Tuesday, June 01, 2010

DOJ Takes Aim at Doctors

... as conspirators:
This case is a watershed for two reasons:

First, until now the Federal Trade Commission, not the Justice Department, has taken the lead in prosecuting physicians. Since 2000, the FTC has brought about three dozen cases against physicians (all but one of which settled without any trial). But the FTC only has civil and administrative jurisdiction; the Antitrust Division has civil and criminal jurisdiction. The Sherman Act makes no distinction between civil and criminal “price fixing,” so in a case like this, it’s entirely a matter of prosecutorial discretion whether to charge the doctors with a civil or criminal offense.

Based on the descriptions in the Antitrust Division’s press release, there’s certainly no reason they couldn’t have prosecuted the doctors criminally and insisted upon prison sentences — and there’s little doubt such threats were made or implied to obtain the physicians’ agreement to the proposed “settlement.”

The second reason this is a landmark case is that the Justice Department has unambiguously stated that refusal to accept government price controls is a form of illegal “price fixing.” (Emphasis mine)

The FTC has hinted at this when it’s said physicians must accept Medicare-based reimbursement schedules from insurance companies. But the DOJ has gone the final step and said, “Government prices are market prices,” in the form of the Idaho Industrial Commission’s fee schedule. The IIC administers the state’s worker compensation system and is composed of three commissioners appointed by the governor. This isn’t a quasi-private or semi-private entity. It’s a purely government operation.

What’s more, the Antitrust Division has linked a refusal to accept government price controls with a refusal to accept a “private” insurance company’s contract offer. This lives little doubt that antitrust regulators consider insurance party contracts the equivalent of government price controls — and physicians and patients have no choice but to accept them.
Read the whole thing to understand the implications of this settlement. Given the 21% cut to Medicare payments that occurred today (but CMS is 'holding claims' for ten days to allow for another stop-gap measure to be implemented), ask yourself two questions: (1) "Where was the AMA?" and (2) Are you ready to be a government employee?"



Jodi said...

The AMA was busy making sure that they were able to retain their CPT code monopoly.

Their vision of, "The American Medical Association helps doctors help patients by uniting physicians nationwide to work on the most important professional and public health issue", became much less valuable since they make so much less from memberships than they do their CPT code materials.

Here is an interesting article to read on the AMA.


The AMA is gone, please move forward. You need to regroup as physicians and re-establish your collective voice without them. As a nurse, a mom, and a patient, I am counting on America's doctors to start doing that. Join the group Docs 4 Patient Care. They are working on a name change to sound more credentialed, but for now it's the original grassroots name.

Their goals are:

- Promote and protect the doctor-patient relationship

- DEFUND – REPEAL – REPLACE the Patient Protection and Affordable Care Act (PPACA)

I. Defund the harmful aspects we can next year

II. Repeal the current law (Public Law 111-148 - PPACA).

III. Replace it with responsible reform (see website for our Prescription for Health Care Reform)

- Defend practicing physicians against government intrusions

- Replace the AMA as the voice of practicing physicians

- Educate the public about the dangers of government controlled health care

They are working to reach these goals by:

- Educating legislators on health care issues

- Established name recognition in DC as a result of regular visits

- Political Action Committee and D4PC Alliance

- Endorsing political candidates committed to our goals

- Media Marketing Campaign – Internet, Radio, Newspaper, TV

Please, WAKE UP America's physicians, it is well past the time to join together and speak up for patients and the future of our health care system.

American Medical Association said...

For years, the AMA has been the most visible group in the fight to repeal the Medicare physician payment formula and stop Medicare cuts that will harm seniors’ access to health care. In 2010 alone, we conducted a multi-city satellite news conference with AARP and the Military Officers Association of America that generated national press coverage. We placed ads in influential Washington, DC, publications to urge congressional action. Tomorrow, we are launching a multi-million dollar ad campaign aimed at rallying seniors and military families in support of this issue. The AMA’s Patients’ Action Network has generated millions of contracts to Congress from patients and physicians in the last few years. The AMA will continue to fight these cuts aggressively. Congress needs to continue to hear from patients and physicians. Physicians are encouraged to contact their members of Congress using the AMA's toll-free grassroots hotline at (800) 833-6354. Urge Congress to end its mismanagement of Medicare and TRICARE and honor their commitment to older Americans and military families. Congress must find a long-term solution to the Medicare physician payment mess that does not create an even bigger problem in the future. Enough is enough!

Jodi said...

To the AMA

You came out in support of health care reform without getting any of these things resolved. NOW you stomp your feet in protest?

You wasted no time, every time, delivering Washington your thumbs up to their bills despite their lack of meeting these important needs. NO federal tort reform, and NO SGR fix. A NEW advisory board that can lower physician fees without worries of election consequences, the demise of physician owned hospitals.

You failed at representing your members by instantly throwing your support behind something that met NONE of their urgent and pressing needs, and created new problems to boot.

Now you want people to believe that you're rallying on behalf of doctors, patients, and the health care system?

Ads, news conference, press coverage? Most physician specialty organizations have done these things as well. You had the chance to influence the health care debate on behalf of these needs for doctors and you chose to protect your monopoly instead.

You clearly represent noone but yourselves.

Jodi said...

Continued to the AMA,

Ads, news conference, press coverage? You HAD a seat at the table. But you chose to offer up doctors, patients, and the health care system on a silver platter at that seat, lest it be your more profitable CPT code monopoly.

Critical Care RN.

Anonymous said...

Jodi is right--AMA makes its money on CPT codes, so it doesn't really care about its physicians. I recently wrote an article for WND.com about Dr. John Natale who is in federal prison for misdictating an op note. Hard to believe, I know, but check out the whole article at


Where is the AMA protesting the maltreatment of such physicians? You should know that the Association of American Physicians and Surgeons does care, and has filed Amicus Brief in the case. We have gotten other docs out of jail, and generally support due process and liberty in medicine. www.AAPSonline.org.

Lee Hieb, MD
Orthopaedic and Spinal Surgery