DIR Facing QME Lawsuit
The Department of Industrial Relations and their director, Christine Baker, are being sued by three former qualified medical evaluators (QMEs) for allegations that each violated the state's medical-legal fee schedule (doctors Timothy Howard, Meera Jani, and Benjamin Simon). In addition, the lawsuit also names George Parisotto in his capacity as director of the DWC and Dr. Raymond Meister as Executive Medical Director of the DWC as defendants.
The former QMEs allege the department used "underground regulations" to deny them their livelihood. They also accuse the department of circumventing the necessary rule-making process by establishing new criteria for who can serve as a QME, implementing new standards for determining when QMEs can address the issue of medical causation and changing different complex factors that are applied in determining proper billing codes. They claim this will result in the DIR permanently eliminating the hourly billing code without ever announcing regulations to do so. "In this way, Respondents have started to systematically and illegally purge the workers' compensation system of its most qualified, experienced, productive and ethical QMEs without due process of law." The lawsuit also alleges "By denying reappointment of QMEs based on mere accusations without any hearing, Respondents have deprived QMEs of due process of law." The plaintiffs also claim that before denial of reappointments, they never received a complaint from the DWC about their billings.
The DIR officials raised allegations that each of the plaintiffs had violated the state's medical-legal fee schedule, therefore, denying them reappointment as QMEs. Approximately 400 QMEs so far have been affected by the new regulations, which are under dispute in this case. Attorneys for the plaintiffs claim the department has not responded to requests for a hearing to address the regulation violation allegations or to their requests for their reinstatement until the allegations have been resolved. The plaintiffs are also challenging the DIR's analysis of the disputed bills.