Refusal of new Medicaid patients spurs antitrust suit

The Illinois attorney general has accused two clinics of collusion, but doctors say payment cuts forced their independent decisions to trim program caseloads.

By Amy Lynn Sorrel, AMNews staff. July 23/30, 2007.

In a case that some experts say adds a new twist to physicians' antitrust fears, the Illinois attorney general is suing two private medical clinics for allegedly refusing to take new Medicaid patients in order to force an increase in reimbursement rates.

The antitrust lawsuit filed by Attorney General Lisa Madigan in June accuses the Carle Clinic Assn. and Christie Clinic, both in Champaign County, Ill., of collectively boycotting new Medicaid patients by adopting identical policies in 2003. The two groups employ more than 90% of physicians in the area.

According to the complaint, the clinics declined Medicaid enrollees who either were not already registered patients or who had not seen a clinic physician for at least three years. Both groups continued to accept patients referred by a nearby free health center for consultations but sent them back to the center for ongoing treatment.

Similarly, with hospital emergency department referrals, the Carle and Christie clinics treated Medicaid patients only for the condition for which they were referred, and did not provide follow-up care.

The restrictive policies "left many of the 20,000 Medicaid-eligible children and adults in Champaign County at risk by leaving them with fewer choices to obtain quality primary medical care -- if they could access primary care at all," Madigan said in a statement.

As a result, the lawsuit alleges, many of those patients were forced to get medical attention at area hospital EDs, at a higher cost to the state. Madigan is seeking to require the Carle and Christie clinics to open their doors to new Medicaid patients and to recover civil fines and damages for their anticompetitive conduct.