Elite's Billing Theory Rejected By WCAB

Reconsideration Granted!

The WCAB has granted reconsideration to the QMETRIX defendants and rejected the analysis applied by former WCALJ Susan England.  The WCAB determined the judge misapplied Kuntz when she relied on amounts billed rather than actually accepted by Elite during the three years in question.

 

In a victory for defendants all over, the WCAB also suggested it was unreasonable to award Elite "up to 556% of what in-patient hospitals accept for the same procedure and up to 930% of what similarly situated San Diego surgery centers receive for the same service."

 

Since Judge England has retired the matter is remanded for reassignment.

 

Opinion filed May 6, 2008.

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