Compliance Corner
Attorney fees, physician fees, and hospital charges for services under this South Carolina workers’ compensation law are subject to the approval of the commission, but a physician or hospital may not collect a fee from an employer or insurance carrier until the physician or hospital has made the reports required by the commission in connection with the case.
As Simply Research subscribers know, when it comes to fees and charges in S.C., the following rules apply.
Approval Required
In South Carolina, a person may not:
(a) Receive a fee, gratuity, or other consideration for a service rendered pursuant to this title unless the fee, gratuity, or other consideration is approved by the commission or a court of competent jurisdiction; or
(b) Make it a business to solicit employment for an attorney or himself with respect to a claim or award for compensation.
Crime & Punishment
A violation of the law on fees constitutes a misdemeanor and, upon conviction, each offense is subject to a fine of not more than five hundred dollars, imprisonment for not more than one year, or both.
Changing the Fee Schedule
The commission may adopt criteria to establish a new fee schedule or adjust an existing fee schedule to establish maximum allowable payments for medical services provided by medical practitioners exclusive of hospital inpatient services and hospital outpatient services and ambulatory surgery centers based in whole or in part on the requirements of a federally funded program, but if it adopts adjustments to an existing fee schedule, it must adopt these adjustments on an annual basis and the adjustments may not exceed the percentage change indicated by the federally funded program. The commission shall conduct an evidentiary hearing to review a proposed adjustment to increase or reduce these fees by more than ten percent annually to determine whether to:
(a) increase or reduce the proposed adjustment as the commission considers appropriate; or
(b) accept the proposed adjustment.
Court Involvement
A decision of the commission to increase or reduce a fee schedule to establish maximum allowable payments for medical services provided by medical practitioners exclusive of hospital inpatient services and hospital outpatient services and ambulatory surgery centers by more than 10% is reviewable by expedited appeal to the Administrative Law Court pursuant to the Administrative Procedures Act
On appeal, the court may:
(1) Accept the increase or decrease;
(2) Impose a lesser increase or decrease;
(3) Revert the fee schedule as it was immediately prior to the annual adjustment;
(4) Adjust the appropriate conversion factors as necessary; or
(5) Make other adjustments the court considers reasonable.
The court shall issue a decision within 90 days after it receives the appeal. During the pendency of the appeal, the portion of the fee schedule under review must remain the same as it was immediately prior to the proposed changes, but all other portions of the fee schedule or conversion factors are effective and remain unchanged.
