Advisory Opinions - Yearly Index

YEARLY INDEX OF HEALTH CARE ANTITRUST ADVISORY OPINIONS
BY COMMISSION AND  STAFF
March 12, 2001

Health Care Adivsory Opinions Index

2000

  • Northeast Pharmacy Service Corporation. To Paul E. Levenson; July 27, 2000.
    (Network of independent pharmacies in Massachusetts and Connecticut offering package of medication-related patient care services to physician groups).

1999

  • BJC Health System. To Gary Senner; November 9, 1999. (Sale of pharmaceuticals by non-profit hospital system to the system's employees, affiliated managed care program enrollees, and home care subsidiary).
  • Orange Pharmacy Equitable Network. To John A. Cronin, Pharm D., J.D.; May 19, 1999. (Network of retail pharmacies and pharmacists offering drug product distribution and disease management services).
  • Wesley Health Care Center, Inc. To David A. Ruffo; April 29, 1999. (Sale of pharmaceuticals by non-profit skilled nursing facility to volunteers working at the facility).

1998

  • Associates in Neurology, Inc., To Robert C. Norton; August 13, 1998. (IPA network composed of eleven neurologists formed to contract with managed care plans).
  • Phoenix Medical Network, Inc. To William T. Harvey; May 19, 1998. (Physician network of osteopathic services providers formed to contract with third party payers).
  • North Mississippi Health Services. To Bruce J. Toppin, Esq.; January 7, 1998. (Sales of pharmaceuticals by non-profit hospital to patients of the hospital’s cancer treatment center).

1997

  • Alliance of Independent Medical Services, LLC. To Timothy C. Cashmore; December 22, 1997. (Network of ambulance and ambulette services providers formed to contract for transportation services with third party payers).
  • Community Hospital, Inc. To Darrell O. Fancher; December 22, 1997. (Corporate restructuring of nonprofit hospital corporation).
  • New Jersey Pharmacists Association. To Allen Nichol, Pharm. D.; August 12, 1997. (Pharmacist network offering health education and monitoring services to diabetes and asthma patients).
  • First Look, L.L.C. To James L. Wiant; June 19, 1997. (Network of optical firms organized to respond to requests for proposals for employer contracts for optical and vision services).
  • Yellowstone Physicians, L.L.C. To David V. Meany, Esq.; May 14, 1997. (Multispecialty physician network joint venture formed to contract with third party payers).
  • Foundation for the Accreditation of Hematopoietic Cell Therapy To Paul L Yde; April 17, 1997. (Standard-setting and accreditation program for organizations involved in medical or laboratory practice related to hematopoietic progenitor cell therapy).
  • Henry County Memorial Hospital To Clifton E. Johnson, Esq.; April 10, 1997. (Sales of pharmaceuticals by non-profit hospital to patients of the hospital’s PHO).
  • Ohio Ambulance Network. To Shawn M. Lyden, Esq.; January 23, 1997. (Network of ambulance and ambulette services providers formed to contract for transportation services with third party payers).
  • Mobile Health Resources. To John A. Cook, Esq.; January 23, 1997. (Network of ambulance companies formed to contract for transportation services with third party payers).

1996

  • Southwest Florida Oral Surgery Associates. To Guy E. Whitesman; December 2, 1996. (Cooperative of oral and maxillofacial surgery practices formed to jointly market services to third party payers).
  • North Ottawa Community Hospital. To Sheldon Klein, Esq.; October 22, 1996. (Sales of pharmaceuticals by non-profit hospital to unaffiliated, non-profit hospice).
  • Business Health Companies, Inc. To Ralph T. Smith, Jr.; October 18, 1996. (Survey of hospital prices by third party consultant).
  • North Mississippi Health Services. To Bruce J. Toppin, Esq.; October 3, 1996. (Sales of pharmaceuticals by non-profit medical center to retired employees).
  • Valley Baptist Medical Center. To Daniel L. Wellington, Esq.; September 19, 1996. (Sales of pharmaceuticals by non-profit medical center to medical center operated clinic).
  • Mayo Medical Laboratories. To George A. Cumming, Jr., Esq.; July 17, 1996. (State or regional networks of hospital laboratories providing outpatient laboratory services organized to compete for payer contracts).
  • Wiliam W. Backus Hospital. To Robert M. Langer, Esq.; June 11, 1996. (Sales of pharmaceuticals by non-profit hospital to related non- profit clinics).
  • American Medical Association. To Kirk B. Johnson; March 26, 1996. (Dissemination of public information relating to proposed revisions to Medicare’s resource-based relative value scale).
  • Uronet of Louisiana, L.L.C. To Christopher C. Johnston; January 23, 1996. (IPA network of urologists formed to contract with managed care plans).

