EMC Silent PPO Class Action Certified

Plaintiffs in the Employers Mutual Casualty Class Action Lawsuit allege they’ve been underpaid by approximately 20% of their medical services/bills on workers’ compensation claims because Employers Mutual Casualty (EMC) engages in a “silent PPO scheme.”

“Silent PPO” is the term used for the somewhat common practice of companies who are responsible for paying medical claims, such as EMC, improperly deducting PPO discounts from their payments to medical providers. The term “silent” is used because providers are not told the PPO discount will be taken until after the service is rendered and the claim has been processed. This often occurs because the physician’s PPO provider network and its accompanying negotiated contracts are sold to third-party payers and brokers without the physician’s knowledge or consent. Physicians only become aware that they’ve been enrolled in a silent PPO when they provide services to a patient not covered by the PPO or when they’re reimbursed at a discounted rate and not the higher rate they were expecting. The American Medical Association believes this practice is fraudulent and began cracking down on silent PPOs in past 5 to 10 years. It estimates medical providers nationwide have lost between $750 million and $3 billion annually since silent PPOs became common 20 years ago.

The Employers Mutual Casualty Class Action Lawsuit charges that EMC “wrongfully and deceptively reduced payments” to licensed healthcare providers on valid claims “by claiming the benefits of PPO agreements without performing any of the associated obligations to that agreement.”

The newly certified class action lawsuit includes all Illinois health care providers who treated workers’ compensation patients from February 1, 2004 to the present. A copy of the lawsuit can be read here.