Case Details

Year Initiated/Committed

2013

Year Resolved

2013

Settlement Amount

n/a

Lead State

NY

Participating States

NY

Defendant(s)

Faxton-St. Luke’s healthcare; St. Elizabeth’s Medical Center

Case Description

The two acute care hospitals in the city of Utica sought to merge. Both are in a weak financial state and treat needy patients, most of whose care is covered by Medicaid or Medicare. The settlement includes provisions prohibiting the hospitals from requiring independent physicians to work exclusively at the hospitals, and from requiring health plans to reimburse competing hospitals or health care providers at the same or lower rates than the health plans reimburse the hospitals. The hospitals committed to negotiate in good faith with rate payers. If these payors believe that the hospitals are acting unfairly, the settlement gives the payors the right to continue their currently-existing relationships with the hospitals for five years at current prices, subjected to annual increases not to exceed historic levels. The settlement also provides for continued monitoring by the Attorney General to ensure that the hospitals have implemented their promised efficiencies prior to termination of the rate-protection provisions.