[Federal Register Volume 60, Number 192 (Wednesday, October 4, 1995)]
[Notices]
[Pages 52014-52023]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-24596]
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DEPARTMENT OF JUSTICE
Antitrust Division
United States v. HealthCare Partners, Inc., et al.; Proposed
Final Judgment and Competitive Impact Statement
Notice is hereby given pursuant to the Antitrust Procedures and
Penalties Act, 15 U.S.C. Sec. 16(b)-(h), that a proposed Final
Judgment, Stipulation, and a Competitive Impact Statement have been
filed with the United States District Court for the District of
Connecticut in United States v. Healthcare Partners, Inc., et al.,
Civil No. 395-CV-01946-RNC as to HealthCare Partners, Inc., Danbury
Area IPA, Inc., and Danbury Health Systems, Inc.
The Complaint alleges that defendants entered into an agreement
with the purpose and effect of restraining competition unreasonably
among physicians in the Danbury, Connecticut area, in violation of
Section 1 of the Sherman Act, 15 U.S.C. Sec. 1. The Complaint also
alleges that Danbury Health Systems, Inc. willfully maintained its
monopoly in general acute inpatient services in the Danbury,
Connecticut area, in violation of Section 2 of the Sherman Act, 15
U.S.C. Sec. 2.
The proposed Final Judgment eliminates the continuance or
recurrence of defendants' unlawful agreement and of the additional acts
of Danbury Health Systems, Inc. that gave rise to the violation of
Section 2.
[[Page 52015]]
Public comment on the proposed Final Judgment is invited within the
statutory 60-day comment period. Such comments and responses thereto
will be published in the Federal Register and filed with the Court.
Comments should be directed to call Gail Kursh, Chief, Professions and
Intellectual Property Section/Health Care Task Force; United States
Department of Justice; Antitrust Division; 600 E Street, NW., Room
9300; Washington, DC 20530 (telephone: 202/307-5799).
Rebecca P. Dick,
Deputy Director of Operations.
[Civil Action No. 395CV01946RNC.]
Stipulation
United States of America and State of Connecticut, ex rel.,
Richard Blumenthal, Attorney General, Plaintiffs, vs. HealthCare
Partners, Inc., Danbury Area IPA, Inc., and Danbury Health Systems,
Inc., Defendants.
It is stipulated by and between the undersigned parties, by their
respective attorneys, that:
1. The Court has jurisdiction over the subject matter of this
action and over each of the parties hereto, and venue of this action is
proper in the District of Connecticut;
2. The parties consent that a Final Judgment in the form hereto
attached may be filed and entered by the Court, upon the motion of any
party or upon the Court's own motion, at any time after compliance with
the requirements of the Antitrust Procedures and Penalties Act (15
U.S.C. Sec. 16), and without further notice to any party or other
proceedings, provided that plaintiffs have not withdrawn their consent,
which they may do at any time before the entry of the proposed Final
Judgment by serving notice thereof on defendants and by filing that
notice with the Court; and
3. Defendants agree to be bound by the provisions of the proposed
Final Judgment pending its approval by the Court. If plaintiffs
withdraw their consent, or if the proposed Final Judgment is not
entered pursuant to the terms of the Stipulation, this Stipulation
shall be of no effect whatsoever, and the making of this Stipulation
shall be without prejudice to any party in this or in any other
proceeding.
For Plaintiff United States of America:
Lawrence R. Fullerton,
Acting Assistant Attorney General.
Rebecca P. Dick,
Deputy Director, Office of Operations.
Gail Kursh,
Chief, Professions & Intellectual Property Section.
Mark J. Botti,
Pamela C. Girardi,
Attorneys, U.S. Department of Justice, Antitrust Division, Professions
& Intellectual Property Section, Room 9320, BICN Bldg., 600 E Street,
NW., Washington, DC 20530, (202) 307-0827.
Plaintiff State of Connecticut
Richard Blumenthal,
Attorney General.
By:
William M. Rubenstein,
Assistant Attorney General, Federal Bar No. CT08834, 110 Sherman
Street, Hartford, Connecticut 06105, (203) 566-5374.
For Defendants HealthCare Partners, Inc. and Danbury Health
Systems, Inc.
David Marx, Jr.,
Jillisa Brittan,
McDermott, Will & Emery, 227 West Monroe Street, Chicago, Illinois
60606-5096, (312) 372-2000.
For Defendant Danbury Area IPA, Inc.
James Sicilian,
Day, Berry & Howard, CityPlace, Hartford, CT 06103, (203) 275-0100.
Final Judgment
Plaintiffs, the United States of America and the State of
Connecticut, having filed their Complaint on September 13, 1995, and
plaintiffs and defendants, by their respective attorneys, having
consented to the entry of this Final Judgment without trial or
adjudication of any issue of fact or law, and without this Final
Judgment constituting any evidence against or an admission by any party
with respect to any issue of fact or law;
And Whereas defendants have agreed to be bound by the provisions of
this Final Judgment pending its approval by the Court;
Now, Therefore, before the taking of any testimony, and without
trial or adjudication of any issue of fact or law, and upon consent of
the parties, it is hereby Ordered, Adjudged, and Decreed:
I
Jurisdiction
This Court has jurisdiction over the subject matter of and each of
the parties to this action. The Complaint states claims upon which
relief may be granted against the defendants under Sections 1 and 2 of
the Sherman Act, 15 U.S.C. Secs. 1 and 2.
II
Definitions
As used in this Final Judgment:
(A) Competing physicians means physicians in separate medical
practices in the same relevant physician market;
(B) Control means either:
(1) holding 50 percent or more of the outstanding voting securities
of an issuer;
(2) in the case of an entity that has no outstanding voting
securities, having the right to 50 percent or more of the profits of an
entity, or having the right in the event of dissolution to 50 percent
or more of the assets of the entity; or
(3) having the contractual power to designate 50 percent or more of
the directors of a corporation, or in the case of unincorporated
entities, of individuals exercising similar functions.
(C) DAIPA means Danbury Area IPA, Inc., each of its directors,
officers, agents, representatives, and employees (in such capacity
only), its successors and assigns, and each entity over which it has
control.
(D) DHS means Danbury Health Systems, Inc., each of its directors,
officers, agents, representatives, and employees (in such capacity
only), its successors and assigns, and each entity over which it has
control.
(E) DHS Affiliated Physician means any physician employed, or whose
practice is owned, by DHS or DOPS at the time of the filing of the
Complaint in this action.
