTED THE ATTENTION OF LABOR
SECRETARY LINEAR ASSEMBLY MEMBER
DALY. ARM AND THE CALIFORNIA
SENATE COMMITTEE ON LABOR AND
INDUSTRIAL ASIANS TO EXAMINE
ISSUES AND YOU EXPLORE POSSIBLE
WAYS OF ADDRESSING THEM.
DIR AND CULT COLLABORATION WITH
CD I.
THE DIVISION OF WORKERS COMP THE
COMMISSION ON HEALTH AND SAFETY
CONVENE STAKEHOLDER MEETINGS
ARE.
IN JUNE OF TWO THOUSAND SIXTEEN.
IN ADDITION WEAKENED CONTRACT
WITH THE RAND CORPORATION THEY
CONDUCTED ANALYSES OF THE ISSUES
A PUBLISHED REPORT THAT PROVIDE
RECOMMENDATIONS TO ADDRESS
PROVIDER FRAUD.
BASED ON THE STAKEHOLDER INPUT
AN INDEPENDENT RESEARCH FINDINGS
THE LEGISLATURE PASSED ELEVEN
SIXTY.
SB ELEVEN SIXTY AND YOUR A. B..
TWELVE FORTY FOUR PROVIDING OUR
TEAMS WITH FRAUD FIGHTING TOOLS.
LABOR CODE SECTION FORTY SIX
FIFTEEN NOW INCLUDES AN
AUTOMATIC LIEN STAY PROVISION
DURING CRIMINAL PROSECUTION.
LABOR CODE SECTION ONE THIRTY
NINE POINT TWO ONE CODIFIES A
PROCESS FOR SUSPENDING. AND
EXCLUDING CONVICTED PROVIDERS
FROM THE WORKERS COMP SYSTEM AND
WITH LABOR CODE SIX SECTION
FORTY NINE OH THREE POINT OH
FIVE C. PROVIDES FOR THE CON
CONSOLIDATION. AND DISMISSAL OF
HUNDREDS OF THOUSANDS OF LEANS
THROUGH A DUE PROCESS PROCEDURE.
AB FOURTEEN TWENTY TWO FURTHER
ASSISTED ASSISTED US BY
CLARIFYING INTENT ENSURING
ALIGNMENT BETWEEN TWELVE FORTY
FOUR AND SB ELEVEN SIXTY.
DO YOU ARE PUBLISHED ESTABLISHED
A UNIT WITHIN THE OFFICE OF THE
DIRECTOR TO CARRY OUT ANTI FRAUD
ACTIVITIES IN COLLABORATION WITH
THE DIVISION OF WORKERS COMP.
THIS UNIT HAS ACCESS TO ALL THE
DATA.
WE'VE ESTABLISHED NUMEROUS MO
USE WITH THE DISTRICT
ATTORNEY'S.
AND CD I TO FACILITATE
INFORMATION SHARING FOR
INVESTIGATIONS AND PROSECUTIONS.
TO DATE HUNDRED FIFTY SEVEN
CRIMINALLY CHARGED PROVIDERS
ACCOUNT FOR MORE THAN FOUR
HUNDRED AND FIFTY THOUSAND.
TENSELY STAYED LEANS.
TWO HUNDRED AND SEVEN PROVIDERS
HAVE BEEN SUSPENDED FROM THE
CALIFORNIA SYSTEM AND ANOTHER
THIRTY EIGHT ARE PENDING
SUSPENSION.
MORE THAN TWENTY TWO THOUSAND
FIVE HUNDRED LIENS FILED BY.
OR ON BEHALF OF TEN SUSPENDED
PROVIDERS OR IN CONSOLIDATION
PROCEEDINGS.
WE ARE ALSO PROCESSING VOLUNTARY
DISMISSALS MORE THAN TWENTY
EIGHT THOUSAND LEANS BY OR ARE
OR ON BEHALF OF SUSPENDED
PROVIDERS.
THROUGH BE IT OUR PIECE OF THE
THE PLEA AGREEMENT.
NEARLY THREE HUNDRED THOUSAND
LEANS WERE SUBJECT AUTOMATIC
DISMISSAL FOR FAILURE TO FILE A
LEAN DECLARATION.
PER PER LABOR CODE SECTION FORTY
NINE A THREE POINT OH FIVE SEE
TOTALING TWO POINT FIVE BILLION
IN ESTIMATED CLAIM VALUE.
THESE DISMISSALS PREVENTED
SETTLEMENTS THAT FUND CONVICTED
PROVIDERS AND RICK TURNED
VALUABLE COURT TIME TO INJURED
WORKERS CASES.
THE RESULTS ARE ROBUST.
AND WE HAVE MORE TO DO.
TOGETHER CALIFORNIA'S LOCAL AND
STATE AGENCIES ARE WORKING TO
READ THE SYSTEM OF EGREGIOUS
BEHAVIOR.
AND PIVOT.
IN UP TO A STABLE STABLE PATH
FORWARD FOR THE BENEFIT OF
WORKERS AND EMPLOYERS IN
CALIFORNIA.
WE LOOK FORWARD TO CONTINUING
OUR EFFORTS AND A IN SUPPORT OF
YOUR GOALS THANK YOU VERY MUCH
FOR THE OPPORTUNITY.
THANK YOU MISS BAKER PANDA.
DO YOU HAVE ANY OTHER FOLKS FROM
YOUR TEAM WHO WANT TO SPEAK AT
THIS POINT OR MAYBE JUST BE
AVAIL OR QUESTIONS OKAY ARE.
VERY WILLING AND READY TO
RESPOND GOOD THANK YOU ANY
QUESTIONS FOR MS BAKER IN THE.
DIR TEAM.
ALRIGHT WILL THE.
.
I'VE REALLY JUST WANT TO FOLLOW
UP ON ANALYTICS A.
PROJECT THAT YOU HAVE IS THERE
ANYTHING ELSE YOU WANNA YOU KNOW
IS ANYTHING WE CAN DO TO HELP
YOU WITH YOUR.
WITH THAT ONGOING PROJECT TO OR
ARE YOU FEELING GOOD ABOUT THE
TIMELINESS OF IT AND HOW IT'S
COMING TOGETHER WORK FEELING
VERY GOOD WE'VE PUT.
STRONG PEOPLE IN PLACE WE'VE GOT
AN ANALYTICS TEAM IN PLACE.
I HAVE A CHIEF OF MY ANTI FRAUD
UNIT. WORKING HARD A TO ENSURE
THAT WE HAVE PROPHECIES THAT ARE
DOCUMENTED AND BOMB CAM.
CONTINUE ON.
WEATHERBY REPORTS FORTHCOMING
IMMUNITY SORT OF REGULAR.
WE SUMMARY INFORMATION THAT
YOU'RE IMPROVISING OKAY HERS
GOOD GOOD. GOOD ANY QUESTIONS
ANY OTHER QUESTIONS FOR MS
BAKER.
BEAUTIFUL LET'S SIR THANK YOU
AGAIN MISS BAKER AND WE'LL HEAR
FROM THE US DEPARTMENT OF
INSURANCE FOX.
PLEASE LET US KNOW YOUR NAMES
TO.
THIS ARE GOOD MORNING CHAIRMAN
DALY AND VICE CHAIR MAYES ON THE
MEMBERS OF THE COMMITTEE.
THE OTHER STATE AGENCIES THAT
ARE HERE. MY NAME IS TO ALLOW
CHAIR I'M THE CHIEF DEPUTY FOR
THE DEPARTMENT OF INSURANCE.
I'VE BEEN WITH THE DEPARTMENT
FOR OVER THIRTY YEARS.
AND MUCH OF THAT TIME IN OUR
MARKET CONDUCT AND CONSUMER
SERVICES OPERATIONS AS A.
HIGHER LEVEL MANAGER AND MOST
RECENTLY IN RATE REGULATION.
I WANNA SAY FROM MY EXPERIENCE
AND MARKET CONDUCT WHERE WE.
CONDUCT AUDITS OF.
INSURER CLAIMS IN UNDERWRITING
ACTIVITIES I I DO APPRECIATE THE
EFFORTS OF THE.
STATE OF FEAR OF AUDIT TEAM.
THEIR PROFESSIONALISM WAS REALLY
REMARKABLE. AND.
THEIR WILLINGNESS TO DISCUSS
THEIR FINDINGS AND WORK THROUGH
INFORMATION WITH US.
pREALLY DESERVES PRAISE SO I
THINK YOU TO THE.
STATE AUDITOR'S.
ALSO WANT TO ACKNOWLEDGE SOME
OF THE EFFORTS OF OUR STAFF WHO
SOME OF WHOM ARE WITH US HERE
TODAY.
OF THE PERSON AT THE TABLE WITH
ME HERE IS NOT MIKE LEVY. ART
THAT THE GENERAL COUNSEL HE IN
MARINE PATROLS OF OUR OUR
COORDINATORS FOR THIS EXAM.
AND.
THEY DID A GREAT JOB FOR US I
REALLY APPRECIATE ALL OF OUR
TEAM. IN THIS REGARD.
WE APPRECIATE THE COMMITTEE'S
INTEREST FERRY OUT MY BACK TO
SOME HERE HERE.
NO THE FOR FORMAT HERE BUT.
.
WILL YOU WE APPRECIATE YOUR
INTEREST AND FIGHTING WORKERS
COMP FRAUD. I HOPE YOU
UNDERSTAND FROM THE REPORT
ALTHOUGH THERE ARE FINDINGS OF
NEED FOR IMPROVEMENT THIS IS A
CORE FUNCTION OF THE DEPARTMENT
OF INSURANCE.
IT IS SOMETHING WE VERY MUCH
FOCUS ON.
AT THE
COMMISSIONER JONES.
TOOK THE FINDINGS OF THE AUDIT
VARIOUS SERIOUSLY HE IMMEDIATELY
CORRECTED OUR STAFF TO. PUT
TOGETHER OUR PLANS FOR A MEETING
THOSE RECOMMENDATIONS AND AND.
.
AND DISCUSS THOSE WITH OUR
MANAGEMENT TEAM.
SO.
WE'VE SUBMITTED OUR PLANS TOO
COMMISSIONER JONES AT THAT TIME.
AND SUBSEQUENTLY OF COURSE HAVE
RESPONDED WITH ARE OUR SIXTY DAY
A UPDATE.
TO THAT UPDATE THAT I BELIEVE
OUR RESPONSE DEMONSTRATES THAT
WE ARE ACTIVELY ENGAGED IN
ADDRESSING THE RECOMMENDATIONS
MADE BY THE AUDITOR'S.
AND ARE BEING VERY THOUGHTFUL
AND MAKING MEANINGFUL CHANGES TO
TO OUR PROCESSES.
TO REFLECT OF THEIR
RECOMMENDATIONS.
WE CONTINUOUSLY SEEK TO ENHANCE
THE EFFECTS OF OUR.
STATE OUR BAR SPECIAL
INVESTIGATIVE UNIT EXAMINATIONS.
AND ARE HELPING TO DERIVE
INSURES FOCUS ON IDENTIFYING AND
FIGHTING FRAUD AS WELL.
WE CONTINUED TO DIRECT
SIGNIFICANT EFFORTS TO OUR
RECRUITING AND RETENTION OF
QUALIFIED STAFF.
AND EXPECT PROGRESS IN THAT
REGARD.
IT TO IMPROVE DESPITE THE PAY
DIFFERENTIALS THAT STILL REMAIN
BETWEEN OUR INVEST OF GATOR
CLASSIFICATIONS.
AND THOSE OF THE DEPARTMENTS OF
JUSTICE AND CORRECTIONS AS WAS
NOTED IN THE REPORT IN AND.
SOME OF YOU DISCUSSED.
HERE TODAY.
AND WE WORK TO ENSURE THAT THE
COORDINATION OF OUR EFFORTS AND
THE WORKOF THE DISTRICT
ATTORNEY'S.
WHO ARE PARTNERS?%
PROCEEDS THROUGH INEFFICIENT AND
EFFECTIVE FUNDING PROCESS.
SO I'M GONNA TURN IT OVER TO
MIKE LEVY TO EXPLAIN.
SOME OF THE DETAILS OF IN OUR
SIXTY DAY RESPONSE
THAT THAT TALKS ABOUT ARE AFTER
TO. RESPOND TO THE OTHER THAT
ITSELF THINKING MR LOW SURE AND.
.
BEFORE MISTER LEVY.
STARTS ARM I THINK WILL BE
CURIOUS I WILL BE CURIOUS.
ABOUT.
.
THE RECRUITMENT AND RETENTION
SITUATION THE PAY
CLASSIFICATIONS AND.
AND HOW THAT'S GOING.
.
I TALKED TO MR JONES COUPLE
YEARS AGO ABOUT IT AND I KNOW
THAT THAT WAS AN ISSUE OF A
BECAUSE OTHER DEPARTMENTS PAY.
BETTER.
CLASSIFICATIONS ARE DIFFERENT
NAM HE WAS LOSING SOME OF HIS
BEST PEOPLE IN A. INVESTIGATIVE
AREA.
.
SO TELL US EXACTLY HOW THAT'S
GOING IN IF THERE'S ANYTHING WE
CAN DO TO HELP OUT IN THAT. I
KNOW THE DEPARTMENT OF FINANCE
IS A.
IS A YEAR. AN ONGOING CHALLENGE.
ON MATTERS LIKE THAT BUT IS
THERE ANYTHING WE CAN DO TO HELP
SO GO AHEAD MISTER LEVY.
OR OR.
IF YOU WANT TO COMMENT ON THAT
ELISHA CAN COME IN ON ON THAT
EFFORT.
