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Independent Practice Associates Medical Group, Inc; Analysis of Agreement Containing Consent Order

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3 pages
Federal Register/Vol. 74, No. 2/Monday, January 5, 2009/Notices 291 attempts to engage in any action plans on behalf of either a qualified risk- draft complaint and the terms of the prohibited by Paragraph II.A, or II.B, sharing or a qualified clinically- consent order—embodied in the consent and Paragraph II.D. proscribes BVIPA integrated joint arrangement. Paragraph agreement—that would settle these from inducing anyone to engage in any VI sets out the information necessary to allegations. action prohibited by Paragraphs II.A satisfy the notification requirement. DATES: Comments must be received on through II.C. Paragraph VII imposes other or before January 22, 2009. As in other Commission orders notification obligations on BVIPA and ADDRESSES: Interested parties are addressing providers’ collective requires the termination of certain invited to submit written comments. bargaining with health-care purchasers, contracts that were entered into Comments should refer to ‘‘AllCareIPA, Paragraph II excludes certain kinds of illegally. Paragraphs VII.A requires File No. 061 0258,’’ to facilitate the agreements from its prohibitions. First, BVIPA to distribute the Complaint and organization of comments. A comment BVIPA is not precluded from engaging the Order to (1) physicians who have filed in paper form should include this in conduct that is reasonably necessary participated in BVIPA since 2001; (2) to reference both in the text and on the to form or ...
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ious obligations on BVIPA to report Commission considers an electronic significant efficiencies through the joint or provide access to information to the comment, you must file it on that web- arrangement. Commission to facilitate the monitoring based form. A ‘‘qualified clinically-integrated joint of compliance with the Order. Finally, The FTC Act and other laws the arrangement,’’on the other hand, need Paragraph XI provides that the Order Commission administers permit the not involve any sharing of financial risk. will expire in 20 years. collection of public comments to Instead, as defined in the proposed consider and use in this proceeding as By direction of the Commission. Order, physician participants must appropriate. All timely and responsive participate in active and ongoing Donald S. Clark, public comments, whether filed in programs to evaluate and modify their Secretary. paper or electronic form, will be clinical practice patterns in Order to [FR Doc. E8–31384 Filed 1–2–09: 8:45 am] considered by the Commission, and will control costs and ensure the quality of BILLING CODE 6750–01–S be available to the public on the FTC services provided, and the arrangement website, to the extent practicable, at must create a high degree of www.ftc.gov. As a matter of discretion, interdependence and cooperation FEDERAL TRADE COMMISSION the FTC makes every effort to remove among physicians. As with qualified home contact information for [File No. 061 0258] risk-sharing arrangements, any individuals from the public comments it agreement concerning price or other Independent Practice Associates receives before placing those comments terms of dealing must be reasonably Medical Group, Inc.; Agreement on the FTC website. More information, necessary to achieve the efficiency goals Containing Consent Order To Aid including routine uses permitted by the of the joint arrangement. Public Comment Privacy Act, may be found in the FTC’s Paragraph III, for three years, requires privacy policy, at (http://www.ftc.gov/ BVIPA to notify the Commission before AGENCY: Federal Trade Commission. ftc/privacy.shtm). it enters into any arrangements to act as ACTION: Proposed Consent Agreement. a messenger or an agent on behalf of any 1 The comment must be accompanied by an SUMMARY: The consent agreement in this physicians, with payers regarding explicit request for confidential treatment, matter settles alleged violations of contracts. Paragraph IV sets out the including the factual and legal basis for the request, federal law prohibiting unfair or and must identify the specific portions of the information necessary to make the comment to be withheld from the public record. deceptive acts or practices or unfair notification complete. The request will be granted or denied by the Paragraph V, for three years, requires methods of competition. The attached Commission’s General Counsel, consistent with Analysis to Aid Public Comment applicable law and the public interest. See participating in contracting with health describes both the allegations in the Commission Rule 4.9(c), 16 CFR 4.9(c). VerDate Aug<31>2005 17:13 Jan 02, 2009 Jkt 217001 PO 