Case Details

Year Initiated/Committed

2007

Year Resolved

2009

Settlement Amount

Carle: $240,000 payment to other health care centers; $80,000 (costs); Christie:$154,000 to other health care clinics, $76,000 fees and costs

Court

Champaign County Circuit Court

Docket Number

07h-115

Lead State

IL

Participating States

IL

Defendant(s)

Carle Clinic Association, P.C.; Christie Clinic, P.C.

Case Description

State alleged two clinics conspired to boycott Medicaid patients by adopting identical policies through which they refused to accept Medicaid patients: (1) who were not already registered with the clinic or (2) who had not seen a clinic physician for at least three years. They allegedly sought to increase the Medicaid reimbursement rates and to accelerate reimbursement payments from the State of Illinois. Because the clinics had over 90 percent of the physicians in Champaign county, Medicaid patients in the county were forced to go to hospital emergency rooms, costing the state more money. The state reached a settlement with Carle Clinic, under which Carle guaranteed that it will increase the number of Medicaid patients for which it provides primary health care services to 11,850 over the next three years. Carle will be prohibited from denying primary care services to Medicaid patients due to existing medical debt incurred from March 2003 through September 2007, during the period when these patients were turned away as qualified Medicaid patients. Over the next three years, Carle will pay $240,000 to other local health centers that treat low-income patients, and Carle will reimburse the AG’s costs in the amount of $80,000. In April 2009, Christie Clinic settled with the state, agreeing to increase the number of Medicaid patients it will accept for primary health care services to 8,500 over the next three years; will not deny Medicaid patients primary care services because of existing medical debt incurred from March 2003 through September 2007 – the period during which these patients were turned away as qualified Medicaid patients and were charged for health care services; and will pay, over three years, $120,000 to Frances Nelson Health Center to help fund its primary care services for low-income patients and $34,000 to the Champaign Urbana Public Health District to help pay for its dental program for low-income children. Both Christie and Carle Clinics are committed to accept more than 17,000 Medicaid patients in the initial year, growing to 20,000 over the next three years. Christie paid $76,000 in fees and costs.