SO JUST THE RESPOND FROM WHAT.
WE'VE HEARD.
THE DEPARTMENT DOES RECRUIT.
FOR INDIVIDUALS RIGHT OUT OF
COLLEGE.
WE.
TEN JOB FAIRS WE HAVE ASSIGNED
TWO OF OUR TOP MANAGEMENT TEAM.
TO BE A ACTIVELY ENGAGED IN
RECRUITING AT ALL TIMES.
SO WE DO A LOT OF COLLEGE
RECRUITING BUT WE ALSO DO
RECRUIT. AT THE EXPERIENCE LEVEL
WE WE DO LOOK FOR OFFICERS
COMING OUT OF FOR. SOME OF THE.
OTHER AGENCIES LE COUNTY CITY
AGENCIES AS WELL AS PEOPLE
MOVING THROUGH THE STATE RANKS.
A I THINK.
RECRUITMENT IS A PROBABLY A
DIFFICULT PROCESS FOR ALL
SHIRLEY'S AGENCIES AT THIS POINT
IN TIME.
AND.
BEAMS MENTION THAT.
WE HAD SIXTY THREE I THINK.
VACANCIES THAT WAS MENTIONED
WORK NOW AT FIFTY EIGHT SO SOME.
LIMITED PROGRESS THERE BUT WE DO
HAVE THIRTY ONE POSITIONS RIGHT
NOW CANDIDATES IN BACKGROUND.
BACKGROUND IS A MAJOR COMPONENT
OF HIRING IN LAW ENFORCEMENT.
SAY REALLY HELPED THE VET THE
INDIVIDUAL'S ABILITY TO.
TO DO THE JOB AND.
SO WE HAVE BEEN SUCCESSFUL IN
AND.
IN OUR RECRUITMENT EFFORTS WE
HAVE MOVED A LOT OF PEOPLE INTO
THAT BACKGROUND CHECK AT THIS
POINT IN TIME.
YOU KNOW WE STILL HAVE THAT.
PRETTY SIGNIFICANT PAY
DIFFERENCE.
AND FOR STATE EMPLOYEES YOU KNOW
A THREE PERCENT RAISE WOULD BE A
SIGNIFICANT INCREASE.
BUT.
THE DIFFERENT DIFFERENTIAL
BETWEEN OUR AGENCY AND.
OF FOR EXAMPLE A SIMILAR
CLASSIFICATION AT THE TOP OF THE
RANGE.
FOR OUR INVESTIGATOR VERSUS A
DOJ SPECIAL SPECIAL AGENT THEY
WOULD MAKE CLOSE TO THIRTEEN
PERCENT HIGHER PAY.
AND ACTUALLY THE NUMBERS ARE
EVEN BIGGER FOR. SOME OF THE.
COMPARISONS WITH THE DEPARTMENT
OF CORRECTIONS.
INCLUDING A JUST FOR THE ENTRY
LEVEL.
CANDIDATE BUT AT THE TOP OF THE
RANGE SO AN EXPERIENCED PERSON
AT THE ENTRY LEVEL
CLASSIFICATION. THERE BE A
THIRTY PLUS DIFFERENTIAL.
WITH.
A SPECIAL AGENT AT THE
DEPARTMENT OF CORRECTIONS.
SO THAT'S A SIGNIFICANT DRAW OF
COURSE TO A STATE EMPLOYEE SHARE
THAT'S LOOKING TO UP YOU KNOW
AND SERIOUS LEARNING HERE TO
ANSWER THAT'S A SERIOUS GAP
YEAH.
YEAH SO IT IS.
IT'S CERTAINLY A WE TOOK INTO
ACCOUNT.
COMMENTS OF THE STATE AUDITOR'S
AND AND ARE LOOKING TO ENHANCE
OUR ATTENTION.
OF PROCESS.
AND WE CONTINUOUSLY TRIED TO
UPGRADE OUR RECRUITMENT PROCESS.
TO REALLY COMMUNICATE THE
BENEFITS OF WORKING FOR THE
DEPARTMENT OF INSURANCE AND THE
IMMEDIATE IMPACT.
A PERSON CAN MAKE IN TERMS OF.
SAVING YOU KNOW MONEY FOR
CONSUMERS AND AND AND HELPING
PEOPLE. ACROSS THE RANGE OF OUR
DIFFERENT FRAUD ACTIVITIES THAT
WE DO. CARE SO.
IT'S CERTAINLY A FOCAL POINT
FORSTER COOPER HAS A FOLLOW UP
QUESTION SURE YOU GUYS HAVE
STUDENT ASSISTANCE
FOR THE INVESTIGATOR.
POSITION RECENTLY RETIRED THAT I
KNOW THAT.
LOVE THE IT FOLKS DO THEIR
STUDENTS ISN'T THERE IN COLLEGE
TO COLONEL TAKING COMPUTER
CLASSES. THEM WITH A GRADUATE
BECOME IN THE IN THE PIPELINE
FOR THAT WE WILL YOU AND.
AND SOME OF THEM. I THINK I MET
ONE JUST RECENTLY IN FRESNO
THAT'S. COME ONBOARD YET THAT IS
SOMETHING WE DO I THINK A BIGGER
ISSUE TO ME IN MY MIND AS
CHRISTIANS IS DIFFERENT FROM
BEING THE THEM INVESTIGATOR
POSITIONS.
AND THEY SHOULD.
KELLY TRY RECENTLY DID A RE ORG.
ABOUT ALL THE DIFFERENT IT
POSITIONS OF THE HAD OVER A BILL
WE ET DE ALL THE PUBLIC HEALTH
THERE PROBABLY THIRTY OR FORTY
DIFFERENT. JOB THAT'S CATIONS
UNDER THAT THE ROACHES BICU
ONE INVESTIGATOR POSITION THE
CITY CALIFORNIA.
WITH THE DOJ A. B. C. CONSUMER
AFFAIRS JUST ONE.
PAY GRADING THAT THAT'S WHAT TO
ME IS A BIGGER ISSUE WITH CALLIE
CHAR IN THAT THEY CAN DO IT WITH
THOSE IT PROGRAMS IN. AND
PROGRAMMERS THIS BILL DO THE
INVESTIGATOR POSITION TO MAKE IT
EQUAL AND FOLKS DO ONE MOVE
AROUND VISUALLY IN YOUR BED A.
B. C. FOR FEAR THAT YOU ARE COME
BACK. AND GO TO.
.
FEEL THE INSURANCE SO I THINK
IT IT PREVIOUSLY GOT A. GOOD
GALA KELLI CHAR AND IN GETTING
INVOLVED THIS NEGATES CLICK SAID
IF YOU DO WITH ALL THOSE IT
POSITIONS THIS IS A LOT LESS.
OF A LIFT
WITH HIS INVESTIGATOR POSITIONS.
THE CHAIR GOOD HADN'T MADRE
POINTS MISTER COOPER AND A.
WE CAN NOW. MAYBE WORK ON THE
NEXT GOVERNOR.
TO HELP OUT WITH THIS ONE.
MR CHIU DID YOU HAVE A QUESTION
OKAY OKAY GOOD.
A MISTER LEVY PLEASE GO AHEAD
YES THANK YOU GOOD MORNING
CHAIRMAN DALY AND.
VICE CHAIR MAYES MEMBERS OF THE
COMMITTEE THANK YOU FOR THE
OPPORTUNITY THIS MORNING.
BOB DIRECTLY RESPONDING TO YOUR
QUESTIONS ABOUT RETENTION AND
RECRUITMENT AS DEPUTY LASHER
SAID.
WE ARE WE EXAMINED OUR OUR AYE
INTERNAL EFFORTS WE HAVE.
ROUTINELY BEEN HIRING AT THE
RETIRED LEVEL AND ALSO THE AYE
JUNIOR LEVEL IT JUST WASN'T
REFLECTED IN OUR. RECRUITMENT
PLAN AND NOW IT HAS BEEN REVISED
TO EMPHASIZE THAT ASPECTS OF
THAT IS BEEN COMPLETED AS. AS MR
CARLSON HAS MENTIONED IN TERMS
OF OUR RETENTION PLAN THAT WE
HAVE.
EXAMINED BEST PRACTICES ACROSS
THE STATE OF CALIFORNIA. WE'VE
ALSO EXAMINED OUR DEPARTMENT
WIDE. READ RETENTION EFFORTS AND
WE ARE REASSESSING HOW WE USE
OUR EXIT INTERVIEWS.
TO CREATE A FORMALIZED PROCESS
THERE'S AN INTERNAL DRAFT THAT
IS READY TO BE CIRCULATED IN A
FEW WEEKS AND WE HOPE TO HAVE
THE ENTIRE RETENTION RECRUITMENT
PLAN. EXCUSE ME RETENTION PLAN
IN PLACE BY JUNE FIRST.
SO WE'RE CONFIDENT THAT WILL
PROCEED.
GOOD GOOD IN THAT SQUARES WITH
WHAT TO MISS HOUSE TEAM SAID
EARLIER ABOUT THE JUNE FIRST A.
A GOAL GOOD I THINK ALL THIS HR
TAKA HAS DRIVEN AWAY MY
COMMITTEE MEMBERS THOUGHT ABOUT.
BUT THE NEVER THE LESS IT'S
IMPORTANT WE ALL YOU KNOW THE
HR.
THE ALL THE HR DETAILS REALLY
REALLY MATTER ESPECIALLY IN WITH
THESE COMPLICATED TO THE
CHALLENGES. ROOTING OUT FRAUD
AND SO FORTH.
.
IS THERE ANYTHING ELSE I DON'T
HAVE ANY MORE QUESTIONS AT THIS
POINT YOU HAVE ANYTHING ELSE YOU
WANT TO ADD.
ALRIGHT WELL LET'S THANK YOU
VERY MUCH FOR OF.
TWO ARE OUTSTANDING STATE.
ADMINISTRATIVE EMPLOYEES THANK
YOU.
SO HERE FROM STEAK FROM SOME
STAKEHOLDERS NOW.
WE'VE GOT TO WORKER AN EMPLOYER
PERSPECTIVES NEXT ON OUR AGENDA.
CHRISTINE BAUMER.
THE CALIFORNIA PROFESSIONAL
FIREFIGHTERS.
JASON SCHMELZER FROM THE
CALIFORNIA COALITION ON WORKERS
COMPENSATION JASON ARE YOU.
THERE IS THERE'S MISTER
SCHMELZER.
AND IN LARA CURTIS FROM THE
CALIFORNIA CHAMBER OF COMMERCE.
HOW BOUT OF?
FIVE MINUTES EACH IF I'M I'M
I'M SURE YOU CAN MAKE YOUR POINT
SIR.
IN THAT TIME FRAME.
I HOPE YOU CAN'T.
I DO MY BEST MISS BOMA GO AHEAD
MISTER CHAIRMAN MEMBERS.
MEMBER.
OF THE COMMITTEE. MY NAME IS A
CHRISTY BALBOA I'M HERE OF THE
HAVE THE CALIFORNIA OFFICIAL
FIREFIGHTERS IS YOU KNOW
REPRESENT THIRTY THOUSAND RANK
AND FILE FIREFIGHTERS. IN
CALIFORNIA WORKING IT FOR THE
STATE CITIES COUNTY SPECIAL
DISTRICTS TOOK POWERS AGENCY.
AT MY MEMBERS AS YOU KNOW EACH
DAY. THEY REPORT TO WORK
KNOWING.
THAT THEY'RE GONNA SUFFER
MULTIPLE SIGNIFICANT EXTENSIVE
INJURIES ON THE JOB.
HIM THE COURSE THERE PER
CAREERS AND PROTECTING THE
PUBLIC I DO THIS QUICKLY WHEN I
THANK YOU FOR THE OPPORTUNITY
INVITATION TO SPEAK TODAY. TO
THE AUDITOR'S FINDINGS OF I ALSO
WANNA THANK YOU FOR SEEKING THIS
INFORMATION AND ALWAYS ASKING
THOUGHTFUL QUESTIONS ABOUT. HOW
TO DETERMINE AND FIND SOLUTIONS?
I ALSO WONDER JUST
AS OF PERSONAL PRIVILEGE THANK
THE AUDITOR AND ALSO THE
AGENCIES REPRESENTED HERE TODAY
YOU KNOW I THE OPPORTUNITY WORK
WITH THEM ON A REGULAR BASIS.
AND THEY MAKE IT THEIR MISSION
TO CARE FOR MY MEMBERS AND MAKE
SURE THAT WE HAVE AN EFFECTIVE
SYSTEM OF WORKERS COMPENSATION
TO TREAT THEIR NEEDS.
AND THEN ONE MORE DISCLAIMER
AND I'LL GET TO THE SUBSTANCE
WHICH IS.
I WANTED IS GIVE SOME ALSO SOME
CONTEXT BECAUSE WE HAVE
PRACTITIONERS IN THE SYSTEM
HEALTH CARE PROVIDERS INSURERS
ADVOCATES.
A ALSO WHO PROVIDE CRITICAL
SUPPORT TO MY MEMBERS WHEN
THEY'RE TRYING TO SEEK
A REMEDY FOR THEIR ENTERED
INJURIES AND SO I DO HOPE THAT
MY COMMENTS. ON ISOLATED A
ISSUES THAT NEED TO BE FOCUSED
ON. I DON'T CAST A SHADOW ON THE
DEDICATION OF THESE
PROFESSIONALS IN OUR SYSTEM.
SO UP WHAT STOOD OUT FOR ME
DRAMATICALLY WAS THIS REFERRAL
ISSUE AND. AND WE HAVE.
