9. Apportionment and reapportionment 3 Flashcards
Under what circumstances can the administrative director suspend or terminate a qualified medical evaluator’s privileges?
The administrative director can suspend or terminate privileges based on a hearing that finds substantial evidence of one or more violations.
List the criteria under which a qualified medical evaluator may be suspended or terminated.
- Violating any material statutory or administrative duty. 2. Failing to follow medical procedures or qualifications established. 3. Not complying with timeframe standards. 4. Not meeting requirements of specific subdivisions. 5. Preparing medical-legal evaluations that do not meet minimum standards.
What does ‘substantial evidence’ refer to in the context of evaluating a medical evaluator’s conduct?
Substantial evidence refers to adequate or sufficient evidence that reasonably supports the conclusion reached such as findings from a hearing.
What might constitute a violation of statutory or administrative duty for a medical evaluator?
A violation can include failing to adhere to laws or regulations pertaining to medical evaluations or not fulfilling obligations defined in related administrative codes.
What are the timeframe standards mentioned in subdivision j that medical evaluators must comply with?
The timeframe standards refer to the specific deadlines and time intervals for the performance of tasks or submission of reports that medical evaluators are required to follow.
What happens if a medical evaluator prepares reports that do not meet minimum standards?
If a medical evaluator prepares medical-legal evaluations that fail to meet minimum standards it could lead to suspension or termination of their privileges to evaluate.
Why is it important for medical evaluators to adhere to established medical procedures or qualifications?
Adhering to established medical procedures or qualifications ensures the integrity and reliability of medical evaluations which ultimately impacts patient care and legal proceedings.
What is the significance of a hearing pursuant to subdivision 1 in the process of determining a medical evaluator’s status?
The hearing serves as a formal process to assess evidence against a medical evaluator and provides a basis for the administrative director’s decision regarding their privileges.
What is the role of the administrative director in relation to qualified medical evaluators?
The administrative director is responsible for establishing procedures and regulations regarding the appointment and reappointment of qualified medical evaluators. They have authority over citations for violations and scheduling hearings related to those violations.
What actions can lead to the suspension or termination of a physician’s privilege to work as a qualified medical evaluator?
A physician can have their privilege suspended or terminated for: 1) Making material misrepresentations or false statements in an application for appointment or reappointment 2) Failing to timely pay the required fees or 3) Having their medical license suspended or revoked by the licensing authority.
Is a hearing always required before suspending or terminating a physician’s privilege to serve as a qualified medical evaluator?
No a hearing is not required prior to suspension or termination if the physician has failed to pay the required fee or has had their license suspended or revoked.
What must the administrative director do in case of a violation by a qualified medical evaluator?
The administrative director must cite the qualified medical evaluator for the violation and set a hearing on the alleged violation within 30 days of service of the citation.
What is the time frame within which the administrative director must set a hearing after issuing a citation to a qualified medical evaluator?
The administrative director must set a hearing within 30 days of serving the citation on the qualified medical evaluator.
What is a qualified medical evaluator?
A qualified medical evaluator is a physician who has been designated to evaluate individuals in medical legal contexts often regarding workers’ compensation cases and ensuring compliance with medical standards.
What actions can the administrative director take upon finding a violation listed in subdivision k regarding qualified medical evaluators (QMEs)?
The administrative director may place a qualified medical evaluator on probation subject to appropriate conditions such as ordering continuing education or training.
What is required of the administrative director after disciplining a qualified medical evaluator?
The administrative director is required to report the name of any disciplined qualified medical evaluator to the appropriate licensing board.
Under what circumstances will the administrative director terminate a physician from the list of qualified medical evaluators?
The administrative director shall terminate a physician from the list if their licensure has been terminated by the relevant licensing board if they have been convicted of a misdemeanor or felony related to their medical practice or if they have been convicted of a crime involving moral turpitude.
What happens to a physician who has been suspended or placed on probation by the relevant licensing board?
The administrative director shall suspend or terminate the physician as a medical evaluator.
What is the significance of the term ‘moral turpitude’ in relation to QMEs?
Moral turpitude refers to conduct that is considered contrary to community standards of justice honesty or good morals and can lead to the termination of a physician from the list of medical evaluators if convicted of such a crime.
What are some potential conditions that could be imposed on a qualified medical evaluator placed on probation by the administrative director?
Potential conditions could include completing continuing education or training.
What is the role of the licensing board in relation to the administrative director’s decisions concerning QMEs?
The licensing board is notified by the administrative director about any disciplinary actions taken against a qualified medical evaluator to maintain oversight.
What are two key factors that could lead to automatic termination of a medical evaluator’s position?
Automatic termination could occur if the physician’s licensure has been terminated or if they have been convicted of crimes related to their medical practice.
What responsibilities does the administrative director have regarding the evaluation and monitoring of qualified medical evaluators?
The administrative director is responsible for placing QMEs on probation imposing conditions and reporting disciplinary actions to licensing boards.
If a physician is placed on probation what type of oversight might they be subjected to?
They may be required to fulfill certain training or educational requirements as a condition of their probation.