Kutak Rock attorney Robert Jaffe comments on "patient steering" in the health care industry in the June 14, 2016 edition of Healthcare Dive magazine.
The article discusses a Department of Justice (DOJ) civil antitrust lawsuit against Carolinas HealthCare System (CHS) filed on June 9. The suit alleges CHS used its market power to force major insurers into contracts with steering restrictions. According to the DOJ, the contracts have prevented insurers from steering patients toward other hospitals that offer lower priced, higher-quality services, among other things.
Jaffe explains that health care industry payer-provider agreements should leave each side free to make medical and referral decisions based on the patient’s health issues and the price and quality of services, not on contractual restrictions or market power. "An affirmative contractual statement that each party is free to make referral decisions based solely on medical considerations can help avoid inadvertent antitrust problems,” he says.
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Jaffe, who is of counsel in the firm's Washington, D.C. office, concentrates his practice in complex civil and commercial litigation, including antitrust, banking, business torts, contract disputes, insurance coverage, international trade and securities. He has extensive experience in administrative proceedings and defense of government and agency investigations, and has represented financial institutions, manufacturing corporations, high-tech companies, health care providers, foreign businesses in the United States, and individual officers and investors.