The rule clarifies that mandatory reporting of all instances of overutilization to the division must be accomplished by means of the carrier's compliance with the division's medical claims information filing requirements.
The rule also introduces an elective reporting process by which any person can report to the division a health care provider's violation of statutes and rules, including: 1) failing to submit medical records and reports; 2) failing to refund an overpayment of reimbursement; 3) collecting or receiving payment from an injured worker; 4) failing to follow standards of care; or 5) failing to properly bill medical services.
Recommending treatment that would constitute an overutilization is not, in and of itself, an instance of overutilization. The proposed rule incorporates a new form that provides carriers with a discretionary method of reporting the health care provider violations.
Read more at the WorkersComp Forum homepage.
July 14, 2011
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