Yesterday daisyNews reported on a California provider inexplicably receiving three large checks from Preferred Provider Organization (PPO) Careworks, purporting to bulk-pay 199 bills on behalf of multiple claims administrators. Today, we expand on that report by listing the employers whose funds Careworks used to issue these payments. We also take this opportunity to correct an error from the original post.

According to the paper Explanations of Review (EORs), Careworks applied payment reductions based on the provider’s alleged contract with Fast360. However, the provider has no contract with either Careworks or Fast360, meaning no contractual relationship exists that would justify those reductions.

Making matters worse, every single payment failed to comply with California workers’ comp laws and regulations:

• All payments were untimely in violation of California Labor Code Section 4603.4
• No electronic Explanations of Review (e-EORs) were issued
• The paper EORs failed to contain the required data per CA regulations.

Below, we list the employers whose injured workers’ bills were paid (and discounted) in this confusing and non-compliant manner.

Correction:
In the previous blog article, daisyNews incorrectly cited California Insurance Code §2509.1(d) as prohibiting the commingling of client claims funds. That citation was inaccurate, and no current law expressly bans entities in the workers’ comp space from pooling funds across clients. While such practices may raise transparency concerns, there is no specific legal prohibition. We’ve updated the blog to reflect this and appreciate your understanding.