1995

  • Southern Arizona Therapy Network, Inc. To Martin Janello; December 7, 1995. (Provider network of physical, occupational, and speech therapists organized to facilitate contracts among network members and payers).
  • Columbine Family Health Center. To Richard J. Sahli; November 8, 1995. (Proposal to add a patient sorting provision to an agreement between an acute care hospital and a rural health care clinic).
  • Eastern Ohio Physicians Organization, Inc. ("EOPO"). To Stephen P. Nash, Esq.; September 28, 1995. (Multi speciality physician organization established to contract on behalf of its participating physicians with third party payers).
  • Central Texas Medical Group  ("CTMG"). To John P. Dunn, M.D.; September 28, 1995. (IPA plans to distribute information and educate its members on managed care and community issues).
  • Hematology/Oncology Care Specialists of Western Pennsylvania, P. C. To Stephen P. Nash, Esq.; September 21, 1995. (Physician network of hematology/oncology services providers formed to negotiate with third-party payers).
  • Otolaryngology Specialty Providers of Georgia. To Thomas W. Rhodes, Esq.; August 15, 1995. (Physician network of otolaryngology services providers formed to facilitate individual contracts among network members and third-party payers).
  • Northwestern Nevada Orthopaedic Surgery Alliance. To Jacqueline C. Cox; July 11 & 27, 1995. (Physician network of orthopaedic services providers formed to facilitate individual contracts among network members and payers).
  • Elmore Community Hospital, Inc. To Derrell O. Fancher; June 20, 1995. (Joint venture between two acute care hospitals for the purchase of certain personnel and other services).
  • California All Health. To William G. Kopit, Esq. and Clifford E. Barnes, Esq.; June 14, 1995. (Joint venture of six health maintenance organizations formed to bid for certain California Medicaid contracts).
  • Erlanger Medical Center/ Women's East Inc. To Carlos C. Smith, Esq. and Edward N. Boehm, Esq.; May 31, 1995. (Joint venture between two acute care hospitals for establishment of a new hospital specializing in obstetrical hospital services).
  • Oakland Physician Network, L.L.C. To John A. Cook, Esq.; March 28, 1995. (Physician network joint venture composed of primary care physicians formed to market primary and specialty physician services to health benefit plans).

1994

  • Rocky Mountain Cardiovascular Affiliates. To Neil E. Ayervais, Esq.; September 23, 1994. (Limited liability company composed of physician cardiovascular services practices formed to negotiate and contract with third party payers).
  • Palmetto Dental Alliance. To Scott Y. Barnes, Esq.; September 23, 1994. (Proposed exclusive provider organization to provide dental services to beneficiaries of third party health benefits plans).
  • Suffolk County Dental Society. To Steven L. Roberts, Albert A. Sunshine, DDS, Chairman, Ethics Committee; July 6, 1994. (Legality of "exclusive dental plans"; proposed dental society disciplinary action against dentists sponsoring such plans).
  • South East Managed Care Organization/Jackson Medical Cooperative. To George Q. Evans, Esq.; July 5, 1994. (Physician network joint venture between physician directed managed care organization and group of physician providers).
  • ACMG, Inc. To Paul W. McVay, President; July 5, 1994. (Proposed agreement between state medical society and independent health care management and development company to establish society- sponsored state-wide PPO).
  • Elkhart General Hospital. To Clifton E. Johnson, Esq.; June 13, 1994. (Sales of pharmaceuticals by non-profit hospital to hospital operated home health care program).
  • *American Medical Ass'n. (1994). To Kirk B. Johnson, General Counsel; February 14, 1994. (Professional society peer review of physicians' fees: required physician participation in advisory fee review; medical society discipline for fee-related conduct).

