Tag: Health Professional Services

A doctors’ group consisting of nearly every obstetrician and gynecologist with active medical staff privileges at the two general acute care hospitals in Napa County, California settled charges that they restrained price and other competition by engaging in illegal agreements to fix fees and other terms of dealing with health care insurance plans. According to the complaint issued with the consent order, the doctors refused to deal with the third party payers except on collectively determined terms. The consent order not only prevents the doctors from engaging in similar practices in the future but also requires the dissolution of the group.

An association of 86 physicians practicing in the Fairbanks, Alaska area settled charges that the Alaskan Healthcare Network illegally formulated a fee schedule based on its members’ current prices for use in negotiations with third-party payers in an effort to obtain higher prices for medical services.

The dental association with a membership of more than 1800 dentists practicing in Puerto Rico agreed not to encourage its members to enter into agreements that set or fixed the fees charged or terms and conditions under which dentists would deal with health insurance plans or other payers in an attempt to obtain higher reimbursement rates for dental services.

General surgeons and six competing general surgery practice groups in the Austin, Texas area settled charges that they collectively refused to deal with two health plans, forcing the plans to accept the surgeons’ demands to raise surgical rates.

The Wisconsin Chiropractic Association and its executive director, Russell A. Leonard, settled charges that they conspired to fix the prices for chiropractic goods and services and to boycott third party payers in an attempt to obtain higher reimbursement rates for services and contracts in the La Crosse, Wisconsin area.

Physicians practicing in the North and South Lake Tahoe areas settled charges that they conspired to fix the prices and terms for professional services. The consent order prohibits the IPA from engaging in collective negotiations to fix prices; refusing to deal with third party payers; and coercing payers into accepting PA fee schedules and minimum reimbursement rates.

A Colorado physicians' organization settled charges alleging that the Mesa County IPA conspired with its members to increase prices for physician services and thereby prevented third party payers such as preferred provider organizations, health maintenance organizations, and employer health care purchasing cooperatives from offering alternative health insurance programs to consumers in Mesa County.

Dentists in three communities in Puerto Rico settled charges that they refused to provide dental services under the government's managed care plan for the indigent unless they received certain prices. Under the terms of the consent order, the dentists are prohibited from jointly boycotting or refusing to deal with any third party payer to obtain higher reimbursement rates for dental services.

A group of physicians in the area of Lake Charles, Louisiana settled charges that they illegally conspired to fix the prices for professional services by engaging in joint price negotiations with third-party payers. The final consent order prohibits such practices but does allow the MDP to engage in legitimate joint conduct.

Consent order settles allegations that Urological Stone Surgeons, Parkside Kidney Stone Centers, Urological Services. Ltd and two physicians engaged in a price-fixing conspiracy to raise the price for professional urologist services for lithotripsy procedures in the Chicago metropolitan area. The complaint alleges that the parties agreed to use a common billing agent, established a uniform fee for lithotripsy services, prepared and distributed fee schedules, and negotiated contracts with third party payers on behalf of all urologists using the Parkside facility. The consent order prohibits such practices in the future and requires the parties to notify the Commission at least 45 days before forming or participating in an integrated joint venture to provide lithotripsy professional services.

The Commission authorized staff to file a complaint and settlement in federal district court to settle allegations that the College and three physician groups engaged in an illegal boycott in an effort to coerce the government to make price-related changes under Puerto Rico's government-managed care plan for the indigent. According to the complaint, filed by the Commission and Puerto Rico's Attorney General in the U.S. District Court of Puerto Rico on October 2, 1997, the College and physicians engaged in an eight day boycott of all physician services for non-emergency patient care, which caused many people to be treated at area hospital emergency rooms and forced others to completely forego medical care. The settlement prohibits such practices in the future and in addition, requires the College to pay $300,000 to the catastrophic fund administered by the Puerto Rico Department of Health.