Justice Dept. eyes doctor groups for price-fixing; antitrust regulators tell physician hospital organizations to free up providers. Will those docs join rival HMOs?

Article Abstract:

The physician hospital organization (PHO), a popular way for local hospitals and groups of physicians to package their combined services and better attract insurance companies and self-insured employers, has run into a roadblock from the US Department of Justice. This agency has imposed a strict consent decree on three PHOs who were guilty of alleged price-fixing. Observers feel the Department of Justice did not think a non-risk bearing form of PHO met antitrust criteria but feel the criteria for legitimately integrated joint ventures should include other factors such as reduction in the use of expensive medical equipment.

Hospitals, Analysis, Price fixing, Health services administration

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'Stark' law's definitions restrict group practices; the law bars referrals by certain physicians to entities with which they have financial relationships

Article Abstract:

Complete regulations regarding the 1993 expansion of the 1989 Stark Law took effect in the summer of 1995, refining and clarifying but not substantially changing the law. Designed to end financially motivated physician referrals, the law prohibits billing Medicare or Medicaid for any services performed by an institution to which a patient was referred in which the physician or an immediate member of his or her family has a financial interest. The exceptions to the law, especially regarding group practices, are described.

Cases

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Medical networks raise physician liability issues; while group practices may ease economic concerns, doctors should consider all legal angles

Article Abstract:

A number of forces that are combining to encourage the use of medical networks and delivery systems are also reducing the remuneration and authority of physicians. Some find that group practices combine the benefits of cooperation with legal and financial advantages, but such arrangements demand careful structuring with attention to both state and federal laws. Limited liability companies are the best solution for many. Prohibitions on patient referrals are a particularly important restriction.

Laws, regulations and rules, Limited liability companies, Medical referral

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