(F) DOPS means Danbury Office of Physician Services, P.C., each of
its directors, officers, agents, representatives, and employees (in
such capacity only), its successors and assigned, and each entity over
which it has control.
(G) HealthCare Partners means HealthCare Partners, Inc., each of
its directors, officers, agents, representatives, and employees (in
such capacity only), its successors and assigns, and each entity over
which it has control.
(H) Messenger model means the use of an agent or third party to
convey to payers any information obtained from individual providers
about the prices or other competitive terms and conditions each
provider is willing to accept from payers, and to convey to providers
any contract offer made by a payer, where each provider makes a
separate, independent, and unilateral decision to accept or reject a
payer's offer; the information on prices or other competitive terms and
conditions conveyed to payers is obtained separately from each
individual provider; and the agent or third party
[[Page 52016]]
does not negotiate collectively for the providers, disseminate to any
provider the agent's or third party's or any other provider's views or
intentions as to the proposal, or otherwise serve to facilitate any
agreement among providers on prices or other competitive terms and
conditions.
The agent or third party, so long as it acts consistently with the
foregoing, may:
(1) Convey to a provider objective information about proposed
contract terms, including comparisons with terms offered by other
payers;
(2) solicit clarifications from a payer of proposed contract terms,
or engage in discussions with a payer regarding contract terms other
than prices and other competitive terms and conditions, except that the
agent or third party (a) must tell the payer that the payer may refuse
to respond or may terminate discussions at any time and (b) may not
communicate to the providers regarding, or comment on, the payer's
refusal to offer a clarification or decision not to enter into or to
terminate discussions except to providers who requested the
clarification;
(3) convey to a provider any response made by a payer to
information conveyed or clarifications sought;
(4) convey to a payer the acceptance or rejection by a provider of
any contract offer made by the payer;
(5) at the request of a payer, provide the individual response,
information, or views of each provider concerning any contract offer
made by such payer; and
(6) charge a reasonable fee to convey contract offers, by applying
preexisting objective criteria, not involving prices or other
competitive terms and conditions, in a nondiscriminatory manner.
Additionally, the agent or third party must communicate each
contract offer made by a payer unless the payer refuses to pay the fee
for delivery of that offer; the offer is the payer's first offer and
lacks material terms such that it could not be considered a bona fide
offer, or the agent or third party applies preexisting objective
criteria, not involving prices or other competitive terms and
conditions, in a nondiscriminatory manner (for example, refusing to
convey offers of payers whose plans do not cover a certain minimum
number of people, or offers made after the agent or messenger has
conveyed a stated maximum number of offers for a given time period).
(I) Pre-existing practice group means a physician practice group
existing as of the date of the filing of the Complaint in this action.
All DHS affiliated physicians at the time of the filing of the
Complaint in this action constitute a single pre-existing practice
group. DAIPA does not constitute a pre-existing physician practice
group. A pre-existing practice group may add any physician to the group
after the filing of the Complaint, without losing the status of ``pre-
existing'' under this definition for any relevant physician market, so
long as each additional physician is not currently offering services in
the relevant physician market and would not have entered that market
but for the group's efforts to recruit the physician into the market.
(J) Prices or other competitive terms and conditions means all
material terms of the contract, including information relating to fees
or other aspects of reimbursement, outcomes data, practice parameters,
utilization patterns, credentials, and qualifications.
(K) Provider panel means those health care providers with whom an
organization contracts to provide care to its enrollees.
(L) Qualified managed care plan means an organization:
(1) Whose members or owners share substantial financial risk and
either directly or through membership or ownership in another
organization, comprise, (a) where membership or ownership is non-
exclusive, no more than 30% of the physicians in any relevant physician
market, except that it may include any single physician or pre-existing
practice group, or (b) where membership or ownership is exclusive, no
more than 20% of the physicians in any relevant physician market; and
(2) Whose provider panel, does not have more than where non-
exclusive 30% or where exclusive 20% of the physicians in any relevant
physician market, unless, for those subcontracting physicians whose
participation increases the panel beyond the 20% or 30% limitations,
the organization bears significant financial risk for payments to and
the utilization practices of the subcontracting physicians and does not
compensate those subcontracting physicians in a manner that
substantially replicates membership or ownership in the organization.
The organization may not facilitate an agreement between any
subcontracting physician and any other physician on their charges to
payers not contracting with the organization. The organization may at
any given item exceed the 20% or 30% limitations as a result of (a) any
physician exiting any relevant physician market or (b) the addition of
any physician not previously offering services in a relevant physician
market who would not have entered that market but for the
organization's efforts to recruit the physician into the market;
however, the organization may not exceed the 20% or 30% limitation by
any greater degree than is directly caused by such exit or entry.
(M) Relevant physician market means, unless defendants obtain
plaintiffs' prior written approval of a different definition, each of
the following groups of physicians with active staff privileges other
than courtesy privileges at Danbury Hospital:
(1) Physicians who are: (a) Board-certified only in general
internal medicine or family practice; (b) listed only under family
practice or internal medicine on the attached medical staff lists of
Danbury Hospital; or (c) generally-recognized, and in fact practicing
more than a third of the time as a family practitioner or general
internist (for purposes of determining the percentage of physicians
applicable to a qualified managed care plan, each physician included in
a relevant physician market pursuant to this clause (c) of Paragraph
(II)(M)(1) of this Final Judgment shall count as only one-third of a
physician);
(2) Physicians who are board-certified in, or board-eligible and
actually practicing in, obstetrics or gynecology;
(3) Physicians who are board-certified in, or board-eligible and
actually practicing in, pediatrics; and
(4) Any other group of physicians who offer services in a relevant
product market as defined applying federal antitrust principles.
(N) Subcontracting physician means any physician who provides
services to an organization or to persons receiving healthcare services
from that physician pursuant to an agreement by that organization to
provide such services, but who does not hold, directly or indirectly,
any ownership interest in that organization.
(O) Substantial financial risk means financial risk achieved
through capitation or the creation of significant financial incentives
for the group to achieve specified cost-containment goals, such as
withholding from all members or owners of a qualified managed care plan
a substantial amount of the compensation due to them, with distribution
of that amount to the members or owners only if the cost-containment
goals are met.
III
Applicability
This Final Judgment applies to DHS, DAIPA, and HealthCare Partners,
and to all other persons who receive actual notice of this Final
Judgment by personal service or otherwise and then act or participate
in active concert with any or all of the defendants.
