Meeting_Body
FINANCE, BUDGET, AND AUDIT COMMITTEE
MARCH 19, 2026
Subject
SUBJECT: WORKERS' COMPENSATION MEDICAL BILL REVIEW SERVICES
Action
ACTION: APPROVE RECOMMENDATION
Heading
RECOMMENDATION
Title
AUTHORIZE the Chief Executive Officer to execute Modification No. 3 to Contract No. PS61721000, with Lien On Me, Inc. for workers' compensation medical bill review services to exercise the second, two-year option in the amount of $2,541,000, increasing the total contract amount from $5,160,225 to $7,701,225, and extending the period of performance from July 1, 2026, to June 30, 2028.
Issue
ISSUE
Metro's workforce has increased by 20%, rising from 10,219 FTE employees in FY21 to 12,260 in FY26. With this expansion, the Workers' Compensation division has seen an increase in the average monthly number of claims filed, leading to higher volume of medical bills received and processed. Approval of this recommendation exercises the second, two-year option term to continue providing medical bill review services through June 30, 2028. This will ensure that Metro pays for various medical services in accordance with the State of California approved fee schedules and pre-established rates contracted with Preferred Provider Organization (PPO) providers. The current contract expires on June 30, 2026.
Background
BACKGROUND
The review of medical bills is consistent with industry best practices and is a primary technique employed by government agencies and private entities to lower workers' compensation-related medical expenditures. Bill review service providers analyze gross medical billings from physicians, hospitals, pharmacies, and other providers to recommend reductions in conformance with the State of California Fee Schedule and negotiated PPO contract rates. These providers utilize dedicated software that automatically applies reductions in accordance with the state schedule while detecting duplicate billings at the line-item level.
In addition to reviewin...
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