Section 649.24 - Service Providers Ineligible for Reimbursement(a) A provider may be found ineligible for reimbursement if any of the following circumstances apply:(1) A provider fails to submit requested documentation to verify the victim's or derivative victim's losses or injury.(2) A provider fails to submit requested documentation to verify the services provided.(3) A provider provides, or causes another to provide, false information to the Board.(4) A provider misrepresents a victim's or derivative victim's disability, injury, or other need for treatment or services.(5) A provider fails to comply with statutes and regulations established by their licensing, oversight, or governing bodies.(6) A provider fails to comply with any statutes or regulations governing claims before the Board.(7) A provider fails to comply with a corrective action plan imposed by the Board. A corrective action plan need not be imposed as a prerequisite to a finding of ineligibility based upon any of the preceding circumstances.(b) The finding of ineligibility may extend to pending and future claims. The finding of ineligibility does not prevent reimbursement to victims or derivative victims for pecuniary losses.(c) The Board shall notify the provider of the finding of ineligibility, the extent, and duration of ineligibility, and allow the provider 45 calendar days to challenge it. A finding of ineligibility is final if no challenge is timely received.(d) The provider may challenge the finding of ineligibility by requesting an informal hearing before a hearing officer. The hearing officer will schedule the informal hearing, which may be on the written record, with at least ten calendar days' notice to the provider, taking into consideration the availability of the provider, any witnesses, and the hearing officer. After the hearing concludes and the administrative record is closed, the hearing officer shall prepare a proposed decision for the Board's consideration. The Board's determination of the provider's eligibility is final upon its vote.(e) A provider who disagrees with the Board's final determination of ineligibility may challenge the Board's final decision by filing a writ of mandate.Cal. Code Regs. Tit. 2, § 649.24
Note: Authority cited: Section 13920, Government Code. Reference: Sections 13954 and 13957.2(a), Government Code.
Note: Authority cited: Sections 13920 and 13974, Government Code. Reference: Sections 13954 and 13957.2(a), Government Code.
1. New section filed 8-12-2014; operative 10-1-2014 (Register 2014, No. 33). For prior history, see Register 2011, No. 27.
2. Amendment of section heading, section and NOTE filed 4-17-2024; operative 7/1/2024 (Register 2024, No. 16).