AUDIT REPORT. Legal Billing Compliance. July 29, Report Number: 2015-AUD-09 Legal Billing Compliance

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1 AUDIT REPORT Legal Billing Compliance July 29, 2015

2 Executive Summary Background In order to thoroughly review and manage legal fee bills received from a large pool of legal firms providing legal services to the Claims department, Citizens procured an application, the Acuity Billing Management system (Acuity) during 2013, through which fee bills are submitted. Citizens also formed an in-house bill review department (the Legal Bill Compliance department), during 2011 within the Legal Services department to support Litigated and Disputed Claims department, within the Claims department. This department scrutinizes and assesses bills received with a focus on the validity of fees and expenses billed by outside counsel while Litigated and Disputed Claims manages the day to day claims litigation file. An Internal review of the Claims Legal Defense Billing processes, during late 2013 and early 2014, indicated that processes implemented to manage legal defense billing were not optimal and required improvement. To this effect, Claims Litigated and Disputed Claims was restructured, Acuity was enhanced and the capability of Legal Bill Compliance was improved. Outstanding since this audit was a thorough assessment of the Legal Bill Compliance department s current practices vs practices deployed in the market and the potential for outsourcing this department. Legal Bill Compliance was established in April of 2011 and now consists of three fulltime employees and nine temporary staff who are responsible for reviewing all legal invoices submitted by outside counsel to ensure compliance with billing guidelines and enhance litigation expense management. Litigation invoice activity, as provided by Legal Bill Compliance, from January 2014 through December 2014 is as follows: January 2014 through December 2014 Monthly Average Invoices Reviewed by Legal Compliance 128,210 10,684 Invoices Adjusted by Legal Compliance 53,606 4,467 Total Invoice Amount Billed $ 95,887,231 $ 7,784,703 Total Invoice Adjustment Amounts $ 8,862,340 $ 738,528 During 2015 the Legal Services department commenced with a process to assess the viability of outsourcing the legal bill review process, currently managed by the Legal Bill Compliance department, to national providers that specialize in providing this service to Property and Casualty Insurance Carriers. Earlier in 2015 a Request for Information (RFI) was published and seven prospective vendors responded. Audit Objectives and Scope With this review we assessed whether outsourcing the Legal Bill Compliance department, either partially or completely, would improve benefits gained from the legal bill review process based on the performance and cost of the department and available alternatives. We assessed the roles and functions performed by Legal Bill Compliance, Acuity, participation of outside counsel with the billing process, and results from the RFI. Given that the nature of this review was to consult with and provide advice to Citizens General Counsel and Chief Claims Officer, we do not provide an opinion rating for this work as we did not assess the efficiency of controls but rather provided an independent review of the potential impacts of outsourcing the department. P a g e 1

3 Executive Summary Audit Observations Our review indicated that a full assessment of the potential value to be gained from outsourcing the Legal Bill Compliance department could not be made given level of information provided by the market in response to the RFI and a general lack of knowledge of best practices when assessing the business areas performance. Our assessment results are based on the fact that the processing of each invoice, for reasonableness and verification of supporting documentation, will remain fundamentally a manual process. Citizens will continue to utilize Acuity to manage invoices and the impact of market vendors cannot be reliably quantified to enable an informed management decision. We recorded the following observations: A competitive market of legal invoice billing services does exist. The RFI demonstrated that a competitive market for processing legal invoices exists. The acquisition of resources specializing in legal invoice billing services may provide Citizens with intangible innovation, resource and experience benefits that may not be cultivated within our existing operations. A formal Request for Proposal may solicit a more competitive response with greater cost detail. However, before a decision to outsource the department is made management must define expected cost benefits and acceptable levels of performance in comparison to the current operations. Operational expenses would increase by approximately $500K annually based on vendor responses to the RFI to augment or replace the Legal Bill Compliance department. This would more than double the cost of the Legal Bill Compliance department and does not take into account resources required to monitor and manage the outsourced operation. As an offset to the increase in bill review cost, one could expect a reduction in overall legal fees. Results from the RFI anticipate a decrease of legal bill fees of six to eight percent in the first year as opposed the current fee reduction rate of 13.6% (six month average from October 2014 through March 2015) recorded by the Legal Bill Compliance department. We recognize that the RFI responses were based on market averages and not on a thorough understanding of Citizens billing practices. Furthermore, this does not take into account final pricing of a fully competitive solicitation. The RFI responses did not provide any services to maintain and manage Outside Counsel relationship. Legal Bill Compliance maintains a relationship with each of the 115 legal defense firms submitting invoices. During the first three months of 2015, 69 firms had invoice adjustments that ranged from 40% to 100% of the invoices submitted. The remaining firms required, on average, adjustments for 24% of submitted invoices. Appeal of invoices adjusted by Legal Compliance significantly impact the processing backlog and is not specifically addressed in the RFI responses. Effectiveness of the Legal Compliance unit is improving. The number of invoices submitted by outside counsel and invoices adjusted has remained consistent for During 2014 the value of the adjusted invoices has increased from $440K to $1.1M monthly. As a percentage of submitted legal fees, this represents an increase from 4% in January 2014 to 14% in December Simultaneously the overall value of fees submitted by outside counsel has trended downward and invoice backlog period was reduced from four months to six weeks. The below charts illustrate legal fee trends for P a g e 2

4 MILLIONS Executive Summary 14% of Dec bills $ Amount Billed $11.00 $10.00 $9.00 $8.00 $7.00 $6.00 Management Information reported through Acuity is coming on line in Custom reports provided by Acuity were anticipated to be a significant tool to manage the invoice billing process. However, development of reports has been delayed due to the redirection of resources to address disaster recovery and data security concerns in Now that these concerns have been addressed focus has returned to developing reporting functionality. In April of 2015 vendor (Outside Counsel) score card reports for each firm were released for internal use and will be provided to each vendor in July Reports currently in development include Litigation Remaining Budget Report, Firm Fees Report, Firm Closing Cost Report, Litigation Pending Report and Management Dashboard Reports. As these reports become available management may identify further efficiency opportunities, and proactively identify compliance trends and better manage legal firms. Following this review, Citizens General Counsel approached a claims legal bill review expert to review Citizens internal bill review and compliance program and provide an objective assessment of the program as compared to industry standards and best practices in the area of legal billing and review compliance. The review is expected to evaluate the department efficiency and gauge whether outsourcing the department may, in the first instance, be a viable option for Citizens. We would like to thank management and staff for their cooperation and professional courtesy throughout the course of this audit. P a g e 3

5 Appendix 1 Distribution Addressees Copies Dwane Tyson, Director Assistant General Counsel Claims & Litigation Juan Cocuy, Citizens Audit Committee Chairman Bette Brown, Citizens Audit Committee Member Jim Henderson, Citizens Audit Committee Member Barry Gilway, President/CEO/Executive Director Dan Sumner, Chief Legal Officer & General Counsel Bruce Meeks Inspector General Jay Adams, Chief Claims Officer Elaina K. Paskalakis, Vice President - Claims Litigation Following Audit Committee Distribution The Honorable Rick Scott, Governor The Honorable Jeff Atwater, Chief Financial Officer The Honorable Pam Bondi, Attorney General The Honorable Adam Putnam, Commissioner of Agriculture The Honorable Don Goetz, President of the Senate The Honorable Will Weatherford, Speaker of the House of Representatives Audit Performed By Auditor in Charge Under the Direction of Anthony Huebner Joe Martins Chief of Internal Audit P a g e 4

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