DOJ suit halts physician boycott of HMOs
An attempt by Florida surgeons to play hardball with health plans failed in the face of a Justice Department antitrust suit. The doctors have agreed not to boycott health plans or engage in joint contract negotiations in order to get higher fees.
The suit was filed last month against the Federation of Certified Surgeons and Specialists Inc., a Tampa, FL. corporation composed of 29 competing surgeons who accounted for 87% of general and vascular operations at five hospitals. Pershing Yoakley and Associates, an accounting firm based in Knoxville, TN, was also named.
The government charged that Pershing Yoakley told local health plans that the physicians would terminate their contracts and not participate in the health plans' networks, unless the HMOs agreed to contract with all of the FCSSI doctors under terms set by the physicians. "Each FCSSI surgeon gained $14,097 on average, in projected annual revenues as a result of the illegal joint efforts," according to a DOJ statement. In one case, the doctors received higher fees after 28 of the 29 surgeons had terminated their contracts with the health plan.
In addition, the Justice Department accused Pershing Yoakley of falsely portraying itself as a third-party messenger during contract negotiations. A messenger is essentially a third party that's supposed to act as a neutral mediator in arranging contract terms between doctors and health plans. The consulting firm was really acting on behalf of the Florida doctors, according to the government.