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California Division of Workers’ Compensation (DWC) Issues Notice Of Proposed Emergency Rulemaking Action
By Anthony Santos - December 14, 2016

On December 13, 2016, the California Department of Industrial Relations’ DWC issued Notice of Emergency Regulatory Action, addressing recently passed AB1244. The proposed regulations are being filed to ensure compliance with AB1244, specifically addressing provider suspension procedures. The procedures are slated to go into effect on January 1, 2017.

AB1244 added LC 139.21 (a), which requires the DWC Administrative Director to promptly suspend any physician, practitioner or provider from participating in the Workers’ Compensation system if that individual has been convicted of a misdemeanor or fraud involving fraud or abuse of the Workers’ Compensation system (Medi-Cal and Medicare also included). Current law only removes their certificate to act as a QME and does not suspend the provider.

The DWC justifies the filing of the regulations by outlining recent high profile criminal indictments over the last one and a half years against providers, including but not limited to, Pacific Hospital, Michael Drobot, Landmark Medical, and the infamous Dr. Uwaydah. These have been discussed in great detail over the past year with the criminal proceedings still on-going.

While there was a lot of excitement around the AB1244 and the potential millions in savings for insurance carriers, one must look further at the regulations.  Proposed regulation 9788.1 outlines the suspension of the provider and how notice shall be given to the provider. Look closely at 9788.1 (c), which states “The physician, practitioner, or provider is prohibited from seeking payment or reimbursement, either directly or indirectly, for any goods or services related to an occupational injury or illness that is provided on or after the date of their suspension.”

Yes, you read it correctly. The provider cannot collect for any services ON OR AFTER the date of their suspension.

Hmm, after the date of suspension? What provider will be providing services after their suspension and still try to collect on the services? Don’t answer that! You can hear the same excitement previously outlined shift right from the defense attorneys, adjusters and carriers and right back into provider/lien claimants.

My question to the DWC is “where is the punishment?” The provider has to be found guilty of a misdemeanor or felony for fraud or abuse of the Work Comp system. The exact services that got them in trouble are not exempt from further collection/litigation and frankly, that doesn’t pass the smell test in my opinion.

The emergency regulations will be filed on the DWC Office of Administrative Law on December 21, 2016. Hopefully, they will allow public comment but it’s not guaranteed on emergency regulations. The alternative, per the DWC release on December 13, 2016, is to contact Maureen Gray at mgray@dir.ca.gov or (510) 286-0676. 

If you are alarmed, intrigued or angry about this obvious omission, please contact her. I did….

 

by Anthony Santos, anthonysantos@me.com; published by adjustercom and Lonce LaMon, all rights reserved

 
 

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