No one disputes that Missoula Radiology is the sole provider of imaging interpretations in Montana's second-largest city. But an unusual new lawsuit alleges that the group is illegally maintaining its monopoly through exclusive contracts.
The region's largest health insurer, Blue Cross Blue Shield of Montana (BCBSMT), is among those suing the radiologists.
Missoula Radiology ceased being a participating provider with BCBSMT in June 2003. However, since the group offers the only radiologic interpretations in Missoula, BCBSMT patients often require their services, and are billed for the balance of fees not covered for out-of-network services.
Missoula Radiology has since balance-billed BCBSMT patients an estimated $1.3 million, according to the plaintiffs.
BCBSMT claims it pays three times the amount it pays to other outpatient facilities for services at Advanced Imaging, a freestanding imaging center co-owned by Missoula Radiology.
Missoula Radiology's practice manager reportedly said the practice had lowered its fees for all patients after it left Blue Cross, and that Blue Cross patients also receive a discount from the group.
The public fracas began on September 10 with the filing of a class-action antitrust suit against Missoula Radiology in a Butte, MT, federal court. The suit alleges that the radiologists are illegally steering patients to Advanced Imaging, and that they are colluding on prices with the local hospital that co-owns the facility.
In addition to BCBSMT, the plaintiffs include five individual patients and four Missoula-area employers.
But the fact that BCBSMT is involved in the lawsuit has inflamed some Missoula physicians. Already a group of neurosurgeons and a group of general surgeons in the area have reportedly canceled their contracts with BCBSMT in protest. One neurosurgeon told the local Missoula newspaper he believed the suit was an attempt to bully the radiologists into rejoining the Blue Cross network.
The billing and office manager for Missoula Radiology, Shannon Williams, made similar comments to the press.
"I really believe this suit is part and parcel of what they'll do to intimidate providers who don't accept their rates," Williams said. "I don't believe that Missoula Radiology is doing anything wrong" (Associated Press, September 15, 2004).
Neither Williams nor any other spokesperson for Missoula Radiology returned phone calls from AuntMinnie.com seeking comment. But an attorney representing the plaintiffs told AuntMinnie.com that the suit isn't about Missoula Radiology's lack of participation.
"The problem is there is no choice," said Michael Bissegger, a healthcare antitrust specialist and partner in the Washington, DC, law firm of Epstein, Becker & Green.
"If there were another group of radiologists in town, nobody would probably care if these radiologists participated," Bissegger said. "But (there's a problem) because they have a monopoly, and because they have, as far as we can tell, begun exploiting that monopoly and doing things to maintain it illegally."
The vast Western plains and mountains around Missoula have only about 200,000 prospective patients, so it isn't surprising that the university town of just 60,000 residents is served by a single radiology group. In fact, the plaintiffs aren't alleging that Missoula Radiology's monopoly developed illegally.
However, the lawsuit claims the group has "implemented an anticompetitive strategy" by obtaining exclusive contracts for radiology services with the only two hospitals and the only two outpatient facilities in Missoula.
The individual patients in the lawsuit claim they "have been forced to pay higher prices for radiology services and radiology procedures, and have seen their choice of radiology services and facilities restricted by (Missoula Radiology's) intentional monopolistic and predatory behavior in the Missoula area."
The plaintiffs seek to void the radiology group's exclusive contracts, along with any noncompete agreements that may have been signed by the group's 12 radiologists, and are also trying to force the breakup of Missoula Radiology into at least two competing groups.
The lawsuit also seeks monetary damages, which can be triple the rate of actual damages to the plaintiffs under antitrust law.
The exclusive contracts apparently held by Missoula Radiology are the linchpin of its allegedly illegal action, Bissegger said. But he acknowledged that such contracts would be perfectly legal under different circumstances.
"Exclusive contracts involving radiology are not that uncommon, but that's in markets where there's more than one facility and more than one group," Bissegger said. "The effect of the antitrust rules on monopolists is different than the effect on people without market power."
The lawsuit may also be the first case of a medical practice being sued for monopolization, Bissegger noted.
"Typically there tends to be few provider groups that actually have a monopoly; usually there are some competing physicians in the market," he said. "Secondly, for many physician specialties, there are relatively few barriers to entry."
"Radiology is one of those where you need to have referral sources and access to the facilities," Bissegger said. "If you're a radiologist and you can't read images anyplace, then you can't really practice."
By Tracie L. Thompson
AuntMinnie.com staff writer
September 28, 2004
Related Reading
HMOs to pay more to end doctor suits after ruling, September 2, 2004
Court allows suit over radiologist's findings in pre-employment x-ray, August 20, 2004
Yale slapped with $5.5 million jury verdict, July 27, 2004
Radiology group pays $2.5 million to settle alleged Medicare fraud, June 29, 2004
Doctors' group questions health insurance mergers, October 28, 2003
Copyright © 2004 AuntMinnie.com
