by Holly Hayes The following changes to HB 2605 impacting the resolution of medical fee disputes within the Texas Department of Insurance, Division of Workers’ Compensation were adopted on May 11, 2012, and become effective May 31, 2012. HB 2605 made several legislative amendments that impact the resolution of medical fee dispute cases adjudicated by the Division. This bill enacted Labor Code §413.0312, which alters the appeals process applicable to medical fee disputes after the Division’s review under Labor Code §413.031. Newly added Labor Code §413.0312 provides one appeal process for medical fee disputes regardless of the amount of reimbursement sought. Prior to the enactment of HB 2605, appeals of medical fee disputes were handled by a Division contested case hearing (CCH) if the amount of reimbursement sought by the requestor in an individual fee dispute was $2,000 or less or a contested case hearing conducted by the State Office of Administrative Hearings (SOAH) if the amount of reimbursement sought exceeded $2,000. Parties who had exhausted all administrative remedies and who were aggrieved by the final decision of SOAH could seek judicial review of the decision in the manner provided for judicial review of a contested case under Chapter 2001, Subchapter G Government Code. Pursuant to Labor Code §413.0312, the appealing party is now required to mediate the medical fee dispute at a benefit review conference (BRC) under Labor Code Chapter 410, Subchapter B. If the dispute remains unresolved after a BRC, the parties may elect to engage in binding arbitration as provided by Labor Code §413.0312(d) and under Chapter 410, Subchapter C. However, if arbitration is not elected, the party is entitled to a contested case hearing at SOAH to resolve the dispute in the manner provided for a contested case under Chapter 2001, Government Code. A party who has exhausted all administrative remedies and who is aggrieved by a final decision of SOAH may seek judicial review of the decision in the manner provided for judicial review of a contested case under Chapter 2001, Subchapter G Government Code and Labor Code §413.031(k-1).   Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at: holly@karlbayer.com.

by Jeremy Clare Standard of Proof According to Article 3.1 of the World Anti-Doping Code (the Code), USADA bore the burden of establishing Mr. Armstrong’s violations of the Code. “This standard of proof in all cases is greater than a mere balance of probability but less than proof beyond a reasonable doubt.” USADA noted in the Reasoned Decision that the standard is comparable to the standard applied to other cases of professional misconduct. In the United States, that standard is typically “clear and convincing evidence.” USADA claimed that the evidence against Mr. Armstrong was overwhelming and established violations beyond a reasonable doubt, an even higher standard than necessary. Means of Proof Article 3.2 of the Code provides that violations “may be established by any reliable means.” USADA claimed that the evidence against Mr. Armstrong is both non-analytical and laboratory evidence. While Mr. Armstrong never failed a drug test, a positive drug test is not necessary to establish a violation. USADA claimed that had a hearing occurred, it would have used past drug testing samples from Mr. Armstrong to corroborate the witness testimony and other documented evidence. USADA also claimed that even without the past testing samples, it had enough evidence to prove the violations. Stay tuned – our next post will summarize the specific evidence against Mr. Armstrong. Related Posts: USADA Case against Lance Armstrong | Charges Brought against Armstrong, Disputing, October 16, 2012 USADA Case against Lance Armstrong | USADA Issues its Reasoned Opinion Describing its Evidence against Lance Armstrong, Disputing, October 15, 2012 USADA Case against Lance Armstrong | Remaining Procedural Steps, Disputing, August 29, 2012 USADA Case against Lance Armstrong | USADA Announces Lance Armstrong’s Lifetime Ban from Sport and Forfeiture of Titles, Disputing, August 24, 2012 Armstrong v. Tygart | Austin Federal Court Dismisses Lance Armstrong Lawsuit Against USADA, Disputing, August 20, 2012 Armstrong v. Tygart | Federal Court to Rule Before August 23, Disputing, August 10, 2012 Armstrong v. Tygart | Hearing is Today, Disputing, August 10, 2012 Armstrong v. Tygart | Lance Armstrong Responds to USADA’s Motion to Dismiss, Disputing, August 8, 2012 Armstrong v. Tygart | Fairness of Arbitration Procedure, Disputing, August 8, 2012 Armstrong v. Tygart | Jurisdiction, Disputing, August 7, 2012 Armstrong v. Tygart | Existence of Agreement to Arbitrate, Disputing, August 6, 2012 The International Convention Against Doping in Sport of 2005, Disputing, August 2, 2012 USADA Case against Lance Armstrong | USADA’s Successful Arbitration Track Record, Disputing, August 1, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part VI | Right to Appeal to the Court of Arbitration for Sport (CAS), Disputing, July 30, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part V |USADA Expedited Track, Disputing, July 26, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part IV | The Arbitration