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California tightens rules on workers' compensation doctors

It used to be relatively rare to hear about a physician who had been suspended from the workers' compensation program in California.

However, thanks to legislation that took effect Jan 1, 2017, California's administrative director has already suspended 52 doctors from participation in workers' compensation cases.

Some of the suspensions have been based on some pretty serious issues. At least one provider admitted to fraud and taking health care kickbacks, while another admitted to stealing from California's Fund for Health Care Deposits. A third hasn't admitted guilt but is currently charged with the sexual assault of one of his patients in another state.

The other 49 doctors who have had their licenses suspended fell in one of the new categories established by law in January, 2017. Essentially, any physician who is convicted or pleads guilty to a misdemeanor or a felony, at any level, involving medical billing fraud, Medicare fraud, Medicaid fraud, Med-Cal fraud, workers' comp fraud or patient abuse will lose their eligibility to continue receiving payments under workers' comp in California for examinations, evaluations or treatments.

It's a move that many feel is long overdue. California's workers' comp system is known to be one of the most overburdened by fraud in the nation.

In February, 2017, for example, just seven providers were suspended. Between them, they had more than 8,500 medical liens pending in workers' comp for around a total value of $59 million.

The offenses committed by those suspended should serve as a warning to those hoping to keep their licenses to operate within the worker's comp system. If you want to keep your ability to remain in the lucrative system, avoid easily recognized problem behaviors. These include:

  • Taking kickbacks for referring patients to other providers for additional testing or treatment
  • Referring patients to unnecessary tests just to be able to bill for them
  • Referring patients to specific doctors for kickbacks, even if that particular doctor wasn't right to treat that patient's condition

Naturally, in the fervor to clean up the system, there are likely to be doctors caught up by unfair or inaccurate accusations. If that's your situation, keep in mind you only have 30 days to dispute the suspension of your license.

Contact an attorney with experience in the field of maintaining professional licenses immediately for help.

Source: ohsonline.com, "California Medical Provider Suspensions Up to 52," Oct. 30, 2017

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