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AUSTIN, Texas—Problems within Texas’ Division of Workers’ Compensation “significantly inhibit” its monitoring of health care that is provided to injured workers, according to a state auditor report.
The Division of Workers’ Compensation within the Texas Department of Insurance suffers from four types of process and information problems, according to the Nov. 23 report.
It does not maintain reliable information on complaints about medical providers so auditors could not conclude whether the insurance department issues appropriate and consistent disciplinary orders for providers that commit violations, according to the state auditor’s report.
Meanwhile, the DWC’s complaint process lacks controls and does not comply with the Texas Labor Code and the process used to select medical providers for quality reviews lacks sufficient procedures to prevent overutilization of health care, the state auditor concluded.
There also are weaknesses in enforcement and sanctions, the state auditor found.
In response to the report, the Texas Department of Insurance plans to update workers comp system stakeholders about its corrective measures during a Dec. 14 meeting in Austin, Texas.
The report, “An Audit Report on Medical Quality Reviews at the Division of Workers’ Compensation within the Texas Department of Insurance,” is available at www.sao.state.tx.us/Reports.