California physicians can always rely on ESIS to pay its bills for Medical-Legal services — as long as they're willing to report ESIS to the Division of Workers’ Compensation (DWC) by submitting formal Audit Complaints.

Over the last year, ESIS blatantly ignored 10 Medical-Legal bills, failing to respond to the physicians in any way and giving the runaround to daisyCollect (our fully-managed billing service) agents who reached out to investigate. As a result, daisyCollect filed Audit Complaints against ESIS for failure to pay these Medical-Legal bills — some of which were almost a year overdue —  totalling $15,154.75 in reimbursements.

Following the Audit Complaints, ESIS suddenly sent out checks, paying the amounts charged for all 10 bills. Unfortunately, ESIS still owes penalty and interest payments for 7 of the 10 untimely paid bills.

daisyCollect filed further Audit Complaints for the missing penalty and interest payments and will not consider the matter closed until ESIS meets (all of) its legal obligations to Qualified Medical Evaluators (QMEs) and Agreed Medical Evaluators (AMEs).

ESIS: A Study in Obstinance

No one can say we didn’t try. Before taking our clients’ cases to the DWC, representatives of daisyCollect (our fully-managed billing service) repeatedly reached out to the Third-Party Administrator (TPA). We also repeatedly, publicly documented ESIS’s deadbeat status on this very blog — all to no avail.

It seemed no amount of polite inquiry or online shaming could convince ESIS to honor the most basic principle of commerce: to pay for services rendered. Submitting Audit Complaints was the only recourse available, so that’s what our agents did.

And lo and behold…

Over the last several weeks, ESIS remitted payment for the amounts billed by the physicians. In 3 out of 10 cases, ESIS also “self-executed” the mandatory penalty and interest payments of 10% and 7% per annum, respectively.

The chart below details what ESIS owed and paid as of this writing. Some of the more depressing statistics include:

• Total Amount Owed: $15,154.75
• Largest Amount Owed: $2,921.75
• Most Insanely Overdue Bill: 338 days late

daisyCollect isn’t done with ESIS yet, however.

On behalf of our clients, daisyCollect filed Audit Complaints (below) for the missing penalties and interest owed on 7 of the bills above.

If ESIS’s only consequence for ignoring those 7 bills is having to pay what ESIS already owed in the first place, the TPA has little reason to change its ways. ESIS has demonstrated that polite requests and appeals to common decency don’t work. So when it comes to the remaining amounts owed to these physicians, we’re not asking.

Audit Complaint

To: XXXXXXXX@dir.ca.gov

Subject: ESIS Non-compliance: Failure to Pay Medical-Legal Penalty & Interest

Below is an Audit Complaint reporting that ESIS, Inc. failed to self-execute penalty and interest for late Medical-Legal bill payments.

California Code of Regulations Section 9794(b) requires claims administrators to reimburse providers for Medical-Legal expenses within 60 days after receipt of the bill and supporting documents.

California law mandates that ESIS must issue reimbursement for the total bill charge and the appropriate penalty and interest pursuant to Labor Code §4622(a)(1) because more than 60 days have passed since the submission of the bills.

Attached is a CSV list containing seven bills providers submitted where ESIS failed to remit payment timely within 60 days and failed to self-execute mandated penalty and interest.

The attached CSV list includes the following columns:

• Column F: [Bill] Submission Date
• Column G: EOR Compliance Due Date
• Column I: EOR Payment Effective Date
• Column O: Penalty Amount Due
• Column P: Interest Amount Due
• Column S: Patient Name
• Column T: Claim Number

Audit Complaint Details

This Audit Complaint Data submitted to the DWC represents a credible complaint and credible information of claims handling violations.

Non-compliance: Claims administrator failed to remit payment for Medical-Legal expenses within 60 days after receipt of bill and supporting documents as mandated by California Code of Regulations Section 9794(b).

Per Labor Code Section 4622(a)(1), within 60 days after receipt by the employer of each separate, written billing and report, and if payment is not made within this period, that portion of the billed sum then unreasonably unpaid shall be increased by 10 percent, together with interest thereon at the rate of 7 percent per annum retroactive to the date of receipt of the bill and report by the employer.

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