The workers’ compensation system is instrumental for both employees and employers. For employees, it creates a no-fault system wherein an employee may receive compensation for a work-related injury without having to prove that the injury is the fault of the employer. For employers it creates a system wherein the employer is protected from most tort claims. The system is crucial to the way our employer-employee relationship and law functions. Unfortunately, there are some that seek to exploit the system for their own financial gains. The state of California has made many efforts in recent years to combat growing fraud that exists in the workers’ compensation system. One of these efforts may be seen in Assembly Bill 1244.
On January 1, 2017, AB 1244 went into effect. Under AB 1244, the administrative director would be required to immediately suspend certain physicians or medical providers from participating in the workers’ compensation system under certain circumstances. Providers who have been indicted for a felony or misdemeanor involving fraud or abuse of the workers’ compensation system, the Medi-Cal program, or Medicare shall be suspended from participating in the workers’ compensation system. These medical providers or physicians would also not be allowed to file liens for any treatment provided to the injured workers. The California Department of Health Care Services also maintains a “Medi-Cal Suspended and Ineligible Provider List” which contains doctors, nurses, pharmacies, chiropractors, and medical equipment vendors who are not permitted to participate in the workers’ compensation system due to a previous fraud conviction.
Other providers who are not currently suspended also need to be aware of the suspended providers list. Certain actions taken by providers who are not currently suspended could lead to that provider also landing on the list. Actions such as a pharmacy filling a prescription and then billing for the medication if prescribed by a suspended physician, providers billing for treatment prescribed by a suspended physician, or a clinic employment and submitting claims for treatment rendered by a suspended physician could all end up with a suspension for the previously not-suspended provider.
The law is constantly changing, and it is essential that your business is up-to-date on the latest developments. Call me today at (714) 516-8188 for an appointment to discuss your business’s future and the way it may be impacted by the new laws