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Office of Workers' Compensation Programs, Physicians and Health Care
Providers Excluded under the Longshore Act.
None.
Division of Longshore and Harbor Workers' 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 Longshore Act, 33 U.S.C.
907(c).
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 Longshore and Harbor
Workers' 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 702.431 et seq.; copies of all documents in a
claimant's 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, and
recommendations and decisions; lists of excluded providers released by the
OWCP.
Longshore and Harbor Workers' Compensation Act, 33 U.S.C. 901,
907(c).
To maintain records to determine the propriety of instituting debarment
actions under the Longshore 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 which 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 Benefits Review 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 by the name of the provider.
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 Longshore and Harbor Workers' Compensation Act, Office of
Workers' Compensation Programs, 200 Constitution Avenue, NW, Washington, DC
20210, and District Directors in 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 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 appropriate 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 system manager. In order for the record to be located, the
individual must provide his or her full name, date of birth, and signature.
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 in this
system of records compiled for law enforcement purposes is exempt from
subsections (c)(3); (d); (e)(1); (e)(4)(G), (H), and (I); and (f) of 5 U.S.C.
552a, provided however, that if any individual is denied any right, privilege,
or benefit that he or she would otherwise be entitled to by Federal law, or for
which he or she would otherwise be eligible, as a result of the maintenance of
these records, such material shall be provided to the individual, except to the
extent that the disclosure of such material would reveal the identity of a
source who furnished information to the Government under an express promise
that the identity of the source would be held in confidence, or prior to
January 1, 1975, under an implied promise that the identity of the source would
be held in confidence.
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