Hearing, Disputing, July 25, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part III | The Appointment of Arbitrators, Disputing, July 24, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part II | The Review Board Track, Disputing, July 23, 2012 Armstrong v. Tygart | USADA Files Motion to Dismiss Lance Armstrong’s Suit , Disputing, July 21, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part I | USADA ‘Results Management,’ Disputing, July 19, 2012 Armstrong v. Tygart | Texas Federal Court Will Hear Lance Armstrong Case on August 10, Disputing, July 18, 2012 Armstrong v. Tygart | Lance Armstrong’s Suit and Restraining Order against USADA, Disputing, July 17, 2012 USADA Case against Lance Armstrong | What is the USADA? Disputing, July 16, 2012 USADA Case against Lance Armstrong | USADA Allegations, Disputing, July 13, 2012 Lance Armstrong | The Doping Controversy Continues, Disputing, July 12, 2012 Jeremy Clare is a law clerk at Karl Bayer, Dispute Resolution Expert. Jeremy received his J.D. from the University of Texas School of Law in 2012 and received a B.A. from the University of South Carolina where he studied political science.  

by Jeremy Clare Writers of this blog have been posting about USADA’s case against Lance Armstrong for several months. During the next days, we will be summarizing various portions of USADA’s Reasoned Decision. We begin with the charges USADA brought against Mr. Armstrong. Charges USADA listed the following six separate charges brought against Mr. Armstrong: (1) Use and/or attempted use of prohibited substances and/or methods including EPO, blood transfusions, testosterone, corticosteroids and/or masking agents. (2) Possession of prohibited substances and/or methods including EPO, blood transfusions and related equipment (such as needles, blood bags, storage containers and other transfusion equipment and blood parameters measuring devices), testosterone, corticosteroids and/or masking agents. (3) Trafficking of EPO, testosterone, and/or corticosteroids. (4) Administration and/or attempted administration to others of EPO, testosterone, and/or cortisone. (5) Assisting, encouraging, aiding, abetting, covering up and other complicity involving one or more anti-doping rule violations and/or attempted anti-doping rule violations. (6) Aggravating circumstances (including multiple rule violations and participated in a sophisticated scheme and conspiracy to dope, encourage and assist others to dope and cover up rule violations) justifying a period of ineligibility greater than the standard sanction. Related Posts: USADA Case against Lance Armstrong | USADA Issues its Reasoned Opinion Describing its Evidence against Lance Armstrong, Disputing, October 15, 2012 USADA Case against Lance Armstrong | Remaining Procedural Steps, Disputing, August 29, 2012 USADA Case against Lance Armstrong | USADA Announces Lance Armstrong’s Lifetime Ban from Sport and Forfeiture of Titles, Disputing, August 24, 2012 Armstrong v. Tygart | Austin Federal Court Dismisses Lance Armstrong Lawsuit Against USADA, Disputing, August 20, 2012 Armstrong v. Tygart | Federal Court to Rule Before August 23, Disputing, August 10, 2012 Armstrong v. Tygart | Hearing is Today, Disputing, August 10, 2012 Armstrong v. Tygart | Lance Armstrong Responds to USADA’s Motion to Dismiss, Disputing, August 8, 2012 Armstrong v. Tygart | Fairness of Arbitration Procedure, Disputing, August 8, 2012 Armstrong v. Tygart | Jurisdiction, Disputing, August 7, 2012 Armstrong v. Tygart | Existence of Agreement to Arbitrate, Disputing, August 6, 2012 The International Convention Against Doping in Sport of 2005, Disputing, August 2, 2012 USADA Case against Lance Armstrong | USADA’s Successful Arbitration Track Record, Disputing, August 1, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part VI | Right to Appeal to the Court of Arbitration for Sport (CAS), Disputing, July 30, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part V |USADA Expedited Track, Disputing, July 26, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part IV | The Arbitration Hearing, Disputing, July 25, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part III | The Appointment of Arbitrators, Disputing, July 24, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part II | The Review Board Track, Disputing, July 23, 2012 Armstrong v. Tygart | USADA Files Motion to Dismiss Lance Armstrong’s Suit , Disputing, July 21, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part I | USADA ‘Results Management,’ Disputing, July 19, 2012 Armstrong v. Tygart | Texas Federal Court Will Hear Lance Armstrong Case on August 10, Disputing, July 18, 2012 Armstrong v. Tygart | Lance Armstrong’s Suit and Restraining Order against USADA, Disputing, July 17, 2012 USADA Case against Lance Armstrong | What is the USADA? Disputing, July 16, 2012 USADA Case against Lance Armstrong | USADA Allegations, Disputing, July 13, 2012 Lance Armstrong | The Doping Controversy Continues, Disputing, July 12, 2012 Jeremy Clare is a law clerk at Karl Bayer, Dispute Resolution Expert. Jeremy received his J.D. from the University of Texas School of Law in 2012 and received a B.A. from the University of South Carolina where he studied political science.  

