Attorneys and providers in Georgia will be watching to see what happens in a lawsuit recently filed in the California alleging that One Call is running an illegal referral scheme.
One Call and its subsidiary Align Networks have been accused of illegal, unfair and deceptive or fraudulent business acts. Allegations in the complaint have alleged that One Call has participated in improper financial inducements, interfering with the right of the injured workers to choose a physician within an employer’s medical network and acting as claims administrators when they are not certified as such.
Specifically it is alleged that they are soliciting and receiving improper payments for referring more cases and/or patients to certain providers (in this case physical therapists) and managing services in ways that violate numerous California laws.
California law prohibits the offer or acceptance of any type of compensation in exchange for patient referrals. According to the complaint, One Call has allegedly contracted with these therapists under the pretense that the provider who will accept the lowest payment will get the most referrals. Thus, physical therapists who continue to charge higher rates are only getting the referrals when One Call cannot refer an injured worker to a therapist that has “contracted” with them at the lower rate in the same geographical region.
According to the complaint, injured workers who are looking for a therapist within the One Call network must go through Align in order to get the referral. It is alleged in the complaint that although Align shows multiple physical addresses the phone and fax numbers are all the same. It further alleges that some of the physical therapists listed on the State Funds MPN roster in California are businesses that no longer even contract with Align and in some cases provide other services such as acupuncture and chiropractic care, not physical therapy. There is even one instance where the facility listed is actually a florist.
One Call is negotiating the lower terms with these providers and pocketing the difference. They are even requiring that the providers use them for billing instead of sending their bills directly to the insurance carriers for payment. This way One Call can bill a higher rate to the insurance carrier than the contracted rate with the physical therapy providers. This “middleman” arrangement is another violation of the Labor Code and Insurance Code in California.
Because of these deceptive practices the insurance companies have not idea the degree of discounts or how little One Call is actually paying for the therapy services provided to the injured workers.