Recently, an RGI Insured was victimized by an ongoing medical services provider scam involving an organization known as the Three Rivers Provider Network.
According to our client, her office was faxed a request for W9 information (business name, federal tax identification number, and signature; a common occurrence in most businesses, including the medical industry. Upon returning the W9 form, the Three Rivers Provider Network utilized the information to set up contracts with insurance payers for a 25% discount on her service fees. She does not contract with any insurance providers. Her policy is to bill and collect her standard fee from patients, who in turn file for insurance reimbursement.
She became aware of this situation when contacted by CIGNA Insurance in October regarding the fact that she was charging $27 over her preferred provider rate. Since she does not participate in any preferred provider programs, she notified The Doctors Company and hired an attorney to straighten out the problems relating to this situation.
In May of 2007, following receipt of numerous complains from state medical associations about solicitations from Three Rivers Provider Network, the AMA issued an alert on this issue.
According to the alert, "These solicitations appear to be a routine request for a W-9 or a request for a National Provider Identification Number. If signed, these forms result in the physician practice agreeing to be "in network" with Three Rivers and agreeing to accept 25% discounts off their fees."
At the time of the alert, the AMA also sent a letter to Three Rivers Provider Network outlining its concerns about this solicitation and urging them to make their contracting practices more transparent. The AMA encourages all physicians to alert their staff to be on the lookout for such solicitations and to only sign the documents if the practice wishes to participate in the Three Rivers network.
The letter from Michael D. Maves, MD, MBA, Executive Director and CEO of the American Medical Association, was sent to Todd Breeden, the COO of Three Rivers Provider Network in San Diego, California on May 1, 2007.
The letter states that complaints have been received regarding the misleading nature of their physician solicitations: "This one-page document would appear to be a routine request for a W-9. Yet on closer inspection, it includes language that would bind physicians to a contract reducing the value of their services by 25%; the perception of physicians is that Three Rivers Provider Network is seeking to trick physicians into signing a contact by disguising this document."
A copy of the complete letter can be found at http://www.ama-assn.org/ama1/pub/upload/mm/368/trpn_letter.pdf. A copy of the 2007 alert posted by the AMA can be found at http://www.ama-assn.org/ama/pub/category/17552.html.
Posts
