HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Monday, November 22, 2004

Antitrust: ALJ Says Physician Group Unlawfully Conspired

Here's an item I meant to include last week, now back in my inbox today in the form of this helpful summary from AHLA's "Health Law Highlights":

In an initial decision announced November 16, an Administrative Law Judge (ALJ) upheld the Federal Trade Commission's (FTC's) complaint against a physicians' group alleging that the group conspired to fix prices in certain contracts its doctors entered into to provide medical services to the patients of health plans. According to the FTC, nearly all of North Texas Specialty Physicians' (NTSPs') participating physicians are parties to some non-risk contracts and that "[w]ith respect to these non-risk contracts, NTSP often has sought to negotiate for, and often has obtained, higher fees and other more advantageous terms than its individual physicians could obtain by negotiating individually with payors." In its decision, the ALJ stated that, "In this case, Complaint Counsel [FTC staff] has proven that Respondent [NTSP] engaged in horizontal price fixing through its negotiation, on behalf of its member physicians, of economic terms of non-risk contracts with health plan services for the provision of physician services."

The full text of the initial decision is here (PDF).  As reported in Modern Healthcare, North Texas Specialty Physicians "has been the only IPA to challenge the FTC in the agency's three-year, industrywide investigation of physician price-fixing, which so far has resulted in 20 consent decrees with physician organizations."  The other cases are summarized, beginning at page 7, in the FTC's publication, "FTC Antitrust Actions In Health Care Services and Products" (PDF).

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