Antitrust & Trade Regulation Health Insurance

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CMA Forced to Backtrack on Hospital Divestments in Private Healthcare Market Investigation

The Competition and Markets Authority (“CMA”) has backed down from its decision in the Market Investigation into Privately Funded Healthcare Services (the “PH Investigation”), which required HCA to divest some of the private...more

Insurance Antitrust Legal News - November 2014 - Volume 3 - Number 6

Plaintiff Files Third Amended Antitrust Claim Against Highmark - A long running antitrust dispute in Western Pennsylvania continued on October 1, when a Pennsylvania hotel (Cole’s Wexford Hotel) filed a third amended...more

OIG Approves Yet Another Medigap Policy Contract with Preferred Hospital Network

On September 17, 2014, the U.S. Department of Health & Human Services, Office of Inspector General (OIG) issued Advisory Opinion 14-08 [PDF]. This opinion is yet another favorable advisory opinion approving a Medicare...more

Provider Competition Matters—Even for “Reference Pricing”

In a recent blog post, three Federal Trade Commission (FTC) economists splashed some cold water on advocates of “reference pricing” that seem to imply that such pricing “will increase competition between providers.” In the...more

Insurance Antitrust Legal News - July 2014 • Volume 3, Number 4

In This Issue: - COURT DENIES BLUES’ MOTION TO DISMISS IN RE BLUE CROSS BLUE SHIELD ANTITRUST LITIGATION (MDL 2406): On June 18, United States District Court Judge David Proctor (Northern District of Alabama)...more

Potential Risks of Healthcare Joint Ventures Between Insurance Companies and Hospitals

Healthcare joint ventures are nothing new. Since the mid-2000’s, physician-hospital ventures have been resurgent, notwithstanding the Office of Inspector General’s skepticism regarding the risk of fraud and abuse when...more

Tennessee Insurance Legal News - May 2014 • Volume 3, Number 2

In This Issue: - COMMISSIONER OF TENNESSEE DEPARTMENT OF COMMERCE AND INSURANCE ISSUES POSITION ON FILING REQUIREMENTS OF NEW ENTERPRISE RISK FILING LEGISLATION: On May 28, 2014, Governor Haslam signed...more

Legislation Permitting Healthcare Providers to Negotiate Jointly with Health Insurers Introduced in Congress

Legislation was recently introduced by Representative John Conyers (D-Michigan) that would permit healthcare providers to negotiate jointly with health insurers concerning contract terms without running afoul of the antitrust...more

Insurance Antitrust Legal News - May 2014 • Volume 3, Number 3

In This Issue: - LEGISLATION PERMITTING HEALTHCARE PROVIDERS TO NEGOTIATE JOINTLY WITH HEALTH INSURERS INTRODUCED IN CONGRESS: Legislation was recently introduced by Representative John Conyers (D. Michigan)...more

Expect Focus On Antitrust Issues In The Health Care Industry

There have been a number of high profile antitrust cases brought against health care providers, and the increasing interest of both the Federal Trade Commission (FTC) and plaintiffs should be considered in any proposed...more

FTC Commissioner Criticizes Proposed Legislation That Would Permit Health Providers to Negotiate Jointly with Health Insurers

In a February 26 speech before the Connecticut Bar Association, Federal Trade Commissioner Maureen Olhausen expressed strong opposition to proposed legislation that would create an antitrust exemption for collective...more

Insurance Antitrust Legal News - March 2014 • Volume 3, Number 2

In This Issue: - FTC COMMISSIONER CRITICIZES PROPOSED LEGISLATION THAT WOULD PERMIT HEALTH PROVIDERS TO NEGOTIATE JOINTLY WITH HEALTH INSURERS: In a February 26 speech before the Connecticut Bar Association,...more

Sixth Circuit Limits Scope of Disgorgement Provision in E&O Policy

In a cutting-edge decision, the federal 6th Circuit Court of Appeals has ruled that an exclusion barring coverage for an insured’s liability for “disgorgement” of “remuneration” or “advantage” is limited to “acquiring” funds...more

