I worked for this business for a few years in a couple of their Maryland locations. Without a doubt, they go out of their way to gouge the consumer and insurance company for every cent they can. I worked on the floor, meaning I was medical staff (not administrative up front).
The rules come from the headquarters in Richmond and it is up to the medical directors to enforce them. In one center I worked, the director basically let the staff do what they thought best for the patient, even if it didn't go by Patient First guidelines. As long as it didn't hurt the person, everything was fine. At the other center, it was Patient First way or the highway. I was SO miserable whenever the assistant director worked. She whined and moaned about EVERYTHING. If a person came in writhing in pain and it was obvious they needed to go to the hospital, she would make sure they got a whole slew of lab tests before the ambulance got there (these same tests would be repeated when they got to the hospital minutes later). A few doctors ordered custom splints for people that had no broken bones. Other doctors love giving IV fluids to people (even when they are not sick) because not only do they get lots of money, but it ties up the room for hours and they don't have to work as hard. If a person has no insurance, some doctors would lower their charges. Those doctors that lowered the charges would actually get in trouble!
I went to a holiday party and all the head honchos came up from Virginia. My husband and I were greeted by a few of them and I asked one of the nurses afterwards who they were (I forgot the second they told me their names). A couple were doctors but one was just a business executive and the other a lawyer. It turns out, the lawyer, who is part owner, was the one making some of these billing rules!
Towards the end, I really thought the company was going to get investigated (and me too) for the some of the things they did. Some stuff was a little shady but I guess the worst thing they did was order a bunch a tests when they knew the patient would have to go to the hospital anyway. Not all of the doctors did it and I feel sorry for the ones that did the right thing because I'm sure their bosses threatened them about it.