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2013 antitrust developments for insurance companies

  • DLA Piper LLP
  • -
  • USA
  • -
  • February 13 2014

Insurers and reinsurers are often involved in collective action, either in co-ventures or by government edict. At the same time, any collaboration

UnitedHealth fined $1 million for breach of merger consent decree

  • Williams Mullen
  • -
  • USA
  • -
  • June 28 2011

On June 23, the Nevada Attorney General’s office announced that it had fined UnitedHealth $1 million for breaching the terms of an antitrust Consent Decree that UnitedHealth had agreed to in 2008 to close its acquisition of Sierra Health, a rival health insurer

Department of Justice reaches settlement in first traditional Section 2 case since 1999

  • Kilpatrick Townsend & Stockton LLP
  • -
  • USA
  • -
  • March 2 2011

On February 25, 2011, the United States Department of Justice (DOJ) announced that it settled an antitrust enforcement action against United Regional Health Care System of Wichita Falls, Texas (United Regional) in which the agency alleged that United Regional had monopolized one or more markets for hospital services by entering into agreements with health insurers not to do business with United Regional's competitors

When does the payment of low reimbursement rates or other conduct by an insurer violate the antitrust laws?

  • Duane Morris LLP
  • -
  • USA
  • -
  • December 6 2010

Healthcare providers and insurers should be aware of a recent decision by the U.S. Court of Appeals for the Third CircuitWest Penn Allegheny Health System, Inc. v. UPMCin which the court reinstated an antitrust challenge brought by a hospital system against another hospital system and the area's largest insurer

Recent lawsuits allege anticompetitive market allocation conspiracy by Blue Cross and Blue Shield

  • King & Spalding LLP
  • -
  • USA
  • -
  • April 24 2012

Two recent lawsuits allege that Blue Cross and Blue Shield entities in North Carolina and Alabama have violated federal and state antitrust laws by engaging in concerted action with other Blue Cross Blue Shield (BCBS) plans nationwide to divide geographic markets among them, which has allegedly resulted in reduced competition and higher rates charged to end customers for healthcare services

District Court dismisses follow-on suit challenging Blue Cross's "MFN-Plus' contracts under both per se and rule of reason standards

  • Sheppard Mullin Richter & Hampton LLP
  • -
  • USA
  • -
  • April 11 2012

The District Court for the Eastern District of Michigan recently dismissed antitrust claims brought by the City of Pontiac against Blue Cross Blue Shield of Michigan's practice of requiring hospitals to enter into "MFN-Plus" contracts, which was alleged to have significantly raised prices to Blue Cross's competitors

FTC bars Texas physician group from joint price negotiations

  • King & Spalding LLP
  • -
  • USA
  • -
  • May 13 2011

On May 10, the Federal Trade Commission (FTC) announced that an independent practice association representing 900 physicians in the Amarillo, Texas, area agreed to enter in to an FTC Consent Order barring it from jointly negotiating the rates it charges insurance companies

New York radiology practice sues health care benefits administration firm contracted with major health care insurers alleging antitrust violations

  • Edwards Wildman Palmer LLP
  • -
  • USA
  • -
  • June 27 2008

A New York based radiology practice (the “Plaintiff”) filed an action in the United States District Court for the Eastern District of New York against a benefits administration firm, CareCore National, LLC, that provides services for insurers including Aetna, GHI, HIP, Healthnet, Healthfirst, and Oxford

FTC continues crackdown on unlawful collective fee negotiations

  • Baker & Hostetler LLP
  • -
  • USA
  • -
  • June 25 2009

The Federal Trade Commission's (FTC) aggressive enforcement of the antitrust laws regarding collective fee negotiations continued this month when the FTC sued a California independent practice association (IPA) for allegedly fixing the prices charged to healthcare insurers

Partial repeal of the insurance antitrust exemption introduced as amendment to Senate healthcare bill

  • Edwards Wildman Palmer LLP
  • -
  • USA
  • -
  • December 4 2009

Senator Patrick Leahy (D-VT) filed an amendment to the Patient Protection and Affordable Care Act (H.R. 3590) (the “PPACA”) on December 1, 2009, that would repeal the exemption from federal antitrust laws for the health insurance and medical malpractice insurance industries