Allegheny General Hospital v. Bureau of Workers' Compensation Fee Review Hearing Office (SWIF)

OPINION BY Judge SIMPSON.

This case deals with the cost containment provisions for care of injured workers, as applied in the exceptional instance of trauma care, when urgency limits a provider's ability to contain costs. There is a specific statutory provision which deals with this issue, Section 306(f.1)(10) of the Pennsylvania Workers' Compensation Act (Act). 1 The question here is to what extent an outside database can be used to reprice (reduce) reimbursement for trauma care.

In particular, Allegheny General Hospital (Provider) petitions for review of an order of Medical Fee Hearing…