This Web Site (antitrusthealthplans.com) was created and is maintained by:
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Self-Funding Actuarial Services, Inc. |
Tel (336) 759-2035 |
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8025 North Point Blvd., Suite 207W |
Fax (336) 896-0392 |
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Winston-Salem, NC 27106 Carlton Harker, FSA, MAAA, Principal
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Overview
The purpose of this Web Site is to:
A Sub-Site, Statement of Concerns and Purposes, justify the existence of this Web Site.
Presentation
The topic is bifurcated thusly:
Part A – Unfair Trade Practices – Health Plan Specific
Part B – Antitrust Infractions – All Industries
Part A – Unfair Trade Practices
An overview of this subtopic is set forth in Health Plans and Unfair Trade Practices. The two major areas of concern are then discussed in some detail: (a) the Hospital Billing Controversy and whether the present Hospital Billing Practices-Can/Should Survive and (b) Bundled Vendor Services and Possible Unfair Methods of Competition. To establish whether an act or practice is unfair and/or deceptive, a Special Purpose Audit is often required; this differs in many ways from the Standard Health Plan Audit. A menu of a few Suggested Self-Funded Health Plan Changes in response to potential unfair trade practices are offered.
Part B – Antitrust Infractions – All Industries
Antitrust infractions include (a) those activities which tend toward monopolization or restraint of trade and (b) certain unfair trade acts and deceptive practices.
The topic is presented in four parts:
1.
Antitrust and Restraint of Trade
Sherman Act (15 USC §§ 1-2).
2.
Price Discrimination
Clayton and Robinson-Patman Acts (15 USC §13).
3.
Unfair Trade Practices and Deceptive Acts
FTC Act (15 USC §45).
4.
Important Exemptions-Insurance
McCarran-Ferguson Act (45 USC§20)
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