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.
ACIG Insurance Company of Dallas, TX
Order Number: DWC-3027
Date of Order: 2/21/2014
Order Final In: February
Action Taken: Fined $4,928
Violation: Submitted inaccurate medical billing data to TDI-DWC
Alaska National Insurance Company of Anchorage, AK
Order Number: DWC-3015
Date of Order: 2/14/2014
Order Final In: February
Action Taken: Fined $5,110
Violation: Submitted inaccurate medical bill data to TDI-DWC
America First Lloyd’s Insurance Company of Richardson
Order Number: DWC-3030
Date of Order: 2/24/2014
Order Final In: February
Action Taken: Fined $2,683
Violation: Submitted inaccurate medical billing data to TDI-DWC
City of San Antonio of San Antonio
Order Number: DWC-3029
Date of Order: 2/21/2014
Order Final In: February
Action Taken: Fined $3,964
Violation: Submitted inaccurate medical billing data to TDI-DWC
Dilger, J. Thomas, Jr., M.D. of Spring
Order Number: DWC-3013
Date of Order: 2/14/2014
Order Final In: February
Action Taken: Must not re-apply for designated doctor certification in the Texas workers’ compensation system
Violation: Assigned impairment ratings that failed to comply with medical guidelines; Failed to document objective medical evidence and/or an analysis of evidence to support conclusions on designated doctor questions; Failed to perform adequate examination; Failed to obtain complete set of medical records
Hyatt Corp. of Chicago, IL
Order Number: DWC-3018
Date of Order: 2/14/2014
Order Final In: February
Action Taken: Fined $880.50
Violation: Submitted inaccurate medical bill data to TDI-DWC
Marioni, Luis, D.C. of El Paso
Order Number: DWC-2999
Date of Order: 2/12/2014
Order Final In: February
Action Taken: Fined $2,500; Must complete online medical education course within 180 days; Must attend medical record documentation course; Must submit documentation of continuing medical education completed for medical license renewal
Violation: Administered improper, unreasonable or medically unnecessary treatment and services; Failed to document rationale for not following medical guidelines; Failed to comply with commissioner rule
Meridian Security Insurance Company of Indianapolis, IN
Order Number: DWC-3026
Date of Order: 2/21/2014
Order Final In: February
Action Taken: Fined $4,147
Violation: Submitted inaccurate medical billing data to TDI-DWC
Mesquite I.S.D. of Mesquite
Order Number: DWC-3017
Date of Order: 2/14/2014
Order Final In: February
Action Taken: Fined $1,172
Violation: Submitted inaccurate medical bill data to TDI-DWC
National American Insurance Company of Chandler, OK
Order Number: DWC-3014
Date of Order: 2/14/2014
Order Final In: February
Action Taken: Fined $5,122
Violation: Submitted inaccurate medical bill data to TDI-DWC
Netherlands Insurance Company of Boston, MA
Order Number: DWC-3028
Date of Order: 2/21/2014
Order Final In: February
Action Taken: Fined $6,801
Violation: Submitted inaccurate medical billing data to TDI-DWC
OneBeacon Insurance Company of Canton, MA
Order Number: DWC-3025
Date of Order: 2/20/2014
Order Final In: February
Action Taken: Fined $1,093
Violation: Submitted inaccurate medical bill data to TDI-DWC
Praetorian Insurance Company of New York, NY
Order Number: DWC-3019
Date of Order: 2/14/2014
Order Final In: February
Action Taken: Fined $20,000
Violation: Failed to timely pay medical bill; Failed to timely submit medical bill and payment data to TDI-DWC; Failed to accurately submit medical EDI records to TDI-DWC
T.H.E. Insurance Company of Treasure Island, FL
Order Number: DWC-3016
Date of Order: 2/14/2014
Order Final In: February
Action Taken: Fined $4,146
Violation: Submitted inaccurate medical bill data to TDI-DWC
TASB Risk Management Fund of Austin
Order Number: DWC-3032
Date of Order: 2/25/2014
Order Final In: February
Action Taken: Fined $16,124; Must conduct quarterly self audits during calendar year 2014 and submit first report to TDI-DWC by March 31, 2014
Violation: Submitted inaccurate medical billing data to TDI-DWC
Zenith Insurance Company of Austin
Order Number: DWC-3012
Date of Order: 2/14/2014
Order Final In: February
Action Taken: Fined $3,827
Violation: Submitted inaccurate medical bill data to TDI-DWC
Meyer, Ralph C., D.C. of Garland
Order Number: DWC-2987
Date of Order: 1/31/2014
Order Final In: January
Action Taken: Fined $2,500
Violation: Failed to maintain efficient utilization of health care by ordering unnecessary diagnostic testing, prescribing excessive amounts of physical therapy and scheduling unnecessary office visits
Myles, Robert Tytan, M.D. of Bedford
Order Number: DWC-2985
Date of Order: 1/31/2014
Order Final In: January
Action Taken: Permanently removed from Texas workers’ compensation system as a health care provider
Violation: Performed two surgical procedures that were unreasonable and medically unnecessary because procedures not justified by sufficient medical evidence
Pennsylvania Manufacturers’ Association Insurance Company of Blue Bell, PA
Order Number: DWC-2986
Date of Order: 1/31/2014
Order Final In: January
Action Taken: Fined $1,288
Violation: Submitted inaccurate medical bill data to TDI-DWC
Texas Mutual Insurance Company of Austin
Order Number: DWC-2949
Date of Order: 1/10/2014
Order Final In: January
Action Taken: Fined $2,000
Violation: Failed to timely pay income benefits to injured employee; Failed to pay correct amount of income benefits to injured employee; Failed to timely notify TDI-DWC of payment change
Travis County of Austin
Order Number: DWC-2984
Date of Order: 1/31/2014
Order Final In: January
Action Taken: Fined $734
Violation: Submitted inaccurate medical bill data to TDI-DWC