Thursday, February 11, 2010

Physician Collusion or Government Delusion?

Collusion: A secret agreement for fraudulent or treacherous purposes, a conspiracy. A secret understanding between two or more parties to gain something illegally. To defraud another of his or her rights.

Does this sound like the Independent Practice Association in Garfield County, Colorado? Or, does this sound like what United Healthcare does when it sells its Ingenix data base to other insurance companies so that they can utilize the data to control reimbursements in various markets? Have any of our readers ever looked at the Ingenix database? Didn't the NYAG Andrew Cuomo accuse the company and win a judgement against United Healthcare for using the popular Ingenix database to fraudulently lower the cost for out-of-network care? How about that conflict of interest?

Anti-trust laws were originally intended to prevent collusion and price fixing. It's time that the U.S. Congress stop colluding with the insurance industry and even the playing field for healthcare providers. The Federal Trade Commission should be embarrassed to accuse physicians of price fixing in Colorado. Anti-competitive negotiating tactics? Is the government kidding? Look at whom is calling the kettle black.

If there is one aspect to this case that made the IPA's negotiating tactics suspect, it was their demand that a COLA be included in the contracts. Unfortunately, a cost of living adjustment is a no-no, let alone use that strategy to raise reimbursements. If anything, physicians are entitled to an inflationary adjustment, but even with IA's, the insurance industry looks to avoid having to pay this out.

Orchestration: To compose, to manipulate by means of thorough planning.

Does this sound like what the IPA was doing, or does this sound like what the insurance industry is doing? Yes, doctors, TSB is a physician advocate. Yet, until physicians legally challenge the anti-trust laws, they will be treated like second class citizens. It's time that NASS, AANS, CNS and the AAOS stop wasting their time and money with lobbyists and AdvaMed and challenge the law. If you really want to get angry at someone, try diverting your frustrations and anger at the insurance industry. William McGuire, M.D., the former CEO of United Healthcare walked away with a $300 million dollar golden parachute, while illegally backdating stock, and not a peep was heard.

It's time that the public and American corporations start looking for alternative insurance carriers. The best thing we can do is hurt them, where it hurts most by finding another carrier.

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