Lien Claimants Must Prove Charges Reasonable

Tapia v. Skill Master Staffing (2008) 73 Cal. Comp. Cases 1338 [en banc]:  In a decision that should come as no surprise to any HSSP client, the WCAB, en banc, has struck another blow against abuse by medical providers.  This time it is outpatient surgery center centers that took the blow. 

Since the en banc decision in Kunz v. Patterson Floor Coverings, Inc. (2002) 67 Cal. Comp. Cases 1588 surgery centers have been falsely contending that the only evidence they need to provide in order to prevail on their lien is a bill, regardless of the amount.  In this case the WCAB put that argument to rest once and for all.

In this matter SB Surgery Center billed $23,529.00 for 3 hours in the operating room and 1.75 hours in the recovery room.  The new fee schedule rate would be $832.49 for this procedure.  If the procedure was inpatient it would be $5,690.80 with a 1.8 day stay.  Liberty paid $1,667.66.  The judge awarded $4,700.00.  Liberty did not contest the award, but based on the WCAB’s opinion likely could have successfully done so.

The WCAB determined:

1. 1. An outpatient surgery center lien claimant (like any other lien claimant) has the burden of proving that its charges are reasonable;
   2. The lien claimant’s billing, by itself, does not establish that the claimed fee is reasonable;
   3. Even in the absence of rebuttal evidence, the lien need not be allowed in full if it is unreasonable on its face; and
   4. Any evidence relevant to reasonableness may be offered to support or rebut the lien, not just fees accepted by other outpatient surgery centers in the same geographic area for the services provided.

This decision should have far reaching effects, including in the Elite Surgery Center consolidation being handled by HSSP. 

Opinion filed September 17, 2008.

The California Supreme Court denied review July 29, 2009 making this case final.

To learn more about how we can help you with your case, please contact us today!

Message

Heggeness, Sweet, Simington & Patrico, A P.C.
.........................................
Locations:

San Diego
7071 Convoy Court
Suite 200
San Diego, CA
92111-1023
Phone (858) 874-2100

Riverside
6180 Quail Valley Court
Suite 110
Riverside, CA
92507-0757
Phone (951) 656-1944

Santa Ana
600 West Santa Ana Boulevard
Suite 700
Santa Ana, CA
92701-4555
Phone (714) 550-1133

Bay Area
1633 Bayshore Highway
Suite 360
Burlingame, CA
94010-1537
Phone (650) 350-1908