In an effort to prevent anticompetitive behavior in the American healthcare marketplace, the Federal Trade Commission (FTC) has recently turned its attention to the rise in hospital mergers facilitated through the use of Certificate of Public Advantage (COPA) laws.
COPAs allow state agencies to approve proposed mergers among healthcare facilities following a satisfactory determination that the advantages of the merger outweigh the anticompetitive effects of consolidation in the healthcare marketplace.[1] Typically, the state departments of health are charged with supervising and regulating mergers exercised under COPAs.[2]
The FTC asserts that COPAs function as a mechanism to shield hospital mergers from scrutiny under state and federal antitrust laws subject to state action doctrine.[3] The FTC argues that hospital mergers granted pursuant to COPAs are destined to cause adverse effects in the marketplace, such as higher prices for patients seeking medical care, a decline in the quality of care rendered, and a reduced level of access to various medical services.[4]
It appears that the FTC is concerned that these mergers will eventually result in a heavily consolidated hospital market under the control of a single health system. Studies on the effects of these mergers released by the FTC shows a general increase in commercial inpatient prices by a minimum of 20%.[5] The FTC is also concerned that these mergers pursued under the gloss of COPAs fail to boost wages for hospital employees due to a reduced supply in employment opportunities.[6]
Hospital executives that advocate for mergers through use of COPAs often cite cost savings and efficiencies that could improve patient outcomes following consolidation.[7] Hospital systems nationwide have faced significant financial pressures stemming from rising costs for labor, drugs, and medical supplies in the years following the disturbance caused by the COVID-19 pandemic.[8]
Recently, on September 5, 2024, the FTC has challenged Indiana’s first proposed merger under the state’s COPA, enacted in 2021, referencing the same arguments mentioned above.[9] The FTC has urged the Indiana Department of Health and state lawmakers to oppose the consolidation of Union Hospital and Terre Haute Regional Hospital.[10]
Both hospitals are in Vigo County, located near Indiana’s western border. According to the Indiana Department of Health’s county health scorecard, Vigo County experiences serious public health challenges, particularly ranking in the bottom third among Indiana counties for life expectancy and bottom half for adult obesity.[11] To solve these challenges, Union Health and Terre Haute believe this partnership will enhance patients’ access to quality medical care, create synergies of medical expertise between healthcare providers at both hospitals, and lower costs.[12] The FTC has submitted a comment to the Indiana Department of Health generally objecting to the proposed merger in an effort to dissuade the agency from approving the same.[13]
COPAs exist in Florida but are commonly invoked for rural hospital system mergers and related cooperative agreements. Specifically, Florida Statute Section 381.04065 states the consolidation of hospital networks or technologies between members of rural health networks do not violate state or federal antitrust laws when such arrangements improve the quality of health care and moderate cost increases.[14] The Florida Department of Health is charged with the duty of approving and supervising rural hospital networks that seek to merge under this statute.[15] The state legislature views this policy as a proper means “to facilitate the provision of quality, cost-efficient medical care to rural patients.”[16]
Conclusion
Hospital mergers will continue to be a prevalent option for providers seeking to deliver care more efficiently and maintain healthy operating margins. Indeed, such mergers will see an uptick as financial challenges continue to mount for hospitals. As such, the FTC will be keen on limiting the scope of these proposed mergers under COPAs to achieve its mission of protecting American consumers from anticompetitive business practices that disrupt the healthcare industry.
[1] Federal Trade Commission, COPA Policy Paper, (August 15, 2022), https://www.ftc.gov/system/files/ftc_gov/pdf/COPA_Policy_Paper.pdf.
[2] Id.
[3] Federal Trade Commission, Certificates of Public Advantage (COPAS), https://www.ftc.gov/news-events/features/certificates-public-advantage-copas (last accessed September 13, 2024).
[4] Id.
[5] COPA Policy Paper, at 3.
[6] Id.
[7] Id.
[8] American Hospital Association, New AHA Report Finds Financial Challenges Mount for Hospitals & Health Systems Putting Access to Care at Risk, (April 20, 2023), https://www.aha.org/press-releases/2023-04-20-new-aha-report-finds-financial-challenges-mount-hospitals-health-systems-putting-access-care-risk.
[9] Rebecca Pifer, FTC Opposes Indiana’s First Hospital Merger Under Controversial COPA Law, Healthcare Dive, (September 6, 2024), https://www.healthcaredive.com/news/ftc-opposes-indiana-hospital-copa-union-terre-haute-merger/726253/.
[10] Id.
[11] Health First Indiana, County Health Scorecard, https://www.in.gov/healthfirstindiana/county-health-scorecard/ (last updated June 4, 2024).
[12] Union Health, Union Health and Terre Haute Regional Hospital Merger, https://union.health/upload/docs/UnionHealth/merger/UnionHealthTerreHauteRegionalMergerFAQ.pdf (last accessed September 13, 2024).
[13] Federal Trade Commission, Federal Trade Commission Staff Submission to Indiana Health Department Regarding the Certificate of Public Advantage Application of Union Health and Terre Haute Regional Hospital, (September 5, 2024), https://www.ftc.gov/system/files/ftc_gov/pdf/in_copa_comment_9-5-24_public_redacted.pdf.
[14] Fla. Stat. § 381.04065.
[15] Id.
[16] Id.
