Physicians stunned by FTC complaint of Medicare refusal

Physicians Shocked and Speechless After Complaint Against Roaring Fork Valley Physicians IPA

Sermo, the world’s largest online community for physicians, today announced its weekly hot topic. More than 500 physicians participated in a Sermo post “FTC – Refusal to accept Medicare pricing = Price Fixing.” The discussion focuses on a complaint from the FTC that the Roaring Fork Valley Physicians IPA, by refusing to accept Medicare price controls, violated anti-trust laws. The announcement prompted strong reaction among many physicians who argue they should be able to accept or decline payment terms, like any other profession.

“Many parties fail to recognize that insurance companies use reductions in Medicare rates as provocation for reducing their own payment rates with physicians,” said Dr. Daniel Palestrant, CEO of Sermo. “The antitrust exemption the insurance companies possess allows them to collude to reduce payments to physicians when it benefits them, yet they have no obligation to honor any increases Medicare might implement. For physicians, this means they either have to take it or leave it, where leaving it means facing anti-trust scrutiny – as in this case.”

According to the case, the Roaring Fork IPA engaged in “concerted refusals to deal and to fix prices with payers offering coverage from healthcare services.” It goes on to say that physician members “participated in an illegal agreement, which has increased prices for consumers of physician services.” The Group argues, however, that it banned Medicare-based rates due to a continuing decline in reimbursements. As a pathologist noted, a similar situation caused his practice income to go down 11% and his personal income to decrease by 22%.

Many physicians responded they were “somewhere between speechless with rage and stunned by the announcement.” According to a surgeon, “It seems that the only group in the US that is subject to the anti-trust laws is physicians. We have been divided and conquered.” An anesthesiologist summed up the sentiment, “…The insurance companies can collude to their hearts content, but let physicians refuse to provide a service below its cost of production, but one that the Fed insists you take, and you are breaking the law.”

Although physicians expressed their frustration, many pointed out that the underlying legal argument behind the FTC complaint is sound. They argue that the real issue is the manner in which the insurance companies have turned anti-trust laws to their own advantage. A pain medicine physician commented, “If I read this correctly the problem is that unless the doctors are glued together financially, the corporation can’t set rates, period.”

To view the full discussion and polling results, visit the Sermo Blog at

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