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A C&R Agreement cannot be used to set aside a fee review determination. Rather, a determination in favor of a provider may be set aside only by following the proper procedure set forth in the Act.

The claimant and the employer entered into a C&R Agreement in 2000, settling wage loss benefits, but leaving medical treatment open. In 2015, the employer requested Utilization Review of a topical compound pain cream. Case Law Alerts, 1st Quarter, January 2019

The fee review arena lacks the jurisdiction to determine reasonableness and necessity of treatment. Evidence presented by an insured that billing from a provider was contrary to Medicare policy does not preempt the issue of reasonableness and/or necessity

The claimant was using a neuromuscular electrical stimulation device. The provider dispensed supplies, including two replacement lead wires, on a bi-monthly basis, four times in a six-month period, and billed the insurer on the same basis. Case Law Alerts, 1st Quarter, January 2019