Dismissal of antitrust suit upheld.
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For well over a decade, increasing numbers of medical patients have transferred from traditional indemnity insurance to managed care organizations (MCOs). Increasingly, MCOs are enrolling dental patients as well. Consequently, it is important for periodontists to understand issues in negotiating with MCOs. This article attempts to advise periodontists regarding what they can and cannot do collectively about managed care and what considerations they should take into account in individually negotiating and dealing with managed care plans.
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As the practice of medicine becomes more competitive, the states' attorneys general, the Federal Trade Commission, the Justice Department, and individual competitors progressively will use the Sherman Antitrust Act to ensure a competitive market for the delivery of health care services. Therefore, radiologists must have an understanding of the purposes of the Sherman Act and an understanding of types of anticompetitive activities that will trigger civil and criminal penalties. Specifically, radiologists must avoid blatant violations, such as price fixing, division of markets, and group boycotts, any of which may elicit the interest of the Justice Department. Further, radiologists need to consult knowledgable legal counsel when carrying out peer review activities and when entering into exclusive contracts with hospitals, particularly hospitals that have significant market power.
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