January 27, 2010
Division of Workers' Compensation Announces Recent Enforcement Actions
AUSTIN, TX — Commissioner of Workers’ Compensation Rod Bordelon recently announced final disciplinary actions taken by the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC). The final actions include orders assessing administrative penalties totaling $16,500 for violations of the Texas Labor Code and rules promulgated by the Commissioner of Workers’ Compensation. Commissioner’s orders are subject to appeal to state district court within 30 days after being issued.
Copies of Commissioner of Workers' Compensation orders may be obtained by calling Maria Jimenez, TDI-DWC Enforcement, at 512-804-4703 or via e-mail to Maria.Jimenez@tdi.state.tx.us.
DIVISION OF WORKERS’ COMPENSATION
FINAL DISCIPLINARY ORDERS SEPTEMBER 2009 THROUGH DECEMBER 2009 (alphabetical order)
Coolbaugh, Robert J., D.C. of Lubbock
Order Number: DWC09-0066
Date of Order: 12/18/2009
Order Final In: December
Action Taken: Must timely respond to document requests related to quarterly reviews of patient charts for a 12-month period; must pay quarterly review fees; must act upon the recommendations of the Office of the Medical Advisor (OMA) at the conclusion of each review; and must complete a minimum of 12 hours continuing education approved by the OMA.
Violation: Failed to provide reasonable and necessary health care (seven instances); administered improper, unreasonable, or medically unnecessary treatment (seven instances); failed to timely and appropriately release employees to return to work (four instances).
Dilger, Dr. J. Thomas of Spring
Order Number: DWC09-0057
Date of Order: 9/17/2009
Order Final In: September
Action Taken: Fined $3,000. Must follow compliance plan, must pay for additional review of randomly selected impairment rating examinations.
Violation: Engaged in excessive billing by unbundling procedures and examinations (eight instances); performed excessive and unnecessary exams and billed for noncompensable injuries, conditions or body parts.
Gullapalli, Dr. Uma R. of Victoria
Order Number: DWC-09-0061
Date of Order: 11/6/2009
Order Final In: November
Action Taken: Removed from Designated Doctor List; ordered to cease and desist from practicing before TDI-DWC as a designated doctor or as an approved/certifying doctor.
Violation: Failed to file a response to letter of clarification in a timely manner (four instances); failed to file DWC Form-069, Report of Medical Evaluation, in a timely manner (126 instances); failed to file DWC Form-069 with insurance carrier by facsimile or electronic transmission (122 instances); failed to meet 95 percent compliance standard for timely filing DWC Form-069 and for properly filing DWC Form-069 with the insurance carrier.
North American Specialty Insurance Company of Manchester, NH
Order Number: DWC-09-0064
Date of Order: 12/18/2009
Order Final In: December
Action Taken: Fined $3,000. Must provide requested information and access to requested records.
Violation: Failed to timely respond to data requests.
Oluwole, Dr. Babalola O. of Lewisville
Order Number: DWC-09-0065
Date of Order: 12/18/2009
Order Final In: December
Action Taken: Removed from Designated Doctor List; ordered to cease and desist from practicing before TDI-DWC as a designated doctor or as an approved/certifying doctor.
Violation: Failed to file letter of clarification in a timely manner (six instances); failed to timely file DWC Form-069 with insurance carrier (18 instances).
United States Fire Insurance Company of Plano
Order Number: DWC09-0072
Date of Order: 12/22/2009
Order Final In: December
Action Taken: Fined $10,500
Violation: Failed to pay for preauthorized treatments or services (two instances); failed to pay initial Temporary Income Benefits in a timely manner (three instances); submitted inaccurate information on initial payment of Temporary Income Benefits (12 instances).
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Last updated: 01/28/2010