[[Page 52017]]
IV
Injunctive Relief
(A) DAIPA and HealthCare Partners are enjoined from, directly or
through any agent or other third party, setting, or expressing views
on, the prices or other competitive terms and conditions or negotiating
for competing physicians, regardless of whether those physicians are
subcontracting physicians or owners or members of DAIPA or HealthCare
Partners, unless done as part of the operation of a qualified managed
care plan; provided that, nothing in this Final Judgment shall prohibit
DAIPA or HealthCare Partners from acting as or using a messenger model.
(B) DAIPA, HealthCare Partners, and DHS are enjoined from:
(1) Precluding or discouraging any physician from contracting with
any payer, providing incentives for any physician to deal exclusively
with DAIPA, HealthCare Partners, or any payer, or agreeing to any
priority among themselves as to which will have the right to first
negotiate with any payer, provided that, nothing is in this paragraph
shall prohibit a physician from agreeing to exclusivity in connection
with an ownership interest or membership in a qualified managed care
plan, or prohibit DHS from participant in contracting decisions of DHS-
affiliated physicians;
(2) Disclosing to any physician any financial or other
competitively sensitive business information about any competing
physician, except as is reasonably necessary for the operation of any
qualified managed care plan, or requiring any physician to disclose any
financial or other competitively sensitive business information about
any payer or other competitor of DAIPA or HealthCare Partners; provided
that, nothing in this Final Judgment shall prohibit the disclosure of
information already generally available to the medical community or the
public or the provision of information pursuant to the Antitrust Safety
Zones delineated in the attached Statements 5 and 6 of the 1994
Statements of Enforcement Policy and Analytical Principles Relating to
Health Care and Antitrust;
(3) Owning an interest in any organization (including DAIPA and
HealthCare Partners) that, directly or through any agent or other third
party, sets, or expresses views on, prices or other competitive terms
and conditions or negotiates for competing physicians, regardless of
whether those physicians are subcontracting physicians or owners or
members of that organization, unless that organization is a qualified
managed care plan and complies with Paragraphs IV (B)(1) and (B)(2) of
the Final Judgment as if those Paragraphs applied to that organization;
provided that, nothing in this Final Judgment shall prohibit owning an
interest in an organization that acts as or uses a messenger model.
(C) DHS is enjoined from:
(1) Exercising its control over staff privileges with the purpose
of reducing competition with DHS in any line of business, including
managed care, outpatient surgery or radiology, and physician services;
provided that nothing in this Final Judgment shall limit DHS's
authority to make staff decisions for the purpose of assuring quality
of care;
(2) Conditioning the provision of inpatient hospital services to
individuals covered by any payer on:
(a) The purchase or use of DHS's utilization review program, any
DHS qualified managed care plan, DHS's ancillary or outpatient
services, or any physician's services unless such services are
intrinsically related to the provision of acute inpatient care (as, for
example, are radiology, anesthesiology, emergency room, and pathology
services deemed to be for purposes of this Final Judgment where these
services are performed in connection with an inpatient admission), or
(b) A contract or other agreement to deal through HealthCare
Partners or any other organization; provided that, nothing in this
Paragraph IV(C)(2) shall limit the terms and conditions on which DHS
may contract with any payer pursuant to which DHS bears substantial
financial risk for the delivery of the services or products identified
in Subparagraphs (1) and (2); and
(3) Conditioning rates to any payer for inpatient hospital services
on the exclusive use of DHS outpatient services, provided that nothing
in this Paragraph IV(C)(3) shall (a) limit the terms and conditions on
which DHS may contract with any payer pursuant to which DHS bears
substantial financial risk for the delivery of outpatient services; or
(b) prohibit DHS from entering into exclusive contracts that require
payers to use DHS's outpatient services where rates for those services
are not tied to discounts on inpatient rates.
V
Additional Provisions
(A) DAIPA and HealthCare Partners shall:
(1) Inform each participating physician annually in writing that
the physician is free to contract separately with any payer on any
terms, except with regard to physicians who have agreed to exclusivity
in connection with an ownership interest or membership in a qualified
managed care plan; and
(2) Notify in writing each payer with which HealthCare Partners
currently has or is negotiating a contract, or which subsequently
inquires about contracting with HealthCare Partners, that each provider
on HealthCare Partners' provider panel is free to contract separately
with such payer on any terms, without consultation with DAIPA or
HealthCare Partners.
(B) DHS shall file with plaintiffs each year on the anniversary of
the filing of the Complaint in this action a written report disclosing
the rates for inpatient hospital services to any payer, including any
plan affiliated with DHS, or in lieu of such a report, documents
sufficient to disclose those rates for each payer (other than Medicare
and Medicaid). Plaintiffs agree not to disclose this information unless
in connection with a proceeding to enforce this Final Judgment or
pursuant to a court or congressional order.
VI
Compliance Program
Each defendant shall maintain an antitrust compliance program
(unless the defendant dissolves without any successors or assigns),
which shall include:
(A) Distributing within 60 days from the entry of this Final
Judgment, a copy of the Final Judgment and Competitive Impact Statement
to all officers and directors;
(B) Distributing in a timely manner a copy of the Final Judgment
and Competitive Impact Statement to any person who succeeds to a
position described in Paragraph VI(A);
(C) Briefing annually in writing or orally those persons designated
in Paragraphs VI (A) and (B) on the meaning and requirements of this
Final Judgment and the antitrust laws, including penalties for
violation thereof;
(D) Obtaining from those persons designated in Paragraphs (VI) (A)
and (B) annual written certifications that they (1) have read,
understand, and agree to abide by this Final Judgment, (2) understand
that their noncompliance with this Final Judgment may result in
conviction for criminal contempt of court and imprisonment and/or fine,
and (3) have reported violations, if any, of this Final Judgment of
which they are aware to counsel for the respective defendant; and
(E) Maintaining for inspection by plaintiffs a record of recipients
to whom this Final Judgment and Competitive
[[Page 52018]]
Impact Statement have been distributed and from whom annual written
certifications regarding this Final Judgment have been received.
VII
Certifications
(A) Within 75 days after entry of this Final Judgment, each
defendant shall certify to plaintiffs that it has made the distribution
of the Final Judgment and Competitive Impact Statement as required by
Paragraph VI(A); and
(B) For 10 years, unless the defendant dissolves without any
successors or assigns, after the entry of this Final Judgment, on or
before its anniversary date, each defendant shall certify annually to
plaintiffs whether it has complied with the provisions of Section VI
applicable to it.
