Does the CMA have a silent PPO program?
Think California industries, and what springs to mind? Show business? Napa Valley wines? Silicon Valley chips? To that list, add another: leased PPO networks—businesses that rent out their provider lists and associated discounts to small health plans, workers’ comp plans, and other “payers” that may not have networks of their own. Of the roughly 400 of these networks operating in the US in recent years, more than one in four do business in the Golden State, according to Mark W. Rieger, CEO of National Healthcare Exchange Services, in Sacramento, which assists doctors in auditing and appealing health plan payments. Many operate on the up-and-up, giving doctors access to more patients in return for discounted fees. But, increasingly, leased PPO networks are selling doctors’ discounts without giving them any benefit in return—and without doctors’ knowledge or direct consent. Collectively, these networks are known as “silent PPOs.” (See “The secret world of silent PPOs,” Jan. 20, 2006). Th
