Illinois medical group Carle Clinic Association has cut a deal to settle an antitrust lawsuit alleging that it had conspired with the area's other dominant practice to avoid Medicaid business. In the suit, Attorney General Lisa Madigan argued that the 330-physician group turned away Medicaid patients en masse in an effort to force the state to raise its reimbursement levels.
Earlier this year, a state judge kicked out an antitrust suit against Carle and its alleged partner in the scheme, Christie Clinic, which supposedly helped Carle push patients into more-lucrative emergency departments associated with the practices. Undeterred by the loss, Madigan refiled the case.
Under the terms of the settlement, the Urbana-based clinic denies liability or wrongdoing. It has already agreed to see Medicaid patients through the state's new Illinois Health Connect program--which focuses on medical homes and pays higher reimbursement than usual. The agreement requires Carle to take a certain number of patients in that program.
Carle must also not refuse to see patients who incurred medical debt from 2003 through 2007, who despite being Medicaid-eligible were treated as self-pay by practice policy.
To learn more about the case:
- read this Modern Healthcare piece (reg. req.)
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