STATE OF OREGON, Plaintiff-Respondent, v. CHRISTOPHER LEE WORKMAN, Defendant-Appellant.
Deschutes County Circuit Court 16CR57308; A165068
STATE OF OREGON
Submitted November 5, 2018, affirmed November 20, 2019
300 Or App 622 (2019); 455 P3d 566
Wells B. Ashby, Judge.
Defendant was convicted of third-degree assault,
Affirmed.
Ernest G. Lannet, Chief Defender, Criminal Appellate Section, and Kristin A. Carveth, Deputy Public Defender, Office of Public Defense Services, filed the brief for appellant.
Ellen F. Rosenblum, Attorney General, Benjamin Gutman, Solicitor General, and Michael A. Casper, Assistant Attorney General, filed the brief for respondent.
Before Lagesen, Presiding Judge, and James, Judge, and Haselton, Senior Judge.
LAGESEN, P. J.
Affirmed.
LAGESEN,
Defendant was convicted of third-degree assault,
When the state seeks restitution for amounts paid for medical charges, it must prove that the charges were reasonable.
Although defendant argues otherwise, this is not a case in which the trial court awarded restitution for medical charges based on bills alone. At the restitution hearing, the state called Shaw, the manager of CVCP. She testified that, before paying medical expenses, CVCP would review the bill, the chart notes, and, in the case of a victim with insurance, the explanation of benefits. She testified further that the amounts it paid for the victim‘s medical expenses were for hospital bills, doctor bills, and bills for medication. Most significantly with respect to the issue of reasonableness, Shaw explained that CVCP “did not pay the majority of those bills at 100 percent.” Instead, at least when the victim is uninsured, CVCP pays medical charges using the workers’ compensation fee schedule for medical services. In this case, the victim was uninsured and CVCP, in fact, paid the medical charges at issue in accordance with the workers’ compensation fee schedules, writing off amounts that exceeded what was allowed by the fee schedule.
That evidence is sufficient to support a finding that the medical charges for which restitution was sought in this case were at or below market rate and, therefore, reasonable. By statute,
“(a) The current procedural codes and relative value units of the Department of Health and Human Services Medicare Fee Schedules for all medical service provider services included therein;
“(b) The average rates of fee schedules of the Oregon health insurance industry;
“(c) A reasonable rate of markup for the sale of medical devices or other medical services;
“(d) A commonly used and accepted medical service fee schedule; or
“(e) The actual cost of providing medical services.”
In view of those statutory requirements, it can be inferred that workers’ compensation fee schedules reflect customary market rates for medical services and, consequently, that medical charges paid at those rates, as happened here, were reasonable. The trial court did not err in awarding restitution for the claimed medical expenses on this record.
We observe that our recent decision in J. M. E., 299 Or App at 488-89, which also involved restitution payable to CVCP, is not to the contrary. In that case, “[n]o witness testified that the amount charged—or the amount subsequently paid by CVCP—was at or below the market rate for those services, nor was there any other evidence as to the reasonableness of the medical bill.” Id. at 488. Here, by contrast, the state introduced the type of evidence omitted in J. M. E.—testimony that the charges were paid in accordance with the workers’ compensation fee schedule. That evidence, as noted, allows for the conclusion that the amounts paid were reasonable.
Affirmed.