You reduce a medical provider's bill by $500 under the Official Medical Fee Schedule. The physician bills the applicant who pays and informs you. What is the physician's responsibility?

You reduce a medical provider's bill by $500 under the Official Medical Fee Schedule. The physician bills the applicant who pays and informs you. What is the physician's responsibility?

• A. Three times the amount unlawfully collected.
• B. Return the excess to applicant.
• C. Pay the excess.
• D. Nothing.

Answer: (A)

In California workers’ compensation, the Official Medical Fee Schedule sets the maximum amount a provider may charge. If a provider bills more than this schedule, that overcharge is unlawful. The law imposes a civil penalty of three times the amount unlawfully collected on the provider. So in this situation, by reducing the bill by $500 under the OMFS, the provider effectively received $500 more than allowed. The physician’s responsibility is to pay a penalty equal to three times that excess, i.e., $1,500. (The provider may also need to refund the excess, but the statutorily required remedy highlighted here is the triple-damages penalty.)

In California workers’ compensation, the Official Medical Fee Schedule sets the maximum amount a provider may charge. If a provider bills more than this schedule, that overcharge is unlawful. The law imposes a civil penalty of three times the amount unlawfully collected on the provider. So in this situation, by reducing the bill by $500 under the OMFS, the provider effectively received $500 more than allowed. The physician’s responsibility is to pay a penalty equal to three times that excess, i.e., $1,500. (The provider may also need to refund the excess, but the statutorily required remedy highlighted here is the triple-damages penalty.)