Tag: Health Professional Services

Roaring Fork Valley Physicians, IPA, Inc., a Colorado physicians’ group, settled Commission charges of price-fixing by agreeing to halt its use of allegedly anticompetitive negotiating tactics against health insurers. The Commission charged Roaring Fork Valley Physicians I.P.A., Inc., which represents about 80 percent of the doctors in Garfield County, Colorado, with violating the FTC Act by orchestrating agreements among its members to set higher prices for medical services and to refuse to deal with insurers that did not meet its demands for higher rates.

The Commission settled charges that the executive director of a Colorado physicians’ association actively tried to evade the terms of a 2008 FTC order by telling insurers that because she was not named individually in the order, she could simply negotiate on behalf of competing physicians on the “outside” and “not with my [association] hat, but as an individual.” The Commission complaint and consent order settling the FTC’s charges name the executive director individually, and will prevent her from orchestrating or implementing price-fixing agreements among the group’s competing physicians.

The Commission challenged the conduct of Boulder Valley Individual Practice Association for refusing to deal, or threatening to refuse to deal with insurance providers that failed to increase fees paid to group doctors, and also prevented members from contracting with payers, except through Boulder Valley. During the period between 2001 and 2006 Boulder Valley IPA threatened to terminate contracts with payers unless the payers agreed to pay increased fees-for-service set by Boulder Valley, effectively engaging in illegal price fixing, and harming Boulder country area consumers by charging higher prices for the various physician’s services offered. The settlement prohibits Boulder Valley from entering into agreements between or among physicians: 1) to negotiate on behalf of any physician with any payer; 2) to refuse to deal, or threaten to refuse to deal, with any payer; 3) to designate the terms, conditions, or requirements upon which any physician deals, or is willing to deal, with any payer, including, but not limited to price terms; 4) not to deal individually with any payer, or not to deal with any payer through any arrangement other than one involving Boulder Valley.

Alta Bates Medical Group, Inc., a 600-physician independent practice association serving the Berkeley and Oakland, California, area, settleed Commission charges that it violated federal antitrust law by fixing prices charged to health care insurers. The consent order prohibits Alta Bates from collectively negotiating fee-for-service reimbursements and engaging in related anticompetitive conduct. In addition to price-fixing of fee-for-service reimbursements, the FTC’s complaint alleges an unlawful concerted refusal to deal.

The Commission challenged the conduct of AllCare IPA, alleging that AllCare restrained competition in fee-for-service contracts by fixing prices and other contract terms with payers, engaging in collective negotiations over the terms and conditions of dealing with payers, and preventing group members from negotiating with payers except on terms approved by All Care. The Commission issued a consent order prohibiting All Care from entering into agreements between or among physicians: 1) to negotiate on behalf of any physician with any payer; 2) to refuse to deal, or threaten to refuse to deal, with any payer; 3) to designate the terms, conditions, or requirements upon which any physician deals, or is willing to deal, with any payer, including, but not limited to price terms; 4) not to deal individually with any payer, or not to deal with any payer through any arrangement other than one involving All Care.

An administrative law judge upheld the administrative complaint that charged that the North Texas Specialty Physicians (NTSP), a physician group practicing in Forth Worth, Texas, collectively determined acceptable fees for physician services in negotiating contracts with health insurance plans and other third party payers; thus engaging in horizontal price fixing. On December 1, 2005, the Commission issued a unanimous decision upholding the allegations that NTSP negotiated agreements among participating physicians on price and other terms, refused to negotiate with payers except on terms agreed to among its members, and refused to submit payors offers to members if the terms did not satisfy the group’s demands. The Commission concluded that the group’s contracting activities with payors amounts to unlawful horizontal price fixing and that respondent’s efficiency claims were not legitimate and not supported by the evidence.

The respondent appealed the Commission decision to the U.S. Court of Appeals for the Fifth Circuit. The Court agreed with the Commission that the anticompetitive effects of NTSP’s practices were obvious. Per remand by the Court, the Commission modified one provision of its remedial order, issuing a Final Order in September 2008. On February 28, 2009, the U.S. Supreme Court denied NTSP's petition for review.

There is a related administrative proceeding.

On March 7, 2007, the Fifth Circuit Court of Appeals heard oral arguments in the appeal by respondents of the Commission's opinion in NTSP. The Court agreed with the Commission that the anticompetitive effects of NTSP’s practices were obvious. Per remand by the Court, the Commission modified one provision of its remedial order, issuing a Final Order in September 2008. On February 28, 2009, the U.S. Supreme Court denied NTSP's petition for review.

The FTC challenged a group boycott between two Connecticut chiropractic associations in which the health care providers refused to deal with a cost-saving Connecticut health plan. The Commission issued a consent order ending the agreement and preventing the involved parties from entering into such agreements in the future.

The Commission charged a group of optometrists in Puerto Rico with violating the FTC Act by orchestrating agreements among members of the Colegio de Optometras to refuse, or threaten to refuse, to accept vision and health care contracts except on collectively agreed-upon terms. Two leaders of the group were also charged with facilitating the agreement by urging members not to participate in the vision network. The Commission’s consent order settling these charges bars the group and the two leaders from engaging in such conduct, while allowing them to undertake certain kinds of joint contracting arrangements by which physician participants control costs and improve quality by managing the provision of services. FTC staff worked with the Office of Monopolistic Affairs of Puerto Rico’s Department of Justice on this case.