The Silent PPO could also be a middle man and resell their created network of healthcare providers.
[1] The problem, as advocated, is that when the physician negotiated the discount, they intended to give it only in exchange for referrals from members of the insurer – where a patient is given some advance incentive to choose them.
Silent PPOs typically do not make referrals, but provide access to the discount after the service was rendered.
Additionally, providers argue that, had the patient not entered via a back-door arrangement, they would not have been given the discount applied to the contract.
[citation needed] Various companies specialize in auditing medical care contracts and target issues related to Silent PPOs.