Silent PPOs: the stealth discounting of provider reimbursement.
Physicians are losing millions of dollars per year from payers engaging in abusive discounting practices. One of the worst of these practices is the silent PPO. This article explains what a silent PPO is and how it unlawfully reduces a provider's reimbursement. The article discusses how providers can recognize silent PPOs and how to protect their practices from this discounting. The article also reviews statutes that prohibit or regulate silent PPOs and recent court decisions finding in favor of providers and against silent PPOs.
Marks
James W
JW
Harris Kessler & Goldstein LLC, Suite 590, 640 N. LaSalle Street, Chicago, IL 60610, USA. jmarks@hkgold.com
D032982:Contracts / Q000331:legislation & jurisprudence; D004465:Economic Competition; D019461:Employee Retirement Income Security Act; D006801:Humans; D007349:Insurance, Health, Reimbursement; D011216:Practice Management, Medical / Q000191:economics*; D011243:Preferred Provider Organizations / Q000191:economics* / Q000331:legislation & jurisprudence; D014481:United States