You reduce a medical provider's bill by $500 pursuant to the Official Medical Fee Schedule. The physician bills the applicant who pays and advises you. What is the physician's responsibility?

• A. Three times the amount unlawfully collected
• B. WCAB
• C. Small Claims court
• D. None

Answer: (A)

In California workers’ compensation, medical providers may not bill more than the Official Medical Fee Schedule. If a provider overcharges a claimant and the payer reduces the bill to the schedule amount, the provider is subject to a penalty: they must pay three times the amount unlawfully collected. So in this scenario, the physician is responsible for treble damages to the applicant for the $500 overcharge (and should cease any such overbilling going forward). This penalty is the intended remedy to deter overcharges and protect the injured worker. The WCAB is not the remedy sequence for this civil penalty, and a Small Claims court is not the prescribed remedy for this statutory overcharge.