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Law
Note Series
Social
Workers, Managed Care, and Antitrust Issues
by: Denise Diaz, Esq., Paul
H. Friedman, Esq., and Carolyn Polowy, Esq.
Published: April 1997 ©NASW
Pages: 10, including appendix
INTRODUCTION
Managed care organizations
(MCOs), in conjunction with employers who provide employment-based health
insurance programs, play a large and growing role in the health care options
made available to health plan participants. MCOs have been placed in positions
of bargaining strength vis-à-vis social workers as providers of mental
health care or other covered services. Federal and state antitrust laws are
being used by other health care professionals to challenge MCO practices
that limit or interfere with the right to practice, to be members of provider
panels, and to make appropriate decisions on behalf of their patients. Social
workers should understand the issues and arguments raised in antitrust health
care cases to be able to evaluate the business practices of the MCOs with
which they are dealing.
To assist social workers
in these efforts, this law note describes federal antitrust laws, the type
of conduct that could be actionable under those laws, and health care cases
in which MCO conduct is being challenged as violating antitrust laws. The
note identifies the steps that might be taken by social workers to evaluate
their own fact situation under antitrust laws, including obtaining assistance
from federal and state antitrust authorities, state insurance regulators,
state legislatures, and Congress. Finally, precautions that should be observed
by social workers in their work and as NASW members to minimize their own
risk of antitrust liability are reviewed. A sample protest letter to an MCO
is also included (Appendix A)
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