All fees charged by medical care providers for persons covered by
this Act shall be limited to such charges for the same or similar care
(including supplies) as prevails in the community in which the medical
care provider is located and shall not exceed the customary charges of
the medical care provider for the same or similar services. Where a
dispute arises concerning the amount of a medical bill, the Director
shall determine the prevailing community rate using the OWCP Medical Fee
Schedule (as described in 20 CFR 10.411) to the extent appropriate,
and where not appropriate, may use other state or federal fee schedules.
The opinion of the Director that a charge by a medical care provider
disputed under the provisions of section 702.414 exceeds the charge
which prevails in the community in which said medical care provider is
located shall constitute sufficient evidence to warrant further
proceedings pursuant to section 702.414 and to permit the Director to
direct the claimant to select another medical provider for care to the
claimant.
[60 FR 51348, Oct. 2, 1995]
