Physician’s Review Network Chandler Arizona Review

Physician’s Review Network [PRN] is an independent reviewer of denied medical claims, services, etc. PRN’s function is to facilitate NON-PARTISAN reviews of cases that are submitted by insurance companies, at the request of their insured’s, for second opinions on medical treatment necessity, appeals, and denials. nThe company was founded and [still] owned by Dr. Albert Sheff [a 70+ year old retired former penitentiary psychiatrist] and his wife Linda. Dr. Sheff puts forth that PRN offers a medical specialty specific review process that is timely, cost effective, and which factually represents the medical opinion of the physician advisor who is assigned the case. By making this representation PRN and Dr Sheff are perpetuating medical fraud on insurance companies, Attending Physicians, medical claimants, and the public at large. nOften times PRN does indeed facilitate ‘clean’ case reviews and medical opinion. However, FREQUENTLY Dr. Sheff directs staff members to re-submit already-determined cases to a second physician advisor who is likely to render an opinion [recommendation] more along the lines of his own personal opinions. Dr Sheff is neither qualified nor credentialed to render any medical opinion outside of his Psychiatric specialty, yet he continues to do so. nFor example, once a case is returned from the physician advisor it is transcribed and submitted to two levels of QA. Dr. Sheff [and Linda] spends his weekends at the office doing some of the QA himself. Keep in mind Dr. Sheff is NOT the medical Director of PRN, James Gerace, M.D. is. When Dr. Sheff doesn’t like a recommendation, believes a physician advisor approves ‘too much,’ or is in some way opposed to the doctor’s finding he simply instructs the case processor to find another physician to re-submit the case to; sometimes going so far as to state which reviewer to select. Universally these cases are returned with an opposing recommendation – a recommendation Dr. Sheff agrees with – which is then submitted to the insurance provider as an “Un-Biased

integritious report.”” At this point

absolutely nothing could be further from the truth. nThe trickle down effect impacts the claimant [appealing patient] in such a profound way as to be minimally: unconscionable

and maximally: malpractice. In fact

for PRN’s largest client

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