Tag: Health Professional Services

Eight independent nephrologists in Puerto Rico settled Federal Trade Commission charges that they illegally collectively bargained with insurers and refused to treat health plan patients when their price demands were rebuffed. Under a proposed order settling the FTC’s charges, the doctors are barred from jointly negotiating prices, jointly refusing to deal with any insurer, and jointly refusing to treat patients. According to the FTC’s complaint, the eight doctors have violated federal antitrust laws since late 2011 by 1) collectively negotiating and fixing the prices upon which they would contract with Humana to extract higher reimbursement rates, and 2) collectively terminating their contracts with Humana and refusing to treat Humana patients enrolled in the Mi Salud program when Humana would not meet their price demands.

The Commission required laboratory testing companies Laboratory Corporation of America Holdings and Orchid Cellmark Inc. to divest a portion of Orchid's paternity testing business, to resolve the FTC complaint alleging that LabCorp's $85.4 million acquisition of Orchid would have an anticompetitive impact in the market for paternity testing services used by government agencies. Under the proposed settlement order, the portion of Orchid's U.S. paternity testing business that is focused on sales to government agencies, and related assets, will be sold to another testing company, DNA Diagnostics Center (DDC). On 2/1/2012, the FTC approved a final order.

An association representing 900 physicians in the Amarillo, Texas, area agreed to a Commission order barring it from jointly negotiating the prices it charges insurance providers. The FTC alleged in a complaint filed with the order that the association, Southwest Health Alliances, Inc., d/b/a BSA Provider Network, has violated federal law since 2000 by fixing the prices its member doctors would charge insurers. The Commission's order requires the association to cease and desist.

The Minnesota Rural Health Cooperative (MRHC), comprised by a group of doctors and hospitals in southwestern Minnesota, agreed to a settlement with the Federal Trade Commission that prohibits anticompetitive tactics the group allegedly used to increase health insurance reimbursement rates. The MRHC is made up of approximately 25 hospitals and 70 doctors, representing most of the hospitals and half of the primary care physicians in southwestern Minnesota. According to the FTC’s complaint, when members join the MRHC, they agree that the group’s board of directors will negotiate and contract with health insurers on their behalf and that they will abide by the MRHC contracts. The settlement order bars the MRHC from using coercive tactics to extract favorable contract terms from health plans. In addition, the order requires the MRHC to offer to renegotiate all current contracts with health plans and to submit any revised contracts for state approval.

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.