The California Chiropractic Association, filed a lawsuit in the San Francisco Superior Court on August 31, against One Call Care Management and Align Networks, Inc. claiming that the defendants engaged in “acts of unfair competition.” It seeks an injunction against the alleged practices, and money damages.

The California Chiropractic Association (CalChiro) was established in 1928, and is a Sacramento-based statewide, nonprofit organization of chiropractic doctors and allied industries. CalChiro is comprised of 27 districts and three student chapters. CalChiro is governed by a board of directors elected by its 2,200 members.

One Call Medical, Inc. is a New Jersey corporation that lists with its principal place of business in Jacksonville, Florida. Align Networks, Inc. was acquired by One Call in 2013 and is also a Florida corporation, and a subsidiary and division of One Call. One Call establishes provider networks for the workers’ compensation community.

According to the allegations of the complaint One Call “is known in the industry as a “cost containment” firm. In essence, One Call is nothing more than a for-profit “middleman” in California’s workers’ compensation system. OCM operates as an unlicensed network broker, contracting, on the one hand, with the payors of workers’ compensation services, including workers’ compensation insurers, self-insured employers and third party administrators, to handle the scheduling and payment of treatment visits for injured workers, and, on the other hand, with the health care professionals who provide health care services to injured workers at the deeply discounted rates imposed by OCM.”

They go on to allege that One Call “generally pays its contracted chiropractors significantly below what chiropractors would be paid under the 2018 California Official Medical Fee Schedule (“OMFS”) for workers’ compensation treatment services.”

However, the complaint alleges that “unlike traditional PPO arrangements, injured workers are not simply free to select a health care provider from among the contracted health care professionals. Rather, OCM assigns injured workers to the provider of OCM’s choosing, thus further ensuring it maximizes its revenue by assigning these injured workers to the providers who have acquiesced to the deepest discounts.”

But then the plaintiffs allege that One Call illegally keeps most of the difference in the reduced fee. They allege for example, “assume OCM agrees to provide all the services one of its client’s injured workers need for 10% less than the OMFS for workers’ compensation treatment services; that is, the client agrees to pay OCM 90% of the OMFS for workers’ compensation treatment services for treatment services needed by its employees and insureds. If OCM then pays its contracted chiropractor 50% of the OMFS, OCM would retain 40% of the OMFS for its management services – nearly as much as the chiropractor received for the provided chiropractic treatment.”

This scheme, according to the allegations of the plaintiffs “violates California’s Unfair Competition Law, Cal. Bus. & Prof. Code §§ 17200, et seq. (“UCL”), as well as the numerous California laws that prohibit Defendants from engaging in illegal payment schemes, prohibiting referral systems for workers’ compensation treatment services that are directly tied to financial incentives, prohibiting Defendants from operating without the required authorizations as a physician network service provider, claims administrator or claims adjustor, and otherwise interfering with the health care services being provided to injured workers by their chiropractors.”

One Call and Align have 30 days to answer or otherwise respond to the allegations of the complaint.