Wash. Admin. Code § 296-23-337 - For what reasons shall the department's medical director or designee suspend or terminate approval of an independent medical examination (IME) examiner or firm?
To ensure high quality independent medical examinations (IMEs), the department's medical director or designee may, in the situations described below, terminate, suspend, or inactivate approval of examiners or firms (partnerships, corporations, or other legal entities) that derive income from IMEs. IME providers must have an active provider account number to perform IMEs or provide IME related services.
FOR EXAMINERS:
(1)
AUTOMATIC TERMINATION. The
department's medical director or designee may terminate approval of examiners
in situations including, but not limited to, the following:
(a) Their license has been revoked in any
jurisdiction.
(b) A final order or
stipulation to informal disposition has been issued against the examiner by a
state authority in any jurisdiction including, but not limited to, the
Washington state department of health, when such charges involve conduct or
behavior as defined in chapter 18.130 RCW, Uniform Disciplinary Act. These
include, but are not limited to:
(i) Sexually
inappropriate conduct, behavior or language.
(ii) Behavior that puts a patient's safety or
well-being at risk.
(c)
The examiner has committed perjury or falsified documents provided to the
department or insurer.
(d) The
examiner has a criminal felony history in any jurisdiction.
(e) The examiner has failed to reapply every
three years or when required.
(2)
AUTOMATIC SUSPENSION. The
department's medical director or designee may suspend approval of examiners in
situations including, but not limited to, the following listed below. The
department will initiate a review within ninety days of notification. The
results of the review will determine if further action is necessary, which may
include termination of approval status.
(a)
The examiner has failed to meet or maintain the requirements for approval as an
IME examiner.
(b) The examiner's
license or Drug Enforcement Administration (DEA) registration has been
restricted in any jurisdiction. Exceptions may be granted for any restriction
or offense deemed by the department to be of a minor or clerical
nature.
(c) The examiner has lost
hospital privileges for cause.
(d)
A statement of charges has been filed against the examiner by a state authority
in any jurisdiction, including, but not limited to the Washington state
department of health, when such charges involve conduct or behavior as defined
in chapter 18.130 RCW, Uniform Disciplinary Act. These include, but are not
limited to:
(i) Sexually inappropriate
conduct, behavior or language.
(ii)
Behavior that puts a patient's safety or well-being at risk.
(e) The examiner has any pending
or history of criminal charges or violation of statutes or rules by any
administrative agency, court or board in any jurisdiction.
(3)
OTHER EXAMINER ACTIONS. In
addition to automatic terminations and suspensions described in subsections (1)
and (2) of this section, the department's medical director or designee may
consider any of the following factors in determining a change in status for
examiners. These status changes include temporarily unavailable, suspension or
termination of the approval to conduct IMEs.
These factors include, but are not limited to:
(a) Substandard quality of reports, failure
to comply with current department policy on report contents, or inability to
effectively convey and substantiate medical findings, opinions, and
conclusions, concerning workers.
(b) Unavailable or unwilling to testify on
behalf of the department, worker, or employer.
(c) Failure to cooperate with attorneys
representing a party in industrial insurance litigation at the board of
industrial insurance appeals (board) by not cooperating in a timely manner to
schedule preparatory activities and/or testimony during business hours and
within the dates and locations ordered by the board to complete
testimony.
(d) Failure to stay
current in the area of specialty and in the areas of impairment rating,
performance of IMEs, industrial injury and occupational disease/illness,
industrial insurance statutes, regulations and policies.
(e) Substantiated complaints or pattern of
complaints about the provider.
(f)
Other disciplinary proceedings or actions not listed in subsections (1) and (2)
of this section.
(g) Other
proceedings in any court dealing with the provider's professional conduct,
quality of care or criminal actions not listed in subsections (1) and (2) of
this section.
(h) Untimely
reports.
(i) Unavailable or
unwilling to communicate with the department in a timely manner.
(j) Misrepresentation of information provided
to the department.
(k) Failure to
inform the department of changes or actions that may affect the approval status
as an IME examiner.
(l) Failure to
comply with the department's orders, statutes, rules, or policies.
(m) Failure to accept the department fee
schedule rate for independent medical examinations, testimony, or other IME
related services.
(n) Any pending
action in any jurisdiction.
FOR FIRMS:
(4)
AUTOMATIC TERMINATION. The
department's medical director or designee may terminate approval of firms when
they fail to reapply every three years.
(5)
AUTOMATIC SUSPENSION. The
department's medical director or designee may suspend approval of firms in
situations including, but not limited to, those listed below. The department
will review the matter to determine if further action is necessary, which may
include termination of approval status.
(a)
The firm no longer meets requirements for approval as an IME
provider.
(b) The firm's
representative has committed perjury or falsified documents provided to the
department or insurer.
(c) A firm
representative's behavior has placed a patient's safety or well-being at
risk.
(6)
OTHER
FIRM ACTIONS. In addition to automatic terminations and suspensions
described in subsections (4) and (5) of this section, the department's medical
director or designee may consider any of the following factors in determining a
change in status for firms. These status changes include temporarily
unavailable, suspension or termination of the approval to provide IME related
services.
These factors include, but are not limited to:
(a) Substantiated complaints or pattern of
complaints about the firm.
(b)
Other disciplinary proceedings or actions not listed in subsections (4) and (5)
of this section.
(c) Other
proceedings in any court dealing with the provider's professional conduct,
quality of care or criminal actions not listed in subsections (4) and (5) of
this section.
(d) Untimely
reports.
(e) Unavailable or
unwilling to communicate with the department in a timely manner.
(f) Misrepresentation of information provided
to the department.
(g) Failure to
inform the department of changes affecting the firm's status as an IME
provider.
(h) Failure to comply
with the department's orders, statutes, rules, or policies.
(i) Failure to accept the department fee
schedule rate for independent medical examinations and services.
(j) Any pending action in any
jurisdiction.
Notes
Statutory Authority: RCW 51.04.020, 51.04.030, 51.32.112, 51.32.114, 51.32.055, 51.36.060, 51.36.070. 13-03-129, § 296-23-337, filed 1/22/13, effective 2/25/13; 11-01-069, § 296-23-337, filed 12/10/10, effective 1/10/11. Statutory Authority: RCW 51.32.055, 51, 32, 112 [51.32.112], 51.32.114,51.36.060, and 51.36.070. 09-24-085, § 296-23-337, filed 11/30/09, effective 3/1/10; 04-04-029, § 296-23-337, filed 1/27/04, effective 3/1/04.
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