A federal district court in the Eighth Circuit dismissed claims brought against a physician-hospital organization and an insurer alleging that the defendants violated federal antitrust laws by refusing to deal with certain providers. An ambulatory surgery center (ASC) and two physicians asserted that the …
Federal Court Allows Hospital’s Antitrust Claims to Proceed on Narrow Market Definition
March 27, 2015 Leave a Comment
Winning an antitrust lawsuit hinges on defining the “relevant market,” and this case may prove the point. Methodist Health Services Corporation notched the first win in its battle against Saint Francis Medical Center as a federal court allowed Methodist’s suit to proceed despite a narrow market definition …
OIG Advises that Exclusive Lab Referral Arrangement May be a Kickback
March 25, 2015 Leave a Comment
The Department of Health and Human Services Office of Inspector General (OIG) released an advisory opinion (No. 15-04) today that states a proposed arrangement to provide free laboratory tests for certain patients of associated physician practices could implicate the federal anti-kickback law. An unnamed …
Insurer’s Agreements with Providers Are Not Per Se Antitrust Violations
March 6, 2015 Leave a Comment
The Iowa Supreme Court refused to categorize a health insurer’s agreements with providers in Iowa and its participation in the national Blue Cross and Blue Shield (BCBS) network as per se violations of the antitrust laws. In its decision in Mueller v. Wellmark, Inc. issued on February 27, 2015, the court …
It Was the Economy, Stupid!
January 29, 2015 Leave a Comment
Remember Bill Clinton’s 1992 campaign mantra, “It’s the economy, stupid!” A study released today by the Robert Wood Johnson Foundation indicates those four words are the best answer to the question, “Why are so many employers dropping health insurance?” Or, to put it another way, economic …
QNHII Regs Due Thursday—After Only Five Years
January 28, 2015 Leave a Comment
When the Affordable Care Act (ACA) was signed into law back in 2010, it directed the Centers for Medicare & Medicaid Services (CMS) to establish the Consumer Operated & Oriented Program (CO-OP). The point of the CO-OP is to foster creation of membership-governed QNHIIs. What’s a QNHII? you’re …