BMD provides antitrust advisory services to its health care clients, including: transaction structural advice so as to address antitrust issues; antitrust audits, antitrust compliance plans; and response to antitrust investigation/inquiries by regulators or relevant third parties. Various federal and state antitrust laws regulate how providers can interact with one another, including the sharing of price and cost data. In addition, the recent rapid consolidation of medical groups amongst each other and by hospitals raises new antitrust scrutiny due to market share dominance in some localities. BMD has also recently advised clients on the establishment of clinically integrated enterprises (between hospitals and physician groups) and Accountable Care Organizations; such structures implicate various antitrust laws, which must be navigated.
The Federal Trade Commission and state Attorneys General have been extremely active with health care antitrust enforcement in recent years, including forcing health systems to unwind acquisitions of hospitals or physician groups.
Case Study: BMD advised several large physician groups in the establishment of a management services organization (MSO). The MSO provided payor contracting, claims processing, and other financial and operational services to the member physician groups. Several payors challenged the legitimacy of the MSO and its compliance with federal and state antitrust laws. BMD successfully managed the audit of the MSO, which was shown to be in full compliance with the relevant laws.