COBI 2015 - Insurance Fraud Program

Overview
Issues
Financials

Sources Uses

FY 2016 Appropriation

The 1994 Legislature created the Insurance Fraud Act (UCA 31A-31-101 through 111) and subsequently the department created the Insurance Fraud Division. It conducts criminal investigations and prosecutes insurance fraud violators. Nationwide, insurance fraud is estimated at over $30 billion per year in property and casualty claims. For healthcare fraud the nationwide losses are estimated to be at least $77 billion and possibly reaching over $250 billion. The program is funded by the Insurance Fraud Investigation Restricted Account.

Funding History

Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $2,565,500 from all sources for Insurance Fraud Program. This is a 9.2 percent reduction from Fiscal Year 2015 revised estimated amounts from all sources.

Appropriation Adjustments

In addition to statewide compensation and internal service fund cost increases, the following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time Attorney General Dedicated Credit Adjustments$23,600$0

OngoingOne-TimeFinancing Source

$23,600$0GFR - Insurance Fraud Investigation

This item designates additional funding appropriated to an agency to pay higher costs for Attorney General services, due to statewide and AG-specific compensation increases.

Intent Language

HB0003: Item 71

Under Section 63J-1-603 of the Utah Code the Legislature intends that appropriations for Insurance Department Administration not lapse at the close of Fiscal Year 2015. Any appropriations related to the transfer of federal funds of $374,000 from the closing of the Comprehensive Health Insurance Pool program and $100,000 for general program revenues shall not lapse at the close of FY 2015. Transferred funds from the Comprehensive Health Insurance Pool program shall be utilized for any late claims from former program participants, audit costs, legal fees related to the program and health outreach activities. Any other funds are for replacement of computers, printers and copy machines, and scanners for electronic storage of documents.

Funding for the Insurance Fraud program is from the Insurance Fraud Investigation Restricted Account. Funds are used mainly for staff and corresponding current expense costs. Restitution payments are also made from the Fraud program as ordered by the Courts to victims of fraud insurance.

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Expenditure Category

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Appropriation History by

Sources of Finance	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Federal Funds	5,700	85,500	48,300	63,700	140,000	0	140,000	0	140,000
Dedicated Credits Revenue	1,872,000	0	1,100	700	8,600	0	8,600	0	8,600
GFR - Insurance Fraud Investigation	0	1,984,500	2,732,400	2,119,700	2,241,500	0	2,241,500	86,400	2,327,900
Beginning Nonlapsing	73,900	0	210,300	660,800	622,800	52,500	675,300	(434,900)	240,400
Closing Nonlapsing	0	(210,300)	(660,800)	(675,300)	(775,100)	534,700	(240,400)	89,000	(151,400)
Lapsing Balance	(266,400)	0	0	(284,000)	0	0	0	0	0
Total	$1,685,200	$1,859,700	$2,331,300	$1,885,600	$2,237,800	$587,200	$2,825,000	($259,500)	$2,565,500

Categories of Expenditure	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Personnel Services	790,000	834,000	1,066,600	1,109,000	1,306,000	94,000	1,400,000	184,100	1,584,100
In-state Travel	4,300	8,000	16,700	4,300	29,500	5,500	35,000	(5,000)	30,000
Out-of-state Travel	13,000	13,700	26,400	8,800	58,000	(8,000)	50,000	(5,000)	45,000
Current Expense	827,500	957,000	1,183,100	662,800	763,500	186,500	950,000	(191,200)	758,800
DP Current Expense	50,400	35,700	38,500	94,700	80,800	234,200	315,000	(167,400)	147,600
DP Capital Outlay	0	0	0	6,000	0	75,000	75,000	(75,000)	0
Capital Outlay	0	11,300	0	0	0	0	0	0	0
Total	$1,685,200	$1,859,700	$2,331,300	$1,885,600	$2,237,800	$587,200	$2,825,000	($259,500)	$2,565,500

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Other Indicators	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Approp
Budgeted FTE	13	13.50	13	14	14	0	14	14
Actual FTE	13	9.80	12.70	13.10	0	0	0	0
Vehicles	10	10	11	12	10	2	12	12

COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.