California’s Official Medical Fee Schedule (OMFS) establishes the rates at which claims administrators must pay providers who agree to treat injured workers. But rather than paying a doctor at OMFS rates, Conduent, in cahoots with Third-Party Administrator (TPA) Athens Administrators, faxed the doctor a ‘discount contract’ requesting a massive reimbursement discount.

This Athens-Conduent contract offered the doctor the following:

1. 80% of the OMFS, instead of 100% as established by California law,
2. No guarantee of payment; Athens retained the right to deny the bill,
3. At best, 1 day faster payment than already mandated by California law,
4. At worst, payment well past the date mandated by California law, and
5. In the event Athens-Conduent failed to pay the proposed reduced reimbursement, the doctor waives “all penalties and interest/attorney fees” owed for the “referenced dates of service”

That’s it.

Why would any doctor’s authorized representative sign this contract? For the exact same reason any mark falls for a bait-and-switch scheme: the lure of a superficially attractive offer that, in reality, sets a trap for the unwary.  

Below, we document the underhanded way in which Athens-Conduent attempted to hustle one doctor on behalf of The Permanente Medical Group, Inc., a self-insured employer.

Step 1: Create False Urgency

Operating “For and on behalf of Athens Administrators,” Conduent attempted to wring revenue from a daisyCollect client by faxing a two-page contract (we document in a separate article how Conduent also badgered the doctor with telephone calls insisting the doctor accept sub-OMFS rates).

The cover sheet of the faxed discount contract conveyed a manufactured sense of urgency by setting a bolded, arbitrary deadline for the doctor to accept the offer of reduced payment ASAP.

Step 2: Propose Reimbursement Rate of 80% OMFS

It is important to recognize two important facts:

1. Athens authorized the treatment provided by the doctor.
2. After treating the injured worker, the doctor sent Athens a bill which listed the rates established by the OMFS (the doctor simply expected to receive payment at OMFS rates, nothing more). 

Yet, the Athens-Conduent duo faxed the doctor a discount contract urgently requesting that the doctor accept a reimbursement $127.65 below OMFS rates. This amount represents only 80% of OMFS rates allowed for this doctor’s treatment of Permanente Medical Group’s injured worker.

Step 3: Offer Payment Date AFTER Mandated Payment Date

Like many workers’ compensation discount contracts, the fine print is deadly.

In exchange for $127.65, the Athens-Conduent duo proposed to pay the doctor within “7-10 business days.” According to this timeline, the earliest date the doctor would receive payment (if the doctor signed immediately) is 5/5/2022. Since the doctor had until 4/29/2022 to sign the contract, payment could have come as late as 5/13/2022 (or even later).

Except, this doctor billed electronically for the services rendered. Therefore, California law mandates Athens must remit payment to the doctor no later than 5/6/2022 (a single day after the earliest date Athens-Conduent proposed to pay the doctor).

Fact: In exchange for $127.65, Athens-Conduent is offering to pay the doctor — at best — a single day earlier than the California-mandated payment deadline.

Step 4: Athens Retains Right to Deny Bill

According to the proposed contract, even if the doctor signs the contract accepting 80% of OMFS reimbursement, signing the contract is not a guarantee of payment, because Athens retains the right to deny the bill.

The contract explicitly states that “Should such bill be determined to be denied or to not be covered [by Athens], this offer shall be null and void.”

Step 5: Athens Retains Right NOT to Pay Quickly

Next, the proposed contract uses particularly opaque language to stipulate that Athens-Conduent does “not guarantee payment earlier than as required” by California law.  

The most generous interpretation of this part of the contract: the provider is signing away $127.65 for the privilege of being paid according to already-existing law. The sole inducement to sign this contract is meaningless; should the provider give another 20% of their reimbursement to Athens-Conduent for meeting other basic requirements, like returning an EOR?

Step 6: Take Away Doctor’s Right to Penalty and Interest

We’ve established that the Athens-Conduent contract guarantees neither payment nor timely payment.

Moreover, in the tiniest print (ever), the proposed contract establishes that in the event Athens-Conduent fails to timely pay the 80% OMFS rate, the doctor waives “all penalties and interest/attorney fees” owed for the “referenced dates of service.”

In other words, this contract allows Athens-Conduent to pay the doctor 80% of OMFS reimbursement in 10 days, 10 months, or 10 years — with no right to penalty and interest for the doctor, and potentially zero repercussions for Athens.

SCAM Defined

By signing this contract gifting Athens-Conduent $127.65, an unwitting doctor’s authorized representative would grant this duo the contractual right to delay payment without penalty, in exchange for accepting 80% of OMFS rates.

We wonder if self-insured employers like The Permanente Medical Group, Inc. are aware of these schemes being implemented by Conduent and Athens on the employer’s behalf.

Source: https://www.merriam-webster.com/dictionary/scam

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