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since 1979

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What to do if you receive an RFA (or anything that can be construed as an RFA) from a provider where liability is disputed:

1. Remember, you can issue a UR deferral within 5 days of receipt of an RFA where we dispute (1) liability for the injury itself or (2) liability for the recommended treatment for reasons other than medical necessity (non-industrial body part, non-MPN provider, more than 24 chiro visits, etc.)

2. Timely issue the UR deferral! Many lien claimants hang their hat on examiners either not issuing a UR deferral where liability is disputed or issuing a late UR deferral.  Make sure that the date you receive the RFA is well documented in your claims file and that UR deferrals are issued.

3. If liability for the injury itself or for the treatment is later established (e.g., industrial causation is established), make sure all RFAs previously deferred go through retro-UR within 30 days after liability is established. Example: Claim denied based on no medical evidence.  RFA received for chiro treatment.  Objection and UR deferrals are issued due to denial of claim.  Parties proceed to AME, who finds industrial causation exists.  Immediately send all previously deferred RFAs to UR ASAP!

  • News Icon Published October 4, 2018

    Head of Numerous California Imaging Centers Indicted for Fraud

    The U.S. Attorney for the Southern District of California has issued an indictment and arrest warrant against Sam Solakyan, who headed numerous imaging centers in the state tied to fraud allegations. Solakyan allegedly paid $8.8 million in kickbacks for referrals, which were used to bill workers’ compensation payers for $284 million.

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  • News Icon Published October 2, 2018

    DWC Dismisses over 4,000 Liens Connected to Drobot Conspiracy

    The California Division of Workers’ Compensation has dismissed almost 5,000 liens filed by companies associated with Michael R. Drobot, including Industrial Pharmacy Management and California Pharmacy Management. This marks the first major case involving a provision in AB 1244 which requires the DWC to dismiss liens held by individuals convicted of fraud.

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  • News Icon Published September 14, 2018

    Federal CA Officials Secure Restitution and Guilty Plea in Two Fraud Cases

    On Thursday, a federal judge in Northern California ordered Pain Free Diagnostics Inc. to deposit the $1.2 million it owes in restitution to over 24 defrauded carriers. In an unrelated case, the U.S. Attorney’s Office for Southern California obtained a guilty plea from a doctor for accepting kickbacks for prescriptions and therapy.

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