Young: Tidying Up

Monday, December 19, 2016 | 0

Workers’ comp will see some significant tidying up in 2017.

Julius Young

Marie Kondo’s widely read book “The Life Changing Magic of Tidying Up” advises us to take an inventory and toss those things in our lives that don’t bring us joy.

And so it was in 2016 that California workers’ comp stakeholders and legislators finally recognized that bad behavior in the state workers’ comp system had grown out of control. Too many rogue providers were causing heartburn, not joy.

The result was Assemblyman Adam Gray’s bill, AB 1244. That bill aims to prevent fraudsters and abusers from participating in the comp system.

Among those likely to find themselves suspended will be those on the Medi-Cal Suspended and Ineligible Provider List that is maintained by the California Department of Health Care Services. The list includes not just doctors but also nurses, pharmacies, in-home supportive service providers, chiropractors, durable equipment providers and other sorts of health care vendors.

The CDHCS site notes:

“Examples of providers who need to be aware of the provisions of this law, and could be suspended if violating the law are:

• Billing services that submit claims for Medi-Cal providers who are suspended.
• Pharmacies that fill prescriptions and bill for services prescribed by a suspended provider.
• Providers who bill for services under referral or prescription of a provider who is suspended.
• Providers who employ and submit claims for the services of an individual who is a suspended provider.
• Physician groups, clinics and institutions that employ and submit claims for the services of an individual who is a suspended provider.
• Any individuals or entities that enter into a business arrangement and submit claims for or in conjunction with an individual or entity that is suspended.”

The Division of Workers' Compensation has now unveiled proposed emergency regulations to implement AB 1244. On Wednesday, those regs will go to the Office of Administrative Law (OAL) for approval. The regulations, once approved by the OAL, may remain in effect for up to 180 days, during which time the DWC would be able to go through permanent rule-making procedures for this law.

Those rules provide for a very tight, 10-day appeal period for suspended providers once notice of suspension is given.

One issue that is likely to arise is the question of what happens to providers who were suspended from Medi-Cal in the past (including providers suspended decades ago) but who successfully petitioned for reinstatement in the program. The DHCS website acknowledges that this can be done (although reinstatement after suspension is not automatic). Perhaps that is an issue that will be addressed during permanent DWC rule-making and comment.

Julius Young is a claimants' attorney for the Boxer & Gerson law firm in Oakland, California. This column was reprinted with his permission from his blog, www.workerscompzone.com.