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.
Austin Total Healthcare of Austin
Order Number: DWC-2834
Date of Order: 11/5/2013
Order Final In: November
Action Taken: Fined $3,000
Violation: Failed to respond to request for refund from an insurance carrier; Failed to timely comply with a TDI-DWC order
Deiter, Cary Thomas D.C. of El Paso
Order Number: DWC-2848
Date of Order: 11/19/2013
Order Final In: November
Action Taken: Fined $3,000; Must complete continuing education hours approved by TDI-DWC
Violation: Administered improper, unreasonable or medically unnecessary treatment or services
Farmers Insurance Exchange of Los Angeles, CA
Order Number: DWC-2845
Date of Order: 11/8/2013
Order Final In: November
Action Taken: Fined $1,000
Violation: Failed to provide on-site visit or other appropriate services to three policyholders with a premium greater than $25,000 within a 12 month period
Griffith, David M., D.C. of San Antonio
Order Number: DWC-2835
Date of Order: 11/5/2013
Order Final In: November
Action Taken: Fined $3,000; Must complete continuing education hours approved by TDI-DWC
Violation: Failed to document subjective and objective functional improvement gains for injured worker
Kaufman, James K., M.D. of Fort Worth
Order Number: DWC-2865
Date of Order: 11/22/2013
Order Final In: November
Action Taken: Removed from the Texas Workers’ Compensation system as a health care practitioner
Violation: Performed surgeries without demonstratable pathology or benefit to be derived from surgery
Kordestani, Rouzebeh K., M.D. of Amarillo
Order Number: DWC-2863
Date of Order: 11/22/2013
Order Final In: November
Action Taken: Voluntary and permanent surrender of designated doctor certification and certification to assign maximum medical improvement dates and impairment ratings
Violation: Failed to obtain TDI-DWC approval prior to changing location of a designated doctor examination; Failed to follow proper procedure to reschedule a designated doctor exam; Failed to comply with a DWC Order for Production; Failed to timely file and/or accurately complete TDI-DWC forms, reports or records
Plano Independent School District of Plano
Order Number: DWC-2864
Date of Order: 11/22/2013
Order Final In: November
Action Taken: Fined $2,500
Violation: Improperly withheld funds from injured employee’s salary
Stephenson, Jackie Dean M.D. of San Antonio
Order Number: DWC-2850
Date of Order: 11/19/2013
Order Final In: November
Action Taken: Removed from Texas Workers’ Compensation system as a health care practitioner as of December 31, 2013
Violation: Failed to provide health care reasonably required by nature of injury and needed to promote recovery; Failed to maintain an efficient utilization of health care through extensive and prolonged treatment without adequate documentation
Strickland, Mark Joseph, D.C. of Copeville
Order Number: DWC-2866
Date of Order: 11/22/2013
Order Final In: November
Action Taken: Fined $2,500
Violation: Failed to maintain efficient utilization of medical care through documentation and record keeping; Provided improper, unreasonable or medically unnecessary treatment or services
Alexander, Richard A., D.C. of San Antonio
Order Number: DWC-2827
Date of Order: 10/28/2013
Order Final In: October
Action Taken: Must complete continuing education hours approved by TDI-DWC
Violation: Administered improper or unreasonable treatment or services — treatment plan did not enhance ability of injured employee to return to work
Cole, George M., D.O. of Dallas
Order Number: DWC-2826
Date of Order: 10/28/2013
Order Final In: October
Action Taken: Fined $500; must complete designated doctor core competency workshop within 90 days
Violation: Failed to include required information in a designated doctor examination narrative report
Jensen, Jack Edward M.D. of Houston
Order Number: DWC-2796
Date of Order: 10/3/2013
Order Final In: October
Action Taken: Fined $2,000
Violation: Failed to timely respond to two requests for letters of clarification
Texas Automobile Dealers Self Insurers Group of Austin
Order Number: DWC-2828
Date of Order: 10/28/2013
Order Final In: October
Action Taken: Fined $1,000
Violation: Failed to timely pay benefits to injured employee
The Insurance Company of the State of Pennsylvania of New York, NY
Order Number: DWC-2825
Date of Order: 10/28/2013
Order Final In: October
Action Taken: Fined $2,200
Violation: Submitted inaccurate medical EDI records; Failed to timely pay and ordered benefit advance; failed to timely notify TDI-DWC of change in benefit type, termination of income benefits
Williams, Clyde Marion M.D. of Amarillo
Order Number: DWC-2795
Date of Order: 10/3/2013
Order Final In: October
Action Taken: Nunc Pro Tunc Order
Violation: Corrects two clerical errors in Order No. 2105 regarding DWC forms filed and reduces fine
Source: TDI-DWC