Antitrust Law Daily Wrap Up, ANTITRUST NEWS: Puerto Rico ophthalmologist group settles FTC action over illegal boycott of health plan, (Jan 20, 2017)

By Linda O’Brien, J.D., LL.M.

Cooperativa de Medico Oftalmologos de Puerto Rico (OFTACOOP), a Puerto Rico ophthalmologist cooperative, has agreed to settle FTC charges that its actions harmed competition by unlawfully orchestrating an agreement among competing ophthalmologists to refuse to deal with a health plan, MCS Advantage, Inc., and its network administrator, Eye Management of Puerto Rico, LLC, the Commission has announced.

OFTACOOP has about 100 member ophthalmologists. MCS provides healthcare services to enrollees of its Medicare Advantage plans, and must offer a network with a sufficient number of physicians to provide its enrollees with adequate access to healthcare services.

In its complaint, the FTC alleges that, in an effort to lower its costs after Medicare reduced its premiums, MCS asked Eye Management to create and manage a network of ophthalmologists in Puerto Rico. In response to letters from MCS and Eye Management to individual doctors offering lower rates for the new network, OFTACOOP urged ophthalmologists to refuse to sign the proposed contract and to unite in refusing to deal with Eye Management. In August 2014, Eye Management informed MCS that it had been unable to form an adequate network of ophthalmologists. The ophthalmologists then refused to contract directly with MCS at lower rates thereby forcing MCS to maintain its current reimbursement rates.

OFTACOOP’s concerted refusal to deal forced MCS to abandon its plan to engage Eye Management to create a lower-cost network of ophthalmologists, according to the complaint. MCS was also forced to maintain its then-current reimbursement rates paid to ophthalmologists. OFTACOOP restrained competition without any justification, in violation of federal antitrust law.

The proposed consent order prohibits OFTACOOP from entering into or facilitating agreements between or among ophthalmologists (1) to refuse to deal, or threaten to refuse to deal, with any payor regarding any term, including price terms, or (2) not to deal individually with any payor, or not to deal with any payor other than through OFTACOOP.

The order also prohibits information exchanges to facilitate any prohibited conduct, and it bars any attempts to engage in any prohibited conduct. OFTACOOP is also barred from encouraging, suggesting, advising, pressuring, inducing, or trying to induce anyone to engage in any prohibited conduct.

Companies: Cooperativa de Medico Oftalmologos de Puerto Rico

News: Antitrust FederalTradeCommissionNews