Calif. audits lead to nearly $100K in fines for utilization review companies

The California Division of Workers’ Compensation fined nine organizations that provide utilization reviews for injured worker treatments a combined $95,750 for violations uncovered during 2021 audits.

At the same time, while the division identified 75 violations in utilization review audits of 36 claims administrators last year, it waived all penalties because of the high scores the audit subjects earned.

The DWC in 2021 audited 10 utilization review organizations, including five in California, two in Tennessee and one each in Florida, Nevada and Wisconsin. The review of 574 requests for authorization found 51 late responses, 61 responses that were faulty and two that were not properly distributed.

In all, the division identified 372 violations with potential penalties of $102,350. Because some fines can be waived for audit subjects that score 85% or higher, the total amount the DWC will collect is $95,750.

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