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May
20

Kudos to CorVel

I’ve often had issues with CorVel for their billing practices and other matters, but I’d be remiss if I didn’t applaud the managed care firm for their willingness to fire a doctor that was allegedly prescribing Wasabi Rub, theramine pills, Gaba-2k rubs, and surface EMGs, some of which were allegedly upcoded to needle EMGs – and then refusing to discuss these treatments with peer review docs.

The incident happened – of course – in California, where CorVel and Dr Douglas Rogers have been in litigation for several years over CorVel’s summary termination of Rogers from their workers comp MPN. The court case is somewhat complicated by CorVel’s failure to follow their contractual obligations in terminating Rogers, but the court nonetheless upheld the decision. (Decision is here)

What makes this case so important is it “balances” an earlier case, known as Palm Medical, where SCIF (the state fund of California) refused to admit a provider to its MPN.  Ultimately the court found in the provider’s favor, much to the dismay of the insurer and employer communities.

The CorVel v Rogers case gives payers hope that they can terminate a provider who fails to meet the obligations contained in their contract with the payer, obligations which should – and almost always do – include requirements that the provider follow applicable treatment guidelines, respond to requests for consultation with peer review physicians, and otherwise treat appropriately.

That said, CorVel could have lost the case as it did not follow the “three-step” process in terming Rogers.

What does this mean for you?

Word to the wise payer – if you’re asking the providers to follow the contract, probably a good idea if you do too.  

Thanks to WorkCompCentral for the heads’ up.


3 thoughts on “Kudos to CorVel”

  1. That’s why you should always have that final line in your provider contracts – “This Agreement may be terminated for any or no reason at all by the Participating Provider or the (Name of Company) with thirty (30) days prior written notice to the other party.”

  2. Agree with Downs if you can get it done. There needs to be more provider de-listings of providers on the bad side of the bell curve and especially the egregious ones.

  3. Frankly, this just illustrates the problems with provider networks in general. Why was this physician even in the network? Because he agreed to the discount, that’s why. Discount and penetration is all that these networks care about.

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Joe Paduda is the principal of Health Strategy Associates

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