232 Cal. App. 4th 543
Cal. Ct. App.2014Background
- Petitioners sought writ review of a WCAB decision on Elite’s facility fee liens for arthroscopic knee/shoulder procedures and epidural injections at three San Diego ASCs (2000–2003).
- WCJ found reasonable facility fees; Board adopted; petition for reconsideration denied; Board affirmed in 2013.
- Senate Bill 863 (2012) created an independent bill review (IBR) process and independent medical review (IMR); petitioners argued SB863 divested the Board of jurisdiction over pending billing disputes.
- At the time, ASC facility fees lacked an OMFS; hospital OMFS existed for 2001–2003 and ASC OMFS took effect 2004.
- WCJ weighed varied evidence (Dr. Kupfer, Centner data, Dr. Miller) and concluded reasonable fees fell between hospital OMFS (2001–2003) and ASC OMFS (2004).
- Statutory interpretation of SB863 was ambiguous; court held SB863 applies prospectively and does not divest the Board of jurisdiction over pending disputes.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Does SB863 divest the Board of jurisdiction over pending billing disputes? | Petitioners contend SB863 divests WCAB of jurisdiction. | Board/Elite argue ambiguity but SB863 should apply as enacted. | Board retains jurisdiction over pending dispute. |
| Is SB863 retroactive or prospective for pending disputes regarding IBR?</br> | Petitioners argue retroactive application. | Legislation intended prospective application; IBR not available for pending claims. | Statute interpreted as prospective; IBR not applicable to this dispute. |
| Are the Board’s three findings of fact regarding reasonable facility fees supported by substantial evidence? | Petitioners argue findings lack substantial support. | Board/ WCJ considered broad range of evidence; findings supported by substantial evidence. | Yes; findings are supported by substantial evidence. |
Key Cases Cited
- Tapia v. Skill Master Staffing, 73 Cal. Comp. Cases 1338 (Cal. Ct. App. 2008) (how to assess reasonableness of ASC facility fees; non-exhaustive factors allowed)
- Kunz v. Patterson Floor Coverings, Inc., 67 Cal. Comp. Cases 1588 (Cal. Ct. App. 2002) (relevant factors include economics and unusual circumstances in determining reasonableness)
- Tenet/Centinela Hospital Medical Center v. Workers’ Comp. Appeals Bd., 80 Cal.App.4th 1041 (Cal. Ct. App. 2000) (standard for reviewing Board findings; cannot reweigh evidence on appeal)
- City of Long Beach v. Workers’ Comp. Appeals Bd., 126 Cal.App.4th 298 (Cal. Ct. App. 2005) (deference to Board’s statutory interpretation absent clear error)
- Californians for Disability Rights v. Mervyn’s, LLC, 39 Cal.4th 223 (Cal. 2006) (statutes typically interpreted prospectively absent clear contrary intent)