(A) The
administrator of the bureau of workers' compensation may refuse to certify or
recertify or may decertify a provider or
, MCO, or QHP as provided in this chapter.
(B) The bureau shall
will monitor
and may investigate a provider or
, MCO, or QHP, and may
participate with other state or federal agencies or law enforcement authorities
in gathering evidence for such matters.
(C) Prior to the administrator issuing an
adjudication order on the matter, the administrator
shall
will afford the
provider
or
,
MCO
, or QHP an opportunity for a hearing
by serving written notice to the provider, MCO or
QHP in accordance with
the provisions of
Chapter 119. of the Revised Code
and this
rule.
The notice will include a statement
informing the provider, MCO, or QHP that if the bureau does not receive a
request for a hearing within thirty days of the time of the service of the
written notice, the administrator may proceed with an adjudication order
concerning the provider, MCO, or QHP.
(D) Prior to the administrator
entering an adjudication order, the bureau shall send written notice to the
provider or MCO by certified mail containing the following
information:
(1) A statement of the reasons and a
summary of the evidence relied upon for the proposed administrative action
concerning the provider or MCO;
(2) A citation of statutes or rules
forming the basis for the administrative action;
(3) A statement indicating that the
provider or MCO is entitled to a hearing, if requested within thirty days of
the time of the mailing of the notice;
(4) A statement indicating that the
provider or MCO may appear at the hearing in person, and may be represented by
an attorney, or may present its position, arguments or contentions in
writing;
(5) A statement that at the hearing
the provider or MCO may present evidence and examine witnesses appearing for
and against the provider or MCO, and that the provider or MCO may request that
the bureau issue subpoenas to compel the attendance of
witnesses;
(6) A statement informing the
provider or MCO that if the bureau does not receive a request for a hearing
within thirty days of the time of mailing of the written notice, the
administrator may proceed with an adjudication order concerning the provider or
MCO.
(E)(D) If no timely
request for a public hearing is made by the provider or
, MCO, or QHP, the administrator may issue an adjudication
order concerning the provider or
, MCO, or QHP.
(F)(E) If
the provider or
, MCO, or QHP files a
timely request for a hearing, the bureau shall
immediately set the date, time, and place for such hearing, not less than seven
nor more than fifteen days from the bureau's receipt of the request for
hearing. The bureau shall notify the provider or MCO and any representatives of
the hearing. The bureau may continue the date of the hearing upon the
application of any party or upon its own motion
will schedule the hearing in accordance with sections
119.07 and
119.09 of the Revised
Code. The hearing shall
will be held at the bureau central office in
Columbus, but if requested by the provider or
, MCO, or QHP, the bureau may hold the hearing in the
bureau office closest to the place of business of the provider
or
, MCO, or QHP.
(G)(F) Conduct of hearing.
(1)
The hearing will
be conducted in accordance with Chapter 119. of the Revised Code. The
administrator may conduct the hearing personally or may delegate the hearing to
a referee, who shall
will be an attorney at law. The referee may be
from the bureau's legal division or an attorney employed by the administrator
especially for such purpose. The bureau has
theThe burden of proof
shall be on the bureau to establish, by a preponderance of the evidence, cause for
taking action against
suspending or revoking the certification of a
the provider or
, MCO, or QHP.
(I)(G) Should the provider
or
, MCO, or QHP be adversely affected by the order of the
administrator, the provider or
, MCO, or QHP may file a
notice of appeal of the decision in accordance with section
119.12 of the Revised
Code.
(J)(H) Any adjudicating
order of the administrator to decertify, or to refuse to recertify a provider
or
, MCO, or QHP shall include a clear indication of the
beginning date of such action and the specific
medical services or dates of medical services or supplies that shall be
excluded from payment.
Notes
Ohio Admin. Code
4123-6-17
Effective:
4/15/2024
Five Year Review (FYR) Dates:
8/1/2025
Promulgated Under:
119.03
Statutory
Authority: 4121.12,
4121.121,
4121.30,
4121.31,
4121.44,
4121.441,
4123.05
Rule
Amplifies: 119.05,
119.07,
119.09,
119.092,
119.12,
4121.12,
4121.121,
4121.44,
4121.441
Prior
Effective Dates: 02/16/1996, 01/01/1999, 02/14/2005, 02/01/2010, 11/13/2015,
04/01/2021
