REVISION 16 HIGHLIGHTS

This edition of California Lien Claims keeps you current with analysis of recent significant decisions and developments. This year's most important developments focus on fraud prevention. DWC places the dollar amount of liens held by providers who have been charged or convicted of workers' compensation fraud at $600 million – or 17% of all liens in the system.

New Chapter 10 Anti-Fraud Provisions Affecting Lien Recovery and Medical Service Providers covers Senate Bill 1160 and Assembly Bill 1244 which enacted extensive provisions designed to address the problem of fraudulent and abusive medical liens:

• Automatic stay. New Labor Code §4615 provides for automatic stay of adjudication of liens at the WCAB for providers charged with fraud until the fraud case is resolved. §10:50
• Criteria for suspending providers. Labor Code §139.21 requires physicians, practitioners, and providers to be suspended from participating in the workers' compensation system if they have been convicted of certain types of fraud or abuse or suspended from the Medi-Cal or Medicare system for fraud or have had their licenses suspended. §10:60
• Notice of suspension and request for hearing. The statute grants a suspended provider the right to notice and a hearing, with a stay on the suspension during the pendency of the proceedings. §10:62
• Suspension hearings. Emergency regulations specify hearing procedures, deadlines, and admissible evidence. §10:63
• Appeals of suspension orders. Appeals of suspension orders are to the Superior Court of California by writ "as provided in the Code of Civil Procedure." §10:64
• Special lien proceedings for liens of suspended providers. Labor Code §139.21 requires that the liens of suspended providers be addressed outside of regular Labor Code lien procedures. §10:70
• Medical provider declaration requirements. Labor Code §4903.05 is amended to require providers to file a declaration with the lien filing and original bill stating under penalty of perjury that the lien is legitimate under one of seven possible categories. §10:80

CHAPTER 2 MEDICAL TREATMENT LIENS

• Self-Referrals. §2:286
• Independent Bill Review (IBR). §2:392
• No Basis for Payment in Excess of OMFS. §2:427

CHAPTER 4 LIENS FOR LIVING EXPENSES

• Amount of Lien Recovery. §4:34
• Concurrence of Payments with Award. §4:71

CHAPTER 8 LIEN PROCEDURE

• Requirements for Filing Lien Claims with the WCAB. §8:09
• Documents Required by SB 863 to Be Filed With Liens. §8:12
• Special Notice of Representation Requirements for Lien Claimants and Their Attorneys or Representatives. §8:13.1
• The Lien Filing and Activation Fees. §8:20
• Determination of Medical-Legal Disputes. §8:302