Court Opinion

ID: 9651762
Source: CourtListenerOpinion
Date Created: 2023-08-23 16:35:11.288049+00
Date Added: 2024-06-11T18:12:39.137741
License: Public Domain

Judge SMITH-RIBNER,
concurring and dissenting opinion.
I concur in the decision to quash the appeal of Chiro-Med Review Company (Petitioner). I dissent, however, from the majority’s decision to affirm the order of the Bureau of Workers’ Compensation Hearing Officer because of the clear error of law committed in this matter. The Hearing Officer reversed the Bureau’s revocation of Petitioner’s authority to perform utilization reviews despite finding that Petitioner violated certain Cost Containment Regulations, 84 Pa.Code §§ 127.1-127.755, governing Utilization Review Organizations (UROs). The majority affirms essentially because Petitioner’s violations “were minor” and because the Hearing Officer had discretion to ignore the violations and only had the option of affirming or reversing the Bureau’s revocation.
In Chiro-Med Review Co. v. Bureau of Workers’ Compensation, 879 A.2d 373 (Pa.Cmwlth.2005) (Chiro-Med), the Court vacated a prior decision of the Hearing Officer, which denied Petitioner’s appeal from the Bureau’s revocation of Petitioner’s authorization to perform utilization reviews. The Court concluded that the Hearing Officer improperly reviewed the Bureau’s revocation decision under an abuse of discretion standard rather than conducting a de novo hearing and issuing a proper decision based on the evidence. The Court relied on Millcreek Manor v. Department of Public Welfare, 796 A.2d 1020 (Pa.Cmwlth.2002), and Lawson v. Pennsylvania Department of Public Welfare, 744 A.2d 804 (Pa.Cmwlth.2000), to support its conclusion that the Hearing Officer conducted an appellate review of the Bureau’s revocation decision rather than a proper de novo review. However, nowhere in Chiro-Med or in the cases it relied upon did the Court authorize the Hearing Officer in conducting his de novo review to ignore any violations that he found and to reject the Bureau’s revocation. The regulations permit the Bureau to revoke a URO’s authorization when the Bureau determines that the URO has violated the regulations. See 34 Pa.Code § 127.669.
*990The Hearing Officer credited the Bureau’s witnesses and made the following findings regarding Petitioner’s violations at page 12 of his decision:
51. This Hearing Officer finds that Chiro-Med has violated Regulations during the period August 1, 2002 to October 2, 2003 as follows:
a. Chiro-Med submitted six determinations in May and June of 2003 by reviewers that were not on Chiro-Med’s panel of reviewers. Chiro-Med failed to report a change in the list of reviewers to the Bureau within 30 days of the change in violation of Regulation 127.660 and 127.652.
b. Chiro-Med was not open for business on August 15, 2003 in violation of Regulation 127.657.
c. Though this Hearing Officer finds that any changes in the fee schedule were motivated by principles of fairness and reasonableness, nevertheless, Chiro-Med’s failure to notify the Bureau of a deviation in its fee schedule violated Regulation 127.652.
The regulations that Petitioner violated provide that any changes to information contained in a URO’s application must be reported to the Bureau, Section 127.652; that a URO shall have its business office open within this Commonwealth at a minimum from 9 a.m. to 5 p.m. Monday through Friday, except holidays, Section 127.657; and that a URO shall have available by contract or otherwise the services of a sufficient number and specialty distribution of qualified physicians and other practitioner reviewers to ensure that the URO can perform reviews as required, and any changes in the URO’s list of reviewers must be reported to the Bureau within 30 days of the change. Section 127.660. The majority does not specify the nature of the violations found or set forth the specific requirements of the regulations. It simply states that the Hearing Officer found the violations to be minor and that the Bureau did not dispute that fact.
Contrary to the majority’s acquiescence in the unsupported conclusion that Petitioner’s violations are de minimis and therefore worthy of avoiding sanction, I note that the Hearing Officer expressed concern over the fact that Petitioner did violate the regulations and that its conduct should not be condoned. Nevertheless, he decided that his response must be reasonable despite the violations and that an insufficient basis existed to revoke Petitioner’s authorization. The Hearing Officer may not simply ignore the violations, and I agree with the Bureau that he may not disregard validly promulgated regulations and that the regulations “are not optional or graduated in importance, but instead apply equally upon the Hearing Officer, the Bureau and Chiro-Med.” Bureau Brief, at 24.
The majority evidently disagrees that the Hearing Officer is bound by the Bureau’s regulations just as Petitioner is bound by them. Also, without any authority whatsoever, the majority concludes that the Hearing Officer had the authority to alter the Bureau’s revocation decision despite having found Petitioner’s violation of the regulations. The majority finds it interesting that the Bureau made no specific findings of fact and conclusions of law and that its revocation letter was not based on an evidentiary hearing, although the majority offers no authority for its contention that a hearing was required before the Bureau could revoke the authorization. The regulations provide that the Bureau may revoke a URO’s authorization upon “investigation and following a conference with the Chief of the Medical Cost Containment Division, if the Bureau determines that a URO ... has violated the requirements of the act or this chapter.” *99134 Pa.Code § 127.669. The Bureau followed the regulatory process.
The case law is quite clear. In UGI Utilities, Inc. v. Unemployment Compensation Board of Review, 776 A.2d 344 (Pa.Cmwlth.2001), this Court affirmed the dismissal of an appeal in an unemployment case because the appeal was not filed in the manner and within the time specified by Board regulations. The Court concluded that the applicable appeal regulations do not provide for “substantial compliance.” It also observed that a court should defer to an agency’s interpretation of its own regulation unless that interpretation is clearly erroneous and is inconsistent with the statute under which the regulation was promulgated.
In Popowsky v. Pennsylvania Public Utility Commission, 853 A.2d 1097, 1106-1107 (Pa.Cmwlth.2004), appeal granted, 582 Pa. 667, 868 A.2d 454 (2005), the Court cited Teledyne Columbia-Summerill Carnegie v. Unemployment Compensation Board of Review, 160 Pa.Cmwlth. 17, 634 A.2d 665 (1993), for the proposition that the PUC just “like any other agency, cannot ignore or fail to apply its own regulations, and those persons subject to the agency’s regulation are also bound.” Because the Hearing Officer here was bound by the Bureau’s regulations, he was not authorized to ignore Petitioner’s violations by dismissing them as de minimis. The Hearing Officer committed an error of law in this regard, and, as a result, his order should be reversed and the Bureau’s revocation of Petitioner’s authorization reinstated.