00000 Frm 00033 Fmt 4703 Sfmt 4703 E:\FR\FM\05JAN1.SGM 05JAN1 292 Federal Register/Vol. 74, No. 2/Monday, January 5, 2009/Notices FOR FURTHER INFORMATION CONTACT: John interpretation of the agreement and contract with the payor only through an P. Wiegand, FTC Western Region, San proposed Consent Order or to modify agreement with AllCare. Francisco, 600 Pennsylvania Avenue, their terms in any way. Further, the AllCare did not engage in any activity that might justify collective agreements NW, Washington, D.C. 20580, (415) 848- proposed Consent Order has been on the prices its members would accept 5174. entered into for settlement purposes for their services. The physicians in only and does not constitute an SUPPLEMENTARY INFORMATION: Pursuant AllCare, with respect to PPO contracts, admission by Respondent that it to section 6(f) of the Federal Trade do not share any financial risk in violated the law or that the facts alleged Commission Act, 38 Stat. 721, 15 U.S.C. providing medical services, do not in the Complaint (other than 46(f), and § 2.34 of the Commission collaborate in programs to monitor and jurisdictional facts) are true. Rules of Practice, 16 CFR 2.34, notice is modify clinical practice patterns to hereby given that the above-captioned The Complaint’s Allegations control members’ costs and ensure consent agreement containing a consent quality, or otherwise integrate their AllCare is a multi-specialty order to cease and desist, having been delivery of health care services. The independent practice association filed with and accepted, subject to final Respondent’s actions have restrained approval, by the Commission, has been consisting of multiple, independent price and other forms of competition placed on the public record for a period medical practices with a total of among physicians in the Modesto, of thirty (30) days. The following approximately 500 physician members, California, area and thereby harmed Analysis to Aid Public Comment of which approximately 200 are devoted consumers (including health plans, describes the terms of the consent to primary care, in the Modesto, employers, and individual consumers) agreement, and the allegations in the California, area. Since its formation, by increasing the prices for physician complaint. An electronic copy of the AllCare has negotiated contracts with services. full text of the consent agreement payors under which it has received package can be obtained from the FTC capitated (per member per month) The Proposed Consent Order Home Page (for December 24, 2008), on payments. These contracts shift the risk The proposed Consent Order is the World Wide Web, at (http:// of patient illness to the IPA by designed to prevent the continuance www.ftc.gov/os/2008/12/index.htm). A specifying that the health plan will pay and recurrence of the unlawful conduct paper copy can be obtained from the the IPA a flat monthly fee for each alleged in the Complaint while allowing FTC Public Reference Room, Room 130- enrollee, with almost no regard for AllCare to engage in legitimate, joint H, 600 Pennsylvania Avenue, NW, patient utilization. This type of conduct. The proposed Consent Order Washington, D.C. 20580, either in contracting is a form of financial does not affect AllCare’s activities in person or by calling (202) 326-2222. integration. The Complaint does not contracting with the payors on a Public comments are invited, and may challenge AllCare’s activities capitated basis. be filed with the Commission in either concerning these contracts. Paragraph II.A prohibits Respondent paper or electronic form. All comments AllCare and its physicians also from entering into or facilitating should be filed as prescribed in the contract with Preferred Provider agreements between or among any ADDRESSES section above, and must be Organizations (‘‘PPOs’’) to provide fee- health care providers (1) to negotiate on received on or before the date specified for-service medical care. In PPO behalf of any physician with any payor, in the DATES section. arrangements, the payor compensates (2) to refuse to deal, or threaten to refuse physicians or group practices for Analysis of Agreement Containing to deal with any payor, (3) regarding any services actually rendered pursuant to Consent Order To Aid Public Comment term, condition, or requirement upon agreed-upon fee schedules. PPO which any physician deals, or is willing The Federal Trade Commission has contracts may or may not entail to deal, with any payor, including, but accepted, subject to final approval, an financial risk-sharing or clinical not limited to price terms or (4) not to agreement containing a proposed integration on the part of providers. It is deal individually with any payor, or not Consent Order with Independent AllCare’s negotiation of certain PPO to deal with any payor except through Practice Associates Medical Group, Inc., contracts