Austin, TX – Commissioner of Workers’ Compensation Rod Bordelon recently announced final disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC).
The final actions include orders related to violations of the Texas Labor Code and rules promulgated by the Commissioner of Workers’ Compensation. Violations cited in orders naming insurers included failure to timely pay a medical bill, failure to timely pay income benefits to an injured employee, and retrospectively reviewing the medical necessity of a preauthorized medical service or treatment. Violations cited in orders naming health care providers included failure to timely file and/or accurately complete TDI-DWC forms, reports or records.
Associated Indemnity Corporation of Novato, CA
Order Number: DWC-2474
Date of Order: 4/29/2013
Order Final In: April
Action Taken: Fined $2,400
Violation: Failed to accurately submit medical bill and payment data; Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines
Chevron Corporation of San Ramon, CA
Order Number: DWC-2438
Date of Order: 4/12/2013
Order Final In: April
Action Taken: Fined $2,000
Violation: Failed to pay correct amount of Temporary Income Benefits to injured worker
Nguyen-Khoa, Kevin Quang D.P.M. of Richardson
Order Number: DWC-2439
Date of Order: 4/12/2013
Order Final In: April
Action Taken: Must submit care of injured employees for Medical Quality Review and be subject to possible future enforcement action
Violation: Misrepresented or omitted pertinent facts in a medical evaluation and narrative report while serving as Designated Doctor
Poly America, L.P. of Grand Prairie
Order Number: DWC-2437
Date of Order: 4/12/2013
Order Final In: April
Action Taken: Fined $23,500
Violation: Failed to timely pay medical bill or to pay medical bill according to TDI-DWC Medical Fee Guidelines; Failed to accurately submit medical bill and payment data
Roybal, Robert Edward M.D. of Dallas
Order Number: DWC-2440
Date of Order: 4/12/2013
Order Final In: April
Action Taken: Must attend compliance training for doctors and medical office staff; Must undergo monitoring and review of randomly selected workers’ compensation patients records
Violation: Failed to properly document and explain findings from examinations of injured employees
St. Luke’s Episcopal Health System of Houston
Order Number: DWC-2461
Date of Order: 4/26/2013
Order Final In: April
Action Taken: Fined $3,500
Violation: Improperly billed an injured employee for workers’ compensation medical services provided
Vega, Oscar M.D. of El Paso
Order Number: DWC-2475
Date of Order: 4/29/2013
Order Final In: April
Action Taken: Fined $4,000
Violation: Improperly billed an injured employee for workers’ compensation medical services provided
AMA Regal, Inc. of Londonderry, NJ
Order Number: DWC-2380
Date of Order: 3/15/2013
Order Final In: March
Action Taken: Fined $500
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
American Home Assurance Company of New York, NY
Order Number: DWC-2387
Date of Order: 3/22/2013
Order Final In: March
Action Taken: Fined $5,500
Violation: Failed to timely pay medical bill; Failed to timely comply with a benefit dispute agreement
Arrowhead Hospital of Glendale, AZ
Order Number: DWC-2390
Date of Order: 3/22/2013
Order Final In: March
Action Taken: Fined $2,000
Violation: Improperly billed an injured employee for workers’ compensation medical services provided
Greater San Antonio Emergency Physicians of San Antonio
Order Number: DWC-2386
Date of Order: 3/22/2013
Order Final In: March
Action Taken: Fined $2,000
Violation: Improperly billed an injured employee for workers’ compensation medical services provided
Liberty Mutual Fire Insurance Company of Boston, MA
Order Number: DWC-2389
Date of Order: 3/22/2013
Order Final In: March
Action Taken: Fined $7,000
Violation: Failed to timely pay income benefits to injured employee
Renaissance SNF, L.L.C. of Dallas
Order Number: DWC-2379
Date of Order: 3/15/2013
Order Final In: March
Action Taken: Fined $1,500
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
Standard Fire Insurance Company of Hartford, CT
Order Number: DWC-2388
Date of Order: 3/22/2013
Order Final In: March
Action Taken: $5,000
Violation: Failed to timely pay income benefits to injured employee
TSC Staffing Solutions, Inc. of Bedford
Order Number: DWC-2391
Date of Order: 3/22/2013
Order Final In: March
Action Taken: Fined $1,500
Violation: Failed to comply with Commissioner’s Order to provide requested information about workers’ compensation coverage status
Wolinsky, Joel Scott M.D. of Sugar Land
Order Number: DWC-2378
Date of Order: 3/15/2013
Order Final In: March
Action Taken: Fined $5,000
Violation: Failed or refused to reply to TDI-DWC order to produce documents
Source: TDI-DWC