Physicians Joint Venture Attorneys Near Me
The balance of power between health insurance companies and physicians has shifted decidedly in favor of the insurer. That does not mean that physicians are powerless to provide the best care for patients while protecting themselves. As a physician, you can leverage your own power when you form networks, especially when you are working with a physicians joint venture attorney near you.
How Physicians Networks Help Doctors
Physician networks are when a group of medical providers joins together in order to sell their services to a third-party payer. They are a powerful way of banding together to deal with insurance companies when they are trying to flex their own economic muscle. Physicians networks are a way for doctors to work together to both improve patient care and increase the reimbursements that they receive from HMOs.
Like any kind of arrangement in which potential competitors work together, there are antitrust laws that apply to this arrangement. However, physicians joint ventures are entirely legal as long as doctors follow certain rules. Working within an antitrust attorney, they can structure these agreements to comply with antitrust laws. There is a fine line between a cooperative agreement that works for doctors and patients and one that breaks antitrust laws.
One of the foremost requirements for a physician’s networks is that the doctors share economic risks in this venture. Otherwise, the agreement could be viewed as a group of competitors coming together to increase prices.
Legal Rules that Apply to Physicians Networks
Sharing risks does not mean that doctors need to all go into business together. Instead, they enter into an agreement where each doctor’s bottom line may be hurt if there are cost overruns. In this arrangement, doctors may have fees and billings withheld if efficiencies suffer.
Here are some things that physician’s networks cannot do:
- Fix prices – doctors can work together to get higher reimbursements, but antitrust laws prohibit any type of agreement among competitors to set prices if the doctors do not share economic risk
- Become too big – when networks sign up too many doctors in one specialty in a geographic area, they cause antitrust concern because of their power to impact the market
- Try to restrict competition – when too many doctors in the network are asked not to sign contracts with competing networks, it cuts back on competition
There are many ways that physicians can work together within the rules. The Department of Justice and the Federal Trade Commission have explicit guidelines that govern physician networks. Physicians are continuously trying to come up with new arrangements to help increase their efficiency and build their own practices. At the same time, the federal government is paying close attention, ready to take enforcement action and file lawsuits against networks that go too far.
Contact Physicians Joint Venture Attorneys Near You
Contact the attorneys at The Law Offices of George M. Sanders, P.C., to learn more about how you can legally work with other doctors as a physician and stay on the right side of antitrust laws. We can help you compete in the marketplace while looking out for your bottom line.