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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 4. Certification Standards for Health Care Organizations

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§9779.2. Suspension; Revocation; Hearing.

(a) Complaints pertaining to an HCO's violations of this article may be directed in writing to the administrative director. Upon receipt of a complaint, or in the course of monitoring the HCO's operations, the administrative director may investigate an alleged violation. The investigation may include, but not be limited to, a request for and review of pertinent HCO records, interviewing medical and administrative personnel, or an on-site medical survey. If the investigation reveals reasonable cause to belive that the HCO has violated a requirement of this article, the administrative director may initiate proceedings to suspend or revoke an HCO's certification.

(b) Certification of an HCO may be suspended or revoked if:

(1) Service under the HCO is not being provided according to the terms of the certified HCO.

(2) The HCO fails to meet the requirements of this article, the Labor Code, or other applicable law.

(3) False or misleading information is knowingly or repeatedly submitted by the HCO or a participating provider or the HCO knowingly or repeatedly fails to report information required by this article.

(4) The HCO knowingly continues to use the services of a provider or medical reviewer whose license, registration, or certification has been suspended or revoked or who is otherwise ineligible to provide treatment to an inured worker under California law.

(c) In the event an HCO or organization is formally notified of the administrative director's intention to revoke or suspend the HCO's certification, or to refuse certification or recertification as an HCO, the HCO or organization shall be entitled to a hearing before the administrative director or an administrative law judge which shall be shall be held in accordance with the Administrative Procedure Act {Chapter 5 (commencing with Section 11500), of Part 1 of Division 3 of Title 2 of the Government Code}, and the administrative director shall have all of the powers granted under that act.

NOTE: Authority cited: Sections 133, 4600.5, 4603.5 and 5307.3, Labor Code. Reference: Sections 4600 and 4600.5, Labor Code.

HISTORY

1. New section filed 12-31-93; operative 1-1-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 93, No. 53).

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