| (a) Grounds for sanctions. In addition to the grounds
for issuing sanctions against a doctor under §180.26 of this
title (relating to Criteria for Imposing, Recommending and Determining
Sanctions; Other Remedies), other division rules, or the Labor Code,
the commissioner may revoke or suspend a designated doctor's certification
as a designated doctor or sanction a designated doctor for noncompliance
with requirements of this chapter for:
(1) refusing four times within a 90-day period to accept
or perform a division-offered appointment or division-ordered appointment
for which the doctor is qualified and that relates to a claim to which
the doctor has not been previously assigned;
(2) refusing four consecutive times to perform a division-offered
appointment within the required time frames or a division-ordered
appointment for which the doctor is qualified and relates to a claim
the doctor has not been previously assigned to;
(3) failing to attend a designated doctor examination;
(4) not complying with the rescheduling requirements
of this chapter;
(5) refusing at any time to accept or perform a division-offered
appointment or division-ordered appointment that relates to a claim
on which the doctor has previously performed an examination;
(6) misrepresenting or omitting pertinent facts in
medical evaluation and narrative reports;
(7) submitting unnecessary referrals to other health
care providers to answer any question that the division submits to
the designated doctor;
(8) ordering or performing unnecessary testing of an
injured employee as part of a designated doctor's examination;
(9) submitting inaccurate or inappropriate reports
due to insufficient medical history or physical examination and analysis
of medical records;
(10) submitting designated doctor reports that fail
to include all elements required by §127.220 of this title (relating
to Designated Doctor Reports), §127.10 of this title (relating
to General Procedures for Designated Doctor Examinations), and other
division rules;
(11) failing to timely respond to a request for clarification
from the division about an examination or any other information the
division requests;
(12) failing to successfully complete training and
testing requirements as specified in §127.100 of this title (relating
to Designated Doctor Certification);
(13) self-referring, including referring to another
health care provider with whom the designated doctor has a disqualifying
association, for treatment or becoming the employee's treating doctor
for the medical condition the designated doctor evaluated;
(14) behaving in an abusive or assaultive manner toward
an injured employee, the division, or other system participant;
(15) failing to maintain the confidentiality of patient
medical and claim file information;
(16) performing a designated doctor examination that
the division did not order the doctor to perform;
(17) failing to complete required training or pass
required testing detailed in the designated doctor's approval of certification;
or
(18) violating other applicable statutes or rules while
serving as a designated doctor.
(b) Responsibility for agents' actions. Designated
doctors are liable for all administrative violations committed by
their agents on the designated doctor's behalf under this section,
other division rules, or any other applicable law.
(c) Notification and appeal. The process for notification
and opportunity for appeal of a sanction is governed by §180.27
of this title (relating to Restoration) except that suspension, revocation,
or other sanctions relating to a designated doctor's certification
will be in effect during the pendency of any appeal.
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