Workers Comp Zone


Workers’ comp will see some significant tidying up in 2017.

Marie Kondo’s widely read book “The Life Changing Magic of Tidying Up” advises us to take an inventory and toss those things in our lives that don’t bring us joy.

And so it was in 2016 that California workers’ comp stakeholders and legislators finally recognized that bad behavior in the California’ workers’ comp system had grown out of control. Too many rogue providers were causing heartburn, not joy.

The result was Assemblyman Adam Gray’s bill, AB 1244 (see link to the text below). That bill aims to prevent fraudsters and abusers from participating in the comp system.

Among those likely to find themselves suspended will be those on the “Medi-Cal Suspended and Ineligible Provider List” that is maintained by the California Department of Health Care Services (see link to the CDHCS site below which contains a link to an excel spreadsheet of the current list). The list includes not just doctors but also nurses, pharmacies, in-home supportive service providers, chiropractors, durable equipment providers and other sorts of health care vendors.

The CDHCS site notes that :

“Examples of providers who need to be aware of the provisions of this law, and could be suspended if violating the law are:

  1. Billing services that submit claims for Medi-Cal providers who are suspended;
  2. Pharmacies that fill prescriptions and bill for services prescribed by a suspended provider; 
  3. Providers who bill for services under referral or prescription of a provider who is suspended;
  4. Providers who employ and submit claims for the services of an individual who is a suspended provider;
  5. Physician groups, clinics and institutions that employ and submit claims for the services of an individual who is a suspended provider; 
  6. Any individuals or entities that enter into a business arrangement and submit claims for or in conjunction with an individual or entity that is suspended.”

The DWC has now unveiled emergency proposed regulations to implement AB 1244. On December 21 those regs will go to the Office of Administrative Law (OAL) for approval. The regulations, once approved by the OAL, may remain in effect for up to 180 days during which time the DWC would be able to go through permanent rule making procedures for this law.

The Medi-Cal Supsension List can be found here:

Here is the link to the DWC’s proposed emergency rules:

Those rules provide for a very tight 10 day appeal period for suspended providers once notice of suspension is given.

One issue that is likely to arise is the question of what happens to providers who were suspended from Medi-Cal in the past (including providers suspended decades ago) but who successfully petitioned for reinstatement in the program. The DHCS website acknowledges that this can be done (although reinstatement after suspension is not automatic). Perhaps that is an issue that will be addressed during permanent DWC rule making and comment.

The text of AB 1244 is viewable here:

Stay tuned.

Julius Young