| (a) 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 Texas Workers' Compensation Act, the
commissioner may revoke or suspend a designated doctor's certification
as a designated doctor or otherwise sanction a designated doctor for
noncompliance with requirements of this chapter or for any of the
following:
(1) four refusals within a 90-day period to accept
or perform a division offered appointment or ordered appointment for
which the doctor is qualified and that relates to a claim to which
the doctor has not been previously assigned;
(2) four consecutive refusals to perform within the
required time frames a division ordered appointment for which the
doctor is qualified and that relates to a claim to which the doctor
has not been previously assigned;
(3) any refusal to accept or perform a division offered
appointment or ordered appointment that relates to a claim on which
the doctor has previously performed an examination;
(4) misrepresentation or omission of pertinent facts
in medical evaluation and narrative reports;
(5) submitting unnecessary referrals to other health
care providers for the answering of any question submitted to the
designated doctor by the division;
(6) ordering or performing unnecessary testing of an
injured employee as part of a designated doctor's examination;
(7) submission of inaccurate or inappropriate reports
due to insufficient medical history or physical examination and analysis
of medical records;
(8) submission of 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;
(9) failure to timely respond to a request for clarification
from the division regarding an examination or any other information
request by the division;
(10) failure to successfully complete training and
testing requirements as specified in §127.110 of this title (relating
to Designated Doctor Recertification);
(11) self-referring, including referral 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 evaluated by the designated doctor;
(12) behaving in an abusive or assaultive manner toward
an injured employee, the division, or other system participant;
(13) failing to maintain the confidentiality of patient
medical and claim file information;
(14) performing a designated doctor examination which
the designated doctor was not ordered by the division to perform;
or
(15) other violations of applicable statutes or rules
while serving as a designated doctor.
(b) 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) 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 sanction
relating to a designated doctor's certification will be in effect
during the pendency of any appeal.
(d) This section will become effective on September
1, 2012.
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