Section 649.28 - Oversight of Medical, Medical-Related, and Mental Health Providers(a) A provider of medical, medical-related, or mental health services who receives payment from, or whose services were reimbursed by, the Board may be subject to a clinical or fiscal audit, or both, to ensure that treatment and reimbursement were authorized by law.(b) A provider shall make all necessary clinical and fiscal records available to the Board for review upon request for up to three years after the date that reimbursement was paid.(c) A corrective action plan may be imposed by the Board if any of the following circumstances apply: (1) A provider fails to comply with a clinical or fiscal audit.(2) A provider fails to submit requested documentation to verify the victim's or derivative victim's losses or injury.(3) A provider fails to submit requested documentation to verify the services provided.(4) A provider provides, or causes another to provide, false information to the Board.(5) A provider misrepresents a victim's or derivative victim's disability, injury, or other need for treatment or services.(6) A provider fails to comply with statutes and regulations established by their licensing, oversight, or governing bodies.(7) A provider fails to comply with any statutes or regulations governing claims before the Board.(d) The corrective action plan shall identify the provider's noncompliance, the methods by which the provider must correct the noncompliance, and the deadline for correction.(e) The Board shall notify the provider of the corrective action plan and allow the provider 45 calendar days to challenge it. A corrective action plan is automatically imposed if no challenge is timely received. (1) The provider may challenge imposition of the corrective action plan 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 on imposition of a corrective action plan is not subject to further review.(2) The imposition of a corrective action plan does not constitute a final decision by the Board for purposes of review by writ of mandate.(f) A provider who fails to comply with a corrective action plan may be found ineligible for reimbursement pursuant to Section 649.24.Cal. Code Regs. Tit. 2, § 649.28
Note: Authority cited: Section 13920, Government Code. Reference: Sections 13954, 13957(a)(2) and 13957.2(a), Government Code.
Note: Authority cited: Section 13920(c), Government Code. Reference: Sections 13954, 13957(a)(2) and 13957.2(a), Government Code.
1. New section filed 10-10-2003 as an emergency; operative 10-10-2003 (Register 2003, No. 41). A Certificate of Compliance must be transmitted to OAL by 2-9-2004 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 10-10-2003 order transmitted to OAL 2-6-2004 and filed 3-23-2004 (Register 2004, No. 13).
3. Amendment of section heading and new subsection (c) filed 6-12-2009; operative 7-12-2009 (Register 2009, No. 24).
4. Amendment of subsection (c) and amendment of Note filed 1-6-2011; operative 2-5-2011 (Register 2011, No. 1).
5. Change without regulatory effect repealing subsection (c) and amending Note filed 1-31-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 5).
6. Amendment of section heading, section and NOTE filed 4-17-2024; operative 7/1/2024 (Register 2024, No. 16).