Back in Action v. Liberty Northwest Ins. Corp.

Both the temporary, OAR 436-009-0040 (07/07/08), and permanent, OAR 436-009-0040(1), rules permit the enforcement of fee discount contracts because they only set an upper limit on fees for medical services.

Back in Action and 11 other medical providers had contracts with MedRisk to provide rehabilitative treatment to injured workers at specified rates under the workers’ compensation system. The Court described the facts with respect to the “control” petitioner because the issues presented in all cases were largely the same. MedRisk processed billings for Liberty, and Liberty paid Back in Action at the agreed upon reduced rates through MedRisk. The Department of Consumer and Business Services (DCBS) issued a temporary rule, OAR 436-009-0040 (07/07/08), which enforced contracts for fee discounts, but a permanent rule, OAR 436-009-0040(1), was in force before the temporary rule took effect. The ALJ issued a final order which the Director of the DCBS modified in an amended final order applying the temporary rule allowing contract discounts. Back in Action argued on appeal that the temporary rule did not apply or was invalid, and that MedRisk did not actively manage medical care for Liberty. Both the temporary and permanent rules permit the enforcement of fee discount contracts because they only set an upper limit on fees for medical services. The Court rejected the argument that MedRisk did not actively manage medical care because it does not prohibit MedRisk from making a contract for discount services. Affirmed.