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Content Last Revised: 2/14/75
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CFR  

Code of Federal Regulations Pertaining to U.S. Department of Labor

Title 20  

Employees' Benefits

 

Chapter I  

Office of Workers' Compensation Programs, Department of Labor

 

 

Part 10  

Claims for Compensation Under the Federal Employees' Compensation Act, As Amended

 

 

 

Subpart I  

Information for Medical Providers


20 CFR 10.813 - If OWCP reduces a fee, may a provider bill the claimant for the balance?

  • Section Number: 10.813
  • Section Name: If OWCP reduces a fee, may a provider bill the claimant for the balance?

    A provider whose fee for service is partially paid by OWCP as a 
result of the application of its fee schedule or other tests for 
reasonableness in accordance with this part shall not request 
reimbursement from the employee for additional amounts.
    (a) Where a provider's fee for a particular service or procedure is 
lower to the general public than as provided by the schedule of maximum 
allowable charges, the provider shall bill at the lower rate. A fee for 
a particular service or procedure which is higher than the provider's 
fee to the general public for that same service or procedure will be 
considered a charge ``substantially in excess of such provider's 
customary charges'' for the purposes of Sec. 10.815(d).
    (b) A provider whose fee for service is partially paid by OWCP as 
the result of the application of the schedule of maximum allowable 
charges and who collects or attempts to collect from the employee, 
either directly or through a collection agent, any amount in excess of 
the charge allowed by OWCP, and who does not cease such action or make 
appropriate refund to the employee within 60 days of the date of the 
decision of OWCP, shall be subject to the exclusion procedures provided 
by Sec. 10.815(h).

                         Exclusion of Providers
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