Most Recent Articles

City of Riverside Pays MD $31 by Triple-Stacking PPOs

This week’s Diabolical Discounter is the City of Riverside. This self-insured public employer slashed a doctor’s reimbursement for a municipal worker’s Evaluation and Managem...

Sedgwick: Careworks' Bulk Payments - Employers Take Note (Part 2)

Yesterday daisyNews reported on a California provider inexplicably receiving three large checks from Preferred Provider Organization (PPO) Careworks, purporting to bulk-pay 1...

Sedgwick: CA Doctors Still Waiting for Purloined PPO Reimbursement

In January, Sedgwick Claims Management Services, Inc. admitted to shortchanging a California orthopedic practice by hundreds of thousands of dollars—thanks to bogus Preferred...

Diabolical Discounts: Berkshire Hathaway's Reimbursement Roulette (Part 1)

A sad fact about California workers’ comp: once a doctor joins a Preferred Provider Organization (PPO), there’s no predicting how devastating the impact on practice revenue w...

Diabolical Discounts: Rampant Anthem PPO Carnage

Preferred Provider Organization (PPO) Anthem Blue Cross is enabling egregious abuse of California providers at scale. Since June, dozens of claims administrators have ...

Sedgwick’s Shell Game? 139 CA Employers Exposed

A California workers’ comp physician recently received eight checks totaling $110,858 from Careworks, a vendor affiliated with Third-Party Administrator (TPA) Sedgwick.

Starbucks, Are You Paying Attention? Sedgwick’s Numbers Don’t Match

California employers should be suspicious of Third-Party Administrator (TPA) Sedgwick’s record-keeping.A doctor (a daisyCollect client) treated a Starbucks injured wor...

Hyatt: Gallagher Bassett Stiffs Provider With "Denial Dump" EOR

Why provide one baseless, nonsensical reason for refusing to pay a provider when you can provide 10? That’s the approach Gallagher Bassett took when it improperly deni...

CA Employers: Comp Premium Hike Based On Bad Data

While most states are lowering employers’ workers’ comp premiums, California is heading in the opposite direction. Insurance Commissioner Ricardo Lara approved a premium rate...

Taxpayers Beware: Anaheim Misreports Payment Data

Citizens of Anaheim, CA, may want to examine the city’s books closely, given the suspicious accounting of taxpayer dollars designated for the care...

CA: How to Challenge PPO Discounts

California providers, if you suspect a reimbursement discount is invalid, you have the right to demand proof of an applicable discount contract.As we detailed last wee...

ESIS Makes Bonkers “Offer” to Pay Doctor 45% of Fee Schedule Rate

At daisyNews, we see the complex and sophisticated mechanisms payers use to slash reimbursement for providers treating injured workers. …but sometimes, there’s nothing...