Keeping an eye on United

Nevada's formation of a physician advisory council in the wake of a health plan merger gives doctors a chance to scrutinize UnitedHealth Group's conduct.

Editorial. April 7, 2008.

UnitedHealth Group's market-grabbing takeover of a Nevada health plan may be a done deal, but state officials there at least are trying to make sure that freedom from accountability wasn't part of the bargain.

In doing so, the Nevadans did a more complete job than the Justice Dept., which placed a single condition on United's acquisition of Sierra Health Services. Of the federal action -- or lack of it -- the assessment of William G. Plested, MD, American Medical Association immediate past president, was blunt: It "will do nothing to block UnitedHealth Group from gaining a stranglehold on the Las Vegas commercial insurance market." The AMA is considering its legal options in fighting the United-Sierra approval.

But the Nevada attorney general's insistence that physicians get a voice at United guarantees that physicians won't have to suffer in silence if and when the company's stranglehold gets too tight.

The only requirement the Justice Dept. put on United in its $2.6 billion acquisition is that United sell 25,000 of its Medicare Advantage customers to Humana for $185 million. That still left United with a large share of the commercial insurance market in Nevada, including 95% of the Las Vegas HMO business.

But the state attorney general's office demanded more as the deal closed Feb. 25, only four days before the approval of Nevada's insurance department would have expired.

Among the many requirements, the office required United to refrain, for two years, from a pair of practices long harshly criticized by physicians as health plan abuses. One is all-products clauses, which require physicians to sign up for all United plans if they signed up for one. The other is most-favored-nation treatment, requiring physicians to give United the lowest reimbursement rate of any plan. The office required United to fund audits by the state's Division of Insurance.