1993

  • *Presentation Health System.  To Tamara D. Lee, Esq.; December 21, 1993. (Sales of pharmaceuticals by non-profit hospitals to related non-profit long-term care facilities).
  • California Managed Imaging Medical Group, Inc. To J. Bert Morgan, Esq.; November 17, 1993. (Radiologist-owned PPO network to provide professional radiology services to payers on a regional or statewide basis; letter discusses fee-setting, market power, and limitation of provider panel).
  • Unnamed Hospital. To James D. Miller, Esq.; March 31, 1993. (Non- profit hospital purchase of drugs to be dispensed to HMO members and to members of a senior citizens' program).

1992

  • Oneida City Hospital. To Linus W. Walton, Esq., City Attorney; June 1, 1992. (Sale of prescription drugs by a city-operated hospital to city employees at a price reflecting discounts received by the hospital).

1991

  • Benedictine Health Centers. To Patrick M. Sheller, Esq.; July 10, 1991. (Hospital offer of free office space to newly recruited physicians).
  • IPA sponsored PPO. To Martin J. Thompson; June 20, 1991. (Physician IPA network that sponsors a PPO to negotiate prices with hospitals whose services will be marketed as part of the PPO).
  • Dental Consultant Salary Survey. To Samuel D. Dednam, D.M.D.; May 30, 1991. (Survey of salary ranges for certified dental consultants).
  • Wichita Area Chamber of Commerce. To F. Tim Witsman, President; May 22, 1991. (Collective allocation by hospitals of services, equipment, or facilities).
  • National Capital Society of Plastic and Reconstructive Surgeons. To Robert J. Wilensky, M.D., President-Elect; April 23, 1991. (Physician panel to render advisory opinions regarding fee disputes).

1990

  • American Society of Cataract and Refractive Surgeons. To Jerald A. Jacobs, Esq.; September 20, 1990. (Advisory advertising guidelines).
  • American Dental Association. To Peter M. Sfikas, Esq.; February 15, 1990. (Study of establishment of UCR rates by dental insurers and the impact of those rates on consumers' out-of-pocket costs).
  • Independent Video Services. To Bonnie B. Larson, Marketing Manager; January 17, 1990. (Price differences in sale of educational video programs to physicians and hospitals).

1989

  • Pan American Management Associates. To Robert P. Macina, Esq.; June 27, 1989. (Limited partnership between hospital and physicians to establish a PPO; physicians to be excluded from price negotiations with payers).

1988

  • Intracorp. To Sharon B. Donzis, Esq.; March 25, 1988. (Cost- containment service to use physician-developed RVS to determine UCR price screens).
  • Washington Health Care Ass'n. To Stephen J. Maag, Director of Legal and Regulatory Affairs; February 16, 1988. (Nursing home association program to evaluate the quality of care provided by nursing homes).

1987

  • Academy of Ambulatory Foot Surgery. To Andrew K. Dolan, Esq.; July 31, 1987. (Professional association assistance to third-party payers in determining when foot surgery may be restricted to less expensive outpatient settings).
  • Maryland Medical Eye Associates. To Charles E. Rosolio; May 15, 1987. (Formation, marketing, and operation of a partially integrated professional organization, owned by nine ophthalmologists who are in five separate medical practices, to offer services to HMOs and other groups on a capitation and fee schedule basis).

1986

  • Pacific International Health, Inc. To Richard C. Greenberg, Esq.; August 28, 1986. (Formation and operation of a provider-controlled PPO; price agreements to be between individual participating physicians and each payer).
  • Association for Quality Health Care, Inc. To Cecil M. Cheves, Esq.; August 28, 1986. (Association of employers with self-funded health plans to negotiate with providers).
  • The Equitable Life Assurance Society. To Jonathan E. Gaines, Esq., V.P. and Counsel; March 26, 1986. (Insurer to enter into contracts with hospitals for DRG-based payment; prices would apply to insurer's own business and would be available to self-funded plans that contract with the insurer for that service).
  • California PPO. To: Michael A. Duncheon, Esq.; March 17, 1986. (Proposal by PPO composed of multiple hospitals and physician organizations to negotiate contracts with third-party payers).
  • Passaic County Medical Society. To William T. McGuire, Executive Director; January 3, 1986. (Professional society peer review of physicians' fees that is mandatory and binding on the physician).

