California hospitals receiving duplicate payments, legislators revisiting reimbursement law

Hospitals throughout California are receiving duplicate payments from spinal surgeries given to workers' compensation patients in 2010.

A study conducted by the California Workers' Compensation Institute found that in 2010, $67.5 million in duplicate payments had been paid by the state's workers' compensation program for spinal surgeries.

According to California Watch, state law says that hospitals are to be paid 120 percent of the base of the Medicare rate from the compensation program for patients who undergo spinal injury operations. However, additional charges are required for workers' compensation cases, and hospitals are often given a second payment, called a "pass-through," from the program to cover the cost of implanted hardware during surgery, although the study found that the charges for those devices are included in the initial reimbursement to the hospital.

The news source reports that the price of state workers' insurance coverage is increasing due to the duplicate payments, which means California citizens are the ones paying for the costs with their tax dollars. Lachan Taylor, acting executive officer of the state's Commission on Health & Safety and Workers' Compensation, says that residents are paying an additional $11.4 million in taxes because of the second payments.

The Institute's report says that state legislators are looking to repeal the pass-through payment requirement with a new law titled SB 959 (Lieu). The organization believes the estimated $67.5 million in duplicate payments is "conservative due to the lack of clear and comprehensive billing detail on the full spectrum of hardware used in these hospital admissions."

California Watch writes that the state's hospitals are against the repeal of the original law and say that second payments are required in order to cover the costs for the hardware and devices for spinal surgery.

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