SC Supreme Court to hear oral arguments
The South Carolina Supreme Court was set to hear oral arguments February 16 in the ongoing dispute between the South Carolina Workers’ Compensation and the state’s ambulatory surgery centers. The surgery centers contend the commission arbitrarily maxed their reimbursement at only 40% more than what Medicare would pay for the same procedures.
The disputed fee schedule would have become effective October 1, 2006 but the surgery centers immediately challenged it in court. To date, thanks to several successful court fights, the surgery centers continue to be reimbursed under the old formula, which specified only that the surgery centers were to give a 12.1 % discount off their charges.
In other words, the centers’ payment for medical services for workers’ compensation patients was capped at 87.9% of their charges. As the Commission states it in its brief, “this method was inherently susceptible to high fees, since the providers were free to set the fee to which the discount would apply. The Commission controlled the rate of discount, but the providers controlled the amount of the original charge to which the discount was applied.”
The surgery centers contend the Commission overreached in setting the new fee schedule because they were not given notice or opportunity to present their case, even though the new fee schedule threatened to reduce their revenue by $8 million -$10 million per year. “The Commission failed to comply or act within the due process standards established by the South Carolina General Assembly in the South Carolina Administrative Procedures Act for either regulations or contested cases,” the surgery centers argue in their brief.
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