Silent PPOs

Silent PPOs are corrupt reimbursement tools developed by payers to deceive providers into accepting improper discounts. Silent PPOs are difficult to identify because the payers purport to belong to a PPO network that the provider actually accepts. TGF works with providers to identify these issues and recover unpaid balances from imprudent payers who employ these illegal methods. TGF devotes particular emphasis to this area because a silent PPO is not merely an abuse of power, but intentional, fraudulent activity.

TGF works within the civil justice system, aptly turning the tables on these payers by treating the fraudulent discount as a UCR denial and asserting rights to balance bill. By leveraging the right to bill the patient, TGF resolves silent PPO issues directly with the payer and avoids inefficiencies of dealing with TPAs.


  • Silent PPOs are illegal reimbursement tools developed by payers to deceive providers into accepting improper discounts
  • Silent PPOs are often difficult to identify—TGF works with providers to identify these issues and pursue imprudent payers who employ these methods
  • The illegal methods of reimbursement are deserving of special attention because they are not merely abuses of a weakness, but intentionally fraudulent activity
  • TGF aptly turns the tables on these payers by treating the fraudulent “discount” as a UCR denial—which it actually is—creating balance billing liability for the patient
  • By leveraging patient’s rights against the payer, TGF works to resolve silent PPO issues directly with the payer and avoids inefficiencies of third party administrators