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The Proliferation of Fraudulent Silent (“Mirror”) Healthcare Models – Should I Join?
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief
]
Beware the Silence
A silent, faux, or “mirror” PPO, HMO or other provider model is not a formal managed care organization. Rather, it usually is simply an intermediary attempt to negotiate practitioner fees downward by promising a higher volume of patients in exchange for the discounted fee structure.
Of course, the intermediary then resells the packaged contract product to any willing insurance company or other payer, thereby pocketing the difference as a nice profit. And, sometimes these virtual organizations are just indemnity companies in disguise.
Physicians should not fall for this ploy, since pricing pressure will be forced even lower in your next round of “real” PPO negotiations!
Occasionally, an insurer or bold insurance agent will enter a market and tell its practitioners that they have signed up all the local, or many major, employers. Then, they’ll go to the employers and give them the same story about signing up all the major providers. The true story is that they haven’t signed up either and a Ponzi like situation is created!
As an active fiduciary Certified Medical Planner™, insurance agent and licensed medical provider, I urge you to be on guard for silent HMOs, MCOs and any other silent insurance variation, since these virtual organizations may not exist except as exploitable arbitrage situations for the middleman.
So, has anyone been duped out there?
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Filed under: Health Insurance | Tagged: Insurance Matters |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
Fortunately, I do not have personal experience with this type of model. The concept of a “middleman” is common in many manufacturing and service industries. The middleman can sometimes provide a valuable service, by facilitating sales, manufacturing, or delivery.
The difference in this case is the dishonest nature of the transaction, both for the purchasers and providers of healthcare. Your comparison of this “model” with a Ponzi scheme is quite appropriate!
Brian J. Knabe; MD
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Fee – Fi – Faux
The well know holistic financial advisor Roy Diliberto thinks that fiduciaries should feel a moral obligation to clients and not need a law to force them to do the right thing.
http://www.fa-mag.com/news/the-spirit-of-being-a-fiduciary-15535.html
And, I love the term faux fiduciary; sort of onomatopoetic don’t you think?
Dr. David Edward Marcinko MBA CMP™
http://www.CertifiedMedicalPlanner.org
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