Jury Tells Radiologists It Pays To Be Stand Up Guys In Big Healthcare Antitrust Victory

Radiologists offering stand up MRIs – an innovative type of MRI – to their patients in New York scored a victory last week with a jury verdict finding that radiology benefits manager CareCore National, LLC. violated antitrust laws by denying the doctors admission to health insurance networks. Plaintiffs, who are represented by Constantine Cannon, won a jury verdict under federal and New York State antitrust laws that could eventually result in a $40 million award after post-trial motions in Stand-Up MRI Of The Bronx, et al, v. CareCore National, LLC, et. al., in federal court in the Eastern District of New York. With CareCore's liability for boycotting the plaintiffs – seven radiology practices that offer stand up (also known as upright) MRI services, and their management company – now found by the jury, the plaintiffs will ask the court to order injunctive relief that will enable them to see patients covered by major insurance plans administered by CareCore. The trial victory came late in the afternoon on November 30, 2010, when the jury reached its verdict, finding CareCore liable under the antitrust laws for conspiring to unreasonably restrain trade in the market for commercially-insured outpatient radiology services. The jury awarded more than $11.7 million in damages to the seven Stand-Up MRI centers and their management company, Health Diagnostics, LLC. With mandatory trebling under the antitrust laws, damages would be more than $35.1 million. With mandatory attorneys' fees and costs added, the award could approach $40 million. The Stand-Up MRI centers alleged CareCore was denying patients access to their innovative, medically necessary upright MRI services, which permit patients to be scanned in a variety of weight-bearing positions or the positions in which they actually feel pain. At trial, plaintiffs' witnesses testified that upright MRIs lead to more accurate diagnoses of many ailments – including, in particular, spinal conditions – which may be misdiagnosed on a traditional, or recumbent, MRI machine. CareCore is a radiology benefits management company that is owned and controlled by competing radiologists, and which provides network admission services for some of the largest insurance companies in New York. The plaintiffs alleged that CareCore was infected with a conflict of interest because it is comprised of competing radiologists who control which competitors are admitted into the networks managed by CareCore. The Stand-Up MRI centers claimed that CareCore and its radiologist owners violated the antitrust laws by preventing their competitors – the Stand-Up MRI centers – from becoming "in network" providers for Oxford, Aetna, HIP and HealthNet. The jury agreed, finding that CareCore and its radiologist owners conspired to block Stand-Up MRI centers from servicing tens of thousands of patients by denying their applications to become part of the Oxford, Aetna, HIP and HealthNet networks. By denying Stand-Up MRI applications, CareCore's radiologist owners were protected from competing for patients that may have otherwise gone to the Stand-Up MRI centers. The plaintiffs alleged the conspiracy not only harmed the Stand-Up MRI centers and their management company, but also harmed Oxford, Aetna, HIP and HealthNet patients who were unable to receive upright MRI services on an in-network basis. This particular fight over health care is far from over. Not only are the plaintiffs planning to file a motion for injunctive relief, but CareCore is expected to file a motion challenging the jury's verdict.

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