Billing Fraud

As reported by workcompcentral, The Division of Workers’ posted proposed emergency regulations to implement the legislative mandate to suspend doctors convicted of billing fraud or harming patients.

Gov. Jerry Brown on Sept. 30 signed into law Assembly Bill 1244 requiring the division to suspend any provider from participating in the state’s comp system following a felony or misdemeanor conviction involving fraud or abuse of Medi-Cal, Medicare or the work comp system. The bill also requires the division to suspend any provider who has been suspended from participating in Medicare or Medicaid programs because of fraud or abuse.

The emergency rules will require a provider to request a hearing within 10 calendar days of receiving notice  and must  include the legal and factual reasons for demanding a hearing. Failure to timely serve and file a request for a hearing will constitute a waiver of the right to a hearing and will be deemed an admission that the grounds for suspension are true.

The division said it will submit the proposed rules to the Office of Administrative Law on Dec. 21. The office will have 10 days to review the proposed emergency regulations. If approved, the rules will be in effect for 180 days while the division engages in formal rule-making, which will include a public comment period and a hearing.

More information from the DWC, including links to the proposed rules and the division’s “finding of emergency,” is here.