Idaho orthopedists settle antitrust case over alleged insurer boycotts

The settlement prohibits the doctors from collectively agreeing on fees and contract terms.

By Amy Lynn Sorrel — Posted June 16, 2010

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Several Idaho orthopedists and orthopedic groups agreed to settle federal civil allegations that the physicians conspired to secure higher fees from the state's workers' compensation program and a local insurer, in violation of antitrust laws.

The Dept. of Justice accused the Idaho Sports Medicine Institute, the Idaho Orthopaedic Society and five orthopedists of collectively boycotting patients covered by workers' compensation insurance to pressure the Idaho Industrial Commission to raise the rates it paid for treating injured workers. The department said the boycotts took place from 2006 to 2008. The state commission regulates workers' compensation claims, insurance and fee schedules.

Federal officials also alleged that all but one of the orthopedists threatened to terminate their contracts with Blue Cross of Idaho in 2008 to leverage more favorable fees.

The doctors' actions undermined competition and led to higher prices for orthopedic services, the government said. Justice Dept. attorneys also noted that the orthopedists did not collaborate in any risk-sharing or clinical quality programs that integrated patient care delivery, moves that could have allowed for legal collective payment negotiations.

The May 28 agreement prohibits the orthopedists from collaborating with each other on fees or contract terms, refusing to deal with payers, or threatening contract terminations. The physicians also are barred from collectively denying medical care to patients.

The orthopedists admitted no wrongdoing under the settlement, which remains subject to final court approval.

The Idaho Orthopaedic Society did not return calls seeking comment. An attorney representing the physicians and physician groups could not be reached.

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