I’ve heard of TPAs in California who have a “partial ownership interest” in a particular UR company and the TPA’s policy is to refer ALL requests for medical treatment to that UR company, even things so obvious as a cane to prevent falls after major surgery on a lower extremity.
One should expect that every service provided to a TPA for the purpose of adjusting the costs of a claim will include a mark up that eventually finds its way back to the TPA’s revenue line. Since most, if not all of these services are ordered at the behest of the TPA itself (in the name of saving money for its customer), the frequency of use and thus the amount of this revenue are completely within the control of the TPA and could be considered self-dealing. Insured employers are not insulated from this practice either. Caveat emptor…buyer beware.
I’ve heard of TPAs in California who have a “partial ownership interest” in a particular UR company and the TPA’s policy is to refer ALL requests for medical treatment to that UR company, even things so obvious as a cane to prevent falls after major surgery on a lower extremity.
One should expect that every service provided to a TPA for the purpose of adjusting the costs of a claim will include a mark up that eventually finds its way back to the TPA’s revenue line. Since most, if not all of these services are ordered at the behest of the TPA itself (in the name of saving money for its customer), the frequency of use and thus the amount of this revenue are completely within the control of the TPA and could be considered self-dealing. Insured employers are not insulated from this practice either. Caveat emptor…buyer beware.