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"                      <p class=\"imgtitle\">Barrasso</p>           Liberty Mutual Insurance didn't violate workers compensation law when it discounted bills through a preferred provider organization, the Supreme Court of Louisiana decided on Nov. 30.<br /><br />  All seven Justices reversed Third Circuit appeals judges in Lake Charles, who awarded reimbursement, penalties and legal fees to Agilus Health in a \"PPO\" test case.<br /><br />  The Justices bound Agilus Health to a contract that exchanged greater patient volume and prompt payment for a 20 percent discount.<br /><br />  Resolving a clash between state and federal courts in Louisiana, the Justices upheld the view of federal judges that the discounts broke no law.<br /><br />  Justice Philip Ciaccio wrote, \"In no way does paying a lesser amount to the health care provider pursuant to a contract relieve any liability to the injured employee.\"<br /><br />  He wrote that the employer simply paid what the provider agreed to charge.<br /><br />  At oral argument in October, three Justices obligated Agilus Health counsel Greg Williams to eat a word.<br /><br />  He said the insurer forced discounts on providers.<br /><br />  Justice Jeffrey Victory barked, \"Forced! You signed a contract.\"<br /><br />  Justice Bernette Johnson said, \"It sounds like the argument is disingenuous.\"<br /><br />  Williams tried to back track but Justice Greg Guidry stopped him and said, \"You said several times, forced to do this.\"<br /><br />  Williams apologized.<br /><br />  Johnson asked, \"What is the harm?\"<br /><br />  Williams said, \"A lesser number of providers providing.\"<br /><br />  Johnson said, \"That doesn't seem to be the case. They are lining up to accept 80 percent in order to get patients, aren't they?\"<br /><br />  Three unhappy Justices turned into a majority when Ciaccio pounced on Williams.<br /><br /> \"You are saying the state can go into the price fixing business and tell you that you can charge this and nothing less,\" Ciaccio said.<br /><br />\"The act sets out the schedule and we have experienced parties. Where does the state get into this picture?<br /><br /> \"The employer isn't complaining. He saves money.\"<br /><br />  Williams tried to back track but Ciaccio stopped him and said, \"Although I agreed to it, I'm just fooling.\"<br /><br />  Ciaccio said, \"I really want the hundred even if I said 80.\"<br /><br />  Agilus Health billed $906 to treat Accor Lodging employee Allison Taylor.<br /><br />  Liberty Mutual paid $724.80, and Agilus Health petitioned workers compensation commissioner James Braddock for the balance.<br /><br />  Agilus Health argued that an insurer could discount bills for general health plans but not for workers compensation cases.<br /><br />  Braddock agreed, awarding Agilus Health $181.20 in reimbursement, $4,000 in legal fees, and $2,000 in penalties.<br /><br />  By affirming Braddock, the Third Circuit raised the stakes to millions for employers, insurers and providers all over the state.<br /><br />  Briefs from friends of the court on both sides piled high.<br /><br />  John Quaglino of Metairie sided with Liberty Mutual on behalf of the state as employer of 105,000 persons and defendant in 90 suits with estimated exposure of $1,210,000.<br /><br />  In a separate brief he estimated exposure of Sedgwick Claims Management Services clients at $3,250,000, in 10,000 claims.<br /><br />  In another he estimated exposure of General Motors at $1,120,000 in legal fees and $700,000 in penalties.<br /><br />  For Louisiana Workers Compensation Corporation, Jeffrey Warrens of Baton Rouge predicted a crisis as dangerous as one that led to creation of the corporation.<br /><br />  Rates rose more than 125 percent from 1986 to 1990. And, in the last five years, rates dropped more than 40 percent, Warrens wrote.<br /><br />  Hospitals and doctors expressed equal alarm at the prospect of reversal.<br /><br />  For the state medical society, Amy Phillips of Baton Rouge wrote that injured workers lost options for quality care because some members ceased treating them.<br /><br />  The medical society, the state hospital association, and Ochsner Health System all called on legislators to write a new fee schedule for workers compensation.<br /><br />  The providers can hope for help at the Capitol, but not at the Supreme Court.<br /><br />  Ciaccio's opinion quoted state code that, \"Parties are free to contract for any object that is lawful, possible, and determined, or determinable.\"<br /><br />  He wrote that workers compensation code doesn't impose a duty on an employer to pay one amount or another, it simply caps an employer's monetary obligation to a provider.<br /><br /> Legislators clearly intended to encourage providers to charge less than the amounts in the fee schedule, Ciaccio wrote.<br /><br />  He rejected distinctions between fees, charges, and reimbursements, finding they mean the same throughout the code.<br /><br /> Ciaccio knocked down an argument that insurers misapply and mismanage PPO's, writing that parties can stay out of them or opt out.<br /><br /> \"In no way are health care providers forced to enter into these contracts,\" he wrote. <br /><br />  He found no evidence that patients received substandard care or that providers no longer treat workers compensation patients.<br /><br />  Ciaccio sits for Chief Justice Catherine Kimball as she recovers from a stroke.<br /><br />  Judy Barrasso represented Liberty Mutual.    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