L.A. Care Offers Help to Physicians Post-SynerMed Fraud

Wednesday, February 7, 2018

L.A. Care Offers Help to ‘Orphan’ Physicians After SynerMed Irregularities Discovered

LOS ANGELES — L.A. Care Health Plan, in an effort to protect its members from unethical activities at SynerMed, a healthcare management firm, has launched a full-fledged effort to contract directly with individual physicians who were inadvertently impacted by the fraud-plagued firm. 

After confirming that SynerMed was improperly denying claims, L.A. Care terminated its contract with Employee Health Systems (EHS), an Independent Practice Association (IPA) that was managed by SynerMed. The decision came a month before the California Department of Managed Health Care demanded health plans end their contracts with EHS.

Most EHS physicians in L.A. Care’s provider network also participated in other L.A. Care-contracted IPAs, allowing for the majority of impacted members to continue to see their primary care physicians and specialists. However, some physicians did not have any contracts outside of EHS and, as such, have been identified as ‘orphan’ physicians. To ensure continuity of care for members, L.A. Care is actively recruiting these physicians into its direct network and thereby eliminating the need for them to contract with another IPA. By joining L.A. Care’s direct network — Community Access Network (CAN) — they will support efforts to enhance access and availability to quality health care in Los Angeles County.

All affected physicians are being contacted by mail this week, and physicians interested in joining CAN will be offered various options to find out more about the program. They can:

  • Schedule a one-on-one meeting with an L.A. Care representative by emailing PNMLettersofInterest@lacare.org to set up an appointment.
  • Inquire via email by writing to CANProviders@lacare.org .
  • Call our Provider Network Team at 213-694-1250, x4297.
  • Attend one of two Open Houses. One is February 20 and the other is February 22 at the L.A. Care Family Resource Center in Lynwood. 

L.A. Care will provide all the necessary support that physicians expect from an IPA, but it will be offered directly by the health plan. L.A. Care already has 191 providers in the direct network, which was established in 2016 to expand access and availability across Los Angeles County. 

About L.A. Care Health Plan

L.A. Care Health Plan is a public entity and community-accountable health plan serving residents of Los Angeles County through a variety of health coverage programs including L.A. Care Covered™,  Medi-CalL.A. Care Cal MediConnect Plan and PASC-SEIU Homecare Workers Health Care Plan. L.A. Care is a leader in developing new programs through innovative partnerships designed to provide health coverage to vulnerable populations and to support the safety net. With more than 2 million members, L.A. Care is the nation’s largest publicly operated health plan.