  On October 10, 2012, the United States Anti-doping Agency (“USADA”) issued a 202-page reasoned decision describing evidence against Lance Armstrong and alleged rule violations (the “Reasoned Decision”). Under Articles 8.3 and 13.2.3 of the World Anti-Doping Code (the “Code”), USADA is obligated to send its Reasoned Decision to the parties with the having the right to appeal to the Court of Arbitration for Sport (“CAS”)- Mr. Armstrong, the International Cycling Union (“UCI”), the World Anti-Doping Agency (“WADA”), and the Word Triathlon Corporation. We will discuss USADA’s Reasoned Decision in upcoming posts. Stay tuned! Related Posts: USADA Case against Lance Armstrong | Remaining Procedural Steps, Disputing, August 29, 2012 USADA Case against Lance Armstrong | USADA Announces Lance Armstrong’s Lifetime Ban from Sport and Forfeiture of Titles, Disputing, August 24, 2012 Armstrong v. Tygart | Austin Federal Court Dismisses Lance Armstrong Lawsuit Against USADA, Disputing, August 20, 2012 Armstrong v. Tygart | Federal Court to Rule Before August 23, Disputing, August 10, 2012 Armstrong v. Tygart | Hearing is Today, Disputing, August 10, 2012 Armstrong v. Tygart | Lance Armstrong Responds to USADA’s Motion to Dismiss, Disputing, August 8, 2012 Armstrong v. Tygart | Fairness of Arbitration Procedure, Disputing, August 8, 2012 Armstrong v. Tygart | Jurisdiction, Disputing, August 7, 2012 Armstrong v. Tygart | Existence of Agreement to Arbitrate, Disputing, August 6, 2012 The International Convention Against Doping in Sport of 2005, Disputing, August 2, 2012 USADA Case against Lance Armstrong | USADA’s Successful Arbitration Track Record, Disputing, August 1, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part VI | Right to Appeal to the Court of Arbitration for Sport (CAS), Disputing, July 30, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part V |USADA Expedited Track, Disputing, July 26, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part IV | The Arbitration Hearing, Disputing, July 25, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part III | The Appointment of Arbitrators, Disputing, July 24, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part II | The Review Board Track, Disputing, July 23, 2012 Armstrong v. Tygart | USADA Files Motion to Dismiss Lance Armstrong’s Suit , Disputing, July 21, 2012 USADA Case against Lance Armstrong | USADA Adjudication Process Part I | USADA ‘Results Management,’ Disputing, July 19, 2012 Armstrong v. Tygart | Texas Federal Court Will Hear Lance Armstrong Case on August 10, Disputing, July 18, 2012 Armstrong v. Tygart | Lance Armstrong’s Suit and Restraining Order against USADA, Disputing, July 17, 2012 USADA Case against Lance Armstrong | What is the USADA? Disputing, July 16, 2012 USADA Case against Lance Armstrong | USADA Allegations, Disputing, July 13, 2012 Lance Armstrong | The Doping Controversy Continues, Disputing, July 12, 2012