Medical board decides it does have authority to discipline utilization review physicians June 27, 2013 General Medical Board of California, Professional Liability, Workers Comp, Disciplinary Actions 0 The Medical Board of California recently considered the issue of whether workers' compensation utilization review can be considered the "practice of medicine" and, if so, does the medical board have the authority to discipline physicians who do not practice within the standard of care when performing utilization review on behalf of payors and other entities? After testimony by the California Medical Association (CMA) and the California Society of Physical Medicine and Rehabilitation (CSPMR), the board agreed that physicians conducting worker's compensation utilization review were indeed engaged in the practice of medicine and subject to review by the board. Although the board has long stated publicly that physicians performing utilization review are engaging in the practice of medicine, it had recently been denying jurisdiction to investigate complaints about utilization review physicians' decisions and their impact on injured workers. Utilization review is a process required by law and is used to determine if medical treatment requested for an injured worker is medically necessary. Recently, several entities have asked that the medical board investigate complaints filed against physicians who participate in utilization review activities. CMA and CSPMR had joined together to push the board to accept jurisdiction and follow up on these complaints. Medical board staff has been directed to bring forward any legislative or regulatory changes that would be required to allow these complaints against California licensed physicians performing utilization review to be investigated. The board does not, however, have jurisdiction over out-of-state physicians performing utilization review in California. State law does not currently require utilization review physicians to be licensed by the California Medical Board. In 2011, Gov. Jerry Brown vetoed AB 584, which would have required worker's compensation utilization review physicians to be licensed in California. CMA supported that bill, as well as numerous others, to require that all utilization review be done by California-licensed physicians in order to ensure that there is a disciplinary pathway for the medical board in case an injured worker is unduly hurt by a utilization review-based modification or denial of care. Contact: Carolyn Ginno, cginno@cmanet.org or (916) 551-2547. Comments are closed.
