AAICP LEGAL ISSUES

Louisiana Litigation Surrounding the Appropriateness of Preferred Provider Organization (PPO) Discounts

Litigation in the state of Louisiana surrounding the appropriateness of preferred provider organization (PPO) discounts has been ongoing for some time. Recently,
the Louisiana Third Circuit Court of Appeals held that health care providers could not accept payments less than the state approved fee schedule, and that
payment of such contractually reduced medical bills warranted the assessment of attorney’s fees and penalties by the Worker's Compensation Commission.
This finding had the potential to increase overall costs for claimants, businesses, health care providers, and insurers. The Louisiana Supreme Court accepts
writs of certiorari on these important issues.

The AAICP, along with others in the insurance industry, became actively engaged on this issue and filed a comprehensive Amicus Brief to the state's high court in support of industry's reasonable reliance on such PPO contracts in reducing medical costs. As a result of these efforts, employers and health care providers won a major victory in December 2010 when the Louisiana Supreme Court overturned the previous decision and unanimously ruled that taking discounts allowed by
valid PPO contracts does not violate state law.

Legal Documents
Final Louisiana Supreme Court Decision
Amicus Curiae Brief on behalf of AAICP
Motion and Order for Leave to File Original Amicus Curiae Brief on behalf of AAICP

Articles:
Return to High Court: PPO Discounts Don’t Violate Comp Act, workcompcentral, December 2, 2010
Attorney Fees Outweigh PPO Reimbursements in Appellate Decision, workcompcentral, November 8, 2010