Saturday, February 24, 2018

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Health plans terminate contracts with EHS and transition patients to other entities

The California Department of Managed Health Care (DMHC) issued a cease-and-desist order on December 26, 2017, requiring nine health plans to terminate their contracts with Employee Health Systems (EHS) Medical Group Inc. This order comes after SynerMed—a company closely affiliated with EHS—was accused of blocking patient access to specialists to hold down costs.

EHS has 600,000 patients statewide—90 percent of whom are Medi-Cal managed care patients. As required by the DMHC, health plans affected by this order were required to submit a transition plan by January 3, 2018 and have begun the transfer all EHS patients to different health care providers due to be completed by February 5, 2018.

EHS reports to the California Medical Association (CMA) that provider capitation checks for January have been issued and all fee-for-service payments to physicians will continue through the end of January uninterrupted. Additionally, the health plans have representatives onsite at SynerMed to ensure the timely exchange of authorization data and that enrollee and physician inquiries are being addressed appropriately.

Other groups affected by the health plan terminations are Multicultural Medical Group, a San Diego based independent medical association acquired by EHS in late 2017, and Inland Valleys IPA acquired by EHS in 2009. Continue reading on cmanet.org.

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