7/5/2017 STAYS, SUSPENSIONS AND NEW PROCEDURES. The Impact of SB1160 & AB1244 on Liens

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1 STAYS, SUSPENSIONS AND NEW PROCEDURES The Impact of SB1160 & AB1244 on Liens 1

2 Honorable Myrle Petty Workers Compensation Administrative Law Judge The following material and any opinions contained herein are solely those of the author and are not the positions of the Division of Workers Compensation, Dept. of Industrial Relations, the WCAB or any other entity or individual. Mary R. Huckabaa, Esq. Assistant Chief Counsel State Compensation Insurance Fund The following material and any opinions contained therein are solely those of my own and are not the positions of the State Compensation Insurance Fund or any other entity or individual. 2

3 SB1160 Intent AB1244 Intent Criminally Charged Providers (LC4615) Automatic stay of liens and accrual of interest of any provider with a pending criminal charge. Applies to all treatment and medical-legal liens Criminal Charge must be one of the following: Insurance Fraud Billing Fraud Medical/Medi-Cal Fraud 3

4 Tracking Criminally Charged Providers Effective Jan. 1, 2017 DIR maintains a list of medical providers criminally charged with those certain types of fraud places a stay on the litigation of their liens. Charged-Providers.pdf 4

5 Unresolved Issues Related to Criminally Charged Providers A criminally charged provider may have ownership interest in or have association with lien claimant entities. A carrier may have knowledge and documentation of a criminal charge against a provider not listed on the DIR webpage. AntiFraudUnit@dir.ca.gov Suspended Providers (LC139.21) Provides for the suspension of physicians, practitioners, and providers from participating in the Workers Compensation System under certain conditions: 5

6 Suspended Providers cont. A. Conviction of a felony or misdemeanor that: i. Involves fraud or abuse of the Medi-Cal or Medicare program, workers compensation system, or any patient; ii. Relates to the individual s medical practice as it pertains to patient care; iii. Is a financial crime relating to Medi-Cal, Medicare or the workers compensation system; or iv. Is otherwise substantially related to the qualifications, functions, or duties of a provider of services. Suspended Providers cont. B. Suspension due to fraud or abuse form the federal Medicare or Medicaid programs.* C. Surrender or revocation of the individual s license, certificate, approval to provide health care. 6

7 Notice and Opportunity to be Heard The Administrative Director monitors the quarterly updates to the list of suspended and ineligible providers maintained by the State Department of Health Care Services The AD will send notice of a right to hearing to the physician, practitioner or provider. The provider has 10 days to request the hearing. Notice and Opportunity to be Heard If no request: The provider will be suspended 30 days from the date of the notice. If there is a request for hearing: The request will stay the suspension The hearing will take place w/in 30 days of the receipt of the request. 7

8 Notice and Opportunity to be Heard If the AD finds paragraph (a)(1) is applicable, the physician, practitioner, or provider shall be immediately suspended. Notice will be sent to the Chief Judge of the Division, and that will be cascaded to the District offices and WCJs. Tracking Suspended Providers Effective Jan. 1, 2017, DIR excludes medical providers convicted of fraud from participating in the workers compensation system. ension-list.htm 8

9 Special Lien Proceedings (e) also provides for a special lien proceeding for the adjudication of the liens of the provider actually convicted. If the disposition of the criminal proceeding provides for dismissal of the liens and forfeiture of the sums claimed, all of those liens shall be deemed dismissed w/prejudice by operation of law. If the disposition of the criminal proceeding fails to specify the disposition of the liens, all of the liens pending in any workers compensation case in any district office, shall be consolidated and adjudicated in a special lien proceeding. 9

10 New Procedures: Disclosures Lien filers after January 1, 2017 will be required to specify in their filing the basis upon which the lien is authorized These same data elements must also be added to pre-existing liens. Lien filers have until July 1, 2017 to comply New Procedures: Disclosures Must be in the carrier s network or authorized to provide treatment Can be the AME or QME for the case in which the lien was filed The lien claimant provided emergency medical treatment Lien claimant provided treatment after making a determination that the employer does not have an MPN Lien claimant has documentation that treatment was neglected or refused to the injured worker Certified interpreters or copy services could file a lien if they provided med-legal services or incurred other expenses allowed under rules adopted by the DWC 10

11 Legal Challenges Barri v. WCAB : Dr. Barri, D.C. challenged constitutionality, dismissed as premature, hearing has taken place, suspended as of 4/3/2017 Anguizola Anecdotes and Thoughts What happens when a providers liens are stayed, he/she pleads guilty, but has not been sentenced? What if you hear about a lien claimant who has been arrested, charged, etc.. But is not on the list and your WCJ will not grant a stay or continuance? 11

12 Anecdotes and Thoughts Indicted providers transferring ownership interest via Secretary of State. Is the new owner also stayed? QUESTIONS 12