iPTCA Files Amended Federal Lawsuit Against One Call Medical Management and Align Networks
Latest Filing Drawing Concern Regarding Potential ‘Kickbacks’
|WE ARE NOW IN FEDERAL COURT!!!
For the 1st Amended Complaint of the Federal Lawsuit click here.
Please focus on page 14 where key excerpts from some of Align’s Pay-for-Play offers are included:
“Align Networks has identified your group as one with potential for increased referrals with a more competitive rate.”
“The rates we propose determine the amount of referral volume we are able to funnel to your facility…. More referrals will offset what you think you may be losing to the higher FS discount.”
“I know that you all have the opportunity to move up higher on our map of Providers and in return your office will be utilized more often for sending our patients to if we can work on renegotiating one aspect of your contract.”
“Every competitor in your area has competitively leveraged their daily rate to increase their likelihood of being utilized more often by Align Networks.”
“If you agree to a certain rate you all will have a much higher likelihood of being utilized more often by Align Networks.”
“I know that if we renegotiate your daily maximum we can put you in a much more competitive position. … you will be the only Tier 3 in the area, which will put you at the top of the Provider Map. If you all want to increase your likelihood of being utilized more often please let me know.”
“A Tier 1 provider is the option selected by our scheduling department. This is for any prospective referral. Our referral sources include our Insurance Carriers, the patient, referring MD, an employer and Attorney (If applicable)…. A Tier 3 and Tier 4 provider does not see any
prospective referral volume.”
“Whereas a Tier 1 or 2 provider, is looking to generate an increase in revenue, through increased prospective volume. It all just depends on what your facility is looking to do. We have plenty of business in the area and the volume is there for the taking.”
“In discussing a proposed rate increase by a physical therapist: “Please note that this will bump your current status with Align from Tier 1 to a Tier 3, so it may affect the amount of referral volume you have been receiving from us.” (emphasis added).”
And here was the original press release from the Superior Court lawsuit, described by DaisyBill as a BOMBSHELL!!
ENCINITAS, CA (PRWEB) MARCH 16, 2017
The Independent Physical Therapists of California (iPTCA), a non-profit association of California physical therapists dedicated to advocating for physical therapists and their patients, announced today that it has filed suit against One Call Medical, Inc, D/B/A One Call Care Management, and Align Networks in the Superior Court of the state of California, County of San Diego- North County, Case No. 37-2017-00008817-CU-BT-NC. Click here to view the formal complaint. (To Review the Complaint, Please Click Here).
The Complaint in this unfair competition lawsuit alleges that iPTCA and its non-contracted members have suffered injury and lost money or property as the result of numerous unlawful, unfair, and deceptive or fraudulent business acts and practices engaged in by the defendants, which operate as unlicensed ‘middlemen’ between Workers’ Compensation payers and injured workers and their rehabilitation providers.
Dr. Paul Gaspar, DPT, President of iPTCA summarized the Complaint. “The Complaint details numerous allegedly unlawful activities by the defendants, particularly a referral scheme where defendants demand that physical therapists accede to significant discounts or potentially lose the ability to provide physical therapy services to large numbers of injured workers.” The Complaint explains how such conduct potentially violates numerous state laws, including, but not limited to unauthorized claims administration and violation of laws that tighten restrictions on injured worker referrals by prohibiting companies from offering discounts or other forms of compensation as an inducement for increasing business referrals.
According to Doctor Gaspar, “California’s Legislature approved an appropriate medical fee schedule for the care of injured workers in 2012 by passing Senate Bill 863 (DeLeon). It is unlikely, in my opinion, that they intended a significant percentage of these payments might be diverted away from direct patient care services toward an out-of-state middleman. Injured workers deserve the benefit of the resources the Legislature directed toward their care.”
“iPTCA is confident it will prevail in the lawsuit,” said Dr. Gaspar, “because as the Complaint alleges, the unlawful, unfair, and deceptive or fraudulent business acts and practices detailed in the Complaint have potentially harmed the Association and many of its members, have the potential to result in increased harms to consumers, and are contrary to state law and the California Legislature’s intent in passage of this reform legislation.”
You can also click here to see the press release.