1985

  • North Texas Chapter of the American College of Surgeons. To B. Ward Lane, M.D., President; December 12, 1985. (Survey of members' fees).
  • American Intra-Ocular Implant Society. To Jerald A. Jacobs, Esq.; October 11, 1985. (Development of standard disclosure protocol for intraocular lens manufacturers who offer inducements to physicians).
  • Private Healthcare Systems. To Michael L. Denger, Esq.; September 24, 1985. (Proposal by an insurer to develop a proprietary national network of managed health care systems and to function as a joint purchasing agent for commercial health insurers).
  • American Dental Association. To Peter M. Sfikas, Esq.; August 26, 1985. (Survey of range of dentists' fees in local markets).
  • *American Society of Internal Medicine 105 F.T.C. 505 (1985). To William G. Kopit, Esq.; April 19, 1985. (Development and dissemination of RVG by association of physicians).
  • Utah Society of Oral and Maxillofacial Surgeons. To Dennis L. Dedecker, D.D.S., Secretary; February 8, 1985. (Survey of range of fees and average fees charged by members).

1984

  • Tarrant County Medical Society. To Lynn C. Perkins, M.D., President; July 11, 1984. (Medical society advisory fee review program for the voluntary resolution of disputes).
  • Maine Medical Ass'n. To Frederick C. Holler, M.D., President; May 14, 1984. (Physician association to urge members to freeze fees or to lower fees by a given percentage).
  • Peer Review Organizations of Ohio Foundation. To Larry D. Spencer, Executive Director; April 25, 1984. (Association of nine Professional Standards Review Organizations to bid for contract with HHS to serve as a Peer Review Organization for Ohio under the Medicare program).
  • Kitsap Physicians Service. To William G. Kopit, Esq.; May 22, 1984, and March 26, 1984. (Proposal by physician-owned IPA/HMO with most of the local physicians as participants to close off access to plan to new/additional physicians).
  • HMO/IPA. To Gilbert M. Frimet, Esq.; March 22, 1984. (Use by IPA of fee schedule to allocate capitation payment among participating physicians; proposal to require exclusive dealing by IPA members with the IPA).
  • American Podiatry Association. To Werner Strupp, Esq.; March 13, 1984. (Use of HCFA's Medicare fee profile by society as reference aid in reviewing reasonableness of disputed fees).
  • Medical Society of the County of Erie. To James F. Phillips, M.D., President; March 12, 1984. (Medical society discussions with third- party payers regarding fee allowances).
  • North Carolina Chiropractic Ass'n. To Collin M. Haynie, D.C., Chairman, Ethics Committee; February 29, 1984. (Code of ethics provisions regarding advertising, prior approval of advertising, and fee discounts).

1983

  • American Podiatry Association. To Norman Klombers, DPM, Executive Director, and John Grad, Esq., General Counsel, Podiatry Society of Virginia; August 18, 1983. (Professional society advisory peer review of fees, utilization, and quality of care).
  • American Academy of Ophthalmology,101 F.T.C. 1018 (1983). To Jerald A. Jacobs, Esq.; June 17, 1983. (Code of ethics provisions regarding delegation of services to non-physician health care providers, arrangements for postoperative care, use of experimental procedures, and advertising).
  • Health Care Management Associates. 101 F.T.C. 1014 (1983). To Irwin S. Smith, M.D., President; June 7, 1983. (PPO organized by an independent intermediary between physicians and payers).
  • Rhode Island Professional Standards Review Organization, 101 F.T.C. 1010 (1983). To Edward J. Lynch, Executive V.P.; May 9, 1983. (Physician organization nonbinding peer review for private employers' health benefits programs).
  • Burnham Hospital. 101 F.T.C. 991 (1983). To Robert E. Nord; February 24, 1983. (Grant to physician group of exclusive right to offer radiology services at a hospital).

1982

  • Louisiana Health Care Ass'n. To Steven E. Adams, J.D., Director of Governmental Relations; April 23, 1982. (Group purchasing agreement for nursing home association's members).
  • *Iowa Dental Ass'n. 99 F.T.C. 648 (1982). To Peter M. Sfikas, Esq.; April 8, 1982. (Voluntary and advisory professional society peer review of dentists' fees).

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Rev. Friday, October 25, 1996