Physician Network Attorney
Insurers and third-party payers like Medicare and Medicaid have acquired a stranglehold over most physicians in the United States. Indeed, most doctors are no longer in a position to negotiate contracts. They must “take or leave” whatever prices the insurers dictate, even if means accepting less money for performing the same services. While this may be good for the insurance company’s bottom line, it does nothing to help doctors struggling to stay in business–or their patients whose lives depend on receiving high-quality health care.
In an attempt to restore some sense of healthy balance to the marketplace, many physicians have formed joint ventures and networks that are designed to improve patient care. But such networks are not without their own legal challenges. Since joint ventures involve nominally competing physicians, regulators and payers may try to challenge such arrangements under the federal antitrust laws.
At the Law Offices of George M. Sanders P.C., we know how to help physicians fight back against such charges. Our team of physician network attorneys understand both the antitrust laws and the health care industry. Our expertise can help your physician network or joint venture address any antitrust concerns that may arise.
When Is a Joint Venture an Illegal Cartel?
Traditionally, a “cartel” is a group of competitors who collude to fix prices or allocate markets within a given industry. Antitrust laws like the Sherman Act and the Federal Trade Commission Act have long prohibited cartels as “unreasonable” restraints of trade. This can include physicians who compete in the same geographic area or specialty.
It is generally acceptable under the antitrust laws for physicians to merge or “clinically integrate” their practices. In such cases the integrated practice is considered a single entity and therefore legally incapable of colluding with itself. The problem, however, is that oftentimes it makes more sense for physicians to work together in a joint venture that falls short of total integration. For instance, doctors may wish to share the administrative costs of managing insurance contracts.
This is where the advice and assistance of a qualified physician network attorney is often crucial. Many physician joint ventures run afoul of antitrust regulators without even realizing it. The insurance industry has become quite skilled at lobbying antitrust officials to pursue actions against physicians at the first hint of “anti-competitive” behavior. This is why if you are considering any kind of networking arrangement, you need to deal upfront with an attorney who understands both antitrust and the specific needs of the health care market.