Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Life Health > Life Insurance

Feds Ban Group From Advising Doctors On Network Contracts

Your article was successfully shared with the contacts you provided.

The antitrust division of the U.S. Justice Department has blocked a union affiliate from helping Cincinnati-area gynecologists bargain for higher rates from managed care companies.

The Federation of Physicians and Dentists, Tallahassee, Fla., has agreed to accept a proposed final judgment that would limit its efforts to strengthen physicians’ negotiating power.

The settlement would resolve United States of America vs. Federation of Physicians and Dentists et al., a civil antitrust suit the division filed against the federation in 2005, in the U.S. District Court in Cincinnati. The division published a notice of the proposed final judgment in the Federal Register earlier this week.

The federation, an affiliate of the American Federation of Labor-Congress of Industrial Organizations, Washington, has accused managed care companies of making unfair use of their clout to hold down the reimbursement rates for the doctors in their provider networks.

Federal law prohibits independent physicians from joining unions, but the federation was trying to overcome that obstacle by giving doctors who join the federation private coaching on how to negotiate better contracts.

As a result of federation efforts to help Cincinnati ob-gyns from September 2002 to late 2003, the three largest Cincinnati-area health care insurers were forced to increase fees for federation member ob-gyns by more than 15% in 2003, more than 20% in 2004 and more than 25% in 2005, officials say in the impact statement.

The antitrust division accused the federation, a federation employee and three local physicians who helped the federation, of violating Sherman Act antitrust provisions.

The three physicians settled in November 2005.

The proposed final judgment with the federation and the federation employee would prohibit them from:

- Representing (including as a messenger) any private-practice physician with any payer.

- Reviewing or analyzing, for any such physician, any proposed or actual contract or contract term between such physician and any payer.

- Communicating with any independent physician about that physician’s, or any other physician’s, negotiating, contracting, or participating status with any payer.

- Responding to any question or request initiated by any payer, except to state that the final judgment prohibits such a response.

- Training independent physician in any aspect of contracting or negotiating with any payer.

The proposed final judgment would permit the federation — and the federation employee accused of antitrust violations — to speak about general topics, including contracting, at regularly scheduled medical continuing education seminars.

The federation and the federation employee also could publish articles on general topics, including contracting, in a newsletter, and they could educate independent physicians about legislative developments in workers’ compensation, Medicaid, and Medicare programs other than Medicare Advantage, officials say.

The federation has agreed to the proposed judgment in Cincinnati and a similar consent decree in Delaware because it lacks the resources to keep up the fight, according to Jack Seddon, the federation’s executive director.

The proposed Cincinnati judgment “certainly puts restrictions on what we can do,” Seddon says.

But the federation plans to make use of the exceptions in the proposed judgment to collect and publish actual historical physician reimbursement rate data, Seddon says.

Rep. Tom Campbell, R-Calif., introduced a bill in 1999 that could have given doctors in independent practices the right to unionize.

Objections from House Republican leaders and many Republicans in the Senate derailed that bill.

Now, Rep. John Conyers Jr., D-Mich., chairman of the House Judiciary Committee, is asking questions about the issue, Seddon says.


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.