VIII
Plaintiffs' Access
For the sole purpose of determining or securing compliance with
this Final Judgment, and subject to any recognized privilege,
authorized representatives of the United States Department of Justice
or the Office of the Attorney General of the State of Connecticut, upon
written request of the Assistant Attorney General in charge of the
Antitrust Division or the Connecticut Attorney General, respectively,
shall on reasonable notice be permitted:
(A) Access during regular business hours of any defendant to
inspect and copy all records and documents in the possession or under
the control of that defendant relating to any matters contained in this
Final Judgment;
(B) To interview officers, directors, employees, and agents of any
defendant, who may have counsel present, concerning such matters; and
(C) To obtain written reports from any defendant, under oath if
requested, relating to any matters contained in this Final Judgment.
IX
Notifications
Each defendant shall notify the plaintiffs at least 30 days prior
to any proposed (1) dissolution of that defendant, (2) sale or
assignment of claims or assets of that defendant resulting in the
emergence of a successor corporation, or (3) change in corporate
structure of that defendant that may affect compliance obligations
arising out of Section IV of this Final Judgment.
X
Jurisdiction Retained
This Court retains jurisdiction to enable any of the parties to
this Final Judgment, but no other person, to apply to this Court at any
time for further orders and directions as may be necessary or
appropriate to carry out or construe this Final Judgment, to modify or
terminate any of its provisions, to enforce compliance, and to punish
violations of its provisions.
XI
Expiration of Final Judgment
This Final Judgment shall expire ten (10) years from the date of
entry.
XII
Public Interest Determination
Entry of this Final Judgment is in the public interest.
Dated: ____________________________.
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United States District Judge
Note: The Danbury Hospital Medical Staff List by Department,
Statement of Department of Justice and Federal Trade Commission
Enforcement Policy on Providers' Collective Provision of the Related
Information to Purchasers of Health Care Services, and Statement of
Department of Justice and Federal Trade Commission Enforcement
Policy on Provider Participation in Exchanges of Price and Cost
Information are attachments to the proposed Final Judgment filed
with the Court. A copy of the attachments may be obtained from the
Department of Justice, Legal Procedures Unit.
Competitive Impact Statement
Pursuant to Section 2(b) of the Antitrust Procedures and Penalties
Act, 15 U.S.C. Sec. 16(b)-(h) (``APPA''), the United States files this
Competitive Impact Statement relating to the proposed Final Judgment
submitted for entry in this civil antitrust proceeding.
I
Nature and Purpose of the Proceeding
On September 13, 1995, the United States and the State of
Connecticut filed a civil antitrust complaint alleging that defendant
HealthCare Partners, Inc. (``HealthCare Partners''), defendant Danbury
Area IPA, Inc. (``DAIPA''), and defendant Danbury Health Systems, Inc.
(``DHS''), with others not named as defendants, entered into an
agreement and took other actions, the purpose and effect of which were,
among other things, to restrain competition unreasonably by preventing
or delaying the development of managed care in the Danbury, Connecticut
area (``Danbury''), to willfully maintain DHS' market power in acute,
inpatient care, and to gain an unfair advantage in markets for
outpatient services, in violation of Sections 1 and 2 of the Sherman
Act, 15 U.S.C. Secs. 1, 2. The Complaint seeks injunctive relief to
enjoin continuance or recurrence of these violations.
The United States and the State of Connecticut filed with the
Complaint a proposed Final Judgment intended to settle this matter.
Entry of the proposed Final Judgment by the Court will terminate this
action, except that the Court will retain jurisdiction over the matter
for further proceedings that may be required to interpret, enforce, or
modify the Judgment, or to punish violations of any of its provisions.
Plaintiffs and all defendants have stipulated that the Court may
enter the proposed Final Judgment after compliance with the APPA,
unless prior to entry plaintiffs have withdrawn their consent. The
proposed Final Judgment provides that its entry does not constitute any
evidence against, or admission by, any party concerning any issue of
fact or law.
The present proceeding is designed to ensure full compliance with
the public notice and other requirements of the APPA. In the
Stipulation to the proposed Final Judgment, defendants have also agreed
to be bound by the provisions of the proposed Final Judgment pending
its entry by the Court.
II
Practices Giving Rise To The Alleged Violations
DHS's 450-bed acute care facility, Danbury Hospital, is the sole
source of acute inpatient care in the Danbury area. It faces no
competition from other general acute care hospitals in the market for
these services and, accordingly, possesses a monopoly in general acute
inpatient care. The Hospital also provides outpatient surgical care and
other services.
By 1992, managed care organizations had recruited a sufficient
number of physicians with active staff privileges at Danbury Hospital
to offer managed care plans to employers and individuals in the Danbury
area. The introduction of managed care plans into the Danbury area
reduced the Hospital's market power in inpatient services by decreasing
the number of hospital admissions and the length of hospital stays,
thereby causing the Hospital to lose significant inpatient volume.
Additionally, the introduction of managed care plans resulted in
increased competition among doctors and reduced referrals to
specialists in
[[Page 52019]]
DOPS (Danbury Hospital's affiliated multispecialty practice group).
In 1993, DHS took steps to form an alliance with virtually every
doctor on its Hospital's medical staff to protect the economic
interests of both the Hospital and the doctors and forestall the
continued development of managed care plans in Danbury. On May 6, 1994,
HealthCare Partners was incorporated to represent jointly Danbury
Hospital and physicians in negotiations with managed care
organizations, and DAIPA was created as the vehicle for physician
ownership in HealthCare Partners. Danbury Hospital and DAIPA jointly
own HealthCare Partners, and each appoints six of the twelve directors
of HealthCare Partners' board of directors.
Only active members of Danbury Hospital's medical staff could be
owners of DAIPA. Over 98% of the doctors on Danbury Hospital's medical
staff joined DAIPA. Each paid a small fee. None committed to any
integration of their practices.
Each doctor who joined DAIPA contracted with HealthCare Partners
and authorized it to negotiate fees on the doctor's behalf. The doctors
authorized HealthCare Partners to enter into non-risk-bearing contracts
in one of two ways.\1\
\1\ While the doctors also authorized HealthCare Partners to
enter into risk-bearing contracts, HealthCare Partners has not
exercised this authority. Even if it had, or does in the future, the
negotiation of risk-bearing contracts would not justify the unlawful
negotiation of non-risk-bearing contracts that occurred here. See
Statements of Enforcement Policy and Analytical Principles Relating
to Health Care and Antitrust (``Health Care Policy Statements'')
that the U.S. Department of Justice and the Federal Trade Commission
issued jointly on September 27, 1994, 4 Trade Reg. Rep. (CCH) para.