WE HAVE WE'VE MOVED FROM THE
LABOR COMMUNITYHAVE ALLEGED
THAT MAYBE OUR INSURERS SOME OF
THEM DON'T HAVE ENOUGH SKIN IN
THE GAME AND TRYING TO PREVENT.
OF THE FRAUD THAT'S BEING
PERPETRATED TO THE SYSTEM.
.
AND SO THE REFERRAL THERE SOME
CASE ABSENCE THERE OF SEEMS LIKE
SOMETHING TO TAKE A LOOK AT.
.
THERE I ALSO WANNA MAYBE MAKE A
COMMENT ABOUT THE ALARMING
NUMBERS.
UP REGARD THE COST OF FRAUD AND
WHAT MOST OF THE FRAUD EXISTS
WHEN YOU OF PUT IT OF COST
BASIS.
BUT THERE'S ALWAYS A LOT OF
FOCUS WE FEEL LIKE ON CLIMATE
FRAUD BUT IF YOU LOOK AT THE
NUMBERS.
NINETY EIGHT PERCENT OF THE
MONEY THAT'S GOING OUT THE DOOR
A NOT TO INJURED WORKERS ABOUT
TWO.
PROTECT EMPLOYERS PAYROLLS IS TO
FRAUDULENT ACTIVITIES NOT
RELATED TO INJURED WORKERS.
AND THEN I JUST WANNA MAKE SOME
GENERAL COMMENTS ABOUT FUTURE
DISCUSSIONS.
A AND URGE MY FRIENDS WHO MAYBE
OVER IN THIS AUDIT AND THE FROM
THE INSURANCE INDUSTRY THAT THEY
WORK JUST AS HARD AND COMMIT THE
SAME LEVEL OF EFFORT.
TO FINDING PREVENT RATIFICATION
PROVIDER FRAUD AS THEY DO.
SOMETIMES MY MEMBERS FEEL IN
EXAMINING AND REEXAMINING AND
DELAYING AND DENYING TREATMENT.
BECAUSE WHAT'S HAPPENING TO MY
MEMBERS AS THEY LOVE THEIR JOB
THEY WANT TO GET BACK TO IT THEY
WATCH THEIR EMPLOYERS SPEND
MILLIONS OF DOLLARS BACK FILLING
THEIR POSITIONS WHILE THEY'RE
WAITING. TO BE TAKEN CARE OF IN
THE WORKERS COMPENSATION SYSTEM.
UP SO WE THINK THE POSITIVE
IMPACT OF THAT KIND OF LEVEL
EQUAL LEVEL OF EFFORT WOULD BE
DRAMATIC ON THE SYSTEM.
I DO STILL HERE WEEKLY FROM MY
MEMBERS ABOUT DELAYS THEIR
FRUSTRATION OVER ACCESS TO
PROVIDERS.
OR. OVERALL FAILURE TO RECEIVE
TIMELY ACCESS TO CARE.
A.
AND IT SEEMS THAT THE FINALLY
THIS THE STUDY SUPPORTS MORE
INSURERS PRIMER SKIN IN THE GAME
AS I MENTION.
BUT ONE OTHER ITEM MAYBE THIS IS
JUST.
OF FRUSTRATION OF THE CPF THAT
IT SOMETIMES SEEMS THAT EVEN
WHEN. WE ATTEMPT TO ADDRESS
INSURER OR PROVIDE NOT MEASURE
OF PROVIDER FRAUD OR PREMIUM
FRAUD.
THE PAST AND SOMETIMES FUTURE
EFFORTS HAVE INCLUDED.
SOLUTIONS THAT JUST CREATE MORE
BARRIERS TO INJURED WORKERS.
IN AN ATTEMPT TO GET AT THE
FRAUD
SO WE.
WE HAVE WE ARE AT THE TABLE
RIVER REMAIN AT THE TABLE WE WE
THINK THAT THE PROCESSES SHOULD
BECOME MORE COMPLICATED FOR
INJURED WORKERS IN ORDER TO THE.
TO ERADICATE THIS FRAUD IN THE
OTHER PARTS OF THE SYSTEM.
A AND FINALLY.
OF THE DEPARTMENT IS REGULARLY
PUBLISHED REALLY HELPFUL
INFORMATION ABOUT THE DRAMATIC
AND SIGNIFICANT SAVINGS. OF THAT
HAVE ACCRUED.
AS A RESULT OF RECENT REFORM
LEGISLATION PASSED BY THIS BODY
AND THE VERY EFFECTIVE ANTI
FRAUD EFFORTS OF THOSE AGENCIES
BUT IT'S UNCLEAR TO ME HOW THOSE
SAVINGS ARE BEING PLOWED BACK
INTO THE SYSTEM. TO MAKE IT MORE
EFFICIENT FOR INJURED WORKERS
AND LESS COSTLY FOR EMPLOYERS.
.
WE STAND READY ALONG WITH THE
BROADER LABOR COMMUNITY.
TO WORK WITH YOU TO MAKE SURE
THAT WE HAVE A COST EFFECTIVE
SYSTEM FOR EMPLOYERS. AND
EFFECTIVE SYSTEM FOR INJURED
WORKERS AND THANKS AGAIN FOR THE
OPPORTUNITY.
THANK YOU MISS BEAUMONT BOMB
REALLY EXCELLENT POINTS AND WELL
TAKEN VERY GOOD POINTS.
A POLICE CA.
MISTERS SCHMELZER OR.
LET'S HEAR FROM THE CALIFORNI
CHAMBER COMMERCE GOING MORNING
MY NAME'S FLOOR CURTIS NAME HERE
ON BEHALF OF THE CALIFORNIA
CHAMBER COMMERCE WE APPRECIATE
YOUR TIME TODAY. AND REALLY
APPRECIATE YOUR EFFORTS IN THIS
ARENA I'M OUR MEMBERS RECOGNIZE
AND APPRECIATE THE EFFORTS ON
ONLY OF THIS COMMITTEE BUT ALSO
OF THE LABOR AGENCY THE
DEPARTMENT OF INDUSTRIAL
RELATIONS THE GOVERNOR'S OFFICE
AND THE LEGISLATURE TO HELP
RECTIFY WORKERS' COMPENSATION
FRAUD AS SEATED IN THE AUDIT.
DEPARTMENT OF INDUSTRIAL
RELATIONS ESTIMATES THAT WORKERS
COMPENSATION COSTS BECAUSE STATE
EMPLOYERS WHO PAY FOR THE SYSTEM
THROUGH INSURANCE AND SELF
INSURANCE POLICIES TWENTY FIVE
BILLION DOLLARS IN TWO THOUSAND
FIFTEEN. WORKERS COMPENSATION
COSTS FOR CALIFORNIA EMPLOYERS
MUST GO DOWN IN ORDER FOR
CALIFORNIA TO BECOME COMPETITIVE
WITH EMPLOYER COST IN OTHER
STATES FRAUD PREVENTION WILL
ASSIST IN RECTIFYING THIS COSTS
FOR EMPLOYERS BECAUSE THE AMOUNT
OF WORKERS COMPENSATION FRAUD.
AS STATED IN THE AUDIT IS AN
ESTIMATED ONE TO THREE BILLION
DOLLARS ANNUALLY BY REDUCING
FRAUD WE DIRECTLY REDUCE
EMPLOYER COST SUCH FRAUD NOT
ONLY INCREASES COSTS CALIFORNIA
PLAYERS IT ALSO AFFECTS THE
INJURED WORKER. BY EXPOSING THEM
TO COST AS WELL AS RISK
THEREFORE WE SHOULD CONTINUE IN
THESE EFFORTS AND IT SHOULD BE A
JOINT EFFORT BECAUSE THE
NEGATIVE RAMIFICATIONS ON ALL.
WE UNDERSTAND THAT FRAUD
PREVENTION IS AN ONGOING ISSUE
AND CAL CHAMBERS GREATLY
APPRECIATES EVERYONE'S EFFORTS
BECAUSE ULTIMATELY OUR GOAL IS A
BALANCE WORKERS COMPENSATION
SYSTEM THAT EFFICIENTLY PROVIDES
TIMELY AND FAIR BENEFITS TO THE
INJURED WORKER. WHILE ALSO
REDUCING THE COST TO THE
EMPLOYERS AND THAT'S WHY WERE
GREATLY APPRECIATIVE OF THE
EFFORTS OF THIS COMMITTEE AND
MISTER TERRIER EFFORTS IN THIS
ARENA THINK SO MUCH. OF GOOD
THANK YOU THANK YOU VERY MUCH
FOR YOUR ATTENDANCE TODAY.
MR SMELLS.
THANK YOU MISTER CHAIR MEMBERS
OF THE COMMITTEE HAVE MY NAME'S
JASON SMELTER IN HERE IN HALF
THE CALIFORNIA COALITION ON
WORKERS COMPENSATION TODAY I
WON'T. LAST FIVE MINUTES IN
HEREBY THERE'S LIKE A GENETIC
PREDISPOSITION I THINK ON THE ON
THE PART OF LOBBYIST TO ONLY
SPEAK FOR TWO MINUTES I WENT
CITY OF THE STATE WILL SO I'LL
PROBABLY KEEP IT ROUGHLY THAT
AND WE LIKE THAT TOO BUT I I
KNOW I KNOW YOU. APPRECIATE.
OKAY SO CCW SEIZE OBVIOUSLY
STATEWIDE ASSOCIATION
REPRESENTING CALIFORNIA
EMPLOYERS THAT I THINK WE REALLY
TRY TO.
FOCUS ON TWO THINGS OUT ONE
GOOD BENEFITS FOR. INJURED
WORKERS INTO FAIRNESS AND.
KIND OF EFFICIENCY.
FOR.
EMPLOYERS AND THAT'S WHERE OUR
FOCUS IS I DO WANT TO ASSOCIATE
MYSELF WITH COMMENT SPECIFICALLY
I MADE BY MISS BOMA.
ABOUT.
RESPECTING WITH THE AUDITOR'S
DONE.
THE DEPARTMENTS AND OBVIOUSLY
NOT LETTING ANY SPECIFIC
COMMENTS ABOUT INDIVIDUAL
PROVIDERS COLOR OF THE BROADER.
PROVIDER COMMUNITY THIS VERY
ASTUTE OBSERVATIONS.
THE SYSTEM WIDE COSTS ASSIGNED
TWENTY FIFTEEN FOR WORKERS COMP
AND HEALTH CORNEA WERE AROUND
TWENTY FIVE BILLION DOLLARS.
THAT'S A THAT'S A LOT OF MONEY
IF YOU JUST THINK ABOUT IT.
AND AND THE AUDITOR.
IN THEIR REPORT AND SOME OF THE
ASSOCIATED DOCUMENTS MADE A VERY
GOOD POINT. AND THAT WAS IN PART
BECAUSE OF ITS SIZE AND
COMPLEXITY TO CALIFORNIA'S
WORKER'S COMPENSATION SYSTEM
CREATES AMPLE OPPORTUNITY FOR
FRAUD.
THIS MAY SOUND FAMILIAR IF
YOU'VE BEEN IN THIS COMMITTEE A
LONG TIME A LOT OF THE TIME WE
COME IN HERE IS EMPLOYERS AND
LABOR I THINK AND SAY.
YOU KNOW.
SHOOT FOR CONSISTENCY UNIFORMITY
AND OBJECTIVITY LETS TRY TO KEEP
THE SYSTEM AS SIMPLE AS POSSIBLE
BECAUSE OF THE LABOR CODE AND
THE RULES THAT DICTATE WORKERS
COMPENSATION I AND THAT VERY
THIN PAPER THAT WE ALL DEAL
WITH.
IS ABOUT THAT THICK. WHEN I
FIRST STARTED IN WORKERS COMP IN
NINETEEN NINETY NINE OR SO IT
WAS OF ABOUT THAT BECAUSE ABOUT
HALF OF IT.
I'M SO THIS REALLY IS A VERY
COMPLEX HARD TO UNDERSTAND A
SYSTEM OF BENEFIT DELIVERY. OF
THE CREATES LOTS OF NOOKS AND
CRANNIES AND WHICH PEOPLE CAN
HIDE AND JUST.
SHEER A DOLLAR OFF THE TOP HERE
A DOLLAR OFF THE TOP THERE AND
IF YOU DO THAT A COUPLE HUNDRED
THOUSAND TIMES ARE YOU ACTUALLY
HAVE SOME REAL MONEY. AS TO
KEEPING THE SYSTEM SIMPLE
UNIFORM.
AN OBJECTIVE TO US IS ALWAYS A
KEY POINT WE'RE GLAD THAT THE
AUDITOR PICKED UP ON THAT.
IN THEIR REPORT.
AND TO THE POINT CHRISTIE MADE
EARLIER.
THERE ARE REALLY THREE
CATEGORIES OF FRAUD THAT WE SEE
A MEDICAL PROVIDER FRAUD OR
PROVIDER FRAUD IN GENERAL
DOESN'T BE PROVIDER COULD BE
COPY SERVICE COULD BE ANY NUMBER
OF THANKS.
PREMIUM FRAUD BY EMPLOYERS AND
THEN.
AS OBSERVED BY CHRISTIE UMP
THAT THE SMALLEST CATEGORY I AND
I THINK THE CATEGORY WE LIKE TO
SPEND THE LEAST AMOUNT OF TIME
ON.
IS.
FRAUD BY INJURED WORKERS.
.
LARA POINTED OUT ONE THREE
BILLION DOLLARS A AND FRAUD IN
THE WORKERS COMP SYSTEM A PRE
YEAR AND WHERE THIS GETS
FRUSTRATING UNTHINKABLE
EMPLOYERS AND EMPLOYEES.
IS THAT WE HAVE SPENT.
