Payment to Health Care Providers

The Office of Workers’ Compensation Programs uses a medical fee schedule. It is a schedule of maximum allowable medical charges used to pay health care providers for services provided to federal employees injured on the job. Therefore, there may be a difference in the amount the healthcare provider billed to the Department of Labor (DOL) and the amount paid to the health care provider by the Department of Labor. In other words, the health care provider may not be fully reimbursed by the DOL. Keep in mind however, once the health care provider seeks payment under the DOL schedule of payments, the employee is not responsible for paying the difference between the maximum charge set by the schedule and the charge made by the health care provider.

 

If the health care provider continues to bill the employee after receiving payment from the DOL according to the medical fee schedule, the health care provider may be excluded from participation and payment under the Federal Employee’s Compensation program. Such exclusion is reportable to all Federal employing agencies, the Health Care Financing Administration, and the state or local authority responsible for licensing or certifying the excluded provider.

 

An injured worker finding him or herself in this type of situation may take action by writing a letter to the health care provider advising of same. If the health care provider refuses to comply, a formal complaint to the Department of Labor is the appropriate next step.