13,152, at 20,794 n.35.
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First, it could prepare a minimum fee schedule and present it to
each doctor for approval. A doctor's approval would then authorize
HealthCare Partners to enter into non-risk-bearing contracts on behalf
of the doctor without further consultation so long as the resulting
fees equalled or exceeded the minimum fee schedule.
Alternatively, HealthCare Partners could negotiate fees on behalf
of all the doctors and then present each doctor with the collectively
negotiated fee schedule. Each doctor would then have the opportunity to
accept this jointly negotiated fee schedule.
HealthCare Partners negotiated two contracts using this latter
approach and succeeded in obtaining generous fees for the DAIPA
doctors. Indeed, one of the contracting managed care plans was forced
to increase its fees to doctors outside of the Danbury area to avoid
the excessive administrative costs it would have incurred to administer
one fee schedule for Danbury and a separate schedule for the other
areas in which it operated.
The Hospital's goal in forming HealthCare Partners was to eliminate
competition among physicians in order to further its broader goal of
reducing or limiting the impact of managed care plans on its monopoly
in acute inpatient services. In furtherance of these goals, the
Hospital also used its control over admitting privileges to reduce
competition in physician and outpatient services markets. The Hospital
adopted a Medical Staff Development Plan in part to limit the size and
mix of its medical staff. This Plan effectively controlled the entry of
new physicians into Danbury and thereby insulated HealthCare Partners
from competition. The Hospital also announced a policy that required
its doctors to perform at least 30% of their procedures at the
Hospital. This announcement caused a reduction in the use of a
competing outpatient surgery center.
Based on the facts described above, the Complaint alleges (1) that
the defendants entered into a contract, combination, or conspiracy that
eliminated competition among physicians, reduced or limited the
development of managed care plans, and reduced or limited competition
among outpatient service providers, all in violation of Section 1 of
the Sherman Act, 15 U.S.C. Sec. 1 and (2) that HDS took exclusionary
acts that had the purpose and effect of maintaining Danbury Hospital's
market power in acute inpatient hospital services and gaining an unfair
advantage in markets for outpatient services, in violation of Section 2
of the Sherman Act, 15 U.S.C. Sec. 2.
III
Explanation of The Proposed Final Judgment
The proposed Final Judgment is intended to prevent the continuance
or recurrence of defendants' agreement to eliminate competition among
doctors and reduce or limit the development of managed care in the
Danbury area. The proposed Final Judgment is also intended to prevent
the continuance or recurrence of DHS's exclusionary conduct. The
overarching goal of the proposed Final Judgment is to enjoin defendants
from engaging in any activity that unreasonably restrains competition
among physicians, outpatient service providers, or managed care plans
in the Danbury area, or that willfully maintains Danbury Hospital's
market power in acute inpatient services, or gains Danbury hospital an
unfair advantage in markets for outpatient services, while still
permitting defendants to market a provider-controlled managed care
plan.\2\
\2\ This relief comports with the Health Care Policy Statements,
and in particular with the principles enunciated therein that a
provider network (1) should not prevent the formation of rival
networks and (2) may not negotiate on behalf of providers, unless
those providers share substantial financial risk or offer a new
product to the market place. Statement 8, 4 Trade Reg. Rep. (CCH)
para. 13,152, at 20,788-89; Statement 9, id. at 20,793-94, 20,796.
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A. Scope of the Proposed Final Judgment
Section III of the proposed Final Judgment provides that the Final
Judgment shall apply to defendants and to all other persons who receive
actual notice of this proposed Final Judgment by personal service or
otherwise and then participate in active concert with any defendant.
The proposed Final Judgment applies to DHS, DAIPA, and HealthCare
Partners.
B. Prohibitions and Obligations
Sections IV and V of the proposed Final Judgment contain the
substantive provisions of the Judgment.
In Section IV(A), DAIPA and HealthCare Partners are enjoined from
setting or expressing views on the prices or other competitive terms
and conditions or negotiating entity is a Qualified Managed Care Plan
(``QMCP''--as defined in the proposed Final Judgment and discussed
below). However, DAIPA and HealthCare Partners are permitted to use a
messenger model, as discussed below.
Section IV(B)(1) enjoins DHS, DAIPA, and HealthCare Partners from
precluding or discouraging any physician from contracting with any
payer, providing incentives for any physician to deal exclusively with
DAIPA, HealthCare Partners, or any payer, or agreeing to any priority
among themselves as to which will have the right to negotiate first
with any payer. Nothing in Section IV(B), however, prohibits physicians
from agreeing to exclusivity in connection with an ownership interest
or membership in a QMCP.
Section IV(B)(2) prohibits the sharing of competitively sensitive
information. DHA, DAIPA, and HealthCare Partners are enjoined from
disclosing to any physician any financial or other competitively
sensitive business information about any competing physician and from
requiring any physician to disclose any financial or other
competitively sensitive information about any payer. An exception
permits any defendant to
[[Page 52020]]
disclose such information if disclosure is reasonably necessary for the
operation of a QMCP in which that defendant has an ownership interest,
or if the information is already generally available to the medical
community or the public.
Section IV(B)(3) enjoins DHS, DAIPA, and HealthCare Partners from
owning an interest in any organization that directly or through an
agent or other third party sets fees or other terms of reimbursement,
or negotiates for competing physicians, unless that organization is a
QMCP and complies with Sections IV (B)(1) and (B)(2). However,
defendants may own an interest in an organization that uses a messenger
model.
Section IV(C)(1) enjoins DHS from exercising its control over staff
privileges with the purpose of reducing competition with DHS in any
line of business, including managed care, outpatient services, and
physician services. Nothing in the Final Judgment limits DHS' authority
to make staff decisions for assuring quality of care.
Section IV(C)(2) prohibits DHS from conditioning the provision of
inpatient hospital services to individuals covered by any payer on the
purchase or use of DHS' utilization review program, qualified managed
care plan, ancillary or outpatient services, or any physician's
services, unless the physician services are intrinsically related to
the provision of inpatient care. (These prohibitions, however, do not
apply to any organization or any contract in which DHS has a
substantial financial risk.)
