Archive for April 28th, 2011

Aetna To Acquire Prodigy Health Group, Nation’s Largest Independent TPA

Thursday, April 28th, 2011

AETNA NEWS RELEASE: We’re pleased to announce that we are broadening our capabilities to better meet the needs of a broad range of customers. We have agreed to acquire Prodigy Health Group, the nation’s largest independent TPA.

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California VS Multiplan

Thursday, April 28th, 2011

Subject: Califoria Legal Action

Hey Guys, I wondered if you guys ( bloggers supreme ) had seen this case out of California ? Started as an action by an audit firm against Sutter Health and then the California Department jumped in. The interesting detail to me is how PHCS / MultiPlan is being treated as an “ accomplice “ due to the onerous terms of the PPO agreement ( i.e. no audit , no review ).

My opinion is that this case could be huge if it gets legs and other Departments across the country pick up on the logic. While this case is specifically applied to the anesthesia sleight of hand , could the same rationale not be applied to other areas ? How much abusive billing is covered over by the handcuffs placed on plans via PPO contract terms ? Arguably, the entire chargemaster process is driven by the incentive of “ percentage off “. Bill more get more.

CA v Multiplan  (FOR A QUICK REVIEW, READ PAGES 12-18)