MPN
May 11, 2021
Anthem/SCIF: MPN Kickback Scheme?
Healthcare software firm CareCloud recently agreed to a $3.8 million settlement, in part to resolve allegations that it traded unlawful payments for referrals, in violation o...
Apr 27, 2021
California MPNs: Camouflage for Discounts and Denials
Medical Provider Networks (MPNs) are under fire — as they should be.Far too often, Calforina claims administrators (aka ‘payers’) use MPNs — and providers’ unfamiliari...
Apr 26, 2021
Payola? SCIF / Anthem Coordinate Provider MPN Shakedown
State Compensation Insurance Fund (SCIF) and Anthem Blue Cross (Anthem) have hacked the Medical Provider Network (MPN) system to apparently shake down providers. A recent ema...
Apr 21, 2021
Mob Rule: SCIF/Anthem Hold Patient(s) Hostage
On paper, Medical Provider Networks (MPNs) are a simple workers’ comp quality/cost-control measure. Employers designate an MPN, and injured workers choose from among the MPN ...
Apr 20, 2021
Provider Warning: Prime Health Services (Part II)
Prime Health Services (PHS) provided an unbelievable example of just how far PHS will go to secure unearned PPO discounts for their “clients”, including producing a missing s...
Apr 19, 2021
Provider Warning: Prime Health Services (Part I)
Recently, a provider made the unfortunate mistake of signing a Prime Health Services (PHS) Preferred Provider Agreement contract, commonly known as a PPO agreement. While not...
Jun 22, 2018
Conditional Authorization: How MPNs Cheat Workers’ Comp Providers
Medical Provider Networks (MPNs) are a drag on California workers’ compensation. Nominally designed to help employers control costs, MPNs rarely achieve more than throwing up...
Jun 20, 2018
Data Show MPNs Do Not Benefit Employers
Medical Provider Networks (MPNs) allow employers to limit where employees may seek treatment for work-related injuries. Theoretically, the purpose of MPNs is to direct care w...
Jun 14, 2018
Discount Dangers: Providers Cheated for PR-2 Reports
It seems like claims administrators really, really want to cheat California workers’ comp providers by reducing payment for the Treating Physician’s Progress Report, or PR-2....