Officials in the Lone Star State continue to go after those committing workers compensation fraud.
Commissioner of Workers Compensation Ryan Brannan recently announced final disciplinary actions taken by the Division of Workers Compensation (DWC).
The final actions include administrative penalties ordered against insurance carriers, health care providers and employers in the workers compensation system.
Since Jan. 1, 2014, the Commissioner of Workers Compensation has ordered administrative penalties totaling $1,774,345 for system participants. The penalties include $1,658,245 in fines ordered for insurance carriers, $65,600 in fines ordered for health care providers, $49,500 in fines ordered for other entities and $1,000 in fines ordered for employers.
Violations of the Texas Labor Code by insurance carriers cited in recent orders include failure to timely pay income benefits to an injured employee, failure to timely pay a medical bill, and retrospectively reviewing the medical necessity of a preauthorized medical service or treatment.
Violations cited in orders naming health care providers include failure to document an injury to justify ongoing treatments and medications and failure to timely file and/or accurately complete DWC forms, reports or records.
Violations cited in orders naming other entities include adjusters performing utilization reviews and issuing medical necessity denials without allowing health care providers a reasonable opportunity to discuss with a medical doctor.
Summaries of disciplinary actions are available on the TDI website at: https://wwwapps.tdi.state.tx.us/inter/asproot/commish/da/dwcclips2014.asp.
Author Kori Shafer-Stack, Editor, Amaxx Risk Solutions, Inc. is an expert in post-injury response procedures and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. www.reduceyourworkerscomp.com. Contact: kstack@reduceyourworkerscomp.com.
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