The Assembly Insurance Committee unanimously approved closing a loophole in the law that allows double billing for surgical implants in California workers’ compensation cases.
Senate Bill 959, authored by Ted Lieu, D-Torrance, would address the Medicare fee schedule adopted in 2004 and California law, allows for a 120 percent payment for medical costs and allows separate costs for material and hardware in spinal plants to be added upon the original costs.
This payment, known as a “pass‐through,” is considered a double‐payment because it allows a hospital to pass along the cost of a device, instrumentation, or hardware to even though the cost is technically taken into consideration when setting the reimbursement level.
“Workers’ compensation is California’s system that covers workplace injuries,” Lieu said. “But there is no reason to continue with a reimbursement scheme that adds unnecessary payouts to an already costly system.”
A study earlier this month by the California Workers’ Compensation Institute found that the extra payments boosted the system’s cost by $67.5 million in 2010. The dual reimbursement for such devices added an average of $20,137 in fees to spinal procedures for 3,350 injured workers that year, according to the study.
SB 959 now faces a vote on the Assembly Floor. No date for that review has been set.