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Assembly panel unanimously approves Sen. Ted W. Lieu plan to halt medical overcharges
June 20, 2012
Consumer-protection measure would curb abuse
SACRAMENTO – One day after the latest in a series of news reports citing millions in wasted taxpayer payments for unnecessary spinal-implant surgeries, a key Assembly insurance panel unanimously approved Sen. Ted W. Lieu’s plan to halt the abuse.
“This is a straightforward, common-sense approach to help fight fraud and improve workers’ compensation investigations,” Lieu told members of the Assembly Insurance Committee before their bipartisan vote in support of Senate Bill 959. “This cost-saving measure would ensure that doctors continue to receive appropriate reimbursements for spinal surgeries while ceasing unnecessary and risky surgeries for injured workers.”
As written, SB 959 repeals duplicative or extra payments to medical providers for implantable devices used in spinal surgery. At present, the state’s workers’ comp law sets reimbursement for spinal surgeries at 120 percent of what Medicare pays for the same procedures. At the same time, the law allows an additional payment when the surgery includes implants that aid in treating back injury.
But Medicare’s reimbursement rate already factors in the cost of those devices, so workers’ comp effectively pays twice for the implants, Lieu said.
“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.”
The issue has been cited by numerous news outlets, including the Wall Street Journal and California Watch, a new news source launched by the Center for Investigative Reporting.
In addition, a study 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.
SB 959 now faces a vote on the Assembly Floor. No date for that review has been set.
For more, including a Fact Sheet and links to media coverage on this bill, visit Lieu’s Web site at the address below.
Ted W. Lieu represents nearly 1 million residents of Senate District 28, which includes the cities of Carson, El Segundo, Hermosa Beach, Lomita, Manhattan Beach, Redondo Beach and Torrance, as well as portions of Long Beach, Los Angeles and San Pedro. For more, visit www.senate.ca.gov/lieu.