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Anti-Medicaid or Antitrust?

Last year, the Illinois Attorney General sued two medical clinics for violation of the State's antitrust laws. In Illinois v. Carle Clinic Association, P.C. and Christie Clinic, P.C. the State alleged that Carle Clinic of Urbana, Illinois and Christie Clinic in Champaign, Illinois  jointly agreed to stop accepting new Medicaid-eligible patients seeking primary care. Carle and Christie together employ 90% of the physicians in Champaign County. 
The State believes that the clinics' boycott of new Medicaid patients causes patients to seek primary care in more expensive emergency room settings, and that the clinics are conspiring to pressure Illinois into raising Medicaid reimbursement rates.
The clinics agree that they have stopped seeing new Medicaid patients, but they deny anti-competitive conduct. (While each group might be permitted under antitrust principles to decide unilaterally to restrict who they treat, their alleged joint decision creates antitrust exposure.) 
Christie Clinic's CEO says that his clinic already serves half of Champaign County's Medicaid population. Christie Clinic's President said his clinic saw 31,000 Medicaid patients in 2006, and was working at capacity.  Clinic supporters say that Illinois already owes health care practitioners millions in late payments for Medicaid services.
Supporters of the lawsuit believe it will restore health services to poor patients, while opponents accuse the government of forcing practitioners to accept below-cost Medicaid reimbursement. (The lawsuit is working its way through the Illinois court system.)

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Date

03.23.08

Type

Publications

Authors

Rosen, Barry F.

Teams

Health Care