Section IV(C)(3) prohibits DHS from conditioning rates to any payer
for inpatient hospital services on the exclusive use of the Hospital's
outpatient services. Nothing in this Section limits the terms and
conditions on which DHS may contract with any payer pursuant to which
DHS bears substantial financial risk for the delivery of outpatient
services.
Section V of the proposed Final Judgment contains additional
provisions with respect to DAIPA and HealthCare Partners. Section V(A)
requires DAIPA and HealthCare Partners to notify participating
physicians annually that they are free to contract separately with any
payer on any terms, except with regard to those physicians who have
agreed to exclusivity in connection with an ownership interest or
membership in a QMCP. Similarly, DAIPA and HealthCare Partners must
notify in writing each payer with whom HealthCare Partners has or is
negotiating a contract, or which subsequently inquires about
contracting, that each of its participating physicians is free to
contract separately with such payer on any terms and without
consultation with DAIPA or HealthCare Partners.
Under Section V(B), DHS must file with plaintiffs annually on the
anniversary of the filing of the Complaint a written report disclosing
the rates for inpatient hospital services to any payer, including any
plan affiliated with DHS. In lieu of a report, DHS may file documents
disclosing the rates for each payer other than Medicare and Medicaid.
Section VI of the proposed Final Judgment requires defendants to
implement a judgment compliance program. Section VI(A) requires that
within 60 days of entry of the Final Judgment, defendants must provide
a copy of the proposed Final Judgment and the Competitive Impact
Statement to all officers and directors. Sections VI (B) and (C)
require defendants to provide a copy of the proposed Final Judgment and
Competitive Impact Statement to persons who assume those positions in
the future and to brief such persons annually on the meaning and
requirements of the proposed Final Judgment and the antitrust laws,
including penalties for violating them. Section VI(D) requires
defendants to maintain records of such persons' written certifications
indicating that they (1) have read, understand, and agree to abide by
the terms of the proposed Final Judgment, (2) understand that their
noncompliance with the proposed Final Judgment may result in conviction
for criminal contempt of court, and imprisonment, and/or fine, and (3)
have reported any violation of the proposed Final Judgment of which
they are aware to counsel for defendants. Section VI(E) requires
defendants to maintain for inspection by plaintiffs a record of
recipients to whom the proposed Final Judgment and Competitive Impact
Statement have been distributed and from whom annual written
certifications regarding the proposed Final Judgment have been
received.
The proposed Final Judgment also contains provisions in Section VII
requiring defendants to certify their compliance with specified
obligations of Section VI(A) of the proposed Final Judgment. Section
VIII of the proposed Final Judgment sets forth a series of measures by
which plaintiffs may have access to information needed to determine or
secure defendants' compliance with the proposed Final Judgment. Section
IX provides that each defendant must notify plaintiffs of any proposed
change in corporate structure at least 30 days before that change to
the extent the change may affect compliance obligations arising out of
the proposed Final Judgment.
Finally, Section XI states that the Judgment expires ten years from
the date of entry.
C. Effect of the Proposed Final Judgment on Competition
1. The Prohibitions on Setting and Negotiating Fees and Other Contract
Terms
The prohibitions on setting or expressing views on prices and other
contract terms or negotiating for competing physicians, set forth in
Section IV(A), provide defendants with essentially two options for
complying with the proposed Final Judgment. First, HealthCare Partners
and DAIPA may change their manner of operation and no longer set or
negotiate fees on behalf of competing physicians, for example by using
a ``messenger model,'' a term defined in the proposed Final Judgment.
Second, HealthCare Partners and DAIPA may restructure their ownership
and provider panels to become a QMCP.\3\
\3\ Of course, HealthCare Partners and DAIPA could simply cease
operations and dissolve.
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DAIPA jointly owns HealthCare Partners with DHS and appoints six of
HealthCare Partners directors. DAIPA includes competing physicians
among its owners on whose behalf HealthCare Partners negotiates fees
and other competitively sensitive terms and conditions. These
physicians do not share financial risk. The proposed Final Judgment
prevents HealthCare Partners and DAIPA, under their present structures,
from continuing to set or negotiate fees or other terms of
reimbursement collectively on behalf of the competing physicians.
(Section IV(A)) Such conduct would constitute naked price fixing.
Arizona v. Maricopa County Medical Soc'y, 457 U.S. 332, 356-57 (1982).
The proposed Final Judgment does not, however, prohibit HealthCare
Partners and DAIPA, as presently structured, from engaging in
activities that are not anticompetitive. In particular, while the
proposed Judgment enjoins HealthCare Partners and DAIPA from engaging
in price fixing or similar anticompetitive conduct, it permits
HealthCare Partners and DAIPA to use an agent or third party to
facilitate the transfer of information between individual physicians
and purchasers of physician services. Appropriately designed and
administered, such messenger models rarely present substantial
competitive concerns and indeed have the potential to reduce the
transaction costs of negotiations
[[Page 52021]]
between health plans and numerous physicians.
The proposed Final Judgment makes clear that the critical feature
of a properly devised and operated messenger model is that individual
providers make their own separate decisions about whether to accept or
reject a purchaser's proposal, independent of other physicians'
decisions and without any influence by the messenger. (Section II(H))
The messenger may not, under the proposed Judgment, coordinate
individual providers' responses to a particular proposal, disseminate
to physicians the messenger's or other physicians' views or intentions
concerning the proposal, act as an agent for collective negotiation and
agreement, or otherwise serve to facilitate collusive behavior.\4\ The
proper role of the messenger is simply to facilitate the transfer of
information between purchasers of physician services and individual
physicians or physician group practices and not to coordinate or
otherwise influence the physicians' decision-making process.\5\
\4\ For example, it would be a violation of the proposed Final
Judgment if the messenger were to select a fee for a particular
procedure from a range of fees previously authorized by the
individual physician, or if the messenger were to convey collective
price offers from physicians to purchasers or negotiate collective
agreements with purchasers on behalf of physicians. This would be so
even if individual physicians were given the opportunity to ``opt
in'' to any agreement. In each instance, it would in fact be the
messenger, not the individual physician, who would be making the
critical decision, and the purchaser would be faced with the
prospect of a collective response.
\5\ For example, the messenger may convey to a physician
objective or empirical information about proposed contract terms,
convey to a purchaser any individual physician's acceptance or
rejection of a contract offer, canvass member physicians for the
rates at which each would be willing to contract even before a
purchaser's offer is made, and charge a reasonable, non-
discriminatory fee for messenger services. The proposed Final
Judgment gives guidelines for these and other activities that a
messenger may undertake without violating the Final Judgment.
