Audits Lead to $95,750 in Fines for UROs; High Scores Save Administrators From Penalties

The California Division of Workers’ Compensation fined nine utilization review organizations a combined $95,750 for violations uncovered during 2021 audits. At the same time, while the division identified 75 violations in utilization review audits of 36 claims administrators last year, it waived all penalties because of the high scores the audit subjects earned. The DWC in 2021 audited 10 utilization review organizations, including five in California, two in Tennessee and one each in Florida, Nevada and Wisconsin. The review of 574 requests for authorization found 51 late responses, 61...