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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.
All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.
Health and Safety laws are regulated by various agency officials and theses are arguably the most crucial jobs in our community. Most people do not take the time to adequately research their healthcare providers prior to receiving healthcare services or medication. However, several agencies have been established to safeguard and regulate the health and safety of the healthcare services that consumers receive. These agencies can’t replace individual due diligence but they make every attempt to prevent patient harm and to eliminate fraudulent activity in the healthcare system.
Florida Department of Health
The Florida Department of Health (DOH) was the first accredited public health system in the United States. Their mission is to protect and improve on the health of all people in Florida by regulating healthcare practitioners and facilities. They offer programs and services for the Florida community, but they are also responsible for the licensing and regulation of various healthcare practitioners and facilities. Various healthcare professions must be licensed and are regulated via the Florida Department of Health such as: medical doctors, acupuncturist, optometrists, and many more. Certain facilities such as piercing salons and pharmacies are also regulated by the Department of Health. Complaints can be filed against any of the practitioners or facilities, which will then be investigated by an officer for violations. The complaint is referred over to the Probably Cause Panel, which will determine whether to file an Administrative Complaint against the healthcare provider based on the weight of the evidence that is provided by the complainant and the provider who under investigation. It is not uncommon for the DOH to place an emergency restriction on a provider’s license if they pose an imminent danger to patient safety. If a violation is found, the Department of Health will determine appropriate disciplinary action to enforce the regulations, which includes, probation, suspension, or even revocation of a healthcare provider’s license.
Agency for Health Care Administration
The Agency for Health Care Administration (“AHCA”) was established in Florida to regulate the Medicaid system and healthcare providers who offer services to Medicaid beneficiaries. AHCA administers background screening, compiles healthcare data, and monitors the quality of care and civil rights complaints within healthcare facilities. They also license various healthcare facilities throughout Florida such as assisted living facilities, health care clinics, home health agencies, and many more.
Department of Health and Human Services
The Department of Health and Human Services has a family of agencies to provide services on local levels through state and county agencies. Some of these agencies include:
These are just a few of the hundreds of agencies established to protect our communities from safety and health emergencies. Each agency regulates their own sections within each community or program.
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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.
All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.
In our society, Medical Professionals have always been held to a higher-than-average standard. Doctors, nurses, and physicians must abide by several professional rules of conduct that not many other employees have to keep in mind. This in turn also means that your personal life is up for scrutiny as well. Ethical standards and moral values are usually private assumptions but for those who have chosen the medical field, those normally private matters can have a deep affect your employment status. Any serious off-duty conduct issue must be reported, reviewed, and taken care of on a case-by-case basis.
Florida Requirements for Self-Reporting
In Florida, doctors are required to report all criminal activities committed after they receive their medical license even though it is not in relation to employment and occurs after regular working hours. Any report or complaint filed towards a medical professional will be investigated by the Florida Department of Health. Being placed under arrest can trigger disciplinary action from the state licensing boards. Medical disciplinary actions require a much lower burden of proof than federal cases. It is possible to be penalized, face Medicare/Medicaid exclusion, and potentially have your license revoked based on the severity of the crime and investigation. It is entirely possible that a physician can face the loss of their medical license even if an investigation does not result in criminal prosecution and a conviction at a trial.
Complaints Against Medical Professionals
The most common criminal concerns leading to the harshest disciplinary actions towards a medical professional involve healthcare fraud, solicitation, moral turpitude, dishonesty, or deceit in any jurisdiction in the state. According to the Florida Department of Health’s website, they do not carry out complaints regarding the fees charged for individual procedures, missed, or cancelled appointments, unfair customer service, rudeness or disrespect, bedside manner, professionalism or personality conflicts again medical professionals.
Complaints against medical professionals can lead the Board of Medicine to issue citations based on the type of and severity of the complaint. It is completely free to file complaints against medical professionals. The only potential fees may be for requesting copies of medical records if deemed necessary. Complaints remain confidential until the panel determines reasonable cause, and a violation is issued.
How to Report
According to the Florida Board of medicine, all criminal activities after receiving your medical license must be timely reported. The Board provides various options for reporting including email, online service portal, or via regular mail. If a complaint is issued via sending an email or letter, the correspondence must include the date of the offense, the activity that happened, and the county and state of jurisdiction. The complaint cannot reach processing without the proper information.
The Florida Department of Health’s Medical Quality Assurance (MQA) launched a user-friendly online portal. The portal was developed in collaboration with the Agency for Health Care Administration (AHCA) to allow for easy reporting of any complaints again medical providers from fraud to unlicensed activity and violations. The portal offers education on the different federal agencies for complaints as well.
See below for email, website and address:
MQAOnlineService@FLHealth.Gov
www.mqa-vo.doh.state.fl.us./datamart/voservicesportal
Florida Department of Health
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It should be noted that I am not your lawyer (unless you have presently retained my services through a retainer agreement). This post is not intended as legal advice, it is purely educational and informational, and no attorney-client relationship shall result after reading it. Please consult your own attorney for legal advice. If you do not have one and would like to retain my legal services, please contact me using the contact information listed above.
All information and references made to laws, rules, regulations, and advisory opinions were accurate based on the law as it existed at this time, but laws are constantly evolving. Please contact me to be sure that the law which will govern your business is current. Thank you.