How PHOs can avoid price-fixing charges.

Abstract

Last fall, the U.S. Department of Justice (DOJ) sent the message to PHOs that when negotiating with third parties, they need to be careful not to break antitrust laws, or they could face heavy monetary damages--or even criminal liability. In settlements with PHOs in Danbury, Connecticut, and St. Joseph, Missouri, the DOJ said that PHOs could not become involved in pricing decisions unless they acted in one of two ways: as a qualified managed care plan in which providers share financial risk or as a messenger between providers and third parties. The two cases show how networks may and may not engage in negotiations with payers.