Federal Trade Commission investigating health system | SierraSun.com

Federal Trade Commission investigating health system

The Federal Trade Commission is currently investigating a complaint filed against Tahoe Health Systems, the joint venture between the Tahoe Independent Physician’s Association, Tahoe Forest Hospital and Barton Memorial Hospital.

Blue Shield of California prompted the investigation with a letter to the FTC earlier this year, in which it stated Tahoe Health System’s attempts to negotiate with the company on behalf of the physicians and both area hospitals were tantamount to a boycott.

Many physicians in the Truckee-North Tahoe area have independently dropped out of Blue Shield’s preferred provider network, citing low reimbursement as the cause. Some specialists have reported reimbursement as low as 38 percent of the amount billed.

Pamela Newman, director of Tahoe Health Systems, said the joint venture is working with the FTC, and a meeting is planned this month to discuss the issues in the complaint.

“Tahoe IPA and Tahoe Health Systems are working closely with the Federal Trade Commission in response to a non-public inquiry, triggered by a complaint filed by a large insurance company,” Newman said. “At the time of the complaint, the IPA had already initiated discussions with the FTC to insure that the structure and operations of the IPA and Tahoe Health Systems were within the published guidelines of the FTC.”

She said the IPA and Tahoe Health Systems are cooperating with the FTC investigation, and have already provided extensive documentation and information to the trade commission.

“A meeting is planned before the end of October to discuss issues, and come to a resolution which will enable the IPA and THS to roll out the Community Health Plan as close to the targeted date as possible,” Newman said. “The IPA and THS believe that managed care opportunities have been expanded since the IPA and Tahoe Health System were formed, and are hopeful that these opportunities will continue to expand following culmination of this inquiry.”

Newman said Tahoe Health Systems and the IPA could not discuss details of the possible agreement at this time, for fear of jeopardizing negotiations.

“However, all parties anticipate a satisfactory resolution in the near future,” she said.

Tahoe Forest Hospital Administrator Larry Long said all members of the joint venture are interested in finding out what the FTC has to say, once it has completed its review.

“The FTC will be here to talk us through the issues,” Long said. “We too are interested in understanding the rules of the game.”

Tahoe Health Systems plans to offer its own preferred provider insurance plan for small groups through a partnership with other hospitals in the state and Key Health of Visalia. It is also working to sign contracts on behalf of its members with many other insurance companies, including Blue Shield, Blue Cross, CalFarm and other large firms.

Sierra Sun E-mail: sun@tahoe.com

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