(Section II(H))
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If, on the other hand, HealthCare Partners or DAIPA wants to
negotiate on behalf of competing physicians, it must restructure itself
to meet the requirements of a QMCP as set forth in the proposed Final
Judgment. To comply, (1) the owners or members of HealthCare Partners
or DAIPA (to the extent they compete with other owners or members or
compete with physicians on their provider panels) must share
substantial financial risk, and comprise no more than 30% on a
nonexclusive basis, or 20% on an exclusive basis, of the physicians in
any relevant market; and (2) to the extent HealthCare Partners or DAIPA
has a provider panel that exceeds either of these limits in any
relevant market, there must be a divergence of economic interest
between the owners and the subcontracting physicians, such that the
owners have the incentive to bargain down the fees of the
subcontracting physicians. (See II(L) (1) and (2)) As explained below,
the requirements of a QMCP are necessary to avoid the creation of a
physician cartel while at the same time allowing payers access to
larger physician panels.
a. QMCP Ownership Requirements
The financial risk-sharing requirement of a QMCP ensures that the
physician owners in the venture share a clear economic incentive to
achieve substantial cost savings and provide better services at lower
prices to consumers. This requirement is applicable to all provider-
controlled organizations since without this requirement a network of
competing providers would have both the incentive and the ability to
increase prices for health care services.
The requirement that a QMCP not include more than 30% on a
nonexclusive basis, and 20% on an exclusive basis, of the local
physicians in certain instances is designed to ensure that there are
available sufficient remaining physicians in the market with the
incentive to contract with competing managed care plans or to form
their own plans.\6\ These limitations are particularly critical in this
case in view of defendants' prior conduct in forming negotiating groups
with nearly every physician with active staff privileges at Danbury
Hospital.
\6\ The proposed Final Judgment embodies the parties'
stipulation that only physicians with active staff privileges (not
including those with just courtesy privileges) at Danbury Hospital
are in any relevant physician market. One anticompetitive effect
remedied by the proposed Final Judgment was the reduction in
competition among these physicians, which allowed both the exercise
of horizontal market power in physician markets and the willful
maintenance of the Hospital's market power in acute inpatient
hospital service. Accordingly, the 20% and 30% limitations apply to
this universe of doctors. The proposed Final Judgment specifies
three separate product markets to which these limitations apply:
adult primary care doctors (Section II(M)(1)), OB/GYNs (Section
II(M)(2)), and pediatricians (Section IIM)(3). The limitations also
apply to any other relevant product market for physician services.
(Section II(M)(4)) The proposed Final Judgment permits plaintiffs to
give written approval of relevant markets differing from those
specified.
---------------------------------------------------------------------------
The 20% and 30% limitations will prevent defendants from
aggregating market power to pursue and achieve the same type of
anticompetitive effects that led to this action. Consistent with the
reasons for these limitations, the proposed Final Judgment permits
recruitment of new physicians, and thus an increase in the supply of
physicians in the Danbury area, even if that recruitment causes a QMCP
to exceed the 20% or 30% limitation. Similarly, defendants will not
violate the proposed Final Judgment if these limits are exceeded as a
result of a physician exiting any relevant market.
In addition, the 30% limitation does not apply where a QMCP
includes any single physician or pre-existing practice group that
already has more than a 30% market share. In these circumstances, no
aggregation of market power could occur as a result of the practice
group joining the QMCP. To quality for this exemption, the pre-existing
practice group must exist as of the date of the filing of the Complaint
in this action (Section II(I)) For example, Danbury Hospital would
violate the Final Judgment if it owns an interest in a QMCP in which
DOPS participates as an owner on a nonexclusive basis and, after the
filing of the complaint, DOPS acquires physician practices that cause
it to exceed the 30% limitation or increase its market share in markets
where it already exceeds 30%.\7\
\7\ In contrast, the 20% limitation does not have an exception
for pre-existing practice groups because in an exclusive arrangement
such practice groups could have the incentives and ability to create
the same type of cartel that the proposed Final Judgment is intended
to break up.
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b. OMCP Subcontracting Requirements
Many employers and payers may want managed care products with
panels larger than permitted by the 20% and 30% limitations. The QMCP's
subcontracting requirements are designed to permit a larger physician
panel, but with restrictions to avoid the risk of competitive harm. To
offer panels above the 20% and 30% limits, a QMCP must operate with the
same incentives as a nonprovider-controlled plan. Specifically, the
owners of a QMCP must bear significant financial risk for the payments
to, and utilization practices of, the panel physicians in excess of the
20% and 30% limitations. These requirements significantly reduce the
incentives for a QMCP to use the subcontracts as a mechanism for
increasing fees for physician services.
Consequently, the proposed Final Judgment permits a QMCP to
subcontract with any number of physicians in a market provided
important safeguards are met. Under Section II(L)(2) of the proposed
Final Judgment, the subcontracting physician panel may exceed the 20%
or 30% limitation if the organization bears significant financial risk
for payments to and the utilization practices of the subcontracting
physicians and does not compensate those subcontracting
[[Page 52022]]
physicians in a manner that substantially replicates ownership. These
requirements will assure that there is a sufficient divergence of
economic interest between those subcontracting physicians and the
owners such that the owners have the incentive to bargain down the fees
of the subcontracting physicians. Indeed, without these requirements,
the organization could serve as a cartel manager for all members of
Danbury Hospital's active medical staff by, for example, passing
through directly to payers substantial liability for making payments to
the subcontracting physicians.
A QMCP would meet the subcontracting requirements if, for example,
a QMCP were compensated on a capitated, per diem, or diagnostic related
group basis and, in turn, reimbursed subcontracting physicians pursuant
to a fee schedule. In such a situation, an increase in the fee schedule
to subcontracting physicians during the term of a QMCP's contract with
the particular payer would not be directly passed through to the payer
but rather would be borne by a QMCP itself. This would provide a
substantial incentive for a QMCP to bargain down its fees to the
subcontracting physicians.
