§ 112.402. Erroneous group health insurance claim expenditures.

(a)

Whenever the Director of Finance and Administration or his designee discovers that public funds were paid in error on behalf of an insured of the City's group health insurance coverage and the claim upon which the payment was based does not involve fraud or intent to defraud the City or any other person, the Director of Finance and Administration or his designee shall certify the amount of the erroneous payment, together with all the facts and circumstances surrounding the claim, to the General Counsel or the Mayor, as the case may be. The General Counsel or the Mayor, as the case may be, shall proceed as provided under and subject to the limitations of Section 112.301 et seq. to adjust and settle the erroneous expenditure in the public interest and to accept and give proper releases on behalf of the City and the insured.

(b)

The provisions of Section 112.401 are available in case an insured, being at the time of the settlement an employee of the City, agrees to repay the amount erroneously paid through a deduction against future salary or wage payments to the employee. This deduction shall not be automatic in the event of a settlement involving repayment of public funds by the employee but shall be begun only after the employee agrees to the deduction.

(c)

The provisions of Section 112.401 shall be applicable in the case of erroneous payments due to the fault or omission of an officer or employee of the City.

(d)

Claims upon which erroneous payment were made and which involve fraud or intent to defraud the City or another person shall be referred to the State Attorney for prosecution under the laws of the state. The settlement procedure authorized under this Section shall not be available in the case of these claims, unless:

(1)

The State Attorney declines to prosecute.

(2)

There was a prosecution but the prosecution results in a judgment or finding of not guilty.

(e)

The provisions of this Section shall not apply to the extent the City self-insures its group health insurance plan and hires a third party to pursue, adjust and settle erroneous payment claims.

(Ord. 82-652-288, § 1; Ord. 83-591-400, § 1; Ord. 90-206-208, § 6; Ord. 2014-546-E, § 2; Ord. 2016-140-E , § 16)

Note— Former §§ 120.205, 112.305.

Editor's note

Ordinance 2007-839-E, § 18, authorized updated department/division names pursuant to reorganization.