IMMEASURABLE HOURS IN THIS
COMMITTEE ARGUING OVER WAY LESS
MONEY FOR INJURED WORKERS.
SO IT'S VERY PERSONAL.
TO THE PEOPLE WHO EMPLOY
WORKERS IN THE STATE AND THE
PEOPLE WHO REPRESENT WORKERS IN
THE STATE WE'RE ARGUING OVER
THOSE THAT AMOUNT OF MONEY. AND
WHILE PEOPLE ARE KIND OF*
NILLY JUST OUT THERE STEALING IT
FROM US.
SO WE NEED TO DO A BETTER JOB
WITH FRAUD A NOT.
TO SAVE MY MEMBERS A BUNCH OF
MONEY AT THAT FRANKLY TO THE
POINT CHRISTY WAS MAKING SO
WE'RE NOT SITTING HERE ARGUING
WITH EACH OTHER.
OVER THE ADEQUACY OF BENEFITS
FOR INJURED WORKERS.
I DO WANNA TOUCH ON ONE
RECOMMENDATION.
BACK ON.
BUT THE AUTHOR MADE MIKE UP TO
LIKE I CAN READ ABOUT THEM.
THAT THE AUDITOR MADE WITH
RESPECT TO.
UB'S I'M IN AND I UNDERSTAND
THAT THERE'S.
MAY BE SOME CONFUSION ABOUT
WHAT THE SPECIFIC RECOMMENDATION
WAS.
AND I UNDERSTAND THAT IT'S NOT
AND YOU BE TO EVER INJURED
WORKER ON EVERY.
SERVICE TO WORK YOU KNOW THAT
THEY'RE NOT GONNA GET A FLOOD OF
THESE THINGSAND EMAILS THAT
THERE IS A DESCRIPTION OF AB
QUARTERLY STATEMENTS.
WE DO HAVE SOME CONCERNS BUT
THAT'S GENERALLY AS AN IDEA I I
THINK THERE IS A COST OBVIOUSLY
FOR PROVIDING THESE.
THESE NOTICES.
.
BUT I THINK GENERALLY SPEAKING
WE'RE NOT SURE THAT IT WILL DO
MUCH GOOD FOR INJURED WORKERS TO
RECEIVE THE INFORMATION I I
SPENT SIX YEARS ADMINISTERING
WORKERS COMP CLAIMS AND I'VE
SPENT FOURTEEN YEARS. LOBBYING
WORKERS COMP CLAIMS AND I CAN
TELL YOU WHEN I LOOK AT SOME OF
THESE BILLING CODES AND BUILDING
PRACTICES AND THAT'S TECHNICAL
INFORMATION. MY HEAD STILL
SWIMS.
.
WE SAID AND IF WE IF I WERE TO
PRINT FOR YOU ALL OF THE NOTICE
THAT THAT ARE SENT TO AN INJURED
WORKER.
THROUGHOUT THE CLAIM FOR
INDEMNITY CLAIM IT WOULD BE
ABOUT THAT THICK.
SO THEY ARE GETTING A LOT OF
MAIL FROM US.
MINUTES IMPORTANT MAIL IT'S
MALE THE TALKS ABOUT. WHEN THEIR
BENEFITS ARE STARTING AND
STOPPING.
APES MAIL THAT TALKS ABOUT WHAT
MEDICAL TREATMENTS ARE BEING
APPROVED IN BUT MEDICAL
TREATMENTS ARE BEING DELAYED
DENIED IT STUFF THAT WE REALLY
NEED. THE INJURED WORKER TO READ
SO THEY UNDERSTAND WHAT IS GOING
ON IN THEIR CLAIM. I THINK FROM
THE EMPLOYER PERSPECTIVE WE
WOULD BE CONCERNED THAT SENDING
THEM A WHOLE FLOOD OF
INFORMATION THAT CAUSES THEM TO
SEE AN ENVELOPE WITH OUR NAME ON
IT.
AND THEN THROW IT AWAY BECAUSE
THEY DON'T WANT TO READ IT.
PROBLEMATIC BECAUSE WE NEED THEM
TO OPEN OUR MAIL AND WE NEED
THEM TO TO UNDERSTAND WHAT'S
GOING TO HAPPEN NEXT IN THEIR
CLAIM.
EH IT IMPROVES JUST THE
FUNCTIONALITY OF THE SYSTEM
OVERALL AND AND SELFISHLY FOR
EMPLOYERS IT HELPS AVOID
LITIGATION THAT IS ALMOST ALWAYS
A COST DRIVER IN THE SYSTEM.
SO WHILE WE UNDERSTAND THERE
MIGHT BE SOME BENEFIT THERE IN
SOME SITUATIONS I THINK WE
PREFER TO LEAVE.
THE STATUS QUO WHICH IS A LOT OF
CLAIMS OFFICES RIGHT NOW ALREADY
DO THIS ON A TARGETED BASIS.
WHERE THERE'S A PROVIDER?
OR AN AREA OF MEDICAL TREATMENT
OR SERVICES WHERE WE KNOW THERE
TO BE PROBLEMS.
SO.
I I THINK STATUS QUO'S OKAY.
WOULD BE EXTENSIVE TALKS TO HOW
WE CAN DO BETTER OBVIOUSLY OF
BUT WE DO HAVE THIS FEDERAL
CONCERNED ABOUT.
KIND OF FLOODING INJURED WORKERS
WITH A INFORMATION.
I OF THOSE ARE VERY INTERESTING
POINTS AND I'M GONNA ASK.
.
OUR COMMITTEE STAFF TO FOLLOW UP
WITH YOU ON SOME OF THE
EXAMPLES.
.
WHAT PROMPTS THE SENDING OF
THOSE NOTICES IN SOME CASES?
BY SOME COMPANIES JR. AND DOM.
NEVER.
MORE MAIL AND MORE
COMMUNICATION DOESN'T ALWAYS.
RESULT IN BETTER COMMUNICATION
OR.
AND SO THAT'S OF A GREAT POINT
AND I DON'T KNOW ENOUGH ABOUT
THE VOLUME OF MAIL IN THE TYPES
OF MAIL. THE LEGAL THE LEGALLY
REQUIRED NOTICES TO KNOW HOW TO
FOLD VOTES COMMUNICATIONS INTO
THE COMMUNICATION THAT MISSILE
WAS RECOMMENDING SO ALL S. MARK
AND PAUL TO FOLLOW UP ON THAT
MAYBE THERE'S A SWEET SPOT THERE
THAT WE CAN.
WE CAN NOW CERTAINLY LEARN
ABOUT.
AND PURSUE YES OF THANK YOU
ABSOLUTELY WERE ANY WORSE STILL
A EVEN AS THE AS AN ASSOCIATION
RIGHT NOW LOOKING AT THE
EXISTING NOTICES AND ASKING
OURSELVES. HOW CAN WE REDUCE
WHAT'S ALREADY GOING TO HELP
WORKERS BECAUSE WE WANT THEM TO
RECEIVE WHAT THEY THE I HEARD OF
WHICH WE NEED TO HAVE YEAH I
UNDERSTAND IT OUT OF ME TO
RESPOND TO IT VIA?
WITHOUT AND THAT'S BASICALLY
THE COCA VISION MY POINT SO
HAPPY TO ADDRESS ANY QUESTIONS
FROM.
GOOD THANK YOU ANY QUESTIONS FOR
A.
FOR THE EMPLOYER EMPLOYEE.
PANEL THAT WE HAVE.
IF NOT THANK YOU VERY VERY MUCH
FOR TAKING THE TIME TO GIVE US
YOUR PERSPECTIVE THANK YOU VERY
VERY MUCH.
ENSURE PERSPECTIVES.
OUR NEXT AND THEN WILL HAVE A
PROVIDER PERSPECTIVES SIR.
TO.
TWO SMALL PANEL SIR.
HERE.
ALTHOUGH THE FIRST SPEAKERS NOT.
SMALL HE'S.
LARGE.
COULDN'T RESIST MAN.
YEAH PATH THAT. I COULDN'T
RESIST.
YEAH.
AT THAT.
WE HAVE MISTER JEREMY MURS FROM
THE AMERICAN INSURANCE
ASSOCIATION IS THE LARGER OF THE
TO HEAR.
WE'VE DONE IT ALL OF THE TWO
TALLER AND ARAFAT.
IT.
IN THEN MISTER SEGMENT FROM THE
PROPERTY CASUALTY INSURERS
ASSOCIATION OF AMERICA.
MR MERGE YOU WANT TO GO FIRST.
CLEAR.
MISTER CHAIR MEMBERS.
DAD'S.
REPORTER NUMBER SHAKIRA MY NAME
IS JEREMY MURS AND I'M THE
WESTERN REGION VICE PRESIDENT
FOR THE AMERICAN INSURANCE
ASSOCIATION.
I A AYE A REPRESENTS
SOME OF THE LARGEST INSURERS IN
CALIFORNIA'S WORKER'S
COMPENSATION MARKET.
I WANNA THANK YOU FOR HOLDING
THIS HEARING TODAY ON THIS IS AN
IMPORTANT ISSUE IT'S AN
EVERGREEN ISSUE IT'S AN ISSUE
THAT. I'M WE CONTINUE TO TRY TO
ADDRESS IN THE SYSTEM.
AND.
BUT I WOULD LIKE THINK THE
OPPORTUNITY TO TESTIFY TODAY ON
THE SUBJECT. OF AN AYE AYE
DISSOCIATE MYSELF I GUESS WITH A
FEW OF THE OF MS BOWMAN'S
COMMENT CERTAINLY NOT ALL OF
THEM.
BUT WE YOU KNOW WE'RE TALKING
ABOUT FRAUD WE'RE TALKING ABOUT
PROVIDERS WERE TALKING ABOUT
INJURED WORKERS WERE TALKING
ABOUT EMPLOYER FRAUD THERE'S ALL
SORTS TYPES OF FRAUD. IS
IMPORTANT TO NOTE THAT BY AND
LARGE ON FOLKS ARE OPERATING IN
GOOD FAITH IN THE SYSTEM THIS
FRAUD IS DRIVEN BY A VERY SMALL
PERCENTAGE SO I THINK SHE MADE A
POINTED COMMENT WHICH.
NOT TO CAST A DARKNESS ON A
PROVIDERS IN GENERAL OR ANYONE
ELSE WHO WHEN WE'RE HAVING A
FRAUD DISCUSSION.
.
I THINK I'LL JUMP INTO A FIRST
SOME OF THE THAT THE BENEFITS
THAT THE GOOD THINGS WERE SEEING
IN THE SYSTEM BECAUSE WE HAVE
MADE PROGRESS IN FRAUD AND I
THINK FRANKLY. THERE'S BEEN A
BIT OF A PARADIGM SHIFT IN THE
LAST COUPLE YEARS IN THE WAY
THAT WE ARE.
ADDRESSING FRAUD I'M AS AN
INDUSTRY I'M AND FRANKLY AS A
SYSTEM.
ON THE LEGISLATURE LED BY THIS
COMMITTEE.
AND LED BY THE SENATE LABOR
COMMITTEE.
HAVE RECENTLY ENACTED NEW
LEGISLATION HAS BEEN MENTIONED
TODAY.
THAT I THINK CAN AS A POTENTIAL
TO STRANGLE A LOT OF THE BIG
SYSTEMIC FRAUD ON YOUR TO RECENT
BILLS.
HAVE PROVIDED YOU GIVE YOU SEE
WITH THE TOOLS.
TO ADDRESS THIS TYPE OF FRAUD
IN ADDITION WE'RE LEVERAGING THE
FEDERAL GOVERNMENT'S PURSUIT OF
MEDICARE AND MEDICAID HEALTH
FRAUD TO DETECT AND PROSECUTE
THOSE INDIVIDUALS.
IN A WORKERS COMP SYSTEM
MOREOVER I THINK YOUR AUDIT
REQUEST IN THE HEARING TODAY
SHOWS AN ENCOURAGING FOCUS UPON
THIS EACH READING TOO OFTEN IN
THE SYSTEM WHEN WE ADDRESS
ISSUES.
WE TRY AND.
WE TRY AND MAKE A PUBLIC POLICY
CHANGE AND THEN WE LET IT BE I
THINK THAT THIS IS THIS
CONTINUED FOCUS IS IMPORTANT AND
IT'S GOING TO BE NEEDED. I'M
GOING FOR A FOLLOW UP.
BUT OF COURSE LEGISLATION.
IS ONLY EFFECTIVE AS ITS
IMPLEMENTATION AND ENFORCEMENT
AND THAT THE ADMINISTRATION TO
LEADERSHIP OF SECRETARY LINEAR.
I'M DIRECTOR BAKER DIRECTOR PER
SOTO AND THEIR STAFFS.
HAVE DONE A COMMENDABLE JOB
SWIFTLY IMPLEMENTING THE
LEGISLATION.
AND FRANKLY THE RESULTS BEEN
TANGIBLE YOU HEARD THEM CITED
TODAY.
THE THE NUMBER OF FRAUDULENT
PROVIDERS THAT HAVE THEN.
PUT OUT OF THE SYSTEM THE
NUMBER OF A LEAN STATE ARE GONE
AS WELL.
I I THINK THAT THOSE EFFORTS
NEED TO BE COMMENDED A BUT I
THINK GETTING ONTO THE INSURER
POINTS HERE. AND WE UNDERSTAND
THAT IF WE'RE TRULY GOING
ADDRESS SYSTEM FRAUD AND THE
NEEDS BY AND FROM ALL
STAKEHOLDERS AND WE REPRESENT.