On the other hand, the subcontracting requirements would not be met
if a QMCP's contract with a payer were structured so that significant
changes in the payments by a QMCP to its physicians directly affected
payments from the payer to a QMCP, or if the payer directly bears the
risk for paying the panel physicians or pays the panel physicians
pursuant to a fee-for-service schedule. The requirements would also not
be satisfied if contracts between a QMCP and the subcontracting
physicians provided that payments to the physicians depended on, or
varied in response to, the terms and conditions of a QMCP's contracts
with payers.\8\ Any of these scenarios would permit a QMCP to pass
through to payers, rather than bear, the risk that its provider panel
will charge fees that are too high or deliver services
inefficiently.\9\
\8\ Nothing in the proposed Final Judgment prohibits a QMCP from
entering into arrangements that shift risk to subcontracting
physicians, such as may be desirable to create cost-reducing
incentives, so long as those arrangements are consistent with the
criteria for a QMCP set forth in Section II(L) of the Judgment.
\9\ Similarly, a QMCP would fail the ownership replication
restriction of Section II(L) of the proposed Final Judgment if, for
example, the owners paid themselves a dividend and then, through
declaration of a bonus, paid the same or similar amount to the
subcontracting physicians. The same would be true if the owners
otherwise structured dividends, bonuses, and incentive payments in
such a way that ensures that subcontracting and owning physicians
receive equal overall compensation.
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2. Prohibitions Against Exclusionary Acts
In addition to helping to organize HealthCare Partners and DAIPA,
DHS used other exclusionary acts to maintain its market power in acute
impatient hospital services and to gain an unfair advantage in markets
for outpatient services. The proposed Final Judgment eliminates the
continuance or recurrence of such exclusionary acts.
Section IV(C) of the proposed Final Judgment prohibits Danbury
Hospital from exercising its control over staff privileges with the
purpose of reducing competition with the Hospital in any line of
business, tying the availability of inpatient services to any other
service, or conditioning favorable inpatient rates on exclusive use of
Danbury Hospital's outpatient services. These prohibitions are crafted
to permit Danbury Hospital to assure the quality of care delivered at
the Hospital, participate in managed care plans, retain freedom to
contract on acceptable terms, and compete aggressively in outpatient
markets, while at the same time ensure that Danbury Hospital does not
unlawfully abuse its monopoly in acute inpatient services. The Hospital
is also required to report annually its inpatient rates to payers.
(Section V(B))
3. Other Substantive Provisions
Section IV(B)(2) of the proposed Final Judgment enjoins the
disclosure to any physician of any financial or competitively sensitive
business information about any competing physician. It also enjoins
defendants' requiring any physician to disclose competitively sensitive
information about any payer. This provision will ensure that defendants
do not exchange information that could facilitate price fixing or other
anticompetitive harm.
Section V(A) requires DAIPA and HealthCare Partners to give notice
to doctors and managed care plans that each doctor currently under
contract with HealthCare Partners is free to contract separately from
DAIPA and HealthCare Partners. This will help abate any continuing
effect from the unlawful conspiracy.
4. Conclusion
The Department of Justice believes that the proposed Final Judgment
contains adequate provisions to prevent further violations of the type
upon which the Complaint is based and to remedy the effects of the
alleged conspiracy and DHS' exclusionary acts. The proposed Final
Judgment's injunctions will restore the benefits of free and open
competition in the Danbury area and will provide consumers with a
broader selection of competitive health care plans.
IV
Alternative to the Proposed Final Judgment
The alternative to the proposed Final Judgment would be a full
trial on the merits of the case. In the view of the Department of
Justice, such a trial would involve substantial costs to the United
States, the State of Connecticut, and defendants and is not warranted
because the proposed Final Judgment provides all of the relief
necessary to remedy the violations of the Sherman Act alleged in the
Complaint.
V
Remedies Available to Private Litigants
Section 4 of the Clayton Act, 15 U.S.C. Sec. 15, provides that any
person who has been injured as a result of conduct prohibited by the
antitrust laws may bring suit in federal court to recover three times
the damages suffered, as well as costs and a reasonable attorney's fee.
Entry of the proposed Final Judgment will neither impair nor assist in
the bringing of such actions. Under the provisions of Section 5(a) of
the Clayton Act, 15 U.S.C. Sec. 16(a), the proposed Final Judgment has
no prima facie effect in any subsequent lawsuits that may be brought
against one or more defendants in this matter.
VI
Procedures Available for Modification of the Proposed Final Judgment
As provided by Sections 2 (b) and (d) of the APPA, 15 U.S.C.
Sec. 16 (b) and (d), any person believing that the proposed Final
Judgment should be modified may submit written comments to Gail Kursh,
Chief; Professions & Intellectual Property Section/Health Care Task
Force; United States Department of Justice; Antitrust Division; 600 E
Street, N.W.; Room 9300; Washington, D.C. 20530, within the 60-day
period provided by the Act. Comments received, and the Government's
responses to them, will be filed with the Court and published in the
Federal Register. All comments will be given due consideration by the
Department of Justice, which remains free, pursuant to Paragraph 2 of
the Stipulation, to withdraw its consent to the proposed Final Judgment
at any time before its entry, if the Department should
[[Page 52023]]
determine that some modification of the Final Judgment is necessary for
the public interest. Moreover, the proposed Final Judgment provides in
Section X that the Court will retain jurisdiction over this action, and
that the parties may apply to the Court for such orders as may be
necessary or appropriate for the modification, interpretation, or
enforcement of the proposed Final Judgment.
VII
Determinative Documents
No materials and documents of the type described in Section 2(b) of
the APPA, 15 U.S.C. Sec. 16(b), were considered in formulating the
proposed Final Judgment. Consequently, none are filed herewith.
Dated: September 13, 1995.
Respectfully submitted,
Mark J. Botti,
Pamela C. Girardi,
Attorneys, Antitrust Division, U.S. Dept. of Justice, 600 E Street,
N.W., Room 9320, Washington, D.C. 20530, (202) 307-0827.
Christopher F. Droney,
United States Attorney.
Carl J. Schuman,
Assistant U.S. Attorney, Federal Bar No. CT 05439, 450 Main Street,
Hartford, Connecticut 06103, (203) 240-3270.
Certificate of Service
I, Carl J. Schuman, hereby certify that copies of the Complaint,
Stipulation, Competitive Impact Statement, and Notice of Lodging in
U.S. v. HealthCare Partners, Inc., et. al. were served on the 13th day
of September 1995 by first class mail to counsel as follows:
David Marx, Jr.,
McDermott, Will & Emery, 227 West Monroe Street, Chicago, Illinois
60606-5096.
James Sicilian,
Day, Berry & Howard, CityPlace, Hartford, Connecticut 06103.
Carl J. Schuman
[FR Doc. 95-24596 Filed 10-3-95; 8:45 am]
BILLING CODE 4410-01-M