Align Networks is having a very bad 2017. First, there was the eyebrow-raising decision to instruct its California providers to prematurely bill using new Medicare physical therapy codes – never mind that these codes had not yet been adopted by the DWC and were therefore without an official reimbursement. Then came the lawsuit. Last month, the Independent Physical Therapists of California (iPTCA) sued Align Networks, along with its parent company One Call Medical, alleging fraudulent, misleading, and illegal behavior. We won’t mince words: We’re not surprised. Over the past few years, we’ve become used to complaints about Align Networks from providers across the state and requests for help with problems getting paid.
According to the iPTCA lawsuit, the typical Align pitch to a provider goes something like this: One Call Medical or Align Networks reaches out to a provider about signing a discount contract. The deeper the discount the provider agrees to, the more patient referrals Align promises to funnel their way. (If true, this in itself would constitute criminal behavior, as it directly violates Labor Code 3215, which strictly prohibits compensatory measures in exchange for referrals.) When a provider refuses the pressure, Align sends referrals to another provider in the same general area who succumbed to the deep reimbursement discounts.
Furthermore, One Call Medical is accused of profiting from this scheme. The iPTCA asserts that One Call’s payer clients do not remit direct payment to medical providers. Instead, One Call is accused of doling out payment themselves, and pocketing the difference between the amount received from the payers and the amount owed to providers on steeply discounted contracts. This incentivizes referrals to providers who have agreed to deeper discounts and would constitute illegal behavior, if true.
There’s more. By signing a contract with Align, a provider waives access to the Division of Workers’ Compensation’s protective regulations. Gone are the state requirements to accept electronic billing. Gone, too, are timely payment deadlines, EOR requirements, and standardized fee schedule reimbursements. Sign a contract with Align, and all of these protections fly out the window.
Of course, many providers don’t realize this at the time that they sign on the dotted line. Invariably, they realize it after a few months under contract. Last year, DaisyBill submitted over 2,300 original bills for workers’ comp medical treatment to Align Networks. Because Align is not a claims administrator, and is therefore excused from abiding by those pesky DWC regulations about electronic billing compliance, each of these bills was submitted via fax. The posted bills were paid, on average, in 52 days. That’s a far cry from the 15 business days mandated for electronic billing by the California Labor Code.
And just when you thought things couldn’t get any more Wolf of Wall Street, there’s this gem of a passage from the iPTCA lawsuit (emphasis ours):
“... IPTCA spent significant resources dealing with several insulting YouTube rap/dance videos posted on the Internet by employees of Align Networks, a division and subsidiary of One Call Medical, Inc. since at least 2013, mocking physical therapists and other rehabilitation providers. The videos contained scenes where Align Networks’ employees and executives were dressed in tee shirts and gold necklaces with a dollar bill sign, some waving ‘Show me the money’ signs. One executive sitting at a desk with large piles of money, eventually tossed stacks of money up in the air so that it would “rain” down upon him.... Plaintiff believes Align Networks’ management actively participated in these videos as individuals who appear to be senior managers played ‘starring’ roles in the production. One senior manager was waving a sign that said ‘Just sign the contract’ during her cameo appearance.”
The iPTCA lawsuit has it all. Alleged corruption? Check. Alleged fraudulent behavior? Check. Alleged greed and rampant entitlement? Double-check.
Stay tuned – we’ve only just begun to scrape the surface of this lawsuit. We’ll be back with more details as the story continues to unfold.