Investigation Of Complaints; Sanctions And Appeals Of Agency

DECISIONS. (1) Any physician, other provider, or an injured employee who is receiving case management services may report instances of inappropriate case management services in writing to the Bureau of Workers’ Compensation Medical Director. The Medical Director shall investigate and report the results of the investigation to the Administrator. At the discretion of the Administrator, a report may be sent to the Board of Nursing or other certifying board for appropriate disciplinary proceedings. (2) Failure by a party to comply with any requirement in this Chapter 0800-02-07 shall subject such party to a penalty of not less than fifty dollars ($50) nor more than five thousand ($5,000) per violation at the discretion of the Administrator. The Bureau may also institute a temporary or permanent suspension of the right to perform case management services for workers’ compensation claims in Tennessee, if the case manager, case manager assistant, or employing organization has established a pattern of violations. (3) An agency decision assessing sanctions and/or civil penalties shall be communicated to the party to whom the decision is issued, and the party to whom it is issued shall have fifteen (15) calendar days from the date of issuance to either appeal the decision pursuant to the procedures provided for under the Uniform Administrative Procedures Act, T.C.A. §§ 4-5-101, et seq., or to pay the assessed penalties to the Bureau or otherwise comply with the decision. (4) In order for a party to appeal an agency decision assessing sanctions and/or civil penalties, the party shall file a petition with the Administrator within fifteen (15) calendar days of the issuance of the decision. This petition shall be considered a request for a contested case hearing within the Bureau pursuant to the Uniform Administrative Procedures Act, T.C.A.§§ 4-5-101, et seq., and the procedural rules of Chapter 0800-02-13 are incorporated as if set forth fully herein. The Bureau is authorized to conduct the hearing pursuant to T.C.A.§ 50-6- 118. (5) If the agency decision assessing sanctions and/or civil penalties is not appealed within fifteen (15) calendar days of its issuance, the decision shall become a final order of the Department not subject to further review.