The Division of Workers’ Compensation issued its Notice of Emergency Regulatory Action to implement the provider suspension process required under Assembly Bill 1244.
AB 1244 adds Labor Code section 139.21 which requires the Administrative Director to promptly suspend any physician, practitioner, or provider from participating in the workers’ compensation system if that individual has been convicted of any felony or misdemeanor involving fraud or abuse of the Medi-Cal program, Medicare program, or workers’ compensation system, if that individual’s license, certificate, or approval to provide health care has been surrendered or revoked, or if that individual has been suspended for fraud or abuse from participation in the Medicare or Medicaid programs.
AB 1244 requires the Administrative Director to provide notice of the suspension, which becomes effective after thirty (30) days from the date the written notice is sent, unless the physician, practitioner, or provider stays the suspension by requesting a hearing within ten (10) days from the date the written notice is sent.
AB 1244 mandates the adoption of regulations for suspending a physician, practitioner, or provider from participating in the workers’ compensation system if that individual meets the criteria specified above.
The documentation filed by the DWC in support of their request for emergency regulations claims that “High-profile workers’ compensation fraud prosecutions have revealed that many of these physicians, practitioners, or providers who have been indicted or convicted of fraud are involved in questionable patient care that is harming California’s injured workers. Capping schemes, kickbacks, and illegal patient referrals have resulted in injured workers who have been received unneeded or harmful treatment, been maimed for life, needed additional surgeries to repair incompetent work, and sadly, death of an injured worker’s infant due to failure to provide proper patient care, all driven by these fraudulent schemes rather than their medical needs.”
The emergency regulations will be filed with the state’s Office of Administrative Law (OAL) on December 21, 2016. The regulations to be filed with OAL can be found on the DWC website.
OAL has up to 10 days to consider the rules, but may approve them before the 10 days have elapsed.
Upon OAL approval and filing with the Secretary of State, the regulations are effective for 180 days while the Division initiates formal rulemaking procedures to adopt permanent regulations.
For information on the OAL procedure, and to learn how you may comment on the emergency regulations, go to the OAL’s website.
A notice will be posted at the DWC website when the emergency regulations become effective.