TWO THIRDS
AND THE WORKERS COMP
MARKETPLACES INSURED. AND THAT
PUTS US IN THE U. UNIQUE
POSITION IDENTIFY FRAUD. I'M WE
ADMINISTER THE MOST CLAIMS WE
MAKE THE MOST DIRECT VENDOR
PAYMENTS.
AND COLLECTIVELY WE HAVE THE
MOST SYSTEM DATA.
AND I THINK WHAT YOU'VE SEEN
RECENTLY AND YOU'VE HEARD ABOUT
USE THAT I READ ABOUT IN THE
AUDIT.
AND THE AUDITOR PRESENTED ON
THIS FACT AND CERTAINLY CDI IT
SPOKEN TO IT THERE'S A RESOURCE
LIMITATION.
AND SO WE FOCUSED OUR INSURERS
OF FOCUSED IS ON. ON QUALITY BIG
CASES.
CASES THAT CAN BE PROSECUTED.
AND AND I THINK AN EXAMPLE THAT
IS IT IS A RECENT ONE DOWN AND
ORANGE COUNTY WHERE INSURERS ARE
THE ONES WHO IDENTIFIED. AMASSED
PATTERN OF SUSPICIOUS CUT AND
PASTE PAPER WORK FROM A VERY
LIMITED NUMBER OF ATTORNEYS.
THIS UNCOVERED A MASSIVE.
FRAUDULENT SCHEME THEY REFERRED
IT OVER TO ON THE ORANGE COUNTY
DA WHO TEAMED UP WITH CD EYES
INVESTIGATION TEAM. AND THEY
FOUND A MASSIVE.
WELL ITS WAS A MASSIVE SCHEME
BY TEN ATTORNEYS AND A NUMBER OF
RUNNERS IN CAPPERS.
THIS SCHEME RESULTS IN OVER
THREE HUNDRED MILLION DOLLARS IN
INSURANCE PAYOUTS AND IT
INVOLVED OVER THIRTY THREE
THOUSAND PATIENTS CERTAINLY NOT
ALL OF THAT WAS FRAUDULENT.
BUT IT DOES SPEAK TO THE SCOPE.
OF OF OF HOW BIG THE SCHEMES
CAN GET.
.
WITH REGARD TO THE AUDIT ITSELF
I THINK FIRST WE SUPPORT.
THE INCREASED RESOURCES.
CDI INVESTIGATORS.
BAIT YOU WE NEED A THEY NEED BE
ABLE TO RECRUIT AND RETAIN
INVESTIGATORS TILT TO SERVICE
THE VOLUME THAT WERE SENDING THE
REFERRALS WORSENING.
TODAY I'M.
MUCH LESS IF WE'RE GOING
INCREASE THE VOLUME OF REFERRALS
BEEN DISCUSSED TODAY SO WE ARE
WE WERE SPOKE WE SUPPORT EFFORTS
TO INCREASE THAT FUNDING.
WE SUPPORT.
THAT THEIR RECOMMENDATION IN
THE AUDIT THE TALKED ABOUT A
MAKING SURE THAT.
.
THE FUNDS FROM THE FRAUD
ASSESSMENT COMMISSION GO TO THIS
AND.
UP NEXT WE SUPPORT THE IRISH
CONTINUED USE OF THAT THE BIG
DATA AND ANALYTICS TO DETECT
FRAUD.
WE COMMEND DR FOR ITS
LEADERSHIP IN THIS AREA ALREADY.
AND LOOK FORWARD TO CONTINUING
TO WORK WITH THEM AS THEY
DEVELOP THIS TOOL AND WE
CERTAINLY HAVE THE DATA.
UNDER THE NEW LEGISLATION AND A
RECENT LEGISLATION YOU PASSED WE
HAVE TO NOW CREATE SYSTEMS. THE
TRAXXAS DATA IN A REPORTABLE
FORMAT IN TERMS OF STATE OVER
DEALING WITH YOU ARE DEALING
WITH.
PROVIDER PAYMENTS.
AND THE LIKE.
I THINK WHERE WE DIFFER IS.
HOW EFFECTIVE A POLICY TOOL OF
THE THIS LIST OFSHAME THIS
REPORT ON INSURERS?
THROWING IN AT YOU KNOW HOW
MANY REFERRALS THEY MAKE.
EIGHT GATES YOU I HEAR FROM MY
MEMBERSHIP.
SITUATIONS WHERE I'M THEY SPEND
TIME RESOURCES.
WORKING UP CASES HANDING THEM
OVER TO CDI HANDING THEM THOUGH
OVER TO DA OR FRANKLY TRYING TO
PREVENT PAYMENT FROM WHAT THEY
FEEL ARE FRAUDULENT CHARGES.
WITH THE WORKERS COMP APPEALS
BOARD.
IN THESE EFFORTS ARE ARE ARE.
I CAN BE FRUSTRATING IN THAT CD
I DOES NOT THE RESOURCES TO
HANDLE IT ALL WE THAT SITES BEEN
STATUS THIS THAT HAS BEEN CITED
A LOT TODAY THE FORTY PERCENT.
THEY GET TURNED DOWN BECAUSE
THEY JUST DON'T HAVE THE
RESOURCES
SO.
FOR INSURERS TO CONTINUOUSLY.
MAKE THOSE REFERRALS.
WHEN THEY ARE THEY'RE EITHER
NOT BEING.
FOLLOWED UP ON BY INVESTIGATORS
AND PROSECUTORS OR YOU HAVE W.
CA BE. OF JUDGES WHO ARE FORCING
YOU TO GO OUT AND SETTLE A CLAIM
THAT YOU THINK IS FRAUDULENT OR
PAYMENT THAT YOU THINK IS
FRAUDULENT.
LEADS INSURERS TO USE RESOURCES
ELSEWHERE AND FRANKLY FOCUS ON
THE BIG SYSTEMIC FRAUD. ON TO
TRY TO GET.
BANG FOR THE BUCK.
SO THAT'S I YOU KNOW I I I I
THINK THAT IF WE JUST GO AFTER
INCREASED VOLUME THE QUESTION
FOR
INSURERS BECOMES OKAY. OUT OF
CHRIS OUR VOLUME OF THE
REFERRALS WHAT IS GOING TO
HAPPEN BECAUSE AS OF RIGHT NOW
WE CAN'T HANDLE THE CURRENT
VOLUME.
AND THEN I WILL.
BRIEFLY COMMENT ON THAT THE E.
OBI'S.
I I THINK I WOULD.
ASSOCIATE MCOMMERCE WITH MR
SCHMELZER.
AND I WOULD ASSOCIATE.
SO MY COMMENTS AT THE DIAZ
RESPONSE AUDIO BEES.
I'M NOT SURE THAT THEY'RE
EFFECTIVE TO A WORKERS
COMPENSATION SYSTEM WHERE A BE
INJURED WORKERS A WITNESS BUT
NOT THE VICTIM AND OTHER TYPE OF
HEALTH CARE'S
SET UPS. THERE THE PEOPLE THEY
HAVE SKIN IN THE GAME RIGHT IN
WORKERS COMP THERE'S NO BUT THEY
DO NOT PAY FOR.
THEY DO NOT PAY FOR THEIR
MEDICAL CARE AND SO THEY ARE
OFTEN I'M NOT GOING TO BE AWARE
OR IS INVESTED. AMEND THAT I
THINK THE SECOND POINT IS YOU
LOOK AT OFTEN WHERE THIS
SYSTEMIC FRAUD IS COMING FROM
IT'S COMING FROM SITUATIONS
WHERE THEY'RE DENIED CLAIMS SO
THERE ARE.
THERE'S A TREATMENT THAT WE ARE
AWARE OF SAID THERE'D BE NO
YOU'LL BE TO SEND.
AND THEN THE SUGGESTION THAT IF
WE'RE PERIODICALLY JUST SENDING
OUT ANY OB.
PERHAPS.
TRIGGERS OR THEY HEARD THEIR
IDENTIFIERS THAT WOULD ALLOW US
TO KNOW WHEN FRAUD IS MORE
LIKELY AND WE COULD WE COULD
SEND THAT OUT BUT WHEN YOU'RE
LOOKING AT SYSTEMIC FRAUD YOU
GOTTA BE LOOKING FOR PATTERNS.
YOU GOTTA BE LOOKING FOR BIG
DATA I GUESS THE QUESTION
BECOMES HOW WOULD A. AROUND.
A EIGHTY PERIODIC YOU'LL BE
GOING OUT BE MORE EFFECTIVE THAN
THE ANALYTICS THE WE'RE PUTTING
IN PLACE THAT THAT THAT THE
SYSTEMS OF DATA THAT WERE
TURNING OVER THE DIR AND YOU W.
C. ARE WORKING ON I THINK. WHEN
WE TALK ABOUT PROVIDER FRAUD IN
SOME OF THESE BIG SCHEMES THAT'S
GOING TO BE A MUCH MORE
EFFECTIVE TOOL ON THEN TO MISTER
SMELTERS POINT THROWING OUT
ANOTHER NOTICE SO. I'M WITH THAT
I WILL CONCLUDE MY TESTIMONY
CERTAINLY AVAILABLE FOR ANY
QUESTIONS.
THANK YOU FOR COMMENTING ON THE.
QUESTION ABOUT REFERRALS OF THE
ISSUE OF REFERRALS.
I THINK IT'S STILL KIND OF AN
OPEN QUESTION.
.
YOUR EXPLANATION.
OR AND PERSPECTIVE IS.
SOUNDS VERY PLAUSIBLE AND
REASONABLE.
ON THE OTHER HAND.
THIS IS.
IT'S A REFERRAL BASED SYSTEM
IT'S SO YOU KNOW OF A CLAIMS
BASED.
SYSTEM OR.
IN SO FOR LARGE COMPANIES TO.
TWO NOT REFER AT ALL IN SOME
YEARS.
HIS SARAM IMMINENT IT'S
CIRCUMSTANTIAL AND IT'S IT'S
LIKE IT'S LIKE IT'S LIKE.
DISPROVING A NEGATIVE I SUPPOSE
BUT.
IN MY MIND STILL A BIT OF AN
OPEN QUESTION IN A.
AND WE JUST SAT DISCONNECT TO
KEEP FOCUSED ON THAT I THINK
IT'S VERY REASONABLE TO BRING IT
UP IN THE AUDIT.
AND YOUR RESPONSE.
ON BEHALF OF THE INSURERS NAM.
AS I SAID IS PLAUSIBLE.
AND YET.
NOT SURE IT ANSWERS IT AN
ENTIRELY IN SO LITTLE IN IT WE
JUST HAVE TO STAY FOCUSED ON
THAT MOISTURE IF I COMMENT.
SURE NO I MAY THINK IT'S I
THINK THAT'S RIGHT AND I THINK
IT'S DONE WELL CERTAINLY LOOKING
INTO IT ZERO REFERRALS AND AND
SOME OF THAT DATA IS IS
CERTAINLY EYE OPENING. WHAT I
SHOULDA SAID IS THE LACK OF
RESOURCES ON THE RECEIVING END
IS NOT REALLY TO ME A REASON
IT'S LIKE IT'S LIKE?
NO LONGER CALLING THE LOCAL
POLICE DEPARTMENT BECAUSE THE
RESPONSE TIMES ARE GOOD ENOUGH.
I KNOW IT IS THE IT'S IT'S LIKE
WHICH IS IT SO I JUST.
PUT THAT OUT THERE FOR THE GOOD
OF THE ORDER BECAUSE WE'RE
TALKING ABOUT A A.
SOME CONCEPTUAL A CONCEPTUAL
AREA AND THEN THE ACTUAL REAL.
PRACTICAL AREA.
SO DID IF THE INSURANCE THE
DEPARTMENT OF.
.
THE BEEFS UP ITS INVESTIGATIVE
STAFF AND SOLVE SOME OF THOSE
ISSUES MAYBE THE INSURANCE
COMPANIES WILL BE A LITTLE BIT
MORE.
WILLING TO REFER THOSE MARGINAL
CASES. AND CERTAIN THAT IN ORDER
REFER YEAH WE HAVE AN OBLIGATION
TO DO SO AND I UNDERSTAND THAT
AND AND AND JUST LOOKING AT THE
DATA YEAH I I KNOW THAT TALKING
MY GUYS IT SEEMS TO BE MORE
VAGUE FOCUS ON.
OKAY WHAT CASES ARE THE
PROSECUTORS WORK WE FOCUS IS
ALSO AND IT'S A COST THERE'S
ABSOLUTELY BUT NO TO YOUR POINT
THOUGH I MEAN CERTAINLY WE WE DO
YOU KNOW WHERE THERE IS A
REASONABLE SUSPICION WE HAVE
THAT OBLIGATION AND CERTAINLY
WE.
YOU KNOW TO EXTEND OR NOT WE
SHOULD BE DOING A BETTER JOB OF
REFERRING THOSE YOUR POINTS VERY
WELL TAKEN SIR.
MISTER COOLEY DID YOU A QUSTION
YEAH PLEASURE TO MAKE
OBSERVATION THAT.
IN THIS AREA THE ONE THING THE
INSURERS WILL ALWAYS NEED TO
KEEP MINE IS IT'S IN THE.
THIS ALL PLAYS OUT THE PUBLIC
REALM.
PERIODICALLY WE GO TO THE
WORKERS COMP CYCLE.
AND THEN THAT GETS RESOLVED
WE'RE WHERE HOW PEOPLE VIEW THE
EQUITIES.
TRADITIONALLY I MEAN THIS GOES
BACK A LONG LONG TIME.
DID THE.
THE HIT ON THEINSURERS IS THAT
THEY DON'T NECESSARILY PURSUE
FRAUD AGGRESSIVELY.
