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Court Voids Hospital Acquisition Of Physician Practice

For generations, health care services in the United States have been paid for (or “reimbursed”) based upon the so-called fee-for-service model. A hospital or physician develops a set of charges for their medical services. Health insurers also establish what they will pay health care providers, (e.g., 80 percent of what is charged) and what they will require their insureds to pay as deductibles and/or co-payments. Managed care plans such as health maintenance organizations contract with providers to be in their network and to accept negotiated payments as opposed to the providers’ charges; the plans then offer to minimize or eliminate deductibles and co-payments to their members if the members obtain their health care services from their network providers.

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