According to the National Academy of Social Insurance, U.S. Workers’ Compensation carriers and employers pay between 20.9 and 32.4 billion dollars in medical expenses related to work injuries each and every year.  Cipriani and Werner’s Medical Fee Review Practice Group seeks to protect its clients from these ever ballooning costs and attempted improper billing.

Most workers’ compensation systems have instituted cost control regulations that limit the amount that a medical provider may charge for a given service relative to a work-related injury.  However, some providers and/or pharmacies either excessively bill or seek to utilize loopholes in these systems in an attempt to increase their payments above these prescribed limits.  The Medical Fee Review process is an avenue that providers utilize to challenge the allotted payments and re-pricing of their bills and seek higher recoupments through litigation.

The Medical Fee Review Practice Group works in conjunction with and in support of the Workers’ Compensation Practice Group to defend both carriers and self-insured employers against such schemes and disputed pricing.  We defend our clients from the initial administrative review of challenged bills through full litigation of disputed amounts and timeliness of payments.  We collaborate closely with adjusters to respond to requests from state agencies relative to re-pricing calculations and represent them before Medical Fee Review Officers and Judges.  Through this process, we seek to ensure that our clients are charged only the proper legislatively established prices for medical services and protected against claims for inflated and excessive billing.

If you are dealing with a claim of improper billing from a provider or believe that you are being excessively billed for a work-related injury treatment, a member of the Medical Fee Review practice group is available to discuss proper responsive actions and strategy to address.  Please do not hesitant to reach out to us with any questions.