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December 4, 2008

ATTORNEY GENERAL LISA MADIGAN SETTLES CARLE CLINIC LAWSUIT ENSURING ACCESS TO PRIMARY HEALTH CARE SERVICES FOR MEDICAID PATIENTS IN CHAMPAIGN COUNTY

Springfield — Attorney General Lisa Madigan has reached a settlement with Carle Clinic Association that guarantees access to primary care services to thousands of Medicaid patients in Champaign County. Madigan announced the agreement today after filing settlement papers with the Campaign County Circuit Court. The Court must review and approve the settlement before it becomes final.

The settlement resolves allegations by the Attorney General's Office that Carle Clinic entered into an illegal agreement with Christie Clinic in March 2003 to stop accepting new Medicaid patients. Because the clinics employed more than 90 percent of the physicians in Champaign County, the Attorney General's complaint alleged that the illegal agreement denied many Medicaid patients primary health care services. As a result, local Medicaid patients had to seek routine medical care at area hospital emergency rooms, which is typically more expensive than if the same treatment were delivered in a physician's office.

"My goal has been to ensure that Medicaid patients in Champaign County have access to primary health care services," said Madigan. "This settlement agreement will ensure that needed primary care is available to thousands of people who have struggled to find this care for too long."

Primary care is important to maintaining an individual's overall health. It provides a patient an ongoing relationship with health care professionals who provide care through preventative doctor visits, monitoring of medical needs over time and referrals when necessary. The settlement is designed to ensure greater access to primary care services.

  • Carle Clinic has 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. Due to the 2003 new patient freeze and attrition over the last five years, the current number of Medicaid patients receiving primary care from Carle is approximately 9,000.

  • Under the agreement, 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 and were charged for health care services. Without this requirement under the agreement, these low-income patients with existing debt would continue to be denied access to primary health care at Carle.

Claudia Lennhoff, Executive Director of Champaign County Health Care Consumers, praised the settlement. "We are extremely pleased with this settlement, and deeply grateful to Attorney General Madigan. This settlement brings an end to the horrific health care crisis that Medicaid patients in our community have been going through for more than five years as a result of Carle Clinic's harmful policies."

In addition, over the next three years, Carle must pay $200,000 to Frances Nelson Health Center and $40,000 to the Champaign Urbana Public Health District (CUPHD). The payments to Frances Nelson will subsidize operations at the Center, which treats Medicaid and other low income individuals and provides free service to those who have no coverage at all. The $40,000 to CUPHD will fund critical preventative care - either a vision screening program or a tooth-sealing program - for low income children.

Also, Carle Clinic will reimburse the Attorney General's office in the amount of $80,000 in attorneys' fees and costs related to the litigation.

Senior Assistant Attorney General Blake Harrop and Assistant Attorney General Chad Brooker handled the case for Madigan's Antitrust Bureau. The office continues its litigation against Christie Clinic.

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