Optometrists in
In the fall of 2004, the Colegio de Optmetras de Puerto Rico (COPR)the association that an O.D. must join to practice on the islandallegedly threatened the insurance carrier Ivision for its low reimbursement rates. The FTC charged the COPR with price-fixing in 2005 and the issue was settled in July 2007 with a consent order that bars the COPR from negotiating jointly with any payor.
Ivision International of Puerto Rico contracts with health plan providers to administer plans and offer services to covered patients. In the summer of 2004, Ivision expanded the plans that it worked with, causing the 130 O.D.s who participated directly with these plans to lose a significant percentage of their reimbursement rates.
So, the COPR, represented by Carlos Rivera Alonso, O.D., and Edgar Dvila Garcia, O.D., acted as a group to negotiate with Ivision. According to an FTC brief, Dr. Rivera and the optometrists intimated during one such meeting that the COPR would recommend its members leave the Ivision network. In November, Ivision raised its reimbursement ratesafter 40 O.D.s had left the network.
According to Susan Raitt, attorney for the northeast regional office of the FTC, this constituted price-fixing and a boycott. These doctors are horizontal competitors, she says. The law clearly states that competitors can not get together and agree upon or discuss price, or jointly refuse to deal or threaten to refuse to deal with other entities.
In a written statement, Dr. Rivera and Dr. Dvila maintain that they have never participated in nor encouraged a boycott of Ivision.
The FTC charged the COPR and Drs. Rivera and Dvila with violation of section 5 of the FTC Act by interfering with competition. Section 5 empowers the FTC to regulate methods of competition and business practices through investigation.
We were told that the FTC began their investigation as a result of a complaint by Ivision, say Drs. Rivera and Dvila.
In July 2007, both parties agreed to a consent order, which was to be finalized on August 28. Such a consent order, say Drs. Rivera and Dvila, specifically provides that [we are] settling the FTC complaint without admitting any of the facts alleged by the FTC, other than jurisdictional facts.
Specifically, this consent order will:
Prohibit the COPR, Dr. Rivera and Dr. Dvila from taking part in or aiding in any joint negotiations among optometrists about or with insurance payors.
Prohibit the COPR, Dr. Rivera and Dr. Dvila from aiding in the transfer of information among optometrists regarding the terms upon which they deal with payors.
Require that the COPR, Dr. Rivera and Dr. Dvila notify the Secretary of the FTC in writing 60 days in advance of participating in, facilitating or organizing any discussion among optometrists about price terms, or contacting a payor to negotiate terms on behalf of any group of O.D.s or group practice.
There is precedent for such orders. Similar consent orders were issued to the Colegio de Cirujanos Dentistas (dental surgeons) de Puerto Rico in March 2003 and to the Puerto Rico Association of Endodontists in August 2006.
Such a consent order expires in 20 years.
