Resolution retroactively authorizing the Office of the District Attorney to accept and expend a grant in the amount of $1,122,888 from the California Department of Insurance for the Workers’ Compensation Insurance Fraud Program, for the grant period of July 1, 2025, through June 30, 2026.

This resolution retroactively authorizes the San Francisco Office of the District Attorney (SFDA) to accept and expend a $1,122,888 grant from the California Department of Insurance (CDI) for the Workers’ Compensation Insurance Fraud Program, covering July 1, 2025, through June 30, 2026. The grant's purpose is to enhance the investigation and prosecution of workers’ compensation insurance fraud cases, with the retroactive approval being an administrative step to meet CDI's documentation requirements. The total budget allocates $921,074 for personnel (3 attorneys, 3 investigators, 1 paralegal) and $201,814 for operating expenses, including $53,744 in indirect costs and $25,000 for outreach initiatives like DMV videos. The SFDA targets medical provider, premium, insider, and claimant fraud, having secured $270,900 in restitution from a premium fraud case and pursuing $25 million in liens from a medical provider fraud case. However, the CDI has expressed concerns about San Francisco County's declining performance in investigations, restitution, chargeable fraud, and outreach, noting no felony convictions in the past two fiscal years, and requires a plan for improvement. Over the past five fiscal years, SFDA has ordered $9,126,685.31 in restitution and collected $951,385.42.

This program directly impacts San Francisco residents by combating workers' compensation fraud, which drains public and private funds. By investigating and prosecuting fraudulent claims, the District Attorney's office helps recover stolen money (e.g., over $600,000 from insider fraud in city government) that can then be used for intended public services. It also aims to ensure fair competition for honest businesses and protect injured workers from unscrupulous providers, ultimately contributing to a more stable and trustworthy workers' compensation system in the city.

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