Pacific Health Care Organization Inc (OTCQB: PFHO) is a California-based managed care services company that helps employers control the cost of workers' compensation claims. Revenue is generated through fees for medical bill review, utilization review, Medicare set-aside arrangements, and workers' compensation carve-out services, with pricing structured as flat fees per bill reviewed, percentages of savings achieved, and negotiated caps on hospital bill review. The company targets employers seeking to reduce workers' compensation costs, with county and city government entities among its disclosed customer types. PFHO operates out of Irvine, California, with the majority of its workforce remote as of the 10-K filed March 18, 2026. In fiscal year 2025, total revenues grew 11% year over year and net income reached $1,387,647, a 57% increase versus fiscal year 2024, partly aided by one-time Employee Retention Credit refunds of $488,655 from the Internal Revenue Service. The market for these services is described in the filing as fragmented and competitive, with national managed care providers among the competitors PFHO faces.

Revenue model

Fee-per-bill for medical bill review; percentage-of-savings fees for preferred provider organization repricing and hospital bill review, typically with a negotiated cap; service fees for utilization review, Medicare set-aside arrangements, and workers' compensation carve-out consulting.

Products and services

Medical bill review (coding review, re-bundling, fee schedule compliance, out-of-network review, pharmacy review, PPO repricing); hospital bill review; utilization review; Medicare set-aside services for workers' compensation claims; workers' compensation carve-out negotiation and administration for California employers.

Customers and end markets

Employers seeking to control workers' compensation claim costs, including county and city government customers. End market is California workers' compensation managed care, with some service applicability noted in other states.

Value-chain role

Third-party managed care intermediary sitting between employers and medical providers in the workers' compensation claims process, reviewing bills, managing treatment authorization, and structuring settlement arrangements.

Geographic exposure

Primary operations in California; principal executive office in Irvine, California as of March 31, 2027 lease expiration. Some services noted as applicable in other states.

Competitors

National managed care providers (named category in filing, specific names not disclosed)

Source: SEC 10-K, filed 2026-03-18

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