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Maine comp board sued over hospital fee schedule

Posted On: Nov. 3, 2006 12:00 AM CST

AUGUSTA, Maine--Bath Iron Works is suing the Maine Workers' Compensation Board in an effort to force it to establish a hospital fee schedule, something the state's largest employer asserts the board should have done 14 years ago.

Since enactment of the Maine Workers' Compensation Act of 1992, the board has created a fee schedule for physicians but not one for hospital facilities and other medical providers. As a result, Bath Iron Works has paid for such services in accordance with a fee schedule promulgated under the federal Longshore and Harbor Workers' Compensation Act, explains the suit that was filed Wednesday in Kennebec County Superior Court in Augusta, Maine.

However, one of the hospital providers--Central Maine Orthopaedics in Auburn--refused to accept the federal fee schedule payment for treatment of one of BIW's injured workers and petitioned the Workers' Compensation Board for reimbursement in accordance with its usual and customary fees.

BIW appealed, but a Workers' Compensation Board hearing officer said the act only allows payment of the maximum charge set by the state fee schedule or the customary and usual charge set by the facility, whichever is less. He further ruled that, in absence of a state fee schedule, employers under the purview of the Maine Workers' Compensation Act had only one alternative--to pay providers their usual and customary charge.

"The vast majority, if not all, of the litigation to which BIW has been and is subjected never would have occurred had the board, as required by the legislature, promulgated a fee schedule in accordance with Section 209 of Title 39-1," the employer's suit asserts.

The Maine Workers' Compensation Board did not respond to a request for comment.