that is the subject of the AllCare. dba AllCare IPA (‘‘AllCare’’ or Commission’s Complaint. The other parts of Paragraph II ‘‘Respondent’’). The agreement settles The Complaint alleges that AllCare, reinforce these general prohibitions. charges that AllCare violated Section 5 since at least 2005, has acted to restrain Paragraph II.B prohibits the Respondent of the Federal Trade Commission Act, competition on fee-for-service contracts from facilitating exchanges of 15 U.S.C. § 45, by fixing prices charged by facilitating, entering into, and information between health care to those offering coverage for health care implementing agreements to fix the providers concerning whether, or on services (‘‘payors’’) in the Modesto, prices and other terms in contracts with what terms, to contract with a payor. California, area and refusing to deal PPO payors; to engage in collective Paragraph II.C bars attempts to engage in with payors. The proposed Consent negotiations over terms and conditions any action prohibited by Paragraph II.A Order has been placed on the public of dealing with such payors; and to have or II.B, and Paragraph II.D proscribes record for 30 days to receive comments AllCare members refrain from encouraging, suggesting, advising, from interested persons. Comments negotiating individually with such pressuring, inducing, or attempting to received during this period will become payors or contracting on terms other part of the public record. After 30 days, induce any person to engage in any than those approved by AllCare. The the Commission will review the action that would be prohibited by Complaint further alleges that AllCare, agreement and the comments received, Paragraphs II.A through II.C. to enforce the joint negotiation efforts, As in other Commission orders and will decide whether it should caused a significant number of AllCare addressing health care providers’ withdraw from the agreement or make physicians to sent to at least one payor collective bargaining with health care the proposed Consent Order final. The purpose of this analysis is to the same form termination letter. These purchasers, certain kinds of agreements facilitate public comment on the letters terminated the physicians’ are excluded from the general bar on proposed Consent Order. The analysis is individual agreements with the payor joint negotiations. Paragraph II does not not intended to constitute an official and affirmed that the physicians would preclude AllCare from engaging in VerDate Aug<31>2005 14:05 Jan 02, 2009 Jkt 217001 PO 00000 Frm 00034 Fmt 4703 Sfmt 4703 E:\FR\FM\05JAN1.SGM 05JAN1 Federal Register/Vol. 74, No. 2/Monday, January 5, 2009/Notices 293 conduct that is reasonably necessary to manager, or employee for three years FTC is requesting that any comment form or participate in legitimate after the date on which the Consent filed in paper form be sent by courier or ‘‘qualified risk-sharing’’ or ‘‘qualified Order becomes final. In addition, overnight service, if possible, because clinically-integrated’’ joint Paragraph V.D requires AllCare to U.S. postal mail in the Washington area arrangements, as defined in the publish a copy of the Complaint and and at the Commission is subject to proposed Consent Order. Also, Consent Order, for three years, in any delay due to heightened security Paragraph II would not bar agreements official publication that it sends to its precautions. Comments that do not that only involve physicians who are participating physicians. contain any nonpublic information may part of the same medical group practice, Paragraphs V.E and VI-VII impose instead be filed in electronic form by defined in Paragraph I.B, because it is various obligations on AllCare to following the instructions on the web- intended to reach agreements between provide to the Commission information based form at (http:// and among independent competitors. secure.commentworks.com/ftc- that would assist in the monitoring of Paragraphs III and IV require AllCare Inverness). To ensure that the Respondent’s compliance with the to notify the Commission before it Commission considers an electronic Consent Order. initiates any arrangement to act as an Pursuant to Paragraph VIII, the comment, you must file it on that web- agent or messenger with respect to proposed Consent Order will expire in based form. physician contracting with payors. The The FTC Act and other laws the 20 years from the date it is issued. Order also would require AllCare to Commission administers permit the By direction of the Commission. provide to the Commission key details collection of public comments to Donald S. Clark, of the arrangement and to delay the consider and use in this proceeding as Secretary. implementation of that arrangement to appropriate. All timely and responsive [FR Doc. E8–31385 Filed 1–2–09: 8:45 am] permit further factual discovery