Insurance Antitrust Legal News - January 2014 • Volume 3, Number 1

In This Issue: - MISSISSIPPI GOVERNOR RESCINDS EXECUTIVE ORDER REQUIRING BLUE CROSS OF MISSISSIPPI TO GRANT “IN NETWORK” STATUS TO EXCLUDED HOSPITALS: In early November, Mississippi Governor Phil Bryant...more

2013 – The Health Law Year in Review

As 2013 draws to a close, we are pleased to look back on the year that was and highlight some of the key developments in the ever-changing field of health law. While a great deal of attention was focused on the implementation...more

Bill Seeking to Repeal the McCarran Ferguson Act’s Antitrust Exemption Introduced in Congress

On September 18, Congressman Phil Roe (R-Tennessee) introduced legislation (H.R. 3121) that would, among other things, amend Section 3 of the McCarran-Ferguson Act (15 U.S.C. 1013) to repeal the Act’s antitrust exemption for...more

Insurance Antitrust Legal News - November 2013 • Volume 2, Number 6

In This Issue: - BILL SEEKING TO REPEAL THE MCCARRAN FERGUSON ACT’S ANTITRUST EXEMPTION INTRODUCED IN CONGRESS: On September 18, Congressman Phil Roe (R-Tennessee) introduced legislation (H.R.3121) that would,...more

Interagency Initiative Targets Consumer Fraud in the ACA Exchange Marketplace

Yesterday, the Attorney General, the Secretary of the Department of Health and Human Services (HHS), and the Chairwoman of the Federal Trade Commission (FTC) announced an interagency initiative to prevent consumer fraud and...more

Health Care Legal News - August 7, 2013 • Volume 3, Number 2

In This Issue: - IRS ISSUES TRANSITION RELIEF ON THE ONE-YEAR DELAY IN ACA’S INFORMATION REPORTING AND EMPLOYER SHARED RESPONSIBILITY RULES: On July 9, 2013, the IRS issued Notice 2013-45 which provides...more

Insurance Antitrust Legal News - July 2013 • Volume 2, Number 4

In This Issue: - CONNECTICUT AUTO BODY SHOPS AWARDED MILLIONS IN CONNECTICUT UNFAIR TRADE PRACTICES ACT CLASS ACTION AGAINST THE HARTFORD: In a closely-watched Connecticut state court action that has dragged on for...more

Health Care E-Note - June 19,2013

In This Issue: - FTC Hospital Merger Investigation Highlights Cost of Health Care - Survey Finds Doctors Warming to Health Information Exchanges - Health Insurance Markets Seeing More Competition from New...more

NC Governor Signs Law Banning Most Favored Nations Provisions in Health Care Contracts

Despite opposition and Blue Cross Blue Shield of North Carolina’s claim that it “has not used ‘most favored nation’ clauses in [its] new contracts and in fact [they are] not part of our strategy to use those clauses on...more

Insurance Antitrust Legal News - May 2013 • Volume 2, Number 3

In This Issue: - STATE EFFORTS TO RESTRICT HEALTH INSURER USE OF “MOST FAVORED NATION” CLAUSES IN PROVIDER CONTRACTS CONTINUE TO MULTIPLY: Over the last several years, several states have considered legislation...more

When Most-Favored Is Disfavored: A Counselor’s Guide to MFNs

Originally published in the American Bar Association on April 1, 2013. The U.S. Antitrust Agencies Have turned the spotlight on most-favored-nation (MFN) clauses. The Department of Justice is currently litigating two...more

Do Not Pass Go, Do Not Collect $200: Michigan Statute and Regulatory Order Banning MFN Provisions in Provider Contracts Ends...

In the wake of the passage of a Michigan statute and regulatory order banning the use of most favored nation (“MFN”) clauses by insurers, health maintenance organizations, and nonprofit health care corporations in contracts...more

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