A California doctor sent a bill to a Third-Party Administrator (TPA), for treatment the TPA had authorized. In response, the doctor received a fax from Medical Audit & Review Solutions (MARS), a MultiPlan company.

MARS offered to pay the physician 45% of the fee schedule rates, equal to just 68% of the Medicare rate.

MARS claimed to have been “engaged to perform a review,” but did not identify who, exactly, engaged them. The fax stated that MARS physicians had “concerns” about the bill, but noted that the treating doctor could “avoid any additional MARS physician intervention” by accepting the discount.

We can’t speculate as to what “additional” MARS “intervention” entails. We’ve seen discount contractors peddle bad “agreements” before, including with outright deception. But this is the first time we’ve seen an entity imply that an unsolicited “agreement” amounts to an offer that, to paraphrase Don Corleone, the provider can’t refuse.

MARS/MultiPlan Coercive “Payment Clarity”

In the fax below, MARS claims to have "been engaged" to review the bill, but lacks any information regarding who did the “engaging.”

The physician submitted proof of treatment authorization with the bill. Yet, MARS suggests that the provider performed an inappropriate procedure.

The fax then presents an "agreement" for steeply discounted reimbursement to "help to create payment clarity as well as avoid any additional MARS physician intervention as part of our medical review process [emphases ours]."

"Clarity" is a curious word for an unsolicited demand from an entity with no discernible connection to the claims administrator randomly demanding a 55% pay cut.

Moreover, insisting the doctor sign to “avoid” future “interventions” has distinct “Nice practice you got here; shame if something were to happen…” vibes.

Who Is MARS Working For?

While listing the patient and provider in question, the “Negotiation Terms” fail to identify the injured workers’ claim number and date of injury. Under “PAYOR/CLIENT (via MultiPlan),” MARS lists only “Workers Comp.”

Further, the letter states unequivocally that (emphases ours):

• “MARS and MultiPlan are not payors or agents of any payor, and are not financially responsible for any payments due to the Provider.”
• “...the payment of benefits, if any, is subject to all Workers’ Compensation statutes in force, compensability of services and utilization review requirements…”
• “...this does not establish and will not be taken as a guarantee of payment by the Payor/Client”

In other words, MARS makes no reference to the actual claims administrator, states flatly that it’s not an “agent” of “any payor,” and disclaims that nothing in the document guarantees any particular payment.

Unlike previous whackadoo discount “offers” from ESIS and The Zenith, both of which are actual workers’ comp claims administrators, this offer comes from a seemingly random company that “specializes in combining analytics and clinical reviews to identify clinical billing errors before payment is made.”

MARS is part of MultiPlan, recently rebranded as Claritev, itself the subject of a federal lawsuit by the American Medical Association, the California Medical Association (CMA), and others for allegedly having “conspired to systematically underpay physicians for reimbursements for out-of-network services.”

While the federal lawsuit refers to commercial insurance, not workers’ comp, the CMA warns providers of certain red flags that look very familiar to us (emphases ours):

“Physicians may not always know whether MultiPlan priced their claims. Clues can often be found in explanations of benefits or remittance advice showing references to ‘MultiPlan,’ ‘Data iSight,’ ‘Viant,’ ‘NCN,’ ‘ProPricer,’ or ‘MARS.’”

MARS’ message raises many questions, chief among them: Why would any provider treat injured workers for a TPA that allows outside entities to send vaguely threatening messages demanding discounts and questioning the validity of treatment the TPA authorized?

Providers, you know what to do with an “agreement” like this: ignore it. Instruct staff to disregard any unsolicited “agreements,” especially from apparent randos warning of “intervention.”

daisyBill shows you exactly how much your practice loses to PPO and other network discounts. Click below to learn more:

BILL BETTER: DAISYBILL