A New York based radiology practice (the “Plaintiff”) filed an action in the United States District Court for the Eastern District of New York against a benefits administration firm, CareCore National, LLC, that provides services for insurers including Aetna, GHI, HIP, Healthnet, Healthfirst, and Oxford.  The complaint alleges antitrust violations of Section 1 of the Sherman Act and seeks damages pursuant to Section 4 of the Clayton Act.   Click here to read the complaint.

The Plaintiff alleges that CareCore is contracted with most large health care insurers to administer insurance reimbursement to their beneficiaries.  The Plaintiff believes that these health care insurers with which CareCore contracts insure over half of the people covered by commercial insurance in Nassau County, NY and the Long Island region as a whole.

These exclusive contracts allegedly allow CareCore to “certify” diagnostic imaging practices for admission into a network that accepts reimbursement from the contracted insurers.  As a result, the Plaintiff claims that any diagnostic imaging practice not “certified” by CareCore is precluded from servicing over half of the people covered by commercial insurance in Nassau County, NY and the Long Island region.

The Plaintiff alleges that CareCore “certifies” the diagnostic imaging practices it owns, boycotts other practices, and steers patients towards its own practices.  Plaintiff claims that these acts have yielded anticompetitive effects in the market for diagnostic imaging and are not done for any legitimate business purpose or medically valid reason.

Defendants have not yet answered the complaint.