Scomed Supply v. Bureau of Workers' Compensation Fee Review Hearing Office (Lackawanna American Insurance Co.), 052418 PACCA, 561 C.D. 2017

Docket Nº:561 C.D. 2017
Opinion Judge:P. KEVIN BROBSON, JUDGE.
Party Name:Scomed Supply, Petitioner v. Bureau of Workers' Compensation Fee Review Hearing Office (Lackawanna American Insurance Company), Respondent
Judge Panel:BEFORE: HONORABLE P. KEVIN BROBSON, Judge, HONORABLE MICHAEL H. WOJCIK, Judge HONORABLE J. WESLEY OLER, JR., Senior Judge.
Case Date:May 24, 2018
Court:Commonwealth Court of Pennsylvania
 
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Scomed Supply, Petitioner

v.

Bureau of Workers' Compensation Fee Review Hearing Office (Lackawanna American Insurance Company), Respondent

No. 561 C.D. 2017

Commonwealth Court of Pennsylvania

May 24, 2018

OPINION NOT REPORTED

Submitted: April 6, 2018

BEFORE: HONORABLE P. KEVIN BROBSON, Judge, HONORABLE MICHAEL H. WOJCIK, Judge HONORABLE J. WESLEY OLER, JR., Senior Judge.

MEMORANDUM OPINION

P. KEVIN BROBSON, JUDGE.

Scomed Supply (Scomed) petitions for review of two orders of the Bureau of Workers' Compensation (Bureau) Fee Review Hearing Office, dated April 26, 2017. The Bureau's Fee Review Hearing Office denied and dismissed Scomed's requests for a hearing to contest the fee review determinations made by the Bureau's Medical Fee Review Section. For the reasons set forth below, we vacate the Bureau's Fee Review Hearing Office's orders and remand the matter for further action.

The facts of this case are not in dispute. Velma Sanchez (Sanchez), an employee of Sacred Heart Senior Living (Sanchez's Employer), suffered a work-related injury on April 11, 2015. Sanchez receives treatment for her work-related injury, low back pain, from Karen Howell, D.C. As part of Sanchez's treatment, Dr. Howell prescribed durable medical equipment to Sanchez, including a neuromuscular stimulator, a water circulation unit, electrodes, a lumbosacral brace, and lead wires. Scomed dispensed the durable medical equipment to Sanchez and billed Lackawanna American Insurance Company (Lackawanna), Sanchez's Employer's workers' compensation insurance carrier, for dates of service ranging from October 20, 2015, through February 20, 2016. Lackawanna denied Scomed's invoices, stating, inter alia, that chiropractors may not order durable medical equipment. As a result, Scomed filed six applications for fee review with the Bureau. The Bureau's Medical Fee Review Section determined that Scomed was not entitled to any compensation from Lackawanna because, inter alia, the information provided by Scomed was insufficient to overturn Lackawanna's reimbursement decisions. Thereafter, Scomed filed six requests for a hearing to contest the adverse determinations.

William Blue (Blue), an employee of Roma Concrete, Inc. (Blue's Employer), suffered a work-related injury on June 15, 2015. Blue receives treatment for his work-related injury, a bucket-handle tear of the medial meniscus and a spontaneous disruption of the ACL in his right knee, from John Michael Pizzimenti, D.C. As part of Blue's treatment, Dr. Pizzimenti prescribed durable medical equipment to Blue, including replacement water circulation pads. Scomed dispensed the durable medical equipment to Blue and billed Lackawanna, Blue's Employer's workers' compensation insurance carrier, for two separate dates of service, January 19, 2016, and March 19, 2016. Lackawanna denied Scomed's invoices, stating that chiropractors may not order durable medical equipment. As a result, Scomed filed two applications for fee review with the Bureau. The Bureau's Medical Fee Review Section determined that...

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