December 16, 2017

CA DWC to Hold Public Hearing for Proposed Regs for Medical Provider Suspension Process to Combat Fraud

San Francisco, CA – The Division of Workers’ Compensation (DWC) recently issued a notice of public hearing on proposed regulations to implement the provider suspension process required under Assembly Bill 1244.

AB 1244 (Gray and Daly), which went into effect January 1, introduced new changes to the workers’ compensation system and requires the division’s Administrative Director to suspend any medical provider, physician or practitioner from participating in the workers’ compensation system in cases in which one or more of the following is true:

  • The provider has been convicted of a felony or misdemeanor involving fraud or abuse of the Medi-Cal or Medicare programs or the workers’ compensation system, fraud or abuse of a patient, or related types of misconduct;
  • The provider has been suspended due to fraud or abuse from the Medicare or Medicaid (including Medi-Cal) programs; or
  • The provider’s license or certificate to provide health care has been surrendered or revoked.

The regulations provide for a hearing process should the provider wish to contest the suspension order.

Emergency regulations became effective on January 6, 2017 for a period of 180 days. They were readopted on July 6, 2017 for 90 days. They were readopted for the second and final time on October 5, 2017 and will remain effective until January 4, 2018.

A public hearing has been scheduled for 10 a.m., Monday, December 11, 2017, in the Auditorium of the Elihu Harris State Office Building, 1515 Clay Street, Oakland, CA 94612. Members of the public may also submit written comments on the regulations until 5 p.m. that day.

The notice and text of the regulations can be found on the proposed regulations page.

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