BECAUSE YOU'LL GET IT BACK IN
THE RATE.
SO.
I THINK IT IS.
BENEFICIAL TO INSURERS TO JUST
ALWAYS LOOKING DOWN THE TRAIL TO
THESE PUBLIC DEBATES YOU'LL.
TO MAKE SURE YOU ARE EXHIBITING
AGGRESSIVENESS AND REPORTING.
BECAUSE SOMEBODY WILL MODEL
WANNA MAKE THAT ASSERTION.
I MEAN I CAN THINK BACK FIFTEEN
TWENTY YEARS WHEN THAT.
SPECTER BECAME EXPRESSED IN
REPORTS THAT THEN GET IN THE
PUBLIC REALM.
A AND IT'S AN EASY HIT TO MAKE
BECAUSE IT SORT OF PEOPLE OFTEN
HAVE WHATEVER THE LINE OF
INSURANCE NEGATIVE STEREOTYPES
REGARDING. INSURERS
SO I THINK ARE TO BE AGGRESSIVE
IN PURSUING REPORTS AND
TENDERING THEM IRRESPECTIVE.
DOES START PUTTING THE.
PRESSURE ON ANOTHER PARTY IN
THIS SYSTEM
TO BE ACTIVE AND SORT OF
SAFEGUARDS INSURANCE.
REPUTATION IN THE WHOLE DIALOGUE
WHICH DOES PLAY INTO.
YOU KNOW THOSE PERIODIC
DEBATES WE
SELL.
YOU SAID IT FAR BETTER THAN I
DID MISTER COOLEY THANK YOU VERY
MUCH THANK YOU VERY MUCH.
ANY OTHER QUESTIONS ON. OF
MISTER MARTZ IF NOT. MISTER
SUTTON GREAT MY NAME IS MARK
SEGMENT WITH PROPERTY KATHLEEN
SHIRTS ASSOCIATION AMERICA THE
TRADE ASSOCIATION FORMERLY KNOWN
AS A CIC.
I WANT TO THANK THE A CHAIR AND
HIS STAFF FOR WHAT HAS BEEN A
LONG EFFORT ON FRAUD AND I WANT
TO. REMIND SO THAT THAT STAFF
KNOWS THAT FRAUD IS NOT ONLY
MONETARY COST WE HAD CANNOT
COUNT THE NUMBER OF LIVES HAVE
BEEN DESTROYED BY INAPPROPRIATE
SURGERIES.
FOR OTHER ISSUES WHERE THE FRAUD
HAS ONLY BENEFITED THE PRIVATE
PROVIDED ABOUT THE INJURED
WORKER.
AS LONG AS I'VE BEEN IN THE
CHARTS INDUSTRY IN THAT'S LONGER
THAN I'D LIKE TO ADMIT I'VE
ALWAYS HEARD MY COMPANIES
COMPLAIN ABOUT THE GIFT WRAPPED
CASES A GIVEN THE DOI. AND DO
AYE DOESN'T DO ANYTHING THAT YOU
TALK TO THE DR Y. THEY SAY WELL
THAT STUFF YOU GIVEN US IS NOT
APPROPRIATE.
SO LAST.
YEAR WE ACTUALLY SET UP A
MEETING WITH THE DO Y. AND THE
INSURERS WHICH ACTUALLY ENDED UP
IN A THINK A VERY GOOD WORKSHOP.
DRIVE BRIDGE THIS GAP.
AND SEVERAL THINGS CAME OUT OF
IT WHICH I THINK ARE IMPORTANT
SOME OF THE ISSUES THAT ARE
BROUGHT UP IN THE AUDIT.
A DEAL I WAS FRUSTRATED BECAUSE
THEY HAVE STAFF IN ISSUES.
THEY WANT A FIGHT FRAUD THEY
WANTED OF THE TOOLS TO DO THAT
WE WANT TO SUPPORT THAT.
ANOTHER THING THAT CAME UP THAT
ACTUALLY SPEAKS TO THE AUDITOR'S
COMMENT ON REPORTS OF IS. THEY
DON'T WANT US JUST TO SEND THE
REPORT BECAUSE OF HIM IN THAT
SIXTY DAY PERIOD BECAUSE THEY
DON'T IT'S NOT HELPFUL FOR THEM.
BICU HAVE TO BE CAREFUL TO
MAKE SURE THAT THE MATERIAL
YOU'RE GETTING THAT'S GONNA BE
IN THIS REPORT IS ACTUALLY
REFLECTIVE.
OFTENTIMES WHAT IS MORE HELPFUL
IN THIS REQUIRES HELP WITH THE
DA'S. IS TO GET THE MATERIAL
THAT GOES BEYOND MERE SUSPICION
BECAUSE OFTENTIMES MAYOR
SUSPICIONS INVESTIGATED AND
NOTHING HAPPENS YOU DON'T WANT
THAT MATERIAL REPORTED BECAUSE
THAT'S NOT HELPFUL. BUT WHAT
WOULD BE A GOOD WAY TO JUDGE
COMPANIES POSSIBLY ON THOSE
KINDS OF CASES THAT ARE TAKEN BY
THE DA'S ON THAT ARE ACTUALLY
PROSECUTED. ONE OF OUR COMPANIES
WOULD TO DOESN'T FILE OUT OF
PLACES A GLUT CASES BUT THEY'RE
VERY ACTIVE FRAUD UNIT.
TWENTY FIVE PERCENT OTHER CASES
RESULT IN CONVICTIONS
SO THAT ACTUALLY MAY BE A MORE
ACCURATE SYSTEM.
ARE WE ALSO STRONGLY SUPPORT THE
EFFORTS OF THE DEPARTMENT OF
DUSTER RELATIONS ON THE DATA
ANALYTICS.
WHAT MANY PEOPLE DON'T KNOW IS
THAT IN TWO THOUSAND THREE SOME
INSURERS KNEW ABOUT ROBOT AND
THE ISSUES OF PACIFIC HOSPITAL
BUT BECAUSE THEY ONLY KNOW ABOUT
THEIR SCOPE OF THE EXPOSURE IT
WAS NOT UNTIL MUCH LATER THAT IT
BECAME CLEAR? HOW BROAD THAT THE
ISSUE WAS SO I THINK WE THINK
THAT THE TOOLS
THE DE? IS PUTTING TOGETHER WILL
HELP THAT.
ONE MORE ISSUE I'D LIKE TO BRING
OUT THAT HAS BEEN BROUGHT UP
WHICH IS SEVERAL YEARS AGO THE
INSURANCE INDUSTRY PASSED
LEGISLATION TO TRIED SET UP A
ROUND TABLE. OF INSURERS AND DO
Y. SO WE COULD START TALKING
ABOUT TRENDS AND ISSUES AND
MAYBE START ANTICIPATING SOME OF
THESE ISSUES THAT WERE ST.
THAT WORKING GROUP AND WALLETS
AND STATURE IT IT'S NEVER BEEN
AFFECTED BECAUSE I THINK THE
STATUTE ITSELF NEEDS SOME MORE
WORK. AND I'D LIKE TO KIND OF
ENGAGE IN THAT EFFORT TO.
I'M HERE FOR ANY QUESTIONS THANK
YOU VERY MUCH ANY QUESTIONS FOR
MISTER SEGMENT.
MISS COBB HERO.
ACTUALLY I DON'T I DON'T HAVE A
QUESTION BUT I THINK THE IDEA OF
MEETING.
.
YEAH BUT KIND OF INVESTIGATOR TO
INVESTIGATOR IS IS REALLY A.
.
AND IT'S KIND OF ONE OF THOSE I
CAN AHEAD OF ME A MOMENT RIGHT
IT IT SOMETHING WITH BRYANT
THAT.
WELL IT IT IS BECAUSE HOW A CASE
GETS INVESTIGATED AND WHAT THAT
THE DATA THAT THAT THEN GETS
TRANSMITTED IS REALLY IMPORTANT
AND IF YOU'RE LOOKING AT THINGS
FROM A DIFFERENT PERSPECTIVE.
YOU'RE LIKELY THAT TO NOT MEET
IN THE MIDDLE SO I KNEW I AM I
WANT TO COMMEND THAT AND I
ENCOURAGE AS MUCH AS POSSIBLE
BECAUSE THE BOTTOM LINE IS
YOU'RE OUT AFTER THE SAME THING.
YOU'RE TRYING TO CATCH.
PEOPLE THAT ARE TAKING
ADVANTAGE OF THE SYSTEM AND THAT
ARE DOING IT IN A WAY THAT THAT
IS RIPPING OFF THE SYSTEM AND
NOT THE. MONEY'S NOT GOING WHERE
IT'S SUPPOSED AGO SO CANNELLA
KURDISH APARTMENT TO CONTINUE TO
HAVE THOSE MEETINGS I THINK THE
FIRST ONE AT LEAST FOR THEIR
PART I GOT FROM MY MEMBERS WAS
VERY HELPFUL.
WELL I I I WOULD IMAGINE THAT IT
IS AND I WANNA.
AMEND THE GROUP FOR MEETING AND
HOPE HOPE THAT THAT WILL
CONTINUE INDEFINITELY AS AS THEY
WORK ON CASES STICK AS A WORK ON
THE METRICS OF HOW A CASE SHOULD
BE PREPARED. AND THEN YOU END UP
WITH ACTUAL A EITHER CONVICTIONS
OR UP.
REIMBURSEMENTS BACK TO THE
SYSTEM THAT'S GOING TO SHOW
THEIR THAT THE SYNERGY WITH THAT
GROUP SO I THINK IT'S A GREAT
IDEA.
GOOD THANK YOU.
THANKS AGAIN TO OUR IT ENSURE
PANEL.
NICE JOB.
LAST PANEL.
IT'S MORNING.
ARE FROM THE PROVIDERS
WE HAVE MISTER ALBERTA TO RICO
FROM THE CALIFORNIA APPLICANTS
ATTORNEYS ASSOCIATION. AMY
DURBIN FROM THE CALIFORNIA
MEDICAL ASSOCIATION.
AND STEVE CATHOLICA FROM THE
CALIFORNIA SOCIETY OF INDUSTRIAL
MEDICINE AND SURGERY.
WELCOME THANK YOU FOR.
YOUR INVOLVEMENT HERE AND WE'LL
START WITH MR TO RICO.
THANK YOU MISTER CHAIRMAN AND
MEMBERS COMMITTEE.
OF FOR THE RECORD MY NAME IS
ROBERTO TO RECALL APPEARING ON
BEHALF OF THE CALIFORNIA APP CAN
TURN ASSOCIATION.
ASSOCIATIONS MADE UP OF ABOUT A
THOUSAND ATTORNEYS WHO. WORK FOR
INJURED WORKERS EVERY DAY IN THE
WORKERS COMP SYSTEM IS.
YOU FOR TODAY IT'S A IT'S A
COMPLICATED COMPLEX SYSTEM.
WITH A LOT OF MOVING PIECES OF
BECAUSE ALL ALSO PROUD TO
WORKERS MORE MATURE WORKS ANY
OTHER SONG.
ATTORNEY ASSOCIATION THE STATE
PROBABLY THE COUNTRY. AND WERE
AFFILIATED WITH THE TEAMSTERS
NAM ADDS ONE HIGHLIGHT A FEW
POINTS OF FROM THE AUDIT.
FIRST AND FOREMOST THE AUDITOR
HAS BEEN AS A BEEN STATED TURN
NUMEROUS TIMES TODAY'S FOUND AT
LEAST A BILLION DOLLARS IN NUMB
PROSECUTED.
FRAUD CLAIMS ONLY TWO PERCENT OF
THOSE
CAN BE.
ATTRIBUTED TO FRAUD BY WORKERS
I THINK DATA. IN MY EXPERIENCE
ANYWAY IT IT REALLY CONTRADICTS
THE THE POPULAR STEREOTYPE DATA
THE SYSTEM IS BEREFT OF.
AND I NOW FRAUGHT WITH SO
WORKERS FRAUD. GO THAT'S THE ART
OF FIND THE DEATH THAT THE CASE
NOW SECOND. AS A BEEN NOTED
REPEATEDLY NOW WE MAY HAVE A
CHALLENGE WHEN IT COMES TO THE
REPORTING OF FRAUD FROM
INSURANCE COMPANIES I'M I'M NOT
HERE TO DEBATE THE. THE MOTIVE
FOR THE ORDER RATIONALE I ONLY
WANT TO NOTE THAT. IN THE AUDIT.
THE COMMITTEE REPORT NOTES THAT
STATE LAW CURRENTLY REQUIRES
INSURERS TO REFERRED A FEW DE
AYE AND DISTRICT ATTORNEY'S
OFFICE ANY CLAIM TO CHILL.
REASONABLE EVIDENCE OF FRAUD SO
THAT IS REALLY A CURRENT LAW.
ISSUE ENFORCEMENT.
I'M NOT SURE WHAT THE ANSWER
THAT IS MISTER CHAIRMAN IF THERE
NEEDS TO BE.
SOME.
.
SOME REPERCUSSIONS AROUND
PROTECTIONS IF IF CARLOS NOT
FOLLOWED BUT I WOULD I WOULD PUT
THAT TO THE.
THE COMMITTEE'S CONSIDERATION
FOR FUTURE A POSSIBLE. OUT ON
LEGISLATION SECOND AUDIT FOUND
IS IS BEEN NOTED REPEATEDLY THAT
VACANCIES.
ARM CREATING A SHORTCOMINGS IN
FOUGHT INVESTIGATIONS AND
PROSECUTIONS THERE WERE EIGHTY
FIVE HUNDRED CASES OF FRAUD
CLOSE WITHOUT ANY INVESTIGATION.
TWENTY SOME PERCENT OF FUNDS
WERE.
ALLOCATED WERE NOT USED.
I THINK THIS IS A. IS A SERIOUS
PROBLEM IS IS TWO POINT FOUR
MILLION DOLLARS WERE BATES COULD
RETURN TO INSURANCE COMPANIES.
ARE THIS IS HAPPEN AT THE SAME
TIME AS. LA COUNTY REQUESTED ONE
POINT ONE MILLION DOLLARS FOR
FRAUD PROSECUTION. SENATOR
CONNIE WILKERSON MILLION DOLLARS
IN YOUR COUNTY MISTER CHAIRMAN
ORANGE COUNTY REQUESTED SIX ON A
FIFTY THOUSAND DOLLAR IT SEEMS
TO ME.
THAT THAT MONEY SHOULD HAVE BEEN
REALLOCATED TO THE COUNTIES FOR
ADDITIONAL PROSECUTION. THIRD.
THERE'S BEEN SOME DISCUSSION
ABOUT THE EVIDENCE OF BENEFIT
STATEMENTS.
I DO WANT TO POINT OUT ONE ONE
NUGGET OF INFORMATION HAS NOT
BEEN.
STATED BECAUSE WE THINK THIS
THIS IS SOMETHING TO BE EXPLORED
ONE OF THE EMPLOYERS THAT WAS
INTERVIEWED AS PART OF THE
AUDIT.
IN FACT FROM YOUR DISTRICT
DISNEY LAND. MAKE DO THIS AS A
MATTER OF PRACTICE THEY FOUND
THAT IT INCREASES TRANSPARENCY
IT WOULD MAKE SURE THAT THE
WORKERS UNDERSTAND. THE BENEFITS
THAT ARE REQUIRED.
MAKE SURE THE BOOK OF BETTER
UNDERSTAND SYSTEM.
AND BATES TOLD THE DAUGHTER BUT
THE COST OF OF THESE REPORTS.
THE STATEMENT IS FIFTY CENTS.
FIFTY CENTS PER STATEMENT YOU
KNOW IS THE DROP IN THE BUCKET
WHEN YOU'RE LOOKING AT ONE TO
THREE BILLION DOLLARS. IN FRAUD
SIGH I ALSO PUT THAT TO THE
COMMITTEE'S CONSIDERATION. AND
FINALLY.
THERE HAS BEEN SOME MENTION OF
THE REFORMS.
THE RESULTING REFORMS INCREASED
IN IT INCREASED IN PERMITS
BELIEVE OUTFITS WHICH IS GREAT.
ALSO A REDUCTION IN INSURANCE
PAYMENTS WHICH IS ALSO.
A GOOD OUTCOME HOWEVER.
THERE WAS DISCUSSION THAT THERE
WAS
THERE HAVE BEEN ONGOING ATTEMPT
TO REDUCE THE FRICTIONAL COSTS
IN THE SYSTEM THE DRIVE.
POTENTIALLY COSTS UP.
I WE WOULD SUBMIT TO YOU MISTER
CHAIRMAN AND MEMBERS COMMITTEE
THAT THAT THE FRICTIONAL COSTS
OF IN LARGE PART BEEN TRENT.
HAVE BEEN.
.
TRANSLATOR OR.
FOR OF PUSHED UPON WORKERS
SO WHAT WHAT I MEAN BY THAT
THERE ARE SIGNIFICANT DELAYS.
IN THE SYSTEM THAT A RESULT OF
UTILIZATION REVIEW IN A PANIC A
LITTLE KARU VIEW. THAT RESULTED
NOT SOMETIMES MONTHS SOMETIMES
YEARS OF DELAYS OF GETTING
SERVICES FOR THE WORKERS.
AND THESE ARE THESE COST THESE
ARE COSTS FOR THE WORKERS.
ONCE A WORKER RUNS OUT OF TEMPER
DISABILITY AFTER TWENTY FOUR
MONTHS DEBATE GOT OF INCOME IF
THE CASE SEVEN BEEN CLOSED.
THE THIS PUTS A SIGNIFICANT
BURDEN ON THESE FAMILIES.
AND SECOND.
.
I WOULD SAY THAT.
THE DELAY ALSO IS
IS BORN BY EMPLOYERS.
BECAUSE OF EMPLOYERS ARE MISSING
WORKERS BECAUSE OF INJURIES IN
THE WORKERS CAN GET BACK TO
WORK.
THOSE PLANS HAVE TO BE BACK FROM
SITE I WOULD I WOULD SUBMIT THAT
FOR THE CONSIDERATION THE
COMMITTEE.
THAT THE WHILE THERE ARE
SIGNIFICANT SAVINGS AN INCREASE
IN BENEFITS.
THERE ARE ONGOING COSTS AN
ONGOING ISSUE FOR WORKERS WHEN
IT COMES TO BEING ABLE TO RETURN
TO WORK AND EXPEDITIOUS FASHION.
WITH THAT MISTER CHAIRMAN I WILL
I WANT TO THANK YOU IN THE
COMMITTEE FOR YOUR ATTENTION TO
THIS MATTER AND. WE WOULD.
ENCOURAGE THE COMMITTEE TO.
.
TAKE UP MANY OF THE MANY OF NOT
ALL OF THE RECOMMENDATIONS WILL
NOT AFFECT EXTRA. THANK YOU SIR
MISTER URBAN. THINK MISTER CHAIR
MEMBERS OF THE COMMITTEE IN
LEADER BUT NOT THE CALIFORNIA
MEDICAL ASSOCIATION APPRECIATE
THE OPPORTUNITY HERE AND
CONTINUE TO BE PART OF THE
DISCUSSION AND ONGOING PROGRESS
TO BE CREATES BROUGHT IN THE
WORKERS COMPENSATION SYSTEM.
CMA HAS CONSISTENTLY
PARTICIPATED IN STAKEHOLDER
EFFORTS TO REDUCE FRAUD AND HOLD
APPROPRIATE PARTIES ACCOUNTABLE
AND WE THINK THE AUDITOR'S
REPORT SUGGESTS REASONABLE WAYS
TO FURTHER CURRENT PROCESSES. IT
SHOWS MUCH ROOM FOR IMPROVEMENT
REGARD TO ENFORCEMENT AND
HIGHLIGHTS BUT ISSUE AN
IMPORTANT WAY. AS WE LOOK AT
SOME OF THE BROAD WAYS TO
STRENGTHEN PREVENTION DETECTION
AND ENFORCEMENT HOWEVER WE MUST
PAY CLOSE ATTENTION TO DETAILS
OF IMPLEMENTATION.
FOR INSTANCE THE REPORT
RECOMMENDS THAT DR BETTER
DOCUMENT AS DATA ANALYTICS
EFFORTS TO IDENTIFY PROVIDER
FRAUD.
WHATEVER WE TALK ABOUT SYSTEMS
THAT ALLOW FOR EXAMINATION OF
LARGE VOLUMES OF DATA WE HAVE TO
PAY CLOSE ATTENTION TO APART
PIECES OF HOW THAT WORKS HOW
SUCH PERSONAL PATIENT MEDICAL
INFORMATION IS TO BE EXCHANGED.
EXAMINED AND STORED WHAT
MEASURES ARE IN PLACETO ENSURE
PRIVACY REMAIN SUFFICIENTLY
PROTECTED AND THAT ASSESSMENTS
AND OUTCOMES BASED UPON THEM ARE
FAIR AND EFFECTIVE. THEREFORE WE
VERY MUCH SUPPORT THE FULL AND
TRANSPARENT DOCUMENTATION OF
TEARS DATA ANALYTICS EFFORTS AND
HOW IT IS BEING USED IN WILL BE
YEARS AND WOULD ALSO LIKE TO BE
PART OF DISCUSS DISCUSSIONS AND
CONSIDERATIONS AROUND THESE
EFFORTS.
ON ARE CRYING EXPLANATION OF
BENEFITS STATEMENTS TO INJURED
WORKERS SEAMAN'S CONSISTENTLY
SUGGESTED THAT WE SHOULD LOOK TO
OTHER EXISTING HEALTHCARE
SYSTEMS AND PROCESSES FOR
PROCEDURES THAT ARE PUT IN PLACE
HERE AS WELL. COULD IMPROVE THE
OPERATION OF THE WORKERS
COMPENSATION SYSTEM INCLUDING
THE DETECTION OF FRAUD
IMPLEMENTATION AND CONSISTENCY
REMAINS KEY HOWEVER AND WE AGAIN
WOULD LIKE TO OFFER OURSELVES TO
THAT DISCUSSION.
THE WAY WE LOOK AT FRIDAY IN THE
FUNDING TO COMBAT IT SEEMS TO BE
FAIRLY BROAD AS WELL. FOR
EXAMPLE ON THE REPORT WITHOUT A
SYSTEMS TRACKING WORKERS'
COMPENSATION FRAUD OFTEN DO NOT
ALLOW FOR REAL CLEAR BREAKDOWN
OF TYPES OF FRAUD. FOR INSTANCE
THAT MANY DIFFERENT TYPES OF
PROVIDERS THAT ARE IN THE
SYSTEMIC LEADING COPY SERVICE AS
AND OTHERS LIKE THAT.
AND ALSO DID INCLUDE THE AMOUNT
OF HERBAL FRAUD FOR EMPLOYERS.
PERHAPS THESE DETAILS BABY
MISSING OPPORTUNITIES TO CLARIFY
HOW WE TALK ABOUT FRAUD IN THE
SYSTEM AND GET MORE FOCUSED
EFFECTIVE IN OUR EFFORTS TO
COMBAT IT. AGAIN WE APPRECIATE
THE OPPORTUNITY TO PROVIDE OUR
PERSPECTIVE AND LOOK FORWARD TO
CONTINUING TO CONTRIBUTE TO ANTI
FRAUD EFFORT SO WE CAN REMAIN
FOCUSED ON GETTING INJURED
WORKERS ACCESS TO NECESSARY
MEDICAL TREATMENT.
THINK GOOD THANK YOU VERY MUCH.
AND MISTER. TALER.
GOOD MORNING.
MISTER CHAIR THANK YOU CLEAN
MEMBERS I APPRECIATE THE
OPPORTUNITY TO SPEAK TO YOU
TODAY.
MY NAME IS STEVE CATHOLICA ON
THE DIRECTOR OF GOVERNMENT
RELATIONS OF OF THE CALIFORNIA
SOCIETY OF INDUSTRIAL MEDICINE
AND SURGERY.
AFFILIATES OF THE YEAR AYE IN
NATIONAL MACHINISTS AND
AEROSPACE WORKERS.
I FEEL A LITTLE BIT LIKE
CONFIRMED THOSE OF YOU THEY'RE
OLD ENOUGH SHOT MEMBER ROCKY AND
BULLWINKLE THE.
ADD THAT TO WHERE THE ELEPHANT
GOES ACROSS THERE'S A GUY COME
IN BEHIND HIM.
I FEEL A BIT LIKE THAT GUY.
BUT FOR A NUMBER OF REASONS NOT
JUST BECAUSE I'M HAPPEN TO BE
LAST ON THE ON THE DAY IS HERE.
BUT DIED THERE'S GONNA ARE I
THINK IT A DEARTH OF.
ATTENTION PAID TO.
INFORMATION COMING UP FROM THE
BOTTOM.
WE CERTAINLY HAVE TALKED AND AND
I ASCRIBE TO.
.
MR SECONDS.
DISCUSSION ABOUT REPORTING. ARE
BY INSURANCE CARRIERS HA I THINK
THAT I THINK THAT THEY'RE DOING
WHAT THEY CAN I THINK IT'S
EXTREMELY FRUSTRATING WHEN YOU
GO THROUGH THE EFFORTS THAT THEY
DO. AND ARE FOR WHATEVER REASON
THEIR EFFORTS HERE SEEM TO BE
IGNORED.
BUT I WILL TELL YOU THAT.
YOU MULTIPLY THAT BY THE
THOUSANDS OF INJURED WORKERS AND
HUNDREDS AND THOUSANDS AND
THOUSANDS OF UP PROVIDERS WHO
COMPLAINED TO THE DIVISION OF
WORKERS COMPENSATION TO THEIR
AUDIT UNIT. AND OUR OUR NORD.
THAT WE WE KNOW THEIR PAIN IT'S
A LITTLE DIFFERENT BUT IT
CERTAINLY TOWARDS THE SAME END.
HA WITH RESPECT TO THE I'M NOT
SPENT RESOURCES.
WE BELIEVE THAT EVERY PENNY
SHOULD BE SPENT AND I'M GONNA
HAVE A SUGGESTION ABOUT THAT IN
JUST A FEW MINUTES.
ARM AGAIN SPEAKING TO.
THE WHAT APPEARS TO BE UNEVEN
REPORTING BY INSURANCE CARRIERS
I WOULD SUGGEST THAT WE TALKED
TO MISTER SECONDS ARE MEMBER WHO
HAS A TWENTY FIVE PERCENT
SUCCESS RATE. NOW INTERNALLY MY
GOODNESS FAR MAYBE THAT'S RIGHT.
BETTER NOBODY ELSE'S MAN IF I
CAN IF I UNDERSTAND THE NUMBERS
CORRECTLY.
I DATA ANALYTICS.
WE'RE. COMPLETELY ONBOARD
WITH-USING DATA TO GENERATE
APPROPRIATE INFORMATION SO THAT
GOOD POLICY DECISIONS CAN BE
MADE I DON'T THINK YOU MAKE
POLICY DECISIONS ON DATA ALONE.
BUT BY THE SAME TOKEN.
I THINK THAT WITH RESPECT TO
THIS TO THE FRAUD ISSUE.
THERE'S SOME EDUCATION OUT OF
TAKE PLACE.
I THINK THAT THE DIVISION AND A
CD I NEED TO PUT IN FRONT OF THE
COMMUNITY.
THE WHOLE.
ARMORY.
OF TOOLS THAT THEY HAVE AT THEIR
DISPOSAL.
AND EDUCATE.
THE PARTICIPANTS TO WHAT CAN BE
DONE.
NOT THE TACTICS NOT THE
STRATEGY.
BUT WHY SHOULDN'T EVERYBODY BE
AWARE OF WHERE THEY'RE LOOKING
WHY THEY'RE LOOKING AND WHAT
COULD BE THE RESULTS.
I THINK THAT THAT DETERRENT
WOULD BE IMPORTANT.
I LIKE TO OUT.
WE GO TO WOULD A DIFFERENT LEVEL
OF FRAUD THAT WE BELIEVE IS IS
PERVASIVE ACTUALLY MAKE A TWO
COMMENTS IN THAT REGARD.
OTHER RECENT REVELATION THAT.
AT INSURANCE UTILIZATION REVIEW
POSITIONS RENDERED OPINIONS
BASED ON NURSE RECOMMENDATIONS
ONLY WITHOUT INSPECTING THE
PATIENT'S MEDICAL RECORDS.
HAS LEFT EVERYONE WITH A SHOCK
AND DOUBT.
WHILE THIS INCIDENT OCCURRED IN
THE GROUP HEALTH REALM.
WE HAVE EVIDENCE.
IN WE BELIEVE THAT THE SAME
PRACTICE OCCURS ON A REGULAR
BASIS AND CALIFORNIA'S WORKER'S
COMPENSATION SYSTEM.
THE PROBLEM WITH GATHERING SUCH
EVIDENCE IS THE THREAT OF
RETRIBUTION BY INSURERS AND YOU
ARE COMPANIES WHO MIGHT SINGLE
OPPOSITION TO COME FORWARD.
TO ASSURE THAT INITIATIVES INTO
THIS GO FORWARD AND HAVE A
CHANCE OF SUCCESS.
WHISTLEBLOWER STATUS MUST BE
AFFORDED TO THOSE INDIVIDUALS.
HOW COULD THIS POSSIBLY
OCCURRING THE FIRST PLACE?
WELL MORE BY THINK IT'S CLEAR.
ITS PRODUCTIVITY.
MORE THROUGHPUT OF REVIEWS MEANS
FEWER MISSED DEADLINES AND
HIGHER MARGINS.
THE OPPORTUNITY EXISTS
BECAUSE THE YOU OUR PROCESS
BELIEVES THAT IT CAN HIDE BEHIND
EXCLUSIVE REMEDY.
IN THE MEANTIME THE COMMUNITY
WAITS FOR THE OPINION AND KING
VERSUS COMP PARTNERS CASE
CURRENTLY WITH THE CALIFORNIA
SUPREME COURT.
THAT WILL LIKELY IT LATER REST
THE FACT THAT YOU ARE HAS
RESPONSIBILITY FOR THE CARE AND
SAFETY OF THE INJURED WORKERS
WITH. IRAQ'S.
SHE SEEMS IN THE MEDICAL BOARD
OF CONSISTENTLY HELD THAT YOU
ARE IS THE PRACTICE OF MEDICINE
AND PATIENT SHOULD BE ACCORDED A
LEVEL OF SAFETY AND
ACCOUNTABILITY.
THREE TIMES HE SEEMS ARE PUT
THROUGH LEGISLATION AND WAS NOT
OPPOSED.
THAT WOULD HAVE REQUIRED YOU ARE
PHYSICIANS TO BE LICENSED IN
CALIFORNIA.
EACH TIME IT WAS VETOED BY THE
GOVERNOR THAT WAS SEATED AT THE
TIME.
WHY?
WHAT'S THE FEAR. WE DON'T
UNDERSTAND THAT.
BUT IT'S CONTRIBUTING TO.
THE KIND OF FRAUDULENT ACTIVITY
THE DECEPTION THAT TAKES PLACE.
WHEN A YOU ARE DECISION IS MADE
BY SOMEBODY IT TO DENY. IS MADE
BY SOMEBODY BESIDES.
A PHYSICIAN.
REFERRING BACK TO THE ISSUE
WASTE OF RESOURCES WE PROPOSED
ANY REMAINING MONEY. SHE
ACTUALLY GRANTED TO THE DIVISION
OF WORKERS COMPENSATION.
OR THEY OUGHT TO SHIFT SOME OF
THE MONEY THAT THEY HAVE IN
THEIR CURRENT BUDGET.
IN ORDER TO MAKE THEIR.
AUDIT DEPARTMENT MORE
RESPONSIVE
I MENTIONED BEFORE. THAT THE.
I'M GONNA SAY THOUSANDS
OF COMPLAINTS THAT COME FROM
INJURED WORKERS IN PHYSICIANS
FOR SOME.
IF FOR A PAR ON IT THEY CALL IT.
EVERY FIVE YEARS.
WE BELIEVE THAT ESPECIALLY
AUDITS IN THE ISSUE IN ON THE
ISSUE THAT I'M TALKING ABOUT
UTILIZATION REVIEW. NEED TO BE
INVESTIGATED ALMOST IMMEDIATELY
WHILE THE INFORMATION IS FRESH.
AND THE INFORMATION READILY
AVAILABLE.
SECOND.
IN THIS IS OF A FRAUD THAT'S
EVEN MORE WIDESPREAD INSIDIOUS.
IT INVOLVES THE DELIVERY OF
MANAGED CARE SERVICES TO THIRD
PARTIES THE CONTROL PROVIDER
PAYMENTS WITHOUT PROPER
LICENSURE OR SUPERVISION AND US
WITHOUT ANY ACCOUNTABILITY
WHATSOEVER.
THE RECENT SETTLEMENT OF A
FEDERAL LAWSUIT DEALING WITH
THIS ISSUE IS MERELY THE TIP OF
AN ICEBERG.
IT'S BEEN RAISED ON A NATIONAL
ATTENTION.
IRONICALLY THAT ATTENTION BEGAN
AS EVIDENCE HEARING CALIFORNIA
FEW YEARS AGO. WHEN THE RATING
BUREAU WAS COMPELLED BY THE COCK
CALIFORNIA DEPARTMENT OF
INSURANCE AND OTHER THAN
COMMISSIONER POISONER.
TO BEGIN TO REPORT THE COSTS OF
COST CONTAINMENT SERVICES
SERVICES SUCH AS YOU ARE BILL
REVIEW PPO NETWORK FEES. AND
THOSE PEOPLE WHO MIGHT ON.
TRY GENTLY TAKE MONEY FROM
INJURED WORKERS TO PART BELIEVE
THEY NEED HELP WITH THEIR.
.
VOCATIONAL AWARDS.
THAT YOU LEVEL OF REPORTING
RESULTED IN REVELATION THAT SUCH
COSTS HAVE BECOME A SIGNIFICANT
COST DRIVER. IN THE CALIFORNIA
SYSTEM.
IN THIS BECAUSE THEN THE RISING
COST ALSO CONTRIBUTE TO OUR
REPORTS FROM THE W. C. I R. BE.
THAT THE COST OF CLAIMS
ADMINISTRATION TO WHICH THOSE
COSTS WERE ASSIGNED. REPRESENT A
LARGER PROPORTION OF COSTS
THEN EITHER INDEMNITY BENEFITS
ARE ACTUAL HANDS ON MEDICAL
CARE.
AS I WAS MENTIONED ALSO BY MR
SECOND THE ROUND TABLE THAT DIE
HE DESCRIBED.
WE WOULD.
LIKE TO CONTINUE IT WOULD WOULD
LIKE TO BE INVITED TO
PARTICIPATE.
IN THE LAST TEN TO FIFTEEN
YEARS AS SUB MISTER I THINK
SCHMELZER DESCRIBED THE OUT
LABOR COOKBOOK FROM GOING FROM
HERE ROUGHLY AN INCH TO.
SEVERAL AND THE FORMAT FROM HIM
FOR BY SIX TO A EIGHT BY ELEVEN
AND NOW MAYBE.
LEDGER SIZE IN ORDER TO
MAINTAIN THIS THE SITE NONE OF
THOSE RIVER REFORMS.
OR FOSTER BY THE PROVIDER
COMMUNITY.
THOSE COMPLICATIONS HAVE CAUSED
THE ISSUES THAT CAUSE FRAUD OR
ALLOW FRAUD TO.
TO PROOFREAD WE BELIEVE. THE
MORE COMPLICATED THE SYSTEM IS
THE THE EASIER IT IS TO WIGGLE
YOUR WAY INTO AND CREATED THIS
FOR ONESELF THAT MAY GET HIDDEN.
WE THINK THAT A LARGER TABLE
WITH MORE DISCUSSION.
MORE DELIBERATION.
IS THE WAY TO GO ABOUT THIS AND
I I RESPECT THE CHAIR SAT A
DESIRE TO HAVE OVERSIGHT. I KNOW
THAT.
ASSEMBLYMAN COOLEY IS IS A AS
RULES SHARE IS.
PAUL ABOUT OVERSIGHT AND WE
HOPE THAT THIS IS THE FIRST OF A
SERIES OF OVERSIGHT HEARINGS ON
A NUMBER OF OF ISSUES THAT I
THINK CAN IMPROVE THE WORKERS
COMPENSATION SYSTEM. THANK YOU.
THANK YOU AND.
I APPRECIATE SOME OF THE NEW
IDEAS OR DIFFERENT PERSPECTIVES
ON.
ON THE NEAR TERM FUTURE HERE
THAT ARE UP THERE VERY HELP
UNHELPFUL AND THOUGHT PROVOKING
AND. APPRECIATED VERY MUCH A
DIGITIZER.
LARA AT GROUND LEVEL ON.
ON THESE ISSUES.
COMMITTEE MEMBERS ANY QUESTIONS
FOR THIS.
PANEL THIS IS OUR LAST GO AHEAD
MISS OUT HERE I JUST WANT TO
SECOND WHAT YOU YOU JUST SAID IS
THAT.
IT REALLY THOUGHT PROVOKING
YEAH I IDEAS AND I'M LIKE AGREE
WITH I THINK MORE PEOPLE AT THE
TABLE.
.
COULD HELP US ACHIEVE.
A BETTER OUTCOME IN THE END
WHICH IS HOW DO WE GET WORKERS
INJURED WORKERS BACK ON THEIR
FEET AGAIN SO THAT THEY CAN GO
BACK TO WORK. AND HOW DO WE.
.
APPROPRIATELY PROVIDE MEDICAL
ATTENTION FOR THEM TO BE ABLE TO
DO THAT SO.
THAT MORE COMPLICATED THE
SYSTEM IS AND IT'S COMPLICATED.
AND THE MORE. TWISTS AND TURNS
TO IT. AS A WAY TO DETECT FRAUD.
THE MORE THAT MORE DIFFICULT
BECOMES TO ACTUALLY SEE IT AND
SO I'M I'M WITH YOU ON THAT ONE
AND.
.
I I GUESS ES UP AS A FINAL
PARTING I'M THAT FACT THAT DOWN.
CDI CLOSE IS ABOUT FORTY PERCENT
OF THE REFERRALS.
NOT WITHOUT IN IT WITH OUT AN
INVESTIGATION.
BECAUSE THEY HAVE INSUFFICIENT.
RESOURCES AND IT IS VERY
DISTURBING FOR ME BECAUSE WE'RE
NOT GETTING TO THE ROOT OF THE
ISSUE.
AND AND IT MAY BE THAT NONE OF
THESE WOULD BE VALIDATED RIGHT
BUT WE JUST DON'T KNOW AND SO IN
THE MEANTIME.
WE'RE REALLY. WE'RE REALLY NOT
GETTING TO THE BOTTOM OF WHAT
THE PROBLEM IS SEVERE. IF IT'S A
BIT DISCOURAGING ISN'T IT CAMP.
ANY OTHER QUESTIONS FOR OUR LAST
PANEL HERE IN NO. I REALLY MEAN
IT THOSE ARE SOME EXCELLENT TO
SUGGESTIONS AND POINTS THAT YOU
ALL MADE AND A VERY HELPFUL TO
US AS WE MOVE FORWARD THANK YOU
VERY VERY MUCH THANK YOU
APPRECIATED.
ANYTHING ELSE FOR THE HIGHLY
ORDER DAY.
WERE WERE ON SCHEDULE AND I
THINK WE'LL AT WE LEARNED A LOT
IN HEARING FROM.
THE STAKEHOLDERS.
AND ALL THE OTHER PERSPECTIVES
AND I AGAIN I WANT TO THANK MS
HELL IN HER OUTSTANDING TEAM.
FOUR OF THEM FOR DELIVERING THE
AUDIT DOES SO WELL.
YES MISS COPIER JUST CHECKING TO
SEE IF YOU'RE GONNA DO PUBLIC.
COMMENT.
.
AND I THINK WE WILL INVITE SIR.
COMMENTS ESPECIALLY BECAUSE IT'S
IDENTIFIED ON THE AGENDAS THAT'S
PROBABLY A GOOD IDEA.
YEAH. YEAH AND.
.
LET ME SEE IF THERE ARE ANY
PUBLIC COMMENTS AT THIS POINT.
THANK YOU AND FOR YOUR. FOR
YOUR.
THERE YOUR REMINDER ANY PUBLIC
COMMENTS.
ALRIGHT IF NOT OF THIS HEARING
IS ADJOURNED THANK YOU VERY MUCH