Antitrust

Antitrust laws exist to benefit consumers and to protect them from anticompetitive behavior. When competition exists in any industry—including health care—costs are contained, quality improves and participants are more innovative in their services. Ensuring that you are in antitrust compliance requires educating yourself about antitrust principles, primarily those governing physician network collaborations. Physicians may also benefit by learning about the anticompetitive conduct of health insurers that the antitrust laws are designed to prevent, and about recent antitrust developments.

Health insurer market concentration
The AMA conducts regular, in-depth analyses of health insurer market concentration and market shares in metropolitan markets throughout the country. These studies show that when a health insurer has significant influence over a market due to high concentration, physicians have little leverage to negotiate the demands of that dominant insurer, and both the physician market and patient health care market are harmed. Know the landscape of the current health insurance market and what steps the AMA is taking to prevent the abuse of health insurer market power.

Anticompetitive conduct by health insurers
We diligently monitor the conduct of health insurers for anticompetitive activity, as well as contribute to the ongoing national dialogue about this issue. Learn about the steps that the AMA is taking to track and oppose anticompetitive conduct.

Physician networking & joint contracting
As market changes are leading many physician practices to pursue more collaborative or integrated business models, antitrust compliance becomes a bigger concern. Antitrust laws prevent price fixing and other contractual arrangements which harm consumers. Therefore physicians should understand, and must comply with, the antitrust laws when jointly contracting with insurers. We continue to push for a more flexible government enforcement policy and other antitrust reforms addressing physician collaborations. Until reform happens, know the antitrust risks and how to manage them.

State action immunity
Under certain circumstances, physicians may claim a “state action” defense to antitrust claims. Learn the basics of this defense and consider working with your state medical association to establish appropriate “state action” legislation.

Legal documents & resources
Physician practices should be familiar with the key issues and players related to antitrust on a state and federal level. Following are valuable documents and resources related to this topic:

• Speech by Christine A. Varney, Assistant Attorney General, Antitrust Division, US Department of Justice, regarding Antitrust and Healthcare
• Department of Justice -Antitrust Division
• Federal Trade Commission - Competition in Health Care Marketplace
• Henry Allen, Senior Attorney, AMA – “Consolidating Health Insurer Markets: A Challenge Facing Antitrust Enforcement Policy”
• “Insurer Antitrust Exemption Would End Under House Bill”
• “Statement to the Subcommittee on the Courts and Competition Policy, Committee on the Judiciary, U.S. House of Representatives, Re: Antitrust Laws and Their Effects on Health Care Providers, Insurers and Patients,” December 1, 2010