by the public comments, whether filed in BILLING CODE 6750–01–S Commission at its option. Paragraph III paper or electronic form, will be applies such requirements to considered by the Commission, and will arrangements under which AllCare be available to the public on the FTC FEDERAL TRADE COMMISSION would be acting as a messenger, and website, to the extent practicable, at Paragraph IV applies them to www.ftc.gov. As a matter of discretion, [File No. 061 0123] the FTC makes every effort to remove plans to achieve financial or clinical Inverness Medical Innovations, Inc.; home contact information for integration. Agreement Containing Consent Order individuals from the public comments it Paragraph V.A requires AllCare to To Aid Public Comment receives before placing those comments send a copy of the Complaint and on the FTC website. More information, AGENCY: Federal Trade Commission. Consent Order to its physician including routine uses permitted by the ACTION: Proposed Consent Agreement. members, its management and staff, and Privacy Act, may be found in the FTC’s any payors who communicated with privacy policy, at (http://www.ftc.gov/ SUMMARY: The consent agreement in this AllCare, or with whom AllCare ftc/privacy.shtm). matter settles alleged violations of communicated, with regard to any FOR FURTHER INFORMATION CONTACT: Lore federal law prohibiting unfair or interest in contracting for physician Unt, FTC Bureau of Competition, 600 deceptive acts or practices or unfair services. Pennsylvania Avenue, NW, Washington, methods of competition. The attached Part V.B. of the Order requires AllCare D.C. 20580, (202) 326-3019. Analysis to Aid Public Comment to terminate preexisting payor contracts SUPPLEMENTARY INFORMATION: Pursuant describes both the allegations in the held by physicians who were AllCare to section 6(f) of the Federal Trade draft complaint and the terms of the participants since January 1, 2005, upon Commission Act, 38 Stat. 721, 15 U.S.C. consent order—embodied in the consent (1) receipt by AllCare of a written 46(f), and § 2.34 of the Commission agreement—that would settle these request for termination by relevant Rules of Practice, 16 CFR 2.34, notice is allegations. payors, or (2) the termination date, hereby given that the above-captioned renewal date, or anniversary date of the DATES: Comments must be received on consent agreement containing a consent contract, whichever is earlier. This or before January 20, 2009. order to cease and desist, having been termination can be delayed for up to one ADDRESSES: Interested parties are filed with and accepted, subject to final year after the effective date of the Order, invited to submit written comments. approval, by the Commission, has been upon the written request of the payor. Comments should refer to ‘‘Inverness placed on the public record for a period This provision is intended to eliminate Medical Innovations, File No. 061 of thirty (30) days. The following the effects of AllCare’s joint price setting 0123,’’ to facilitate the organization of Analysis to Aid Public Comment behavior. comments. A comment filed in paper describes the terms of the consent Paragraph V.C requires that AllCare form should include this reference both agreement, and the allegations in the send a copy of any payor’s request for in the text and on the envelope, and complaint. An electronic copy of the termination to every physician who should be mailed or delivered to the full text of the consent agreement participates in each group. Paragraph following address: Federal Trade package can be obtained from the FTC V.D contains further notification Commission/Office of the Secretary, Home Page (for December 23, 2008), on provisions relating to future contact Room 135-H, 600 Pennsylvania Avenue, the World Wide Web, at (http:// with physicians, payors, management, N.W., Washington, D.C. 20580. www.ftc.gov/os/2008/12/index.htm). A and staff. This provision requires Comments containing confidential paper copy can be obtained from the AllCare to distribute a copy of the material must be filed in paper form, Complaint and Consent Order to each must be clearly labeled ‘‘Confidential,’’ including the factual and legal basis for the request, physician who begins participating in and must identify the specific portions of the and must comply with Commission comment to be withheld from the public record. each group; each payor who contacts 1Rule 4.9(c). 16 CFR 4.9(c) (2005). The The request will be granted or denied by the each group regarding the provision of Commission’s General Counsel, consistent with physician services; and each person 1 The comment must be accompanied by an applicable law and the public interest. See who becomes an officer, director, explicit request for confidential treatment, Commission Rule 4.9(c), 16 CFR 4.9(c). 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