Idaho: Settlement keeps orthopedists from conspiring to raise fees, deny care

The Department of Justice recently reached a settlement with the Idaho Orthopaedic Society and five orthopedists who allegedly conspired to gain more favorable fees and other contractual terms by agreeing to coordinate their actions.

These actions included denying medical care to injured workers and threatening to withdraw from health care plans offered by Blue Cross of Idaho. Justice officials said that their conduct caused the state of Idaho and other health care consumers to pay higher fees for orthopedic services.

According to the complaint, the orthopedists agreed not to treat most patients covered by workers' compensation insurance. They entered into a group boycott in order to force the Idaho Industrial Commission to increase the rates at which orthopedists were paid for treating injured workers. The boycott resulted in a shortage of orthopedists willing to treat workers' comp patients, causing higher rates for orthopedic services.

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The proposed settlement prevents the Idaho Orthopaedic Society and the named orthopedists from agreeing with their competitors on fees and contract terms. The settlement also prohibits them from collectively denying medical care to patients, refusing to deal with any payer, or threatening to terminate contracts with any payer.

Read more at the WorkersComp Forum homepage.

August 2, 2010

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