Rosales, David

Applicant David Rosales, a truck driver, sustained an admitted industrial injury on 08/14/2015 and received hospital treatment at White Memorial Hospital, which filed a lien for the value of its services. The medical necessity of treatment was stipulated; the disputes concerned the reasonable value of services and entitlement to penalties and interest. Defendant challenged the lien on three grounds: an alleged PPO contract reduction, improper DRG coding (arguing DRG 563 rather than DRG 483 applied), and that supply implants and operating room services did not warrant separate payment. The WCJ rejected all three arguments and the Board affirmed, holding that defendant failed to meet its burden of proving the PPO contract, that DRG 483 was appropriate given the surgery performed, and that OR services were properly reimbursed under OMFS. The Board granted reconsideration solely to clarify that the 15% increase and interest were a statutory increase under Labor Code section 4603.2(b)(2) rather than a 'penalty,' and otherwise affirmed.