Insurance Antitrust Legal News - November 2012 • Volume 1, Number 4


In This Issue:

- DOJ and FTC Hold Public Workshop to Consider the Antitrust Issues Raised by “Most Favored Nation Clauses” in Health Insurance Contracts by James M. Burns:

On September 10, the Federal Trade Commission and the Department of Justice Antitrust Division held a joint public “workshop” to discuss the competitive issues that can arise in connection with the use of “most favored nation” clauses in health insurer contracts with health care providers. Specifically, the Agencies announced that the workshop would “provide a forum for discussion of the evolution of economic and legal thinking on MFNs and their implications,” and provide an opportunity for senior government antitrust enforcers, economists, private attorneys and academics to express their views on this increasingly significant issue....

- 1st Circuit Affirms Dismissal of Antitrust Case Against Puerto Rico Health Insurer by James M. Burns:

On September 7, the 1st Circuit Court of Appeals affirmed the dismissal of antitrust claims brought against MMM Healthcare, a Puerto Rico health insurer, in Gonzalez-Maldonado v. MMM Healthcare. In doing so, the 1st Circuit held that the insurer’s decision to modify its compensation system for physicians from a fee-for-service basis to a capitation system did not give rise to an antitrust claim by physicians unhappy with the change in their reimbursement formula...

- Glass Repair Shop Suffers Defeat in Antitrust Case against Auto Insurers and Their Glass Network Administrators by James M. Burns:

In early September, Judge Cathy Seibel, United States District Court Judge for the Southern District of New York, put an end to an antitrust case filed by an independent auto glass repair shop against numerous auto insurers and their third party claims administrators (“TPAs”), finding that the plaintiff had failed adequately to allege “antitrust injury” in his complaint or amended complaint...

- Insurer’s Antitrust Action Against Physicians Avoids Dismissal by James M. Burns:

On September 17, Judge Gustavo Gelpi, District Court Judge for the District of Puerto Rico, denied the defendants’ motion to dismiss plaintiff’s complaint in Humana Health of Puerto Rico v. Vilaro. In the case, Humana alleges that defendant, Dr. Vilaro, in concert with several other physicians, unlawfully colluded during the course of their contract negotiations with Humana...

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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