Around the PIA Western Alliance States – Week of September 2, 2024
Published September 3, 2024 at 1:38 PM · News Releases and Bulletins
California — Fraud Detectives: Insurance Commissioner Ricardo Lara and Assemblymember Lisa Calderon, Chair of the Assembly Insurance Committee, announced that the California Senate and Assembly have passed Assembly Bill 2872, which would support the work of sworn officers at the California Department of Insurance who are the state’s leaders in preventing and stopping insurance fraud. This bill would help close the pay gap between the Department’s sworn fraud detectives and sworn officers in other state agencies, helping strengthen staff retention and enforcement efforts that protect public safety. AB 2872 is now headed to Governor Newsom’s desk for his consideration.
“Insurance fraud is a multi-billion-dollar drain on our state’s economy perpetrated by organized crime and complex financial schemes that harm our most vulnerable, including seniors and immigrant communities,” said Commissioner Lara, who sponsored AB 2872. “Stopping and preventing insurance fraud is critical to our state’s economy and community safety, and it is vital that we recruit and retain our committed, hard-working investigators charged with protecting consumers. I urge Governor Newsom to sign this important legislation when it reaches his desk.”
“This legislation not only supports the Department’s efforts to keep our constituents safe from fraud, but is a significant milestone in establishing gender pay equity,” said Assemblymember Calderon, Chair of the Assembly Insurance Committee. “The Department boasts one of the highest percentages of women in law enforcement, not only within the state but also across the entire nation.”
AB 2872 would raise the compensation for the Department’s detectives to match the compensation of Special Agents at the California Department of Justice who are in the same bargaining unit. This will close the over 20 percent pay gap currently between the two departments and help the Department of Insurance recruit and retain more fraud detectives.
The Department of Insurance currently employs more than 200 sworn officers to detect, investigate, and respond to insurance fraud statewide. However, current pay inequities among the investigator classifications have consistently undermined the Department’s ability to recruit and retain experienced fraud investigators. The Department’s current vacancy rate for this classification is over 35 percent, with many investigators citing pay inequity as a reason for leaving the Department to go to other state and local law enforcement departments that pay higher wages for comparable law enforcement work. In fact, over the past two years, more than 75 percent of the transfers out of the Department of Insurance have been to the Department of Justice.
The Coalition Against Insurance Fraud estimates the national economic impact of insurance fraud is $308.6 billion each year -- almost $1,000 per year for every single American; specific to California, they also estimate there are $17.2 billion in economic losses in the state each year due to insurance fraud, which result in higher costs for California consumers and businesses.
The Department’s Fraud Division receives 22,000 suspected fraud claim referrals each year, which represents over $600 million in suspected losses.
Cases of insurance fraud include but are not limited to:
Injured workers not receiving proper medical treatment
Innocent victims of staged auto collisions
Patients victimized by medical providers conducting unnecessary medical procedures for profit
Substance abuse patients trafficked to collect insurance money
The Department’s sworn fraud investigators work directly with local, regional, and federal law enforcement partners, as well as the insurance industry, from detection through prosecution. Just last year, the Department submitted 860 cases to district attorneys’ offices for review.
“We train our investigators to be the best in the business, and we want to keep them here at the California Department of Insurance to continue doing this vital public safety work,” added Commissioner Lara. “I believe AB 2872 is needed to help recruit and retain these hard-working law enforcement officers so we can continue to protect consumers and bring perpetrators to justice.”
Governor Newsom has until September 30, 2024, to act on the bill.
Oregon — The Oregon Division of Financial Regulation recently announced the following proposed rulemaking: Filing Caption: Repealing rules for calculating out-of-network provider reimbursement rates and prevent enrollee
balance billing
Repeal Rules: OAR 836-053-1600, 836-053-1605, 836-053-1610, 836-053-1615
Rule Summary: Repealing because the statutory authority for their enactment expired January 2, 2022.
Filed: August 27, 2024
Hearing Date/Time: September 25, 2024, 1:30 PM - 2:00 PM
This is a hybrid meeting conducted in-person and virtually via Microsoft Teams. See Notice of Proposed Rulemaking for Teams meeting instructions.
Last day/time to offer comment: October 2, 2024, 5:00 PM
For more information on this recently proposed rulemaking, please visit the division's website:
Oregon — The Oregon Division of Financial Regulation recently announced the following permanent rulemaking: ID 33-2024: 2024 Well-Women Rulemaking
Amend: 836-053-0435
Rule Summary: The amended rule updates the services that health plans are required to cover during a comprehensive well-woman visit to include the thirteen well-woman preventive services identified by the United States Health Resources and Services Administration (HRSA) as of December 2022. It aligns with the guidelines set forth by the Women's Preventive Services Initiative (WPSI) and requires carriers to adhere to current practice and form filing requirements.
Filed: August 27, 2024
Effective: September 1, 2024
For more information on this recently adopted rule, please visit the division's website:
https://dfr.oregon.gov/laws-rules/Documents/id33-2024_rule-order.pdf
Washington — Implementation of SSB 5986 and updates to the Balance Billing Protection Act (BBPA) prepublication draft posted: We are releasing a second prepublication draft for the Implementation of SSB 5986 and updates to the Balance Billing Protection Act (BBPA) rule R 2024-01. SSB 5986 added ground ambulances to the BBPA. Rulemaking is necessary to revise Chapter 284-43B WAC to include ground ambulance services. This rulemaking will also update the rules for the BBPA, including but not limited to consideration of arbitrator fees and revisions to the arbitration process.
We scheduled an interested party meeting to discuss the rule:
Sept. 04, 2024 at 2:00 pm
Register in advance
Comments on the prepublication draft are due Sept. 11, 2024; please send them to rulescoordinator@oic.wa.gov. For more information, including the text of the prepublication draft, please visit the Implementation of SSB 5986 and updates to the Balance Billing Protection Act (BBPA) (R 2024-01) webpage.