The Aftermath of Maricopa

Author:

Cohen Harry Philip,Tiano Linda V.

Abstract

An individual practice association (IPA) is a corporation or a partnership composed of physicians which contracts with health maintenance organizations (HMOs) to provide medical services to HMO subscribers. Since physicians typically practice independently, any agreement or arrangement among them may be perceived as an agreement of competitors. Hence, IPAs run the risk of challenge under the antitrust laws for activities such as price-fixing and the exclusion of physicians from membership.Prior to the recent Supreme Court decision in Arizona v. Maricopa County Medical Society, it appeared that courts were willing to consider a variety of factors that distinguished antitrust cases concerning health care providers from antitrust cases in the commercial marketplace, and to find that conduct by providers did not constitute antitrust offenses. Indeed, an earlier article appearing in Law, Medicine & Health Care analyzed the lower court's decision in Maricopa and discussed the development of this trend.

Publisher

Cambridge University Press (CUP)

Subject

General Medicine

Reference68 articles.

1. 9. Chicago Board of Trade v. United States, 246 U.S. 231, 238 (1918).

2. 45. It could be argued that courts should defer to the Department of Health & Human Services (HHS), and find that any risk arrangement approved by HHS as part of the HMO qualification process is sufficient to shield the IPA from per se classification. 42 C.F.R. Part 10, subpart F. However, since IPAs associated with federally qualified HMOs often place the physicians at risk for 15 to 20 percent of their fees (similar to non-qualified HMOs), the persuasiveness of such an argument will depend upon further clarification by the courts of the type and magnitude of risk required to escape per se classifications, and a decision as to whether such federal approval will be interpreted as an implied exemption from antitrust liability.

3. 4. 15 U.S.C. §§1-7 (1976).

4. 22. United States v. Socony-Vacuum Oil Co., supra note 11, at 222.

5. 59. 233 F. Supp. at 954.

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