The Department of Managed Health Care issued a cease and desist order to 9 health plans to no longer contract with Employee Health Systems Medical Group for the care of some 600,000 Medi-Cal patients in multiple counties in California. The plans, which include Blue Cross of Ca., AETNA and HealthNet among others, were contracting with EHSMG to provide utilization management, provider credentialing and other services. EHSMG would in turn contract with SynerMed, Inc. which would then provide those services. The DMHC alleges that these entities unreasonably limited access to specialty care through use of limited networks and a conscious plan to do so. DMHC has jurisdiction over the plans and their cease and desist order requires them to not contract with these entities and find alternative sources for services. EHSMG denies the allegations.
Here is a link to the order:
DME/medical supply providers may have outstanding authorizations for goods and services to Medi-Cal patients in these geographic areas.
