This week’s Diabolical Discounter is the City of Riverside. This self-insured public employer slashed a doctor’s reimbursement for a municipal worker’s Evaluation and Management (E/M) service to just $31.42—only 22% of the amount allowed by California’s Official Medical Fee Schedule (OMFS).

Even more disturbingly, Riverside apparently arrived at this paltry figure by stacking not one, not two, but three Preferred Provider Organization (PPO) contracts—courtesy of some of the usual suspects: Careworks, Coventry, and MultiPlan.

The OMFS rate for this E/M visit is $140.65. That means this terrible trio of PPOs siphoned off $109.23—more than three times what the doctor was paid for treating the injured worker.

Riverside is making it a bad financial decision for providers to care for its injured employees. As a municipal employer, Riverside is using taxpayer dollars to enrich PPO middlepeople—and the private equity firms lurking behind the scenes—while doctors earn less than parking valets (and plumbers).