Office of Workers' Compensation Programs, Physicians and Health Care
Providers Excluded under the Federal Employees' Compensation Act.
None.
The Division of Federal Employees' Compensation, Office of Workers'
Compensation Programs, Washington, DC 20210, and district offices of the Office
of Workers' Compensation Programs set forth in the Appendix to this document.
Providers of medical goods and services, including physicians,
hospitals, and providers of medical support services or supplies excluded or
considered for exclusion from payment under the Federal Employees' Compensation
Act for fraud or abuse (20 CFR 10.815-826).
Copies of letters, lists and documents from Federal and state agencies
concerning the administrative debarment of providers from participation in
programs providing benefits similar to those of the Federal Employees'
Compensation Act and their reinstatement; materials concerning possible fraud
or abuse which could lead to exclusion of a provider; documents relative to
reinstatement of providers, materials concerning the conviction of providers
for fraudulent activities in connection with any Federal or state program for
which payments are made to providers for similar medical services; all letters,
memoranda, and other documents regarding the consideration of a provider's
exclusion, the actual exclusion, or reinstatement under the provisions of 20
CFR 10.815-826; copies of all documents in a claim file relating to medical
care and/or treatment including bills for such services, as well as letters,
memoranda, and other documents obtained during investigations, hearings and
other administrative proceedings concerning exclusion for fraud or abuse, as
well as reinstatement, along with recommendations and decisions; lists of
excluded providers released by the OWCP.
Federal Employees' Compensation Act (5 U.S.C. 8101 et seq.), and
Title 20 CFR part 10.
To maintain records to determine the propriety of instituting debarment
actions under the Federal Employees' Compensation Act. These records also
provide information on treatment, billing and other aspects of a medical
provider's actions, and/or documentation relating to the debarment of the
medical care provider under another Federal or state program.
In addition to those universal routine uses listed in the General
Prefatory Statement to this document, disclosure of information from this
system of records may be made to the following individuals and entities for the
purposes noted when the purpose of the disclosure is compatible with the
purpose for which the information is collected:
a. Federal, state or local government agencies, state licensing boards,
professional organizations, claimants, patients, employers, insurance
companies, and any other entities or individuals, for the purpose of
identifying an excluded or reinstated provider, to ensure that authorization is
not issued nor payment made to an excluded provider, and for the purpose of
providing notice that a formerly excluded provider has been reinstated.
b. Federal, state or local government agencies, state licensing boards,
professional organizations, claimants, patients, employers, insurance
companies, and any other entities or individuals, for the purpose of obtaining
information necessary to ensure that the list of excluded providers is correct,
useful, and updated, as appropriate, and for the purpose of obtaining
information relevant to a Departmental decision regarding a debarment action.
This routine use encompasses the disclosure of such information that will
enable the Department to properly verify the identity of a provider, to
identify the nature of a violation, and the penalty imposed for such
violation.
Disclosure of information contained
in the file to the claimant, a person who is duly authorized to act on his/her
behalf, or to others to whom disclosure is authorized by these routine uses,
may be made over the telephone. Disclosure over the telephone will only be done
where the requestor provides appropriate identifying information. Telephonic
disclosure of information is essential to permit efficient administration and
adjudication of claims.
Pursuant to 5 U.S.C. 552a(b)(1),
information from this system of records is disclosed to members and staff of
the Employees' Compensation Appeals Board, the Office of Administrative Law
Judges, the Office of the Solicitor and other components of the Department who
have a need for the record in the performance of their duties.
None.
The records are in manual files, magnetic tapes or other computer
storage media, or on computer printouts.
Material is maintained either by the name of the provider, a case
citation, or date of release.
Material in the possession of the Office of Workers' Compensation
Programs and its contractors will be, when not in use, kept in closed file
cabinets, appropriate lockers and storage areas, etc.
File is retained in the office for three years after the debarment
action is final and then transferred to the Federal Records Center, and
destroyed thirty years after the debarment action is final. Where the period of
exclusion is defined as a set period of time, the file will be retained two
years after the period of exclusion expires (or the individual is otherwise
reinstated), then transferred to the Federal Records Center, and destroyed
thirty years after the debarment action is final.
Director for Federal Employees' Compensation, Office of Workers'
Compensation Programs, 200 Constitution Avenue, NW, Washington, DC 20210, and
the District Directors of the district offices set forth in the Appendix to
this document.
An individual wishing to inquire whether this system of records
contains information about him/her may write the appropriate system manager at
the address above. In order for the record to be located, the individual must
provide his or her full name, date of birth, and signature.
Any individual seeking access to non-exempt information about a record
within this system of records may write the OWCP district office where the case
is located, or the system manager, and arrangements will be made to provide
review of the file. In order for the record to be located, the individual must
provide his or her full name, date of birth, and signature.
Specific materials in this system have been exempted from certain
Privacy Act provisions regarding the amendment of records. The section of this
notice Entitled "Systems Exempted from Certain Provisions of the Act" indicates
the kind of materials exempted, and the reasons for exempting them. Any
individual requesting amendment of non-exempt records should contact the
appropriate the system manager. Individuals requesting amendment of records
must comply with the Department's Privacy Act regulations at 29 CFR 71.1 and
71.9.
Information in this system is obtained from Federal, state or local
government agencies, state licensing boards, professional organizations,
claimants, patients, employers, insurance companies, any other entities or
individuals, public documents, and newspapers, as well as from other Department
of Labor systems of records.
In accordance with 5 U.S.C. 552a(k)(2), investigatory material compiled
for law enforcement purposes which is maintained in the investigation files of
the Office of Workers' Compensation Programs, is exempt from subsections
(c)(3), (d), (e)(1), (e)(4)(G), (H), and (I), and (f) of 5 U.S.C. 552a. The
disclosure of information contained in civil investigative files, including the
names of persons and agencies to whom the information has been transmitted,
would substantially compromise the effectiveness of the investigation.
Knowledge of such investigations would enable subjects to take such action as
is necessary to prevent detection of illegal activities, conceal evidence or
otherwise escape civil enforcement action. Disclosure of this information could
lead to the intimidation of, or harm to, informants and witnesses, and their
respective families, and the well being of investigative personnel and their
families.
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