§386-27  Qualification and duties of healthcare providers.  (a)  All health care providers rendering health care andservices under this chapter shall be qualified by the director and shall remainqualified by satisfying the requirements established in this section.  Thedirector shall qualify any person initially who has a license for the practiceof:

(1)  Medicine or osteopathy under chapter 453;

(2)  Dentistry under chapter 448;

(3)  Chiropractic under chapter 442;

(4)  Naturopathic medicine under chapter 455;

(5)  Optometry under chapter 459;

(6)  Podiatry under chapter 463E; and

(7)  Psychology under chapter 465.

(b)  To remain a qualified provider under thischapter a health care provider shall:

(1)  Comply with guidelines established by the directoron the frequency of treatment and reasonable utilization of health care andservices;

(2)  Conform to limitations established by thedirector for charges on services under medical fee and other fee schedules;

(3)  File timely reports required under section386-96;

(4)  Avoid unnecessary and unreasonable referrals ofinjured employees to other health care providers;

(5)  Refrain from ordering unnecessary andunreasonable diagnostic tests and studies;

(6)  Remain available as a treating health careprovider to injured employees and as an advisor to the director in proceedingsunder this section; and

(7)  Comply with all requirements established underthis chapter and by rules and decisions adopted and issued by the directorpursuant to this chapter.

(c)  Any health care provider who fails tocomply with subsections (a) and (b) may be subject to such sanctions deemedjust and proper by the director which may include:

(1)  Disallowance of fees for services rendered to aninjured employee;

(2)  Forfeiture of payments for services rendered toan injured employee under this chapter;

(3)  Fines of not more than $1,000 for each violation;

(4)  Suspension as a qualified provider; and

(5)  Disqualification as a provider of services underthis chapter.

(d)  No sanction shall be imposed by thedirector under this section except upon submission of a written complaint whichshall specifically allege that a violation of this section occurred within twoyears of the date of the complaint.  A copy of the complaint shall be sent tothe health care provider charged promptly upon receipt by the director.  Thedirector may establish an advisory panel of health care providers consisting ofthree members, one selected by the complainant, another selected by the healthcare provider charged, and the third selected by the director who shall assistthe director in any case arising under this section.  Fees for servicesrendered by members of the advisory panel shall be paid for by the specialcompensation fund.  No member of the advisory panel shall be liable in damagesfor libel, slander, or other defamation of character of any party for anyaction taken while acting within their capacities as members of the advisorypanel.

The director shall issue, where a sanction isordered under this section, a written decision of findings following a hearingheld upon not less [than] twenty days written notice to the complainant and thehealth care provider charged.  No violation shall be found unless the directordetermines that the violator acted in bad faith.  Any person aggrieved by adecision of the director may appeal the decision under section 386-87.

(e)  In any case arising under this section,the injured employee treated by the health care provider charged with aviolation of this section shall not be a party to the proceeding and shall notappear unless called as a witness before the director or the appellate board. Charges for services rendered by the health care provider alleged to be inviolation of this section shall be suspended pending action by the director andthe appellate board in cases on appeal.

In any case in which fees for services renderedby a health care provider are disallowed by the director, the health careprovider shall be ordered to forfeit payment. [L 1985, c 296, pt of §5; am L2009, c 11, §48; am L Sp 2009, c 22, §11(2)]

 

Note

 

  The L 2009, c 11 amendment is retroactive to April 3